2024-03-29T11:03:58Z
http://jdc.jefferson.edu/do/oai/
oai:jdc.jefferson.edu:otofp-1000
2017-03-21T15:14:27Z
publication:oto
publication:jmc
publication:otofp
The implications of “pay-for-performance” reimbursement for Otolaryngology – Head and Neck Surgery
Cognetti, David M.
Reiter, David
Objective: To introduce otolaryngologists to outcomes-linked reimbursement ("pay-for-performance"), identify clinical practice implications and recommend changes for successful transition from the traditional "pay-for-effort" reimbursement model. Study design: Policy review Results: Payers are actively linking reimbursement to quality. Since the Institute of Medicine issued its report on medical errors in 1999, there has been much public and private concern over patient safety. In an effort to base health care payment on quality, "pay-for-performance" programs reward or penalize hospitals and physicians for their ability to maintain standards of care established by payers and regulatory groups. More than 100 such programs are operational in the United States today. This reimbursement model relies on detailed documentation in specific patient care areas to facilitate evaluation of outcomes for purposes of determining reimbursement. Since performance criteria for reimbursement have not yet been proposed within Otolaryngology-Head and Neck Surgery, otolaryngologists must be involved to ensure the adoption of reasonable goals and development of reasonable systems for documentation. Conclusion: "Pay-for-performance" reimbursement is increasingly common in the current era of outcomes-based medicine. It will assume an even greater role over the next 3 years and will directly affect most otolaryngologists.
2005-09-28T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/1
https://jdc.jefferson.edu/context/otofp/article/1000/viewcontent/auto_convert.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
reimbursement mechanisms
pay for performance
incentive reimbursement
otolaryngology
quality of health care
treatment outcome
Otolaryngology
oai:jdc.jefferson.edu:otofp-1002
2007-11-01T20:32:38Z
publication:oto
publication:jmc
publication:otofp
Sailing the straits of approval: The nature of FDA approval and its implications for surgeons
Reiter, David, MD
Products approved by the US Food and Drug Administration (FDA) for one use are often put to other uses. This practice, known colloquially as "off-label usage," is neither illegal nor unethical. Physicians can and should pursue scientifically sound use supported by medical evidence. The FDA requires only that we:
--Be well informed about the product --Base its use on firm scientific rationale and sound medical evidence, if available --Maintain records of the product’s use and effects --Carry out good medical practice --Use good judgment --Consider the best interests of the patient before all else
2007-05-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/2
https://jdc.jefferson.edu/context/otofp/article/1002/viewcontent/auto_convert.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
FDA
off label use
novel use
ethics
Otolaryngology
oai:jdc.jefferson.edu:otofp-1003
2008-07-01T13:08:03Z
publication:oto
publication:jmc
publication:otofp
Management of the neck in differentiated thyroid cancer
Cognetti, David M.
Pribitkin, Edmund A.
Keane, William M.
Differentiated thyroid cancer is characterized by an excellent long-term prognosis, which unlike other head and neck carcinomas, is not influenced definitively by regional lymph node metastasis. The relative rarity of the disease, together with its tendency for delayed metastasis and its low mortality, makes a prospective randomized trial comparing treatment outcomes difficult. As a result, the effect of cervical lymph node metastases on survival is unclear, making meaningful recommendations for their management somewhat subjective. This article discusses guidelines for the management of the neck in differentiated.
2008-01-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/3
https://jdc.jefferson.edu/context/otofp/article/1003/viewcontent/auto_convert.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
thyroid neoplasms
neck dissection
radioactive iodine
management guidelines
differentiated thyroid cancer
thyroid carcinoma
fine-needle biopsy
disease progression
humans
neck
pathology
surgery
neoplasm metastasis
physiopathology
prognosis
recurrence
sentinel lymph node biopsy
mortality
Otolaryngology
oai:jdc.jefferson.edu:otofp-1004
2011-08-16T13:31:38Z
publication:oto
publication:jmc
publication:otofp
Multimodality education for airway endoscopy skill development.
Deutsch, Ellen S.
Christenson, Thomas
Curry, Joseph
Hossain, Jobayer
Zur, Karen
Jacobs, Ian
OBJECTIVES: Airway endoscopy is a difficult skill to master. A unique practicum was designed to help otolaryngology residents develop endoscopy skills. The learning modalities included lectures, an animal laboratory, high-fidelity manikins, virtual bronchoscopy simulation, and standardized patients. This study compares the relative subjective value of these learning modalities for skill development and realism. METHODS: Participants used a Likert scale (1=disagree to 5=agree) and open responses to anonymously rate the efficacy of 5 learning modalities for teaching airway management, endoscopy skills, and clinical leadership and for providing a realistic experience. RESULTS: The results in 2007 were uniformly positive, with mean scores for every category and modality greater than 4 for developing cognitive, psychomotor, and affective skills; managing normal and abnormal conditions; preventing and managing complications; improving endoscopy skills; understanding team process; and experiencing overall and manual "feel" realism. In 2008, the participants were encouraged to more critically evaluate the course. The ratings demonstrated statistically significant differences between the mean scores for 4 of the 9 evaluation categories in 2007 and all 9 categories in 2008. CONCLUSIONS: Specific learning modalities (e.g., lecture, animal laboratory, high-fidelity manikin, virtual bronchoscopy, standardized patient) were perceived to have different values for teaching airway management, developing endoscopy skills, teaching clinical leadership, and providing a realistic experience. We propose that these learning modalities can be used in a complementary manner.
2009-02-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/4
https://jdc.jefferson.edu/context/otofp/article/1004/viewcontent/Curry_9_09.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Adult
Animals
Bronchoscopy
Clinical Competence
Computer Simulation
Disease Models
Animal
Educational Measurement
Humans
Internship and Residency
Laryngoscopy
Otolaryngology
Reproducibility of Results
Respiratory Tract Diseases
Retrospective Studies
Otolaryngology
oai:jdc.jefferson.edu:otofp-1005
2011-08-16T13:33:58Z
publication:oto
publication:jmc
publication:otofp
Unusual fibrosclerotic lesion of the laryngotracheal complex presenting as subglottic stenosis.
Johnston, Douglas R.
Curry, Joseph M.
Rubin, Raphael
Rosen, Marc R.
We present a case report that describes the pathology, presentation, and management complexities of an unusual, destructive fibrosclerotic lesion of the laryngotracheal complex. An otherwise healthy 21-year-old man presented with a 1-year history of progressive shortness of breath and stridor. The initial examination revealed a 3-cm, grade III subglottic stenosis. Nodular fibrosis of the strap muscles, laryngotracheal cartilages, and trachea was evident. Biopsies revealed dense peritracheal desmoplastic reaction with focal erosion of cartilage. However, features diagnostic for relapsing polychondritis, desmoid tumor, or orbital pseudotumor were absent. The disease progressed to involve severe stenosis and thickening of the trachea and main stem bronchi. Surgical and medical management of this unusual fibrosclerotic lesion did not ameliorate the disease process, but a recent encouraging response to tamoxifen citrate has been observed with improvements in vocal fold motion and activity levels. Prognosis and management experience for this unknown pathologic entity are absent in the literature. In this case, diffuse disease progression occurred despite surgical and medical management, but has been halted by tamoxifen therapy. The prospect of a durable response and disease remission is unknown.
2009-01-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/5
https://jdc.jefferson.edu/context/otofp/article/1005/viewcontent/Johnston_1_09.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Antibodies
Biopsy
Bronchoscopy
Diagnosis
Differential
Fibrosis
Humans
Laryngostenosis
Larynx
Male
Polychondritis
Relapsing
Sclerosis
Trachea
Young Adult
Otolaryngology
oai:jdc.jefferson.edu:otofp-1006
2011-08-16T13:35:18Z
publication:oto
publication:jmc
publication:otofp
Thyroid lymphosonography: a novel method for evaluating lymphatic drainage.
Curry, Joseph M.
Ezzat, Waleed H.
Merton, Daniel A.
Goldberg, Barry B.
Cognetti, David M.
Rosen, David
Pribitkin, Edmund A.
OBJECTIVES: We evaluated lymphosonography, or contrast-enhanced, ultrasonography (US)-guided sentinel lymph node (SLN) detection, as a technique for demonstrating the lymphatic drainage of the thyroid gland. METHODS: In this prospective animal study, four 50-kg Yorkshire swine underwent transcutaneous injection of a US contrast agent and methylene blue dye into the thyroid gland. Contrast-enhanced US was used to identify draining lymphatic channels and SLNs. Sentinel node biopsy was conducted. Subsequently, bilateral neck and upper mediastinal dissection was carried out. RESULTS: In 3 of 4 cases, a blue dye-positive and US contrast-positive SLN was identified. We identified SLNs in level IV in 2 cases. One case revealed 2 adjacent nodes in the superior mediastinum. In 1 case, a lymphatic channel was identified traveling into the mediastinum, but exposure of the SLN could not be obtained. No residual blue dye-positive or US contrast-positive nodes were identified on subsequent dissection. CONCLUSIONS: Lymphosonography of the thyroid gland in a porcine model correlates well with blue dye-guided sentinel node biopsy and is technically feasible, although in some cases access to the SLN may be difficult. This technique could potentially enable a detailed analysis of thyroidal lymphatic drainage if applied to humans.
2009-09-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/6
https://jdc.jefferson.edu/context/otofp/article/1006/viewcontent/Curry_9_09.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Lymphosonography
Sentinel node biopsy
Thyroid
animal experiment
animal model
animal tissue
article
contrast enhancement
echography
experimental pig
human
lymphatic drainage
nonhuman
preoperative period
priority journal
thyroid lymphosonography
Otolaryngology
oai:jdc.jefferson.edu:otofp-1007
2010-05-17T21:22:28Z
publication:oto
publication:jmc
publication:otofp
Assessment of smoking status based on cotinine levels in nasal lavage fluid.
Ozdener, Mehmet Hakan
Yee, Karen K
McDermott, Ryan
Cowart, Beverly J
Vainius, Aldona A
Dalton, Pamela
Rawson, Nancy E
ABSTRACT: Cotinine is a principal metabolite of nicotine with a substantially longer half-life, and cotinine levels in saliva, urine or serum are widely used to validate self-reported smoking status. The nasal cavity and olfactory system are directly exposed to tobacco smoke in smokers and in non-smokers who live with or work around smokers. However, despite the potential for a direct impact of tobacco smoke on the nasal epithelium and olfactory neurons, no prior studies have assessed cotinine levels in nasal mucus. We sought to determine whether cotinine levels in nasal lavage fluid (NLF) would provide a reasonable estimate of smoke exposure. We assayed cotinine using a competitive immunoassay in NLF from 23 smokers, 10 non-smokers exposed to tobacco smoke (ETS) and 60 non-smokers who did not report smoke exposure. NLF cotinine levels were significantly higher in smokers than in non-smokers, regardless of their exposure to ambient tobacco smoke. Cotinine levels in this small group of exposed non-smokers were not significantly different than those of non-exposed non-smokers. A cutoff of 1 ng/ml provided a sensitivity of 91% and a specificity of 99% for smoking status in this sample. Data were consistent with self-reported smoking status, and a cutoff of 1.0 ng/ml NLF cotinine may be used to classify smoking status. While saliva is the most easily obtained body fluid, NLF can be used to provide an objective and precise indication of smoking status and more directly reflects smoke exposure in the nasal and olfactory mucosa.
2009-01-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/7
https://jdc.jefferson.edu/context/otofp/article/1007/viewcontent/1617_9625_5_11.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Thomas Jefferson University
Department of Otolaryngology Head-Neck Surgery
Cotinine
Cotinine-N-oxide
Nicotine
Nicotine 1-N-oxide
Tobacco Smoke Pollution
Nasal Lavage Fluid
Nasal Mucosa
Second Hand Smoke
Passive Smoking
Olfactory Receptor Neurons
Smoking
Cigarette
Otolaryngology
oai:jdc.jefferson.edu:otofp-1008
2010-06-14T20:22:03Z
publication:oto
publication:jmc
publication:otofp
Endoscopic repair of high-flow cranial base defects using a bilayer button.
Luginbuhl, Adam J.
Campbell, Peter G.
Evans, James
Rosen, Marc
OBJECTIVES/HYPOTHESIS: Repair of the skull base still begins with a direct repair of the dural defect. We present a new button closure for primary repair of the dura for high flow defects.
STUDY DESIGN: Retrospective review.
METHODS: We reviewed our 20 cases of primary button grafts and compared the results to the previous 20 high-flow open-cistern cerebrospinal fluid (CSF) cases. Subjects were excluded if they had no violation of the arachnoid space or potential for low-flow CSF leak. The button is constructed so that the inlay portion is at least 25% larger than the dural defect, and the onlay portion is just large enough to cover the dural defect. The two grafts are sutured together using two 4-0 Neurolon sutures and placed with the inlay portion intradurally and the onlay portion extradurally.
RESULTS: The button graft repair of open-cisternal defects had a drop in CSF leak complications to 10% (2/20), and these two leaks were repaired with the button technique as the salvage surgery. This is a significant improvement over the 45% leak rate in the prebutton graft group (P < .03). In our button graft group we used nasoseptal flaps on 16/20 repairs, and 1/2 repairs that leaked in the button group did not have a nasoseptal flap. Lumbar drains were used in approximately 38% in both groups (P = .83).
CONCLUSIONS: The button graft can be used in conjunction with the nasal septal flap or as a stand-alone repair with good results reducing the postoperative leak rate to 10% for high-flow CSF repairs.
2010-05-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/8
https://jdc.jefferson.edu/context/otofp/article/1008/viewcontent/auto_convert.pdf
https://jdc.jefferson.edu/context/otofp/article/1008/filename/0/type/additional/viewcontent/Luginbuhl_Figure_1.ppt
https://jdc.jefferson.edu/context/otofp/article/1008/filename/1/type/additional/viewcontent/Luginbuhl_Figure_2.ppt
https://jdc.jefferson.edu/context/otofp/article/1008/filename/2/type/additional/viewcontent/Luginbuhl_Figure3.ppt
https://jdc.jefferson.edu/context/otofp/article/1008/filename/3/type/additional/viewcontent/Luginbuhl_Tables.doc
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Cerebrospinal Fluid Rhinorrhea
Combined Modality Therapy
Craniopharyngioma
Dura Mater
Endoscopes
Endoscopy
Fascia Lata
Humans
Meningeal Neoplasms
Meningioma
Pituitary Neoplasms
Postoperative Complications
Retrospective Studies
Skull Base
Skull Base Neoplasms
Surgical Flaps
Suture Techniques
Tissue and Organ Harvesting
Otolaryngology
Surgery
oai:jdc.jefferson.edu:otofp-1009
2012-01-19T19:58:16Z
publication:oto
publication:jmc
publication:otofp
Malignant melanoma metastatic to the thyroid gland: a case report and review of the literature.
Kung, MD, Brian
Aftab, BS, Saba
Wood, MD, Moira D.
Rosen, MD, David
The thyroid gland is a relatively uncommon site for a secondary malignancy; even less common is a case of malignant melanoma metastatic to the thyroid. We describe the case of a 68-year-old man who presented with a neck mass in the posterior triangle. Fine-needle aspiration biopsy (FNAB) identified the mass as a malignant melanoma. The patient had had no known primary skin melanoma. He underwent a left modified radical neck dissection, and the mass was discovered to be a positive lymph node. Postoperatively, he declined to undergo radio- and chemotherapy. Eighteen months later, he returned with a diffusely enlarged thyroid. FNAB again attributed the enlargement to malignant melanoma. Soon thereafter, the patient began experiencing seizures, and on magnetic resonance imaging, he was found to have metastatic disease to the brain. He developed ventilator-dependent respiratory failure and required a subtotal thyroidectomy for the placement of a tracheostomy tube. Patients who present with a thyroid nodule and who have a history of malignancy present a diagnostic dilemma: Is the nodule benign, a new primary, or a distant metastasis? The findings of this case and a review of the literature strengthen the argument that any patient with a thyroid mass and a history of malignancy should be considered to have a metastasis until proven otherwise.
2009-01-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/9
https://jdc.jefferson.edu/context/otofp/article/1009/viewcontent/auto_convert.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Aged
Biopsy
Fine-Needle
Follow-Up Studies
Humans
Immunohistochemistry
Lymph Nodes
Male
Melanoma
Neck Dissection
Neoplasm Invasiveness
Neoplasm Staging
Risk Assessment
Thyroid Neoplasms
Thyroid Nodule
Thyroidectomy
Treatment Outcome
Thomas Jefferson University
Philadelphia
United States
Biopsy, Fine-Needle
Otolaryngology
oai:jdc.jefferson.edu:otofp-1011
2012-01-20T16:14:03Z
publication:oto
publication:jmc
publication:otofp
Unilateral olfactory thresholds in a chemosensory clinic population
Cowart, Beverly
Pribitkin, Edmund
Rosen, David
Klock, Christopher
Laflam, Timothy
Poster presentation at 26th Annual Meeting of the Association of Chemoreception Sciences in Sarasota Florida, April 21-25, 2004.
INTRODUCTION
Because there is the possibility of unilateral loss of olfactory function or differential degrees of olfactory dysfunction in the two nostrils, unilateral tests of olfactory threshold sensitivity are routinely included in many chemosensory clinical test batteries to supplement bilateral tests (e.g., Cain et al., 1988; Hummel et al., 1997). Surprisingly, however, the results of unilateral testing in patients with chemosensory complaints have not been extensively reported. Thus, it is unclear how useful these additional measures are in characterizing individual patients.
A number of studies have assessed unilateral olfactory thresholds in largely non-clinical populations. There is substantial disagreement concerning general asymmetries in left-right olfactory sensitivity; however, two large, recent studies both reported that bilaterally obtained threshold values are equivalent to those obtained on the better functioning side of the nose (Betchen & Doty, 1998; Frasnelli et al., 2002), suggesting that bilateral facilitation does not occur at the threshold level in olfaction. Whether this finding holds true in patients with olfactory dysfunction is not known.
In the present study, we address these questions by examining unilateral olfactory thresholds obtained from a large sample of non-anosmic patients referred to the Monell-Jefferson Taste & Smell Clinic for evaluation of chemosensory dysfunction.
2004-04-21T07:00:00Z
poster
application/vnd.ms-powerpoint
https://jdc.jefferson.edu/otofp/11
https://jdc.jefferson.edu/context/otofp/article/1011/type/native/viewcontent/Unilateral_poster.ppt
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Unilateral olfactory thresholds in a chemosensory clinic population
poster
Thomas Jefferson University
Monell Chemical Senses Center
Philadelphia
United States
Pennsylvania
Ophthalmology
Otolaryngology
oai:jdc.jefferson.edu:otofp-1010
2012-01-20T15:49:22Z
publication:oto
publication:jmc
publication:otofp
Nasal airflow and odorant transport modeling in patients with chronic rhinosimusitis
Zhao, Kai
Cowart, Beverly J.
Rawson, N. E.
Scherer, Peter W.
Clock, K. T.
Vainius, A. A.
Dalton, Pamela
Pribitkin, Edward
Rosen, David
Poster presentation at Association for Chemoreception Sciences (ACHEMS) in Sarasota Florida April 25-29, 2007.
Introduction:
Our on-going clinical project aims to quantify the conductive mechanism contributing toolfactory loss in chronic rhinosinusitis (CRS) patients, in addition to other inflammatory causes(see Yee, et al, 200 and Feng, et al, 203). CRS, a common disease affecting 32 millionAmericans annually, is reportedly associated with at least 15% of all olfactory losses. Airwayconstriction as a result of inflammation or the presence of polyps may limit odor access to thereceptor sites and lead to olfactory dysfunction. As yet, the functional impact of various nasalobstructions as sequelae to CRS and their treatment outcomes have not been successfullyindexed by any existing clinical tools, such as acoustic rhinometry, or rhinomanometry.Computational fluid dynamics (CFD) techniques have shown great promises to simulate nasalairflow and predict odorant delivery rates to the olfactory epithelium based on CT scans. In thisreport, we provide additional support for the hypothesis that the CFD calculation is a betterpredictor of olfactory sensitivity among CRS patients than are conventional methods.
2007-04-25T07:00:00Z
poster
application/pdf
https://jdc.jefferson.edu/otofp/10
https://jdc.jefferson.edu/context/otofp/article/1010/viewcontent/Kai_AchemS07v2.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
poster presentation
Nasal airflow
odorant transport modeling
chronic rhinosimusitis
Association for Chemoreception Sciences (ACHEMS)
Thomas Jefferson University
Monell Chemical Senses Center
Ophthalmology
Otolaryngology
oai:jdc.jefferson.edu:otofp-1012
2012-01-20T18:52:13Z
publication:oto
publication:jmc
publication:otofp
Malignant Melanoma metastacizing to the Thyroid Gland: A Case Report and Review of the Literature
Kung, Brian
Aftab, Saba
Wood, Moira
Rosen, David
Oral presentation 2006 AAO-H&NS Annual Meeting
Toronto, Canada September 17-20, 2006.
Objectives: The thyroid gland is a relatively uncommon site for secondary malignancy. Even lesscommon is metastasis of malignant melanoma to the thyroid gland. We present a case of malignantmelanoma metastatic to the thyroid gland presenting as thyroid enlargement.
Study Design: This is a case report which utilizes chart review, intraoperative photographs,radiographic images, and pathology slides.
Methods: A 68 year old patient with no prior evidence of primary skin melanoma presented witha neck mass which tested positive for melanoma. A year and a half following modified radical neckdissection, the patient presented with a diffusely enlarged thyroid gland from which fine needleaspiration revealed metastatic malignant melanoma.
Results: A few months following this, the patient began having seizures and was found on MRIto have metastatic disease to the brain. He developed ventilator dependent respiratory failure andrequired a subtotal thyroidectomy for the placement of a tracheostomy tube.
Conclusions: Patients with a history of malignancy and a thyroid nodule present a diagnosticdilemma—is it benign, a new primary, or distant metastasis? Review of this case and the literaturestrengthens the argument that any patient with a history of malignancy and a thyroid mass shouldbe considered as having metastasis until proven otherwise.
2006-09-17T07:00:00Z
poster
application/pdf
https://jdc.jefferson.edu/otofp/12
https://jdc.jefferson.edu/context/otofp/article/1012/viewcontent/Melanoma_poster_proof.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Malignant Melanoma metastacizing
Thyroid Gland
A Case Report
Review of the Literature
Thomas Jefferson University
Philadelphia
Pennsylvania
United States
Ophthalmology
Otolaryngology
oai:jdc.jefferson.edu:otofp-1013
2012-01-23T18:41:23Z
publication:oto
publication:jmc
publication:otofp
Methemoglobinemia Induced By Topical Anesthesia During Fiberoptic Endotracheal Intubation
Miller, Matthew C.
Gaslin, Michael T.
Herb, Kathleen
Rosen, David
Poster presentation at 2005 American Academy Of Otolaryngology Head and Neck Surgery Annual Meeting, Los Angeles, CA September 25-28, 2005.
Introduction: Although local anesthetics are usually well tolerated, otolaryngologists need to be aware of the sometimes serious adverse events they can cause. The benzocaine containing sprays Hurricaine and Cetacaine are occasionally associated with the onset of life-threatening methemoglobinemia. The specific treatment for this condition is methylene blue.
Methods and Measures: We describe a case report of a 48 year old female who developed a methemoglobin level of 41% after receiving topical benzocaine to her oropharynx. We discuss the case in light of the current literature.
Results: After exposure to benzocaine, the patient developed severe cyanosis refractory to supplemental oxygen. Methemoglobinemia was suspected based on the recent exposure to benzocaine and the deeply cyanotic “chocolate” colored blood in the arterial blood gas specimen. After confirming the diagnosis with co-oximetry, the patient was treated with methylene blue. Her methemoglobin levels returned to normal within several hours.
Conclusions: Otolaryngologists who use local anesthesia should be aware of the rare but serious complication of methemoglobinemia. Early diagnosis with co-oximetry and subsequent treatment with methylene blue can avoid a potentially life threatening situation.
2005-09-25T07:00:00Z
poster
application/vnd.ms-powerpoint
https://jdc.jefferson.edu/otofp/13
https://jdc.jefferson.edu/context/otofp/article/1013/type/native/viewcontent/AAO_HNS_poster.ppt
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Methemoglobinemia Induced
Topical Anesthesia
Fiberoptic Endotracheal Intubation
poster
Thomas Jefferson University
Philadelphia
Pennsylvania
United States
Otolaryngology
oai:jdc.jefferson.edu:otofp-1014
2012-01-24T16:00:16Z
publication:oto
publication:jmc
publication:otofp
Postoperative complications of powered intracapsular tonsillectomy and monopolar electrocautery tonsillectomy in teens versus adults.
Johnston, Douglas R
Gaslin, Michael
Boon, Maurits
Pribitkin, Edmund
Rosen, David
OBJECTIVES: This study was performed to determine whether teens have different rates of posttonsillectomy hemorrhage, admission for dehydration, or recurrent tonsillitis compared to adults. Specifically, these parameters were compared within two groups: patients who underwent powered intracapsular tonsillectomy (PIT) and those who underwent monopolar electrocautery tonsillectomy (MET).
METHODS: In a retrospective review of 579 patients at least 12 years of age from January 2000 to July 2006 in a tertiary referral center, outcome measures of reoperation for hemorrhage, readmission or emergency room visit for dehydration, and postoperative tonsillitis were compared for 200 patients 12 to 19 years of age and 379 patients more than 19 years of age. These outcome measures in teens were compared to those in adults who had tonsillectomy by the same technique (101 teens who underwent PIT compared to 117 adults who underwent PIT, and 99 teens who underwent MET compared to 262 adults who underwent MET). Outcome measures were also compared within the PIT and MET groups based on the indication for surgery (chronic tonsillitis, tonsillar hypertrophy, or both).
RESULTS: In comparing teens to adults who underwent the same technique (PIT versus PIT, or MET versus MET), no statistically significant differences existed in the incidence of hemorrhage, dehydration, or postoperative tonsillitis. Greater hemorrhage rates for adults who underwent MET compared to teens, however, almost met statistical significance (p = 0.053). Analyzing complication rates by indication within the PIT and MET groups exclusively revealed higher rates of hemorrhage in adults who underwent the MET technique for the indication of chronic tonsillitis. Within the PIT comparison, no significant differences were found on the basis of indication for surgery.
CONCLUSIONS: Teenage patients who undergo tonsillectomy should be considered unique as far as complication rates are concerned. Comparison of technique-specific complication rates between adults and teens showed no significant differences in either the PIT or MET groups, although adults who underwent MET had greater hemorrhage rates that almost met significance (p = 0.053). Adults who were undergoing tonsillectomy for chronic tonsillitis were more likely than teens to encounter postoperative hemorrhage if they underwent the MET technique.
2010-07-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/14
https://jdc.jefferson.edu/context/otofp/article/1014/viewcontent/auto_convert.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Adolescent
Adult
Electrocoagulation
Female
Humans
Male
Postoperative Complications
Retrospective Studies
Tonsillectomy
Treatment Outcome
Young Adult
Otolaryngology
oai:jdc.jefferson.edu:otofp-1015
2012-02-02T19:59:12Z
publication:oto
publication:jmc
publication:otofp
Sour ageusia in two individuals implicates ion channels of the ASIC and PKD families in human sour taste perception at the anterior tongue.
Huque, Taufiqul
Cowart, Beverly J
Dankulich-Nagrudny, Luba
Pribitkin, Edmund A
Bayley, Douglas L
Spielman, Andrew I
Feldman, Roy S
Mackler, Scott A
Brand, Joseph G
BACKGROUND: The perception of sour taste in humans is incompletely understood at the receptor cell level. We report here on two patients with an acquired sour ageusia. Each patient was unresponsive to sour stimuli, but both showed normal responses to bitter, sweet, and salty stimuli.
METHODS AND FINDINGS: Lingual fungiform papillae, containing taste cells, were obtained by biopsy from the two patients, and from three sour-normal individuals, and analyzed by RT-PCR. The following transcripts were undetectable in the patients, even after 50 cycles of amplification, but readily detectable in the sour-normal subjects: acid sensing ion channels (ASICs) 1a, 1beta, 2a, 2b, and 3; and polycystic kidney disease (PKD) channels PKD1L3 and PKD2L1. Patients and sour-normals expressed the taste-related phospholipase C-beta2, the delta-subunit of epithelial sodium channel (ENaC) and the bitter receptor T2R14, as well as beta-actin. Genomic analysis of one patient, using buccal tissue, did not show absence of the genes for ASIC1a and PKD2L1. Immunohistochemistry of fungiform papillae from sour-normal subjects revealed labeling of taste bud cells by antibodies to ASICs 1a and 1beta, PKD2L1, phospholipase C-beta2, and delta-ENaC. An antibody to PKD1L3 labeled tissue outside taste bud cells.
CONCLUSIONS: These data suggest a role for ASICs and PKDs in human sour perception. This is the first report of sour ageusia in humans, and the very existence of such individuals ("natural knockouts") suggests a cell lineage for sour that is independent of the other taste modalities.
2009-10-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/16
https://jdc.jefferson.edu/context/otofp/article/1015/viewcontent/PMID_19812697.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Thomas Jefferson University
Monell-Jefferson Taste and Smell Clinic
Department of Otolaryngology
Aged
80 and over
Biopsy
Calcium Channels
Epithelial Sodium Channel
Female
Gene Expression Regulation
Humans
Male
Middle Aged
Nerve Tissue Proteins
Phospholipase C beta
Receptors
Cell Surface
Receptors
G-Protein-Coupled
Sodium Channels
Taste
Taste Buds
Tongue
Aged, 80 and over
Receptors, Cell Surface
Receptors, G-Protein-Coupled
Otolaryngology
oai:jdc.jefferson.edu:otofp-1016
2012-03-08T18:38:14Z
publication:oto
publication:jmc
publication:otofp
Detection of evolving injury to the brachial plexus during transaxillary robotic thyroidectomy.
Luginbuhl, Adam
Schwartz, Daniel M
Sestokas, Anthony K
Cognetti, David
Pribitkin, Edmund
OBJECTIVES/HYPOTHESIS: Continuous intraoperative neuromonitoring (IONM) of transcranial electric motor evoked potentials (tceMEPs) and somatosensory evoked potentials (SSEPs) has gained universal acceptance as an efficacious method for detecting emerging positional brachial plexopathy or peripheral nerve compression during spinal and shoulder surgery. This has implications for transaxillary thyroid surgery.
STUDY DESIGN: Case report with literature review.
METHODS: The patient underwent robotic transaxillary thyroid surgery with continuous tceMEP and SSEP monitoring of brachial plexus function. We present detailed IONM data depicting the emergence of positional brachial plexopathy.
RESULTS: Significant amplitude loss of both IONM modalities were identified during an evolving positional plexopathy, which resolved upon upper extremity repositioning and conversion to an open procedure. No permanent nerve injury or deficit was noted following surgery.
CONCLUSIONS: Given the potential for brachial plexus injury during robotic transaxillary thyroid surgery secondary to arm positioning, we recommend that continuous tceMEP and SSEP monitoring be considered during such procedures.
2012-01-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/15
https://jdc.jefferson.edu/context/otofp/article/1016/viewcontent/auto_convert.pdf
https://jdc.jefferson.edu/context/otofp/article/1016/filename/0/type/additional/viewcontent/Image1.JPG
https://jdc.jefferson.edu/context/otofp/article/1016/filename/1/type/additional/viewcontent/Tracing_baseline.PNG
https://jdc.jefferson.edu/context/otofp/article/1016/filename/2/type/additional/viewcontent/Tracing_intraop.PNG
https://jdc.jefferson.edu/context/otofp/article/1016/filename/3/type/additional/viewcontent/Tracing_postop.PNG
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Axilla
Brachial Plexus
Female
Humans
Intraoperative Complications
Middle Aged
Monitoring
Intraoperative
Robotics
Thyroidectomy
Monitoring, Intraoperative
Otolaryngology
oai:jdc.jefferson.edu:otofp-1017
2012-07-26T17:26:05Z
publication:oto
publication:jmc
publication:otofp
Frontal sinus osteoma removal with the ultrasonic bone aspirator.
Ehieli, Eric
Chu, Jaemi
Gordin, Eli
Pribitkin, Edmund A
Osteomas, the most common skull tumors, are typically excised through either an open or endoscopic ostectomy using a high-speed drill, a technically challenging procedure that can result in injury to adjacent soft tissue structures. Osteoma removal through ultrasonic bone emulsification and aspiration (UBA) offers the advantages of decreased blood loss, preservation of adjacent soft tissue structures, and precise bone removal. UBA was used to successfully remove a forehead osteoma without injury to adjacent nerves and with a satisfactory cosmetic outcome. We describe skull osteoma removal with an ultrasonic bone aspirator, which offers potential advantages over conventional bone removal techniques.
2012-04-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/17
https://jdc.jefferson.edu/context/otofp/article/1017/viewcontent/auto_convert.pdf
https://jdc.jefferson.edu/context/otofp/article/1017/filename/0/type/additional/viewcontent/Frontal_Sinus_Osteoma_Removal____Figure.doc
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Adult
Bone Neoplasms
Equipment Design
Follow-Up Studies
Frontal Sinus
Humans
Male
Osteoma
Paranasal Sinus Neoplasms
Suction
Ultrasonic Surgical Procedures
Thomas Jefferson University
Otolaryngology
oai:jdc.jefferson.edu:otofp-1018
2012-07-30T15:12:19Z
publication:oto
publication:jmc
publication:otofp
Monocarboxylate Transporter 4 and Caveolin-1 Expression in Squamous Cell Carcinoma of the Oral Cavity
Ames, MD, Julie A.
Butera, MD, Aileen
Curry, MD, Joseph
Tuluc, MD, Madalina
Martinez-Outshoorn, MD, Ubaldo E.
Whitaker-Menezes, PhD, Diana
Sotgia, PhD, Federica
Lisanti, MD, PhD, Michael P.
Poster presented at: 8th International Conference on Head and Neck Cancer in Toronto Canada, July 21-25, 2012.
Objective: To determine the significance of caveolin-1 (cav-1) and monocarboxylate transporter 4 (MCT4) in squamous cell carcinoma of the oral cavity. We hypothesized that high stromal MCT4 would predict a worse prognosis and correlate with low stromal Cav-1.
2012-07-22T07:00:00Z
poster
application/pdf
https://jdc.jefferson.edu/otofp/18
https://jdc.jefferson.edu/context/otofp/article/1018/viewcontent/Ames_Poster.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Monocarboxylate Transporter 4
Caveolin-1 Expression
Squamous Cell Carcinoma
Oral Cavity
Thomas Jefferson University
otolaryngology
Otolaryngology
oai:jdc.jefferson.edu:otofp-1019
2012-07-30T19:23:59Z
publication:oto
publication:jmc
publication:otofp
A thermoplastic vest to prevent self mutilation in experimental flap surgery in rats
Gordin, MD, Eli A.
Drejet, MD, Sarah M
Heffelfinger, MD, Ryan N.
Poster presented at: 8th International Conference on Head and Neck Cancer in Toronto, Canada.
Introduction:
Rats are frequently utilized for both research and training related to reconstructive head and neck surgery. The femoral neurovascular complex represents a useful mode for microvascular anastomosis, both for the purposes of testing adjuncts designed to improve anastomotic patency rates, as well as for residents and students to gain experience in microvascular surgery outside the operating room. Additionally, the rat proves useful in investigations examining the survivability of both random and axial pattern skin flaps.
2012-07-22T07:00:00Z
poster
application/pdf
https://jdc.jefferson.edu/otofp/19
https://jdc.jefferson.edu/context/otofp/article/1019/viewcontent/Elis_Rat_vest_poster.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
thermoplastic vest
self mutilation
experimental flap surgery
rats
Thomas Jefferson University
otolaryngology
Philadelphia
Otolaryngology
oai:jdc.jefferson.edu:otofp-1020
2012-08-21T13:36:37Z
publication:oto
publication:jmc
publication:otofp
Frontal sinus osteoma removal with the ultrasonic bone aspirator.
Ehieli, Eric
Chu, Jaemi
Gordin, Eli
Pribitkin, Edmund A.
Osteomas, the most common skull tumors, are typically excised through either an open or endoscopic ostectomy using a high-speed drill, a technically challenging procedure that can result in injury to adjacent soft tissue structures. Osteoma removal through ultrasonic bone emulsification and aspiration (UBA) offers the advantages of decreased blood loss, preservation of adjacent soft tissue structures, and precise bone removal. UBA was used to successfully remove a forehead osteoma without injury to adjacent nerves and with a satisfactory cosmetic outcome. We describe skull osteoma removal with an ultrasonic bone aspirator, which offers potential advantages over conventional bone removal techniques.
2012-04-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/20
https://jdc.jefferson.edu/context/otofp/article/1020/viewcontent/auto_convert.pdf
https://jdc.jefferson.edu/context/otofp/article/1020/filename/0/type/additional/viewcontent/Frontal_Sinus_Osteoma_Removal____Figure.doc
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Adult
Bone Neoplasms
Equipment Design
Follow-Up Studies
Frontal Sinus
Humans
Male
Osteoma
Paranasal Sinus Neoplasms
Suction
Ultrasonic Surgical Procedures
Otolaryngology
oai:jdc.jefferson.edu:otofp-1021
2013-02-06T16:21:24Z
publication:oto
publication:jmc
publication:otofp
Novel Irradiated Axial Rotational Flap Model in the Rodent
Luginbuhl, Adam J.
Modest, BS, Mara
Yan, Kaiguo
Curry, Joseph
Heffelfinger, Ryan N.
Abstract
Objectives: To design an easily reproducible rodent rotational skin flap and to evaluate the effects of radiation on flap viability.
Methods: Ten rats received 40 Gy irradiation to the abdominal wall. Following a recovery period of one month, a 3 X 8 cm fasciocutaneous flap based axially on the inferior epigastric vessel, was raised and rotated 60 degrees into a contralateral deficit. Five non-irradiated rats underwent the identical procedure as a control. Animals were sacrificed seven days postoperatively, areas of flap necrosis were documented, and histological specimens were taken to compare flap viability and vessel density.
Results: 60% of the rats in the irradiated group had necrosis of the distal flap ranging from 1 to 6 cm from the distal edge, whereas none of the animals (0%) in the control group exhibited necrosis (p<0.001). Histology revealed collagen and vascular changes in the irradiated skin. Vascular density analysis revealed a significant difference between radiated and non-radiated flaps; p = 0.004, 0.029 and 0.014 in the distal, middle and proximal segments of the flap respectively.
Conclusion: This novel rat axial rotational flap model demonstrates increases flap necrosis and a decrease in vascular density due to the effects of radiation. Using a linear electron accelerator a dose of 40 gy can be delivered to the skin without resulting in devastating gastrointestinal side effects.
2011-08-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/21
https://jdc.jefferson.edu/context/otofp/article/1021/viewcontent/Novel_Irradiated.pdf
https://jdc.jefferson.edu/context/otofp/article/1021/filename/0/type/additional/viewcontent/Figure__1_XRT_Flap.tif
https://jdc.jefferson.edu/context/otofp/article/1021/filename/1/type/additional/viewcontent/Figure_2_XRT_Flap.tif
https://jdc.jefferson.edu/context/otofp/article/1021/filename/2/type/additional/viewcontent/Figure__3_XRT_Flap.tif
https://jdc.jefferson.edu/context/otofp/article/1021/filename/3/type/additional/viewcontent/Figure__4_XRT_Flap.tif
https://jdc.jefferson.edu/context/otofp/article/1021/filename/4/type/additional/viewcontent/Figure__5_XRT_Flap.tif
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Novel Irradiated Axial Rotational Flap Model in the Rodent
DEPARTMENT OF OTOLARYNGOLOGY
HEAD AND NECK SURGERY FACULTY PAPERS
Thomas Jefferson University
Otolaryngology
oai:jdc.jefferson.edu:otofp-1022
2013-02-26T15:04:39Z
publication:oto
publication:jmc
publication:otofp
Value-based analysis of routine pathologic septal and inferior turbinate specimens.
Daniero, James J
Chu, Jaemi S
O'Hara, Brian J
Pribitkin, Edmund A.
This article was presented at the 2012 AAO-HNSF Annual Meeting & OTO EXPO; September 9-12, 2012; Washington, DC.
Objective To determine the frequency and clinical relevance of unanticipated histopathologic results in routine sinonasal surgery and evaluate the necessity for histologic processing of nasal septal cartilage, bone, and inferior turbinate specimens. Study Design Case series with chart review. Setting Tertiary care academic medical center. Subjects and Methods A retrospective review of surgical pathology reports on adult patients undergoing sinonasal surgery during a 5-year period from 2005 to 2010 was performed. All cases with the preoperative diagnosis of sinonasal neoplasia, autoimmune disease, or directed septal biopsies were excluded from review. Results A total of 1194 pathology reports were reviewed from 1172 individual patients. This included histopathologic evaluation of 1194 septal cartilage and bone specimens and 714 inferior turbinate specimens. None of the patients had unanticipated histopathologic findings that were clinically significant. Conclusion Many surgeons obtain histopathologic diagnoses on all tissue removed from a patient. Based on our institutional case series, histopathology of the septum and inferior turbinates in routine sinonasal cases may not be necessary. A value-based approach to processing grossly unremarkable septal and turbinate tissue by waiving histologic processing and subsequent microscopic evaluation could provide significant cost savings.
2013-01-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/22
https://jdc.jefferson.edu/context/otofp/article/1022/viewcontent/Septoplasty_path_paper_ver2_6.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Value-based analysis of routine pathologic septal and inferior turbinate specimens
otolaryngology
Thomas Jefferson University
Otolaryngology
oai:jdc.jefferson.edu:otofp-1023
2013-06-13T15:13:59Z
publication:oto
publication:jmc
publication:otofp
Repair of Nasal Septal Perforation with Porcine Small Intestinal Submucosa Xenograft
Greywoode, MD, Jewel
Hamilton, MD, James
Malhotra, MD, Prashant S.
Saad, MD, Abdel
Pribitkin, MD, Edmund A.
Background:
Numerous techniques have been described for nasal septal perforation repair, with various degrees of success in achieving closure. Evidence supports the use of bilateral mucoperichondrial advancement flaps with interpositional grafting for greatest success. Many surgeons use autografts such as fascia, cartilage, bone, and pericranium, however, extracellular matrices have also become popular.
Objective:
We analyze factors determining the success of nasal septal perforations repaired using using an acellular, freeze-dried interpositional xenograft derived from Porcine Small Intestinal Submucosa (PSIS).
Methods:
Patients with septal perforation repaired by the senior author from 1998 to 2006 were examined in a retrospective chart review with regard to perforation size, etiology, pre- and postoperative symptoms, follow-up, outcomes and complications.
Results:
Forty-seven PSIS repairs were performed on 46 patients. Two procedures were planned staged procedures. Of the total 47 procedures, 41 (87.2%) continued to be closed at the site of repair during the follow up period. Follow up ranged from 6 months to 4.9 years with a mean of 18.3 months. Two patients (4.3%) were found to have perforations at the site of closure in the immediate post-operative period. One patient (2.1%) perforated at the site of closure after the immediate post-operative period. Subjective symptom scores demonstrated improvement in crusting, epistaxis and obstruction postoperatively. Larger perforations correlated with poorer outcomes.
Conclusions:
The authors conclude that closure of nasal septal perforation with an interpositional xenograft derived from PSIS compares favorably to published results for autografts with advantages including absence of donor site morbidity, easy graft modification and manipulation, and shorter operative time.
2012-09-06T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/23
https://jdc.jefferson.edu/context/otofp/article/1023/viewcontent/repair_of_nasal_septal.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Repair of Nasal Septal Perforation with Porcine Small Intestinal Submucosa Xenograft
Otolaryngology
oai:jdc.jefferson.edu:otofp-1024
2013-06-13T15:15:44Z
publication:oto
publication:jmc
publication:otofp
Early adoption of transoral robotic surgical program: preliminary outcomes.
Cognetti, David
Luginbuhl, Adam
Nguyen, Anthony L.
Curry, Joseph
OBJECTIVE: The objective of this study is to demonstrate the feasibility and safety of establishing a transoral robotic surgical (TORS) program in the post-Food and Drug Administration (FDA) approval setting. Early outcomes are compared with the previously reported results of pioneering centers.
STUDY DESIGN: Clinical data from a prospective TORS study.
SETTING: Academic university institution.
SUBJECTS AND METHODS: Sixty-one patients treated with 63 TORS procedures. Main outcome measures: intraoperative times, margin status, complications, time to diet, and percutaneous endoscopic gastrostomy (PEG) tube retention rate. The authors also report oncologic outcomes on their first 30 patients.
RESULTS: The spectrum of subsites included tongue base, tonsil, parapharyngeal space, retromolar trigone, supraglottis, and posterior pharyngeal wall. Surgical console time averaged 79 ± 53 minutes. After re-resection of 4 patients, final negative margin status was 94% (50/53). A subset of 30 patients with squamous cell carcinoma reaching an average of 18 months of follow-up had a local regional control rate of 97% with a disease-free survival rate of 90%. The PEG tube retention rate was 7%. Complications included 2 readmissions with dehydration, 1 aspiration pneumonia, and 2 with minor oropharyngeal bleeding. Ninety-one percent of patients resumed an oral diet by the first postoperative visit.
CONCLUSION: The initiation of a TORS program in the post-FDA setting can be achieved in a safe and efficient manner. Early results of pioneering TORS centers are reproducible. Continued investigation of TORS as a treatment option for oropharyngeal carcinoma is warranted.
2012-09-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/24
https://jdc.jefferson.edu/context/otofp/article/1024/viewcontent/TORS_experience_FINAL_submissionAL3000__2_.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Aged
Blood Loss
Surgical
Carcinoma
Squamous Cell
Disease-Free Survival
Endoscopy
Feasibility Studies
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neck Dissection
Neoplasm Staging
Oropharyngeal Neoplasms
Otorhinolaryngologic Surgical Procedures
Prospective Studies
Robotics
Surgery
Computer-Assisted
Time and Motion Studies
Blood Loss, Surgical
Carcinoma, Squamous Cell
Surgery, Computer-Assisted
Otolaryngology
oai:jdc.jefferson.edu:otofp-1025
2013-09-13T18:38:42Z
publication:oto
publication:jmc
publication:otofp
The minimally-invasive thyroidectomy incision: a histological analysis.
Ezzat, Waleed H
O'Hara, Brian J
Fisher, Kyle W
Rosen, David
Pribitkin, Edmund A.
BACKGROUND: Minimally invasive thyroidectomy (MIT) has gained popularity in the surgical management of benign and malignant pathology of the thyroid. One of the main benefits of utilizing this technique is the use of smaller incisions resulting in increased cosmetic satisfaction. Unfortunately, the retraction required for adequate exposure during MIT may lead to skin damage, impaired wound healing and poor cosmetic outcomes. Some have proposed that excising incision edges prior to closure may improve cosmesis. A review of the literature does not reveal any histologic evidence to support this technique.
MATERIAL/METHODS: In this prospective observational study, nine subjects undergoing MIT were identified. Both the superior and inferior skin edges were excised and labeled for orientation. Specimens were sent for hematoxylin and eosin staining and histologic analysis by a staff pathologist.
RESULTS: All specimens showed no significant findings such as damage to the architecture of the dermis, acute inflammation, edema or evidence of hemorrhage. Focal blood vessel ectasia within the dermis was identified in three of nine subjects.
CONCLUSIONS: Our findings do not yield a histological basis supporting the routine trimming of incisions during MIT. Although no significant findings were noted histologically, further studies are warranted to investigate the long-term cosmetic outcome of MIT incisions.
2011-02-01T08:00:00Z
article
https://jdc.jefferson.edu/otofp/25
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3524709/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Adult
Aged
Female
Humans
Middle Aged
Surgical Procedures
Minimally Invasive
Thyroid Gland
Thyroidectomy
Young Adult
Surgical Procedures, Minimally Invasive
Otolaryngology
oai:jdc.jefferson.edu:otofp-1026
2013-10-15T13:28:23Z
publication:oto
publication:jmc
publication:otofp
A preliminary report of percutaneous craniofacial osteoplasty in a rat calvarium.
Parkes, William
Greywoode, Jewel
O'Hara, Brian J
Heffelfinger, Ryan N.
Krein, Howard
OBJECTIVE: To evaluate the potential for injectable, permanent bone augmentation by assessing the biocompatability and bioactivity of subperiosteal hydroxylapatite (Radiesse) deposition in a rat model.
STUDY DESIGN: Randomized controlled animal model METHODS: Fourteen adult Sprague Dawley rats were injected in the parietal skull with 0.2 ml of hydroxylapatite (10 animals) or a carrier gel control (4 animals), using a subperiosteal injection technique on the right and a subcutaneous injection technique on the left. At 1, 3, and 6 months, 3 rats (1 negative control, 2 variables) were sacrificed and calvaria were harvested. At 12 months, the remaining 5 rats were sacrificed. After each harvest, the specimens were processed and then examined under both light and polarized microscopy for new bone growth at the injection sites.
RESULTS: The inflammatory response was limited with both hydroxylapatite and carrier injections. Injectables were still present 12 months after the injection. New bone formation was only seen when the injection was located deep to a disrupted periosteum The odd of new bone formation was 48.949 times higher (95% CI (2.637, 3759.961), p = 0.002) with subperiosteal hydroxylapatite injections compared to all other combinations of injection plane and injectable.
CONCLUSION: This preliminary report of subperiosteal hydroxylapatite (Radiesse) injection in a rat model has verified the biocompatibility of injectable hydroxylapatite at the bony interface and suggests the potential for new bone formation.
2013-10-10T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/26
https://jdc.jefferson.edu/context/otofp/article/1026/viewcontent/A_Preliminary_Report_of_Percutaneous_Craniofacial_Osteoplasty_in_a_Rat_Calvarium.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
A preliminary report of percutaneous craniofacial osteoplasty in a rat calvarium
Thomas Jefferson University
Otolaryngology
Otolaryngology
oai:jdc.jefferson.edu:otofp-1027
2013-10-15T13:35:56Z
publication:oto
publication:jmc
publication:otofp
Incidence and management of rhinosinusitis after complex orbitofacial reconstruction.
Parkes, William
Nyquist, Gurston G.
Rizzi, Christopher
Zhang, Sarah
Evans, James J.
Heffelfinger, Ryan N.
Rosen, Marc
Curry, Joseph
OBJECTIVE: To examine the sinus-related sequelae of free flap reconstruction for complex orbitofacial defects.
STUDY DESIGN: Retrospective chart review METHODS: Demographic, clinical, and radiographic data on a series of 55 patients who had undergone free tissue transfer for orbitofacial reconstruction was retrospectively reviewed. Follow-up of ≥ 3 months was available for 49 patients. Outcome measures studied included clinical or radiographic evidence of sinusitis and the need for sinus surgery.
RESULTS: The most commonly involved sinuses were the ethmoid (n=40) and maxillary (n=38) sinuses, and the anterolateral thigh was the most common flap used (n=41). Clinical and/or radiographic sinusitis was evident in 21 patients (43%), and 10 patients (20%) required sinus surgery at some point during follow-up. Involvement of multiple sinuses in the initial orbitofacial surgery was associated with a significantly increased need for subsequent sinus surgery (p=0.009). Adjuvant radiotherapy and adjuvant chemo-radiotherapy were associated with a significantly increased risk for the development of rhinosinusitis (p=0.045 and 0.016 respectively).
CONCLUSION: Rhinosinusitis and the need for operative management of sinus obstruction are common in patients having undergone complex orbitofacial reconstruction. Careful management of the paranasal sinuses is an important component of the multidisciplinary treatment of such patients.
2013-10-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/27
https://jdc.jefferson.edu/context/otofp/article/1027/viewcontent/Incidence_and_Management_of_Rhinosinusitis_after_Complex_Orbitofacial_Reconstruction.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Incidence and management of rhinosinusitis after complex orbitofacial reconstruction
Thomas Jefferson University
Otolaryngology
Otolaryngology
oai:jdc.jefferson.edu:otofp-1028
2013-11-09T23:03:29Z
publication:oto
publication:jmc
publication:otofp
Use of the anterolateral thigh in cranio-orbitofacial reconstruction.
Parkes, William J
Krein, Howard
Heffelfinger, Ryan
Curry, Joseph
Objective. To detail the clinical outcomes of a series of patients having undergone free flap reconstruction of the orbit and periorbita and highlight the anterolateral thigh (ALT) as a workhorse for addressing defects in this region. Methods. A review of 47 patients who underwent free flap reconstruction for orbital or periorbital defects between September 2006 and May 2011 was performed. Data reviewed included demographics, defect characteristics, free flap used, additional reconstructive techniques employed, length of stay, complications, and follow-up. The ALT subset of the case series was the focus of the data reviewed for this paper. Selected cases were described to highlight some of the advantages of employing the ALT for cranio-orbitofacial reconstruction. Results. 51 free flaps in 47 patients were reviewed. 38 cases required orbital exenteration. The ALT was used in 33 patients. Complications included 1 hematoma, 2 wound infections, 3 CSF leaks, and 3 flap failures. Conclusions. Free tissue transfer allows for the safe and effective reconstruction of complex defects of the orbit and periorbital structures. Reconstructive choice is dependent upon the extent of soft tissue loss, midfacial bone loss, and skullbase involvement. The ALT provides a versatile option to reconstruct the many cranio-orbitofacial defects encountered.
2011-11-10T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/28
https://jdc.jefferson.edu/context/otofp/article/1028/viewcontent/487REFID.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
anterolateral thigh
cranio-orbitofacial reconstruction
Otolaryngology
oai:jdc.jefferson.edu:otofp-1029
2015-01-30T14:35:08Z
publication:oto
publication:jmc
publication:otofp
Comprehensive Management of the Paranasal Sinuses in Patients Undergoing Endoscopic Endonasal Skull Base Surgery.
Nyquist, MD, Gurston G
Rosen, MD, Marc R
Friedel, MD, Mark E.
Beahm, MD, D David
Farrell, MD, Christopher J
Evans, MD, James J.
OBJECTIVE: The endonasal route often provides the most direct and safe approach to skull base pathology. In this article we review the literature with regard to management of the paranasal sinuses in the setting of skull base surgery.
METHODS: We describe our institutional experience and review the literature of concurrent management of the sinusitis in patients undergoing endoscopic skull base surgery.
RESULTS: Patients should be optimized preoperatively to ensure the endonasal route is a safe corridor to enter the intracranial cavity. Often the paranasal sinuses can be surgically addressed at the same time as endoscopic skull base surgery. We describe the technical details of management of the paranasal sinuses when addressing skull base pathology.
CONCLUSIONS: Careful management of the paranasal sinuses throughout the peri-operative course is paramount to optimizing sinonasal function and safety.
2014-12-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/29
https://jdc.jefferson.edu/context/otofp/article/1029/viewcontent/Final_World_Neurosurgery_Sinusitis.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Sinusitis
Endoscopic Skull Base Surgery
Transsphenoidal
Skull Base
Pituitary
Pituitary Adenoma
Otolaryngology
oai:jdc.jefferson.edu:otofp-1030
2021-08-16T13:09:31Z
publication:oto
publication:jmc
publication:otofp
A novel in vivo model for evaluating functional restoration of a tissue-engineered salivary gland.
Pradhan-Bhatt, Swati
Harrington, Daniel A
Duncan, Randall L
Farach-Carson, Mary C
Jia, Xinqiao
Witt, Robert L
OBJECTIVES/HYPOTHESIS: To create a novel model for development of a tissue-engineered salivary gland from human salivary gland cells that retains progenitor cell markers useful for treatment of radiation-induced xerostomia.
STUDY DESIGN: A three-dimensional (3D) hyaluronic acid (HA)-based hydrogel scaffold was used to encapsulate primary human salivary gland cells and to obtain organized acini-like spheroids. Hydrogels were implanted into rat models, and cell viability and receptor expression were evaluated.
METHODS: A parotid gland surgical resection model for xenografting was developed. Salivary cells loaded in HA hydrogels formed spheroids and in vitro were implanted in the three-fourths resected parotid bed of athymic rats. Implants were removed after 1 week and analyzed for spheroid viability and phenotype retention.
RESULTS: Spheroids in 3D stained positive for HA receptors CD168/RHAMM and CD44, which is also a progenitor cell marker. The parotid gland three-fourths resection model was well-tolerated by rodent hosts, and the salivary cell/hydrogel scaffolds were adherent to the remaining parotid gland, with no obvious signs of inflammation. A majority of human cells in the extracted hydrogels demonstrated robust expression of CD44.
CONCLUSIONS: A 3D HA-based hydrogel scaffold that supported long-term culture of salivary gland cells into organized spheroids was established. An in vivo salivary gland resection model was developed that allowed for integration of the 3D HA hydrogel scaffold with the existing glandular parenchyma. The expression of CD44 among salivary cultures may partially explain their regenerative potential, and the expression of CD168/RHAMM along with CD44 may aid the development of these 3D spheroids into regenerated salivary glands.
LEVEL OF EVIDENCE: NA.
2014-02-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/57
https://jdc.jefferson.edu/context/otofp/article/1030/viewcontent/auto_convert.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
Department of Otolaryngology-Head and Neck Surgery
Thomas Jefferson University
Adult
Animals
Humans
Hydrogels
Male
Middle Aged
Rats
Rats
Sprague-Dawley
Recovery of Function
Salivary Glands
Tissue Engineering
Rats, Sprague-Dawley
Otolaryngology
oai:jdc.jefferson.edu:otofp-1040
2015-05-31T20:19:18Z
publication:oto
publication:jmc
publication:otofp
Transarterial chemoembolization is ineffective for neuroendocrine tumors metastatic to the caudate lobe: a single institution review.
Shirley, Lawrence A
McNally, Megan
Chokshi, Ravi
Jones, Natalie
Tassone, Patrick
Guy, Gregory
Khabiri, Hooman
Schmidt, Carl
Shah, Manisha
Bloomston, Mark
BACKGROUND: Caudate lobe liver metastases occur commonly in patients with neuroendocrine tumors. It is unknown, however, how these lesions respond to regional therapy and how their presence impacts outcomes. We reviewed our experience treating these lesions using transarterial chemoembolization (TACE).
METHODS: We reviewed radiographic response to TACE in 86 patients with metastatic neuroendocrine tumors to the liver. We determined the impact of caudate lesions on outcomes in comparison to the cohort of patients without caudate lesions, as well as response of caudate lesions to TACE versus lesions elsewhere in the liver.
RESULTS: Caudate lesions were identified in 45 (52%) patients. All patients had disease in other liver segments. Only seven caudate lesions (12.3%) had a radiographic response to TACE, whereas 82% of lesions elsewhere in the liver demonstrated a response. The presence or absence of a caudate lesion did not impact the overall radiographic (82.2% vs. 82.9%), symptomatic (64.4% vs. 56.1%), or biochemical (97.6% vs. 88.9%) response to TACE (P > 0.1 for all). However, median overall survival was reduced in those presenting with caudate lesions (87.1 vs. 45.6 months, P = 0.031).
CONCLUSIONS: Metastatic neuroendocrine tumors to the caudate lobe respond poorly to TACE. Symptomatic or threatening caudate lobe lesions should be considered for palliative resection in spite of additional inoperable liver metastases.
2015-05-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/30
https://jdc.jefferson.edu/context/otofp/article/1040/viewcontent/oto.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Department of Otolaryngology
Thomas Jefferson University Hospital; adult; aged; Article; cancer survival; caudate lobe liver metastasis; caudate lobe liver metastasis; chemoembolization; controlled study; female; hepatography; human; liver metastasis; major clinical study; male; neuroendocrine tumor; overall survival; survival time; treatment outcome; treatment response
Otolaryngology
oai:jdc.jefferson.edu:otofp-1041
2015-07-11T21:10:05Z
publication:oto
publication:jmc
publication:otofp
What is normal nasal airflow? A computational study of 22 healthy adults.
Zhao, Kai
Jiang, Jianbo
BACKGROUND: Nasal airflow is essential for the functioning of the human nose. Given individual variation in nasal anatomy, there is yet no consensus what constitutes normal nasal airflow patterns. We attempt to obtain such information that is essential to differentiate disease-related conditions.
METHODS: Computational fluid dynamics (CFD) simulated nasal airflow in 22 healthy subjects during resting breathing. Streamline patterns, airflow distributions, velocity profiles, pressure, wall stress, turbulence, and vortical flow characteristics under quasi-steady state were analyzed. Patency ratings, acoustically measured minimum cross-sectional area (MCA), and rhinomanometric nasal resistance (NR) were examined for potential correlations with morphological and airflow-related variables.
RESULTS: Common features across subjects included: >50% total pressure drop reached near the inferior turbinate head; wall shear stress, NR, turbulence energy, and vorticity were lower in the turbinate than in the nasal valve region. However, location of the major flow path and coronal velocity distributions varied greatly across individuals. Surprisingly, on average, more flow passed through the middle than the inferior meatus and correlated with better patency ratings (r = -0.65, p < 0.01). This middle flow percentage combined with peak postvestibule nasal heat loss and MCA accounted for >70% of the variance in subjective patency ratings and predicted patency categories with 86% success. Nasal index correlated with forming of the anterior dorsal vortex. Expected for resting breathing, the functional impact for local and total turbulence, vorticity, and helicity was limited. As validation, rhinomanometric NR significantly correlated with CFD simulations (r = 0.53, p < 0.01).
CONCLUSION: Significant variations of nasal airflow found among healthy subjects; Key features may have clinically relevant applications.
2014-06-01T07:00:00Z
article
https://jdc.jefferson.edu/otofp/31
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4144275/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Department of Otolaryngology
Thomas Jefferson University; Adult
Computational Biology
Computer Simulation
Diagnosis
Differential
Ethnic Groups
Female
Humans
Hydrodynamics
Male
Nose
Respiration
Rhinomanometry
Tomography
X-Ray Computed
Young Adult
Adult
Diagnosis, Differential
Tomography, X-Ray Computed
Otolaryngology
oai:jdc.jefferson.edu:otofp-1042
2015-10-19T18:56:32Z
publication:oto
publication:jmc
publication:otofp
Endoscopic Management of Idiopathic Subglottic Stenosis in Twenty-Five Patients
McKee-Cole, MD, Katherine
Bassett, MD, Ethan C.
Boon, MD, Maurits
Spiegel, MD, Joseph
Introduction
While multiple causes exist for the development of subglottic stenosis, the mechanism responsible for idiopathic subglottic stenosis (ISS) remains unknown. Proposed etiologies include gastro-esophageal reflux (GERD) related exposure, telescoping of the first tracheal ring under the cricoid cartilage, a hormonal cause, and the possibility of an unidentified autoimmune process (1,3,6,8,12,18,19).
As ISS represents a rare disease of yet unknown etiology, the optimal management remains to be defined. The treatment options range from endoscopic management, which is less invasive but tends to show recurrence to open tracheal resection with anastomosis for those patients in whom endoscopic techniques are ineffective or have shown a high recurrence rate (5). Endoscopic management is an outpatient procedure, which shows limited voice alteration. In contrast, open resection requires a hospital stay, can be associated with changes in voice, and is reserved for centers with significant expertise due to the demanding nature of the procedure (11,15). However, the procedure results in complete removal of the inflamed and stenotic area (2,10).
The available literature shows limited reports for endoscopic management of ISS in more than twenty patients. This study sought to add to the current literature by reporting the experience at one institution, with a large number of patients during a relatively condensed time frame over which surgical technique has not varied. Specific areas of evaluation in this work include the presence of circumferential/cicatricial scarring which previously has indicated that endoscopic management would not be successful, as well as the goal for endoscopic management as the sole technique rather than a temporizing measure for open intervention. This study also sought to identify any characteristics related to interval of recurrence, which would help identify the patient population in which endoscopic intervention would be a favorable option.
2015-09-28T07:00:00Z
poster
application/pdf
https://jdc.jefferson.edu/otofp/32
https://jdc.jefferson.edu/context/otofp/article/1042/viewcontent/McKee_Cole_16635.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Endoscopic Management of Idiopathic Subglottic Stenosis in Twenty-Five Patients
poster
Otolaryngology
oai:jdc.jefferson.edu:otofp-1043
2015-12-06T22:14:47Z
publication:oto
publication:jmc
publication:otofp
Computational fluid dynamics as surgical planning tool: a pilot study on middle turbinate resection.
Zhao, Kai
Malhotra, MD, Prashant S.
Rosen, MD, David
Dalton, Pamela
Pribitkin, Edmund A.
Controversies exist regarding the resection or preservation of the middle turbinate (MT) during functional endoscopic sinus surgery. Any MT resection will perturb nasal airflow and may affect the mucociliary dynamics of the osteomeatal complex. Neither rhinometry nor computed tomography (CT) can adequately quantify nasal airflow pattern changes following surgery. This study explores the feasibility of assessing changes in nasal airflow dynamics following partial MT resection using computational fluid dynamics (CFD) techniques. We retrospectively converted the pre- and postoperative CT scans of a patient who underwent isolated partial MT concha bullosa resection into anatomically accurate three-dimensional numerical nasal models. Pre- and postsurgery nasal airflow simulations showed that the partial MT resection resulted in a shift of regional airflow towards the area of MT removal with a resultant decreased airflow velocity, decreased wall shear stress and increased local air pressure. However, the resection did not strongly affect the overall nasal airflow patterns, flow distributions in other areas of the nose, nor the odorant uptake rate to the olfactory cleft mucosa. Moreover, CFD predicted the patient's failure to perceive an improvement in his unilateral nasal obstruction following surgery. Accordingly, CFD techniques can be used to predict changes in nasal airflow dynamics following partial MT resection. However, the functional implications of this analysis await further clinical studies. Nevertheless, such techniques may potentially provide a quantitative evaluation of surgical effectiveness and may prove useful in preoperatively modeling the effects of surgical interventions.
2014-11-01T07:00:00Z
article
https://jdc.jefferson.edu/otofp/33
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4435687/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Department of Otolaryngology
Thomas Jefferson University; Aged
Humans
Hydrodynamics
Male
Nasal Obstruction
Paranasal Sinuses
Patient-Specific Modeling
Pilot Projects
Tomography
X-Ray Computed
Turbinates
Aged
Tomography, X-Ray Computed
Otolaryngology
oai:jdc.jefferson.edu:otofp-1044
2016-12-06T16:00:36Z
publication:oto
publication:jmc
publication:otofp
Head and Neck Manifestations of Eosinophilic Granulomatosis with Polyangiitis: A Systematic Review.
Goldfarb, Jared M.
Rabinowitz, Mindy R.
Basnyat, Shristi
Nyquist, Gurston G.
Rosen, Marc R.
OBJECTIVE: To conduct the first and only systematic review of the existing literature on head and neck manifestations of eosinophilic granulomatosis with polyangiitis to guide clinical decision making for the otolaryngologist.
DATA SOURCES: PubMed, Cochrane Library, Scopus, and LILACS.
REVIEW METHODS: A systematic review of the aforementioned sources was conducted per the PRISMA guidelines.
RESULTS: From an initial 574 studies, 28 trials and reports were included, accounting for a total of 1175 patients with eosinophilic granulomatosis with polyangiitis. Among clinical and cohort studies, 48.0% to 96.0% of all included patients presented with head and neck manifestations. In a distinct group of patients detailed in case reports describing patients presenting with head and neck manifestations, patients on average fulfilled 4.6 diagnostic criteria per the American College of Rheumatology. Furthermore, 95.8% of reported cases were responsive to steroids, and 60% required additional therapy.
CONCLUSION: Otolaryngologists are in a unique position for the early diagnosis and prevention of late complications of eosinophilic granulomatosis with polyangiitis. The American College of Rheumatology criteria should be relied on in the diagnostic workup. Close surveillance of these patients in a multidisciplinary fashion and with baseline complete blood counts, chest radiographs, and autoimmune laboratory tests is often necessary. Such patients with head and neck manifestations of the disease are nearly always responsive to steroids and often require additional immunosuppressive therapy or surgical intervention in cases of cranial neuropathies, temporal bone involvement, and refractory symptoms.
2016-11-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/34
https://jdc.jefferson.edu/context/otofp/article/1044/viewcontent/auto_convert.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Churg-Strauss syndrome
CSS
EGPA
eosinophilic granulomatosis with polyangiitis
sinonasal disorders
systematic review
Medicine and Health Sciences
Otolaryngology
oai:jdc.jefferson.edu:otofp-1046
2017-02-17T19:26:05Z
publication:oto
publication:jmc
publication:otofp
Management of Forehead Scars
Heffelfinger, Ryan N.
Sanan, Akshay
Bryant, Lucas M.
This article provides an overview of scar management within the forehead region. It addresses the unique challenges specific to the treatment of forehead wounds. A logical, stepwise approach is used. A subsite based treatment algorithm is provided along with a review of current best practices. Pertinent case examples are included for demonstration purposes.
2017-02-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/35
https://jdc.jefferson.edu/context/otofp/article/1046/viewcontent/auto_convert.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Eyebrow; Facial plastic surgery; Filler; Forehead; Laser; Reconstruction; Scars; Wound healing
Medicine and Health Sciences
Otolaryngology
oai:jdc.jefferson.edu:otofp-1047
2017-07-31T20:35:49Z
publication:oto
publication:jmc
publication:otofp
Macrophage type 2 differentiation in a patient with laryngeal squamous cell carcinoma and metastatic prostate adenocarcinoma to the cervical lymph nodes.
Topf, Michael C.
Tuluc, Madalina
Harshyne, Larry A.
Luginbuhl, Adam J.
BACKGROUND: The tumor microenvironment often polarizes infiltrating macrophages towards a type 2, or M2 phenotype, that is characterized by expression of various cysteine-rich, scavenger receptors, including CD163. The primary function of M2 macrophages is to facilitate wound healing. As such, they are capable of providing metabolic support to a growing tumor, neovascularization, as well as protection from cytotoxic T cells. The tumor microenvironment contains a milieu of secreted factors and vesicles, which in certain circumstances can gain access to lymphatic vessels that drain to local lymph nodes.
CASE PRESENTATION: We report a 59-year-old male with recurrent T4 squamous cell carcinoma (SCC) of the larynx with synchronous prostate adenocarcinoma confined to the prostate and regional pelvic lymph nodes, without metastatic disease. The patient underwent salvage total laryngectomy and bilateral neck dissection with final pathology revealing a recurrent moderately differentiated SCC involving the larynx as well as prostate cancer in draining level 4 cervical lymph nodes bilaterally. CD163 staining was performed on the primary tumor, a negative draining lymph node, and a level four lymph node with a focus of metastatic prostate cancer and compared to benign controls. The negative draining lymph node demonstrated a large CD163 population of cells as did the interface of the focus of prostate cancer and surrounding lymph node. CD163 levels were markedly increased in this patient compared to benign lymph node controls. The macrophage differentiation at the primary tumor in the larynx was strongly CD163 positive supporting an immune permissive environment for tumor growth and metastasis.
CONCLUSION: We describe a unique case of solitary metastatic prostate cancer to cervical lymph nodes in the setting of a laryngeal cancer. These observations suggest that SCC-derived factors drive a tumor-supportive environment in draining lymph nodes dominated by an overwhelming number of CD163+, M2 macrophages. Lymph nodes that are 'primed' by SCC differentiation to M2 phenotype may be at higher risk of harboring metastases.
2017-07-18T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/36
https://jdc.jefferson.edu/context/otofp/article/1047/viewcontent/document_6_.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
CD163
M2 macrophages
Tumor microenvironment
Medicine and Health Sciences
Neurology
Oncology
Otolaryngology
Pathology
Surgery
oai:jdc.jefferson.edu:otofp-1048
2017-08-09T19:23:48Z
publication:oto
publication:jmc
publication:otofp
Biochemical Effects of Exercise on a Fasciocutaneous Flap in a Rat Model.
Aksamitiene, Edita
Baker, Adam L.
Roy, Sudeep
Hota, Salini
Zhang, Li-Hui
Rodin, Julianna
Hobelmann, Kealan
Hoek, Jan B.
Pribitkin, Edmund A.
Importance: An overwhelming amount of data suggest that cardiovascular exercise has a positive effect on the mind and body, although the precise mechanism is not always clear.
Objective: To assess the clinical and biochemical effects of voluntary cardiovascular exercise on pedicled flaps in a rodent model.
Design, Setting, and Participants: Eighteen adult Sprague-Dawley male rats were randomized into a resting animal group (RAG) (n=9) and an exercise animal group (EAG) (n=9) for 14 days (July 23, 2013, through July 30, 2013). A pedicled transposition flap was performed on the ventral surface of the rat, and biopsy specimens were taken from the proximal, middle, and distal portions on postoperative days 0, 2, 5, and 9. Flap survival was analyzed planimetrically, and biopsy specimens were analyzed by hematoxylin-eosin-stained microscopy and immunoblotting. The housing, exercise, surgery, and analysis of the rats were conducted at a single basic science research laboratory at the tertiary care center campus of Thomas Jefferson University in Philadelphia, Pennsylvania.
Exposures: The rats were caged for 14 days or housed in a cage connected to an exercise wheel and pedometer.
Main Outcomes and Measures: Study measures were gross and micrographic necrosis and expression of proteins within cell survival and apoptosis pathways.
Results: A total of 18 rats were studied, 9 in the RAG and 9 in the EAG. the mean (SEM) amount of necrosis in flaps was 41.3% (3%) in the RAG rats and 10.5% (3.5%) in the EAG rats (P < .001). Immunoblotting revealed increased Caspase-9 activity resulting in poly-(adenosine diphosphate-ribose) polymerase 1 cleavage in the RAG vs the EAG, as well as lower phosphorylated protein kinase B (also known as Akt), signal transducer and activator of transcription 3, and total B-cell leukemia/lymphoma 2 protein levels. Throughout the postoperative period, the cumulative vascular endothelial growth factor A levels of the EAG flaps were significantly higher than those of the RAG flaps (2.30 vs 1.25 fold induction [FI], P = .002), with differences of 2.76 vs 1.54 FI in the proximal segment, 2.40 vs 1.20 FI in the middle segment, and 1.90 vs 0.79 FI in the distal segment. A similar response was noted when comparing phosphorylated Akt, with cumulative mean (SEM) p-Akt expression levels of 0.62 (0.04) for RAG and 1.98 (0.09) for EAG (P = .002 between the 2 groups).
Conclusions and Relevance: Voluntary preoperative exercise improves survival in pedicled fasciocutaneous flaps; the EAG rats had less necrosis, decreased apoptotic markers, and increased amounts of vascular endothelial growth factor A and prosurvival proteins. These results have implications to increase flap survival in other mammal populations, such as humans.
Level of Evidence: 3.
2017-07-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/37
https://jdc.jefferson.edu/context/otofp/article/1048/viewcontent/jamafacial_Aksamitiene_2017_oi_160065.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
Medicine and Health Sciences
Otolaryngology
Plastic Surgery
Surgery
oai:jdc.jefferson.edu:otofp-1049
2018-11-07T15:41:39Z
publication:oto
publication:jmc
publication:otofp
publication:pacbfp
publication:pacb
publication:medonc
publication:dcb
publication:medoncfp
publication:dcbfp
Metformin Clinical Trial in HPV+ and HPV- Head and Neck Squamous Cell Carcinoma: Impact on Cancer Cell Apoptosis and Immune Infiltrate.
Curry, Joseph M.
Johnson, Jennifer
Mollaee, Mehri
Tassone, Patrick
Amin, Dev
Knops, Alexander
Menezes, Diana Whitaker
Mahoney, My
South, Andrew P.
Rodeck, Ulrich
Zhan, Tingting
Harshyne, Larry A.
Philp, Nancy
Luginbuhl, Adam J.
Cognetti, David
Tuluc, Madalina
Martinez-Outshoorn, MD, Ubaldo E.
Background: Metformin, an oral anti-hyperglycemic drug which inhibits mitochondrial complex I and oxidative phosphorylation has been reported to correlate with improved outcomes in head and neck squamous cell carcinoma (HNSCC) and other cancers. This effect is postulated to occur through disruption of tumor-driven metabolic and immune dysregulation in the tumor microenvironment (TME). We report new findings on the impact of metformin on the tumor and immune elements of the TME from a clinical trial of metformin in HNSCC. Methods: Human papilloma virus-(HPV-) tobacco+ mucosal HNSCC samples (n = 12) were compared to HPV+ oropharyngeal squamous cell carcinoma (OPSCC) samples (n = 17) from patients enrolled in a clinical trial. Apoptosis in tumor samples pre- and post-treatment with metformin was compared by deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. Metastatic lymph nodes with extracapsular extension (ECE) in metformin-treated patients (n = 7) were compared to archival lymph node samples with ECE (n = 11) for differences in immune markers quantified by digital image analysis using co-localization and nuclear algorithms (PD-L1, FoxP3, CD163, CD8). Results: HPV-, tobacco + HNSCC (mean Δ 13.7/high power field) specimens had a significantly higher increase in apoptosis compared to HPV+ OPSCC specimens (mean Δ 5.7/high power field) (p < 0.001). Analysis of the stroma at the invasive front in ECE nodal specimens from both HPV-HNSCC and HPV+ OPSCC metformin treated specimens showed increased CD8+ effector T cell infiltrate (mean 22.8%) compared to archival specimens (mean 10.7%) (p = 0.006). Similarly, metformin treated specimens showed an increased FoxP3+ regulatory T cell infiltrate (mean 9%) compared to non-treated archival specimens (mean 5%) (p = 0.019). Conclusions: This study presents novel data demonstrating that metformin differentially impacts HNSCC subtypes with greater apoptosis in HPV-HNSCC compared to HPV+ OPSCC. Moreover, we present the first in vivo human evidence that metformin may also trigger increased CD8+ Teff and FoxP3+ Tregs in the TME, suggesting an immunomodulatory effect in HNSCC. Further research is necessary to assess the effect of metformin on the TME of HNSCC. © 2018 Curry, Johnson, Mollaee, Tassone, Amin, Knops, Whitaker-Menezes, Mahoney, South, Rodeck, Zhan, Harshyne, Philp, Luginbuhl, Cognetti, Tuluc and Martinez-Outschoorn.
2018-10-11T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/38
https://jdc.jefferson.edu/context/otofp/article/1049/viewcontent/fonc_08_00436.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
HPV
head and neck cancer
immune infiltrate
metformin
squamous cell carcinoma
tumor metabolism
tumor microenvironment
Dermatology
Medicine and Health Sciences
Oncology
Otolaryngology
Pathology
Surgery
oai:jdc.jefferson.edu:pacbfp-1255
2018-11-07T16:03:31Z
publication:neurosurgeryfp
publication:oto
publication:neurosurgery
publication:jmc
publication:otofp
publication:pacbfp
publication:pacb
Phosphaturic mesenchymal tumor of the nasal cavity: Clinicopathologic correlation is essential for diagnosis
Kerr, Aidan
Rimmer, Ryan
Rosen, Marc
Evans, James J.
Tuluc, Madalina
Mardekian, Stacey K.
Phosphaturic mesenchymal tumor (PMT) is a rare neoplasm in which the tumor cells produce fibroblast growth factor 23 (FGF23), leading to oncogenic osteomalacia and thus a distinct clinical presentation. However, the pathologic findings of PMT are often non-specific and variable, especially in tumors occurring in the head and neck. We present a case of a 66-year-old female who presented with osteomalacia-related symptoms and was found to have a nasal cavity mass. Histopathologic examination was suggestive of PMT but certain characteristic features were lacking, requiring confirmation of the diagnosis by chromogenic in situ hybridization (CISH) assay for FGF23 mRNA. The patient's symptoms and laboratory abnormalities resolved upon resection of the tumor. © 2018
2018-03-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/pacbfp/252
https://jdc.jefferson.edu/context/pacbfp/article/1255/viewcontent/1_s2.0_S2214330018301068_main.pdf
http://creativecommons.org/licenses/by-nc-nd/4.0/
Department of Pathology, Anatomy, and Cell Biology Faculty Papers
English
Jefferson Digital Commons
Phosphaturic mesenchymal tumor
Sinonasal
Endoscopic endonasal resection
Tumor induced osteomalacia
Hypophosphatemia
FGF23
Medicine and Health Sciences
Neurology
Otolaryngology
Pathology
Surgery
oai:jdc.jefferson.edu:otofp-1050
2018-12-06T14:39:01Z
publication:oto
publication:jmc
publication:otofp
A systematic review of treating recurrent head and neck cancer: a reintroduction of brachytherapy with or without surgery.
Rodin, Julianna
Bar-Ad, Voichita
Cognetti, David
Curry, Joseph
Johnson, Jennifer
Zender, Chad
Doyle, Laura
Kutler, David
Leiby, Benjamin E.
Keane, William M.
Luginbuhl, Adam J.
Purpose: To review brachytherapy use in recurrent head and neck carcinoma (RHNC) with focus on its efficacy and complication rates.
Material and methods: A literature search of PubMed, Ovid, Google Scholar, and Scopus was conducted from 1990 to 2017. Publications describing treatment of RHNC with brachytherapy with or without surgery were included. The focus of this review is on oncologic outcomes and the safety of brachytherapy in the recurrent setting.
Results: Thirty studies involving RHNC treatment with brachytherapy were reviewed. Brachytherapy as adjunctive treatment to surgical resection appears to be associated with an improved local regional control and overall survival, when compared with the published rates for re-irradiation utilizing external beam radiotherapy (RT) or brachytherapy alone. Safety data remains variable with different isotopes and dose rates with implantable brachytherapy demonstrating a tolerable side effect profile.
Conclusions: Although surgery remains a mainstay treatment for RHNC, intraoperative interstitial brachytherapy delivery as adjunctive therapy may improve the treatment outcome and may be associated with fewer complication rates as compared to reirradiation using external beam radiotherapy. Further investigations are required to elucidate the role of brachytherapy for RHNC.
2018-10-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/39
https://jdc.jefferson.edu/context/otofp/article/1050/viewcontent/JCB_Art_34062_10.pdf
http://creativecommons.org/licenses/by-nc-sa/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
cesium
head and neck cancer
recurrent
Medicine and Health Sciences
Oncology
Otolaryngology
oai:jdc.jefferson.edu:otofp-1051
2019-02-05T21:39:20Z
publication:oto
publication:jmc
publication:otofp
Application of Tasman technique for congenital absence of nasal cartilage: A case report
Gadaleta, Dominick
Heffelfinger, Ryan N.
2019-03-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/40
https://jdc.jefferson.edu/context/otofp/article/1051/viewcontent/1_s2.0_S2468548818300754_main.pdf
http://creativecommons.org/licenses/by-nc-nd/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
Rhinoplasty
Cartilage
Functional
Tasman
Technique
Medicine and Health Sciences
Otolaryngology
oai:jdc.jefferson.edu:otofp-1052
2019-02-28T14:34:02Z
publication:oto
publication:jmc
publication:otofp
Taking Free Flap Surgery Abroad: A Collaborative Approach to a Complex Surgical Problem.
Swendseid, MD, Brian
Tassone, MD, Patrick
Gilles, MD, Patrick Jean
Pavrette, MD, Magda
Stewart, Matthew
Batatope, Mercy
Weed, MD, Donald
Cognetti, MD, David
Luginbuhl, MD, Adam J.
Curry, MD, Joseph
Accessibility to health care, especially complex surgical care, represents one of the major health care disparities in developing countries. While surgical teams may be willing to travel to these areas to help address these needs, there are many logistical and ethical dilemmas inherent in this pursuit. We reviewed our approach to the establishment of the team-based surgical outreach program, wherein we perform head and neck free tissue transfer surgery in Haiti. We describe the challenges encountered in the delivery of surgical care as well as ethical dilemmas relevant to surgical outreach trips, highlighting an approach reliant on strong local cooperation. Despite the obstacles in place, our experience shows that free flap surgery can be successfully and ethically performed in these areas of great need.
2018-12-11T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/41
https://jdc.jefferson.edu/context/otofp/article/1052/viewcontent/auto_convert.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
Haiti
free tissue transfer
surgical mission trip
surgical outreach
Medicine and Health Sciences
Otolaryngology
Surgery
oai:jdc.jefferson.edu:otofp-1053
2019-03-20T16:39:14Z
publication:oto
publication:jmc
publication:otofp
Biphenotypic Sinonasal Sarcoma-Case Report and Review of Clinicopathological Features and Diagnostic Modalities.
Chitguppi, Chandala
Koszewski, Ian
Collura, Kaitlin
Curtis, Mark
Nyquist, Gurston G.
Rabinowitz, Mindy R.
Rosen, Marc
Background
Biphenotypic sinonasal sarcoma is a recently described malignancy showing dual differentiation with both myogenic and neural elements. Due to its histologic similarities to other sinonasal malignancies, it is a diagnostic challenge.
Objective
The main purpose of this article is to report a case of biphenotypic sinonasal sarcoma and to consolidate data and provide a comprehensive review regarding pathological differences between biphenotypic sarcoma and other sinonasal malignancies and diagnostic modalities used for biphenotypic sarcoma.
Material and Methods
A systematic review of all cases of biphenotypic sinonasal sarcoma was performed using electronic databases (PubMed and Medline). Data collected included age, gender, symptoms, sub-site of origin, immunophenotyping, metastasis, recurrence, treatment, duration of follow-up, and survival outcomes.
Results
Ninety-five cases of biphenotypic sarcoma were found with mean age at diagnosis of 52.36 years (range, 24-87 years). Female to male ratio was 2.27:1. Extra-sinonasal extension was present in 28%. Immunophenotyping revealed that S-100 and SMA (smooth muscle actin) were consistently positive, while SOX-10 was consistently negative. PAX3-MAML3 fusion [t (2; 4) (q35; q31.1)] was the most common genetic rearrangement. Surgical excision with or without adjuvant radiotherapy was the most frequent treatment modality used. Recurrence was observed in 32% of cases with follow-up. None of the cases reported metastasis. Three patients had died at the time of publication that included one case with intracranial extension.
Conclusion
Biphenotypic sarcoma is distinct sinonasal malignancy with unique clinicopathological features. Testing involving a battery of myogenic and neural immunomarkers is essential for diagnostic confirmation and is a clinically useful endeavor when clinical suspicion is high.
© 2019 Georg Thieme Verlag KG Stuttgart. New York.
2019-02-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/42
https://jdc.jefferson.edu/context/otofp/article/1053/viewcontent/auto_convert.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
biphenotypic
nasal
sarcoma
sinus
spindle cell
Medicine and Health Sciences
Otolaryngology
oai:jdc.jefferson.edu:otofp-1054
2019-03-20T16:50:55Z
publication:oto
publication:jmc
publication:otofp
Evaluation of cranial base repair techniques utilizing a novel cadaveric CPAP model.
Chitguppi, Chandala
Rimmer, Ryan A.
Garcia, Hermes G.
Koszewski, Ian J.
Fastenberg, Judd H.
Nyquist, Gurston G.
Rosen, Marc R.
Huntley, Colin
Rabinowitz, Mindy R.
Evans, James J.
BACKGROUND: Although recent guidelines for obstructive sleep apnea recommend early postoperative use of continuous positive airway pressure (CPAP) after endonasal skull base surgery, the time of initiation of CPAP is unclear. In this study we used a novel, previously validated cadaveric model to analyze the pressures delivered to the cranial base and evaluate the effectiveness of various repair techniques to withstand positive pressure.
METHODS: Skull base defects were surgically created in 3 fresh human cadaver heads and repaired using 3 commonly used repair techniques: (1) Surgicel™ onlay; (2) dural substitute underlay with dural sealant onlay; and (3) dural substitute underlay with nasoseptal flap onlay with dural sealant. Pressure microsensors were placed in the sphenoid sinus and sella, both proximal and distal to the repair, respectively. The effectiveness of each repair technique against various CPAP pressure settings (5-20 cm H
RESULTS: Approximately 79%-95% of positive pressure administered reached the sphenoid sinus. Sellar pressure levels varied significantly across the 3 repair techniques and were lowest after the third technique. "Breach" points (CPAP settings at which sellar repair was violated) were lowest for the first group. All 3 specimens showed a breach after the first repair technique. For the second repair technique, only a single breach was created in 1 specimen at 20 cm H
CONCLUSION: Different skull base repair techniques have varying ability to withstand CPAP. Both second and third repair techniques performed in a nearly similar fashion with regard to their ability to withstand positive pressure ventilation.
2019-02-12T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/43
https://jdc.jefferson.edu/context/otofp/article/1054/viewcontent/auto_convert.pdf
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
CPAP
airway
cadaver
obstructive sleep apnea
skull base surgery
Medicine and Health Sciences
Otolaryngology
oai:jdc.jefferson.edu:otofp-1055
2019-09-27T20:06:09Z
publication:oto
publication:jmc
publication:otofp
Carotid dosimetry after re-irradiation with 131Cs permanent implant brachytherapy in recurrent, resected head and neck cancer
Walsh, Amanda
Hubley, Emily
Doyle, Laura, M
Cognetti, David
Curry, Joseph
Bar-Ad, Voichita
Luginbuhl, Adam
Purpose: Permanent seed implant cesium-131 (131Cs) brachytherapy provides highly localized radiation for patients with recurrent head and neck cancer (HNC), who may be ineligible for external beam radiation therapy due to a high-risk of toxicity. As carotid blowout is a concern in the setting of re-irradiation, a dose to the carotid artery was examined for 131Cs brachytherapy implants.
Material and methods: Eleven patients were implanted with131Cs adjacent to carotid at the time of resection for recurrent HNC. Vascularized tissue flaps were used in some patients. The carotid artery was contoured on the post-implant brachytherapy treatment plan, and the maximum carotid point dose and minimum carotid-seed distances are reported. The incidence of carotid blowout in the follow-up period was also measured.
Results: The maximum carotid dose was 77 ±52 Gy (range, 3-158 Gy). The closest seed to the carotid artery was 0.8 ±0.8 cm (range, 0.2-2.6 cm). One patient without a flap experienced carotid blowout, which was attributed to a non-healing wound rather than to high radiation doses.
Conclusions: Carotid artery doses from131Cs are reported. Vascularized tissue flaps should be considered when planning131Cs brachytherapy.
2019-06-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/44
https://jdc.jefferson.edu/context/otofp/article/1055/viewcontent/JCB_Art_37045_10.pdf
http://creativecommons.org/licenses/by-nc-sa/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
brachytherapy
carotid blowout
cesium-131
head and neck cancer
recurrent
Medicine and Health Sciences
Oncology
Otolaryngology
Radiation Medicine
oai:jdc.jefferson.edu:otofp-1056
2019-11-12T19:05:24Z
publication:oto
publication:jmc
publication:otofp
Prognostic Significance of Tumor-Associated Macrophage Content in Head and Neck Squamous Cell Carcinoma: A Meta-Analysis.
Kumar, Ayan Tyagi
Knops, Alexander
Swendseid, MD, Brian
Martinez-Outshoorn, Ubaldo E.
Harshyne, Larry
Philp, Nancy
Rodeck, Ulrich
Luginbuhl, Adam
Cognetti, David
Johnson, Jennifer
Curry, Joseph
Background: Head and neck squamous cell carcinoma (HNSCC) exists within a microenvironment rich in immune cells. Macrophages are particularly abundant in and around tumor tissue, and have been implicated in the growth, malignancy, and persistence of HNSCC (1). However, current literature reports variable degrees of association between the density of tumor-associated macrophages (TAMs) and clinicopathologic markers of disease (2, 3). These inconsistent findings may be a result of differences in approach to TAM detection. Authors have measured total TAMs in tumor tissue, while others have stained tumor samples for individual subtypes of TAMs, which include pro-inflammatory (M1-like) and immunosuppressive (M2-like). Our aim is to more clearly define the prognostic significance of the phenotypes of tumor-associated macrophages in HNSCC. Methods: We conducted a meta-analysis of the existing publications investigating the relationship between TAMs (total and M2-like subtype) and T stage, nodal involvement, vascular invasion, lymphatic invasion, and tumor differentiation (Figure 1). A total of 12 studies were included. Forest plots and risk ratios were generated to report overall effect. Results: Higher density of both total and M2-like subtype of TAMs in the tumor microenvironment is associated with advanced T stage, increased rates of nodal positivity, presence of vascular invasion, and presence of lymphatic invasion (p < 0.0001; Figures 2–9). There is no significant association between TAM density, either total or M2-like subtype, and tumor differentiation (Figures 10, 11). Conclusions: Increased density of TAMs, including those of the M2-like phenotype, correlate with poor clinicopathologic markers in HNSCC. Our findings warrant additional investigation into the subpopulations of TAMs, the mechanisms behind their recruitment and differentiation, and the associated influence of each phenotype on tumor growth and invasion. A greater understanding of TAM dynamics in HNSCC is critical for directing further research and employing TAM-targeted adjunct therapies.
2019-07-23T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/45
https://jdc.jefferson.edu/context/otofp/article/1056/viewcontent/prognostic_Significange_of_Tumor.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
CD163
CD68
M1 macrolphage
M2 macrophage
head and neck (H&N) cancer
tumor associated macrophage (TAM)
tumor microenviroment
Otolaryngology
oai:jdc.jefferson.edu:otofp-1057
2019-12-13T20:46:43Z
publication:oto
publication:jmc
publication:otofp
Reconstructive trends and complications following parotidectomy: incidence and predictors in 11,057 cases.
Bovenzi, Cory D
Ciolek, Peter
Crippen, Meghan
Curry, Joseph M
Krein, Howard
Heffelfinger, Ryan
BACKGROUND: Parotidectomy is a common treatment option for parotid neoplasms and the complications associated with this procedure can cause significant morbidity. Reconstruction following parotidectomy is utilized to address contour deformity and facial nerve paralysis. This study aims to demonstrate national trends in parotidectomy patients and identify factors associated with adverse postoperative outcomes. This study includes the largest patient database to date in determining epidemiologic trends, reconstructive trends, and prevalence of adverse events following parotidectomy.
METHODS: A retrospective review was performed for parotidectomies included in the ACS-NSQIP database between January 2012 and December 2017. CPT codes were used to identify the primary and secondary procedures performed. Univariate and multivariate analysis was utilized to determine associations between pre- and perioperative variables with patient outcomes. Preoperative demographics, surgical indications, and common medical comorbidities were collected. CPT codes were used to identify patients who underwent parotidectomy with or without reconstruction. These pre- and perioperative characteristics were compared with 30-day surgical complications, medical complications, reoperation, and readmission using uni- and multivariate analyses to determine predictors of adverse events.
RESULTS: There were 11,057 patients who underwent parotidectomy. Postoperative complications within 30 days were uncommon (1.7% medical, 3.8% surgical), with the majority of these being surgical site infection (2.7%). Free flap reconstruction, COPD, bleeding disorders, smoking, and presence of malignant tumor were the strongest independent predictors of surgical site infection. Readmission and reoperation were uncommon at an incidence of 2.1% each. The strongest factors predictive of readmission were malignant tumor and corticosteroid usage. The strongest factors predictive of reoperation were free flap reconstruction, malignant tumor, bleeding disorder, and disseminated cancer. Surgical volume/contour reconstruction was relatively uncommon (18%). Facial nerve sacrifice was uncommon (3.7%) and, of these cases, only 25.5% underwent facial nerve reinnervation and 24.0% underwent facial reanimation.
CONCLUSIONS: There are overall low rates of complications, readmissions, and reoperations following parotidectomy. However, certain factors are predictive of adverse postoperative events and this data may serve to guide management and counseling of patients undergoing parotidectomy. Concurrent reconstructive procedures are not commonly reported which may be due to underutilization or underreporting.
2019-11-19T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/46
https://jdc.jefferson.edu/context/otofp/article/1057/viewcontent/reconstructive_trends_and_complications.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
Comorbidities
Complications
Contour
Epidemiology
Facial nerve
Infection
NSQIP
Parotidectomy
Readmission
Reconstruction
Otolaryngology
oai:jdc.jefferson.edu:otofp-1058
2020-01-06T21:52:48Z
publication:oto
publication:jmc
publication:otofp
Virtual Surgical Planning in Subscapular System Free Flap Reconstruction of Midface Defects.
Swendseid, Brian P.
Roden, Dylan F.
Vimawala, Swar
Richa, Tony
Sweeny, Larissa
Goldman, Richard A.
Luginbuhl, Adam
Heffelfinger, Ryan N.
Khanna, Shachika
Curry, Joseph
OBJECTIVES: Reconstruction of the midface has many inherent challenges, including orbital support, skull base reconstruction, optimizing midface projection, separation of the nasal cavity and dental rehabilitation. Subscapular system free flaps (SF) have sufficient bone stock to support complex reconstruction and the option of separate soft tissue components. This study analyzes the effect of virtual surgical planning (VSP) in SF for midface on subsite reconstruction, bone segment contact and anatomic position.
MATERIALS AND METHODS: Retrospective cohort of patients with midface defects that underwent SF reconstruction at a single tertiary care institution.
RESULTS: Nine cases with VSP were compared to fourteen cases without VSP. VSP was associated with a higher number of successfully reconstructed subunits (5.9 vs 4.2, 95% CI of mean difference 0.31-3.04, p = 0.018), a higher number of successful bony contact between segments (2.2 vs 1.4, 95% CI of mean difference 0.0-1.6, p = 0.050), and a higher percent of segments in anatomic position (100% vs 71%, 95% CI of mean difference 2-55%, p = 0.035). When postoperative bone position after VSP reconstruction was compared to preoperative scans, the difference in anteroposterior, vertical and lateral projection compared to the preoperative 'ideal' bone position was82% of measurements. There were no flap losses.
CONCLUSION: VSP may augment SF reconstruction of the midface by allowing for improved subunit reconstruction, bony segment contact and anatomically correct bone segment positioning. VSP can be a useful adjunct for complex midface reconstruction and the benefits should be weighed against cost.
2019-12-19T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/47
https://jdc.jefferson.edu/context/otofp/article/1058/viewcontent/1_s2.0_S1368837519304191_main.pdf
http://creativecommons.org/licenses/by-nc-nd/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
Cutting guides
Dental implants
Free tissue flaps
Head and neck neoplasms
Maxillectomy
Midface reconstruction
Orbital surgery
Scapula free flap
Subscapular system
Virtual surgical planning
Medicine and Health Sciences
Otolaryngology
Surgery
oai:jdc.jefferson.edu:otofp-1059
2021-04-08T13:52:46Z
publication:oto
publication:jmc
publication:otofp
publication:tju
publication:library
publication:jeffoapubs
publication:oapubfund
Design and Printing of a Low-Cost 3D-Printed Nasal Osteotomy Training Model: Development and Feasibility Study.
Ho, Michelle
Goldfarb, Jared
Moayer, Roxana
Nwagu, Uche
Ganti, Rohan
Krein, Howard
Heffelfinger, Ryan
Hutchinson, Morgan Leigh
BACKGROUND: Nasal osteotomy is a commonly performed procedure during rhinoplasty for both functional and cosmetic reasons. Teaching and learning this procedure proves difficult due to the reliance on nuanced tactile feedback. For surgical simulation, trainees are traditionally limited to cadaveric bones, which can be costly and difficult to obtain.
OBJECTIVE: This study aimed to design and print a low-cost midface model for nasal osteotomy simulation.
METHODS: A 3D reconstruction of the midface was modified using the free open-source design software Meshmixer (Autodesk Inc). The pyriform aperture was smoothed, and support rods were added to hold the fragments generated from the simulation in place. Several models with various infill densities were printed using a desktop 3D printer to determine which model best mimicked human facial bone.
RESULTS: A midface simulation set was designed using a desktop 3D printer, polylactic acid filament, and easily accessible tools. A nasal osteotomy procedure was successfully simulated using the model.
CONCLUSIONS: 3D printing is a low-cost, accessible technology that can be used to create simulation models. With growing restrictions on trainee duty hours, the simulation set can be used by programs to augment surgical training.
2020-11-17T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/48
https://jdc.jefferson.edu/context/otofp/article/1059/viewcontent/Design_and_Printing_of_a.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
3D printing
education
low-cost
nasal osteotomy
simulation
Medicine and Health Sciences
Otolaryngology
oai:jdc.jefferson.edu:otofp-1060
2020-12-24T15:57:40Z
publication:oto
publication:jmc
publication:otofp
Identifying Treatments for Taste and Smell Disorders: Gaps and Opportunities.
Mainland, Joel D.
Barlow, Linda A.
Munger, Steven D.
Millar, Sarah E.
Vergara, M. Natalia
Jiang, Peihua
Schwob, James E.
Goldstein, Bradley J.
Boye, Shannon E.
Martens, Jeffrey R.
Leopold, Donald A.
Bartoshuk, Linda M.
Doty, Richard L.
Hummel, Thomas
Pinto, Jayant M.
Trimmer, Casey
Kelly, Christine
Pribitkin, Edmund A.
Reed, Danielle R.
The chemical senses of taste and smell play a vital role in conveying information about ourselves and our environment. Tastes and smells can warn against danger and also contribute to the daily enjoyment of food, friends and family, and our surroundings. Over 12% of the US population is estimated to experience taste and smell (chemosensory) dysfunction. Yet, despite this high prevalence, long-term, effective treatments for these disorders have been largely elusive. Clinical successes in other sensory systems, including hearing and vision, have led to new hope for developments in the treatment of chemosensory disorders. To accelerate cures, we convened the "Identifying Treatments for Taste and Smell Disorders" conference, bringing together basic and translational sensory scientists, health care professionals, and patients to identify gaps in our current understanding of chemosensory dysfunction and next steps in a broad-based research strategy. Their suggestions for high-yield next steps were focused in 3 areas: increasing awareness and research capacity (e.g., patient advocacy), developing and enhancing clinical measures of taste and smell, and supporting new avenues of research into cellular and therapeutic approaches (e.g., developing human chemosensory cell lines, stem cells, and gene therapy approaches). These long-term strategies led to specific suggestions for immediate research priorities that focus on expanding our understanding of specific responses of chemosensory cells and developing valuable assays to identify and document cell development, regeneration, and function. Addressing these high-priority areas should accelerate the development of novel and effective treatments for taste and smell disorders.
2020-10-09T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/49
https://jdc.jefferson.edu/context/otofp/article/1060/viewcontent/bjaa038.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
cell culture
olfaction
sniff
Medicine and Health Sciences
Otolaryngology
oai:jdc.jefferson.edu:otofp-1061
2021-04-07T20:19:21Z
publication:oto
publication:jmc
publication:otofp
publication:tju
publication:library
publication:jeffoapubs
publication:oapubfund
Initial Experience Using 3-Dimensional Printed Models for Head and Neck Reconstruction in Haiti.
Vimawala, Swar
Gao, Terry
Goldfarb, Jared
Gadaleta, Dominick
Ku, Bon
Jean-Gilles, Patrick
Luginbuhl, Adam
Pugliese, Robert
Weed, Donald
Curry, Joseph M
This report describes the first use of a novel workflow for in-house computer-aided design (CAD) for application in a resource-limited surgical outreach setting. Preoperative computed tomography imaging obtained locally in Haiti was used to produce rapid-prototyped 3-dimensional (3D) mandibular models for 2 patients with large ameloblastomas. Models were used for patient consent, surgical education, and surgical planning. Computer-aided design and 3D models have the potential to significantly aid the process of complex surgery in the outreach setting by aiding in surgical consent and education, in addition to expected surgical applications of improved anatomic reconstruction.
2020-08-10T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/50
https://jdc.jefferson.edu/context/otofp/article/1061/viewcontent/initial_experience_using_3_d.pdf
http://creativecommons.org/licenses/by-nc/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
3D printing
mandibular reconstruction
rapid prototyping
resource-limited country
stereolithography
Medicine and Health Sciences
Otolaryngology
oai:jdc.jefferson.edu:otofp-1062
2021-01-06T17:48:28Z
publication:oto
publication:jmc
publication:otofp
Cancer-Associated Fibroblast Density, Prognostic Characteristics, and Recurrence in Head and Neck Squamous Cell Carcinoma: A Meta-Analysis.
Knops, Alexander M
South, Andrew
Rodeck, Ulrich
Martinez-Outschoorn, Ubaldo
Harshyne, PhD, Larry
Johnson, MD, Jennifer
Luginbuhl, Adam J
Curry, Joseph M
Introduction: The progression and clinical course of head and neck squamous cell carcinoma (HNSCC) relies on complex interactions between cancer and stromal cells in the tumor microenvironment (TME). Among the most abundant of these stromal cells are cancer-associated fibroblasts (CAFs). While their contribution to tumor progression is widely acknowledged, and various CAF-targeted treatments are under development, the relationship between CAF density and the clinicopathologic course of HNSCC has not been clearly defined. Here we examine the published evidence investigating the relationship of cancer-associated fibroblasts to local recurrence and indicators of prognostic significance in HNSCC.
Methods: We conducted a meta-analysis of existing publications that compare the relationship between CAF density, local recurrence, and clinically significant pathologic criteria of disease development (T stage, nodal positivity, clinical stage, vascular invasion, perineural invasion, Ki67 expression, and differentiation). Thirteen studies met the selection criteria, providing a total study population of 926 patients. Forest plots and risk ratios were generated to illustrate overall relationships.
Results: Higher CAF density within the tumor microenvironment is associated with advanced T stage, nodal infiltration, clinical stage, vascular invasion, perineural invasion, Ki67 expression, and differentiation (p <0.05). High CAF density is also associated with increased rates of local recurrence (p <0.001).
Conclusions: Across multiple studies, increased CAF density is correlated with histopathological criteria of poor prognosis in HNSCC. These findings highlight that CAFs may play a pivotal role in HNSCC development and progression. Staining for CAFs may represent a valuable addition to current pathologic analysis and help to guide prognosis and treatment. Understanding the mechanisms by which CAFs reciprocally interact with cancer cells will be crucial for optimization of TME-focused treatment of HNSCC.
2020-11-27T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/51
https://jdc.jefferson.edu/context/otofp/article/1062/viewcontent/fonc_10_565306.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
CAF
alpha-smooth muscle actin
cancer-associated fibroblasts
head and neck squamous cell carcinoma
myofibroblast
prognosis
tumor microenvironment
Medicine and Health Sciences
Otolaryngology
oai:jdc.jefferson.edu:otofp-1063
2021-04-08T13:53:11Z
publication:oto
publication:jmc
publication:otofp
publication:tju
publication:library
publication:jeffoapubs
publication:oapubfund
Cancer-Associated Fibroblast Density, Prognostic Characteristics, and Recurrence in Head and Neck Squamous Cell Carcinoma: A Meta-Analysis.
Knops, Alexander M
South, Andrew
Rodeck, Ulrich
Martinez-Outschoorn, Ubaldo
Harshyne, Larry A
Johnson, Jennifer
Luginbuhl, Adam J
Curry, Joseph M
Introduction: The progression and clinical course of head and neck squamous cell carcinoma (HNSCC) relies on complex interactions between cancer and stromal cells in the tumor microenvironment (TME). Among the most abundant of these stromal cells are cancer-associated fibroblasts (CAFs). While their contribution to tumor progression is widely acknowledged, and various CAF-targeted treatments are under development, the relationship between CAF density and the clinicopathologic course of HNSCC has not been clearly defined. Here we examine the published evidence investigating the relationship of cancer-associated fibroblasts to local recurrence and indicators of prognostic significance in HNSCC.
Methods: We conducted a meta-analysis of existing publications that compare the relationship between CAF density, local recurrence, and clinically significant pathologic criteria of disease development (T stage, nodal positivity, clinical stage, vascular invasion, perineural invasion, Ki67 expression, and differentiation). Thirteen studies met the selection criteria, providing a total study population of 926 patients. Forest plots and risk ratios were generated to illustrate overall relationships.
Results: Higher CAF density within the tumor microenvironment is associated with advanced T stage, nodal infiltration, clinical stage, vascular invasion, perineural invasion, Ki67 expression, and differentiation (p
Conclusions: Across multiple studies, increased CAF density is correlated with histopathological criteria of poor prognosis in HNSCC. These findings highlight that CAFs may play a pivotal role in HNSCC development and progression. Staining for CAFs may represent a valuable addition to current pathologic analysis and help to guide prognosis and treatment. Understanding the mechanisms by which CAFs reciprocally interact with cancer cells will be crucial for optimization of TME-focused treatment of HNSCC.
2020-11-27T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/52
https://jdc.jefferson.edu/context/otofp/article/1063/viewcontent/fonc_10_565306__1_.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
CAF
alpha-smooth muscle actin
cancer-associated fibroblasts
head and neck squamous cell carcinoma
myofibroblast
prognosis
tumor microenvironment
Medicine and Health Sciences
Otolaryngology
oai:jdc.jefferson.edu:otofp-1064
2021-02-16T15:08:08Z
publication:oto
publication:jmc
publication:otofp
Free Tissue Transfer for Central Skull Base Defect Reconstruction: Case Series and Surgical Technique
Sagheer, S. Hamad
Swendseid, Brian
Evans, James
Rabinowitz, Mindy
Nyquist, Gurston
Rosen, Marc R.
Toskala, Elina
Heffelfinger, Ryan
Luginbuhl, Adam J.
Curry, Joseph M.
Objectives: Local reconstruction of central skull base defects may be inadequate for large defects or reoperative cases; free tissue transfer may be necessary. Inset of the flap and management of the pedicle can be challenging. We report our experience and approach.
Methods: Retrospective review identifying seven patients with central skull base defects who underwent free flap reconstruction from 2016-2020.
Results: Four patients with recurrent nasopharyngeal carcinoma, one with recurrent craniopharyngioma, one with clival-cervical chordoma, and one with meningioma of the middle cranial fossa were analyzed. Six defects were closed with an anterolateral thigh free flap and one with a radial forearm free flap. In two patients, the flap was secured in an onlay fashion to the defect via a Caldwell-Luc transmaxillary approach. In one patient, the flap was passed transorally, and the pedicle was delivered into the neck via Penrose drain. In two patients, a parapharyngeal technique and in two others, a retropharyngeal was used for nasopharyngeal inset with endoscopic assistance. There were no flap failures, with an average follow-up time of 20.1 (range 3.2 - 47.1) months. One patient required flap repositioning on postoperative day three due to midline shift and intracranial contents compression. The transoral inset flap necessitated flap repositioning on postoperative day 13 to improve the nasopharyngeal airway.
Conclusion: Free flap reconstruction of the central skull base is challenging, but transmaxillary, transoral, parapharyngeal, and retropharyngeal approaches can be used with endoscopic assistance to ensure secure inset flap and avoid airway obstruction.
2021-02-13T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/53
https://jdc.jefferson.edu/context/otofp/article/1064/viewcontent/auto_convert.pdf
http://creativecommons.org/licenses/by-nc-nd/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
Central skull base
Reconstruction
Clival defect
Free tissue flap
Medicine and Health Sciences
Otolaryngology
oai:jdc.jefferson.edu:otofp-1065
2021-03-11T21:42:35Z
publication:oto
publication:jmc
publication:otofp
Lateral Modified Brandt-Daroff Exercises: A Novel Home Treatment Technique for Horizontal Canal BPPV
Teixido, Michael T.
Casserly, Ryan
Melley, Lauren E
OBJECTIVES: Brandt-Daroff exercises (BDEs) are commonly used as an at-home treatment for posterior canalithiasis, but their efficacy in the treatment of benign paroxysmal positional vertigo (BPPV) of the horizontal canal (HC-BPPV) has not been previously studied. Using biomechanical model simulation, we investigated modifications that may optimize BDE use for HC-BPPV treatment.
MATERIALS AND METHODS: The BPPV Viewer, a three-dimensional model of the human labyrinth, was used to analyze BDE for HC-BPPV treatment. While moving the model through sequential BDE positions, the expected position of otoliths was demonstrated. Treatment steps were adjusted to maximize otolith movement around the canal circumference without compromising otolith repositioning into the semicircular duct's anterior arm. All adjustments were integrated into lateral modified BDEs (LMBDEs) presented here.
RESULTS: By implementing several modifications, BDE can effectively treat HC-BPPV. Model simulation indicates tilting the head 20° upward in the lateral position, instead of 45° specified by the original technique, which significantly increases displacement of otoliths originating from the horizontal duct's anterior and intermediate segments. LMBDE can be performed as a direct two-step sequence without pausing in the upright position before switching sides. If the affected ear is known, positioning the head 45° below horizontal on the unaffected side as a third treatment step can promote actual canal evacuation. These treatment enhancements increase circumferential otolith movement around the canal and may promote horizontal canal evacuation.
CONCLUSION: LMBDEs are a modification of BDE that may increase their effectiveness for use in patients with HC-BPPV. This safe treatment adjunct between office visits may promote long-term symptom reduction.
2021-01-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/54
https://jdc.jefferson.edu/context/otofp/article/1065/viewcontent/52_57.pdf
http://creativecommons.org/licenses/by-nc/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
Benign Paroxysmal Positional Vertigo
Optokinetic Nystagmus
Semicircular Canals
Medicine and Health Sciences
Otolaryngology
oai:jdc.jefferson.edu:otofp-1066
2021-05-11T14:11:22Z
publication:oto
publication:jmc
publication:otofp
publication:tju
publication:library
publication:jeffoapubs
publication:oapubfund
Elevated APOBEC mutational signatures implicate chronic injury in etiology of an aggressive head-and-neck squamous cell carcinoma: a case report.
Patel, Jena
den Breems, Nicoline Y.
Tuluc, Madalina
Johnson, Jennifer
Curry, Joseph M.
South, Andrew P.
Cho, Raymond J.
BACKGROUND: Aggressive squamous cell carcinomas (SCCs) present frequently in the context of chronic skin injury occurring in patients with the congenital blistering disease recessive dystrophic epidermolysis bullosa. Recently, these cancers were shown to harbor mutation signatures associated with endogenous deaminases of the active polynucleotide cytosine deaminase family, collectively termed APOBEC, and clock-like COSMIC [Catalogue of Somatic Mutations in Cancer] signatures, which are associated with normal aging and might result from cumulative DNA replication errors. We present a case of a nasal septal SCC arising in the context of recurrent injury, but also modest past tobacco use. Our genetic analysis of this tumor reveals unusually high APOBEC and clock-like but low tobacco-related COSMIC signatures, suggesting that chronic injury may have played a primary role in somatic mutation. This case report demonstrates how signature-based analyses may implicate key roles for certain mutagenic forces in individual malignancies such as head-and-neck SCC, with multiple etiological origins.
CASE PRESENTATION: We report the case of a 43-year-old male former smoker who presented with congestion and swelling following a traumatic nasal fracture. During surgery, the mucosa surrounding the right nasal valve appeared abnormal, and biopsies revealed invasive keratinizing SCC. Frozen section biopsies revealed multiple areas to be positive for SCC. Gene sequencing showed loss of PTEN (exons 2-8), CDKN2A/B and TP53 (exons 8-9), MYC amplification, and BLM S338*. Exome sequencing data also revealed that 36% of mutations matched an APOBEC mutational signature (COSMIC signatures 2 and 13) and 53% of mutations matched the clock-like mutation signature (COSMIC signature 5). These proportions place this tumor in the 90th percentile bearing each signature, independently, in a reference data set combining cutaneous and The Cancer Genome Atlas (TCGA) head and neck SCC data. In contrast, few mutations harbored a tobacco-related COSMIC signature 4, representing about the 10th percentile in our reference SCC data set. The patient was treated with partial rhinectomy with local flap reconstruction, bilateral neck dissection, and adjuvant radiation therapy; the patient remains disease-free to date.
CONCLUSION: Based on comparative mutational signature analysis, we propose that the history of tobacco use and traumatic injury may have collaborated in activating APOBEC enzymes and the clock-like mutational process, ultimately leading to cancer formation. Clinical awareness of the relationship between epithelial injury and tumorigenesis should enhance earlier detection of this particularly aggressive type of cancer.
2021-04-30T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/55
https://jdc.jefferson.edu/context/otofp/article/1066/viewcontent/s13256_021_02685_w.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
APOBEC
Squamous cell carcinoma
RDEB
Epithelial injury
Dermatology
Medicine and Health Sciences
Oncology
Otolaryngology
oai:jdc.jefferson.edu:otofp-1067
2021-08-16T00:54:19Z
publication:oto
publication:jmc
publication:otofp
Preoperative Immunotherapy in the Multidisciplinary Management of Oral Cavity Cancer.
Philips, MD, Ramez
Han, Chihun
Swendseid, MD, Brian
Curry, Joseph
Argiris, Athanassios
Luginbuhl, Adam
Johnson, MD, Jennifer
Despite advances in multimodal treatment for oral cavity squamous cell carcinoma, recurrence rates remain high, providing an opportunity for new therapeutic modalities that may improve oncologic outcomes. Much recent attention has been paid to the molecular interactions between the tumor cells with the adjacent peritumoral microenvironment, in which immunosuppressive molecular changes create a landscape that promotes tumor progression. The rationale for the introduction of immunotherapy is to reverse the balance of these immune interactions in a way that utilizes the host immune system to attack tumor cells. In the preoperative setting, immunotherapy has the advantage of priming the unresected tumor and the associated native immune infiltration, supercharging the adaptive anti-tumor immune response. It also provides the basis for scientific discovery where the molecular profile of responders can be interrogated to elucidate prognostic markers to aid in future patient selection. Preoperative immunotherapy is not without limitations. The risk of surgical delay due to immune adverse events must be carefully discussed by members of a multidisciplinary treatment team and patient selection will be critical. One day, the discovery of predictive biomarkers may allow for algorithms where pre-surgical immunotherapy decreases the size of surgical defect and impacts the intensity of adjuvant therapy leading to improved patient survival and decreased morbidity. With further study, immunotherapy could become a key component of future treatment algorithm.
2021-07-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/56
https://jdc.jefferson.edu/context/otofp/article/1067/viewcontent/Oral_Cavity_Cancer.pdf
https://jdc.jefferson.edu/context/otofp/article/1067/filename/0/type/additional/viewcontent/Oral_Cavity_Cancer_Supp_Table_1.docx
http://creativecommons.org/licenses/by/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
Department of Otolaryngology-Head and Neck Surgery
Thomas Jefferson University
Department of Medical Oncology; head and neck squamouscell carcinoma (HNSCC); immunotherapy; induction; multidisciplinary (care or team); multimodality; oral cavity squamous cell carcinoma (OCSCC); preoperative; window of opportunity
Medicine and Health Sciences
Otolaryngology
oai:jdc.jefferson.edu:otofp-1068
2021-11-02T18:36:54Z
publication:oto
publication:jmc
publication:otofp
Outcomes of Venous End-to-Side Microvascular Anastomoses of the Head and Neck.
Stewart, Matthew
Hammond, Perry
Khatiwala, Ishani
Swendseid, Brian
Taghizadeh, Farshid
Petrisor, Daniel
Zhan, Tingting
Goldman, Richard
Luginbuhl, Adam
Heffelfinger, Ryan
Sweeny, Larissa
Wax, Mark K
Curry, Joseph M.
OBJECTIVES/HYPOTHESIS: The literature on outcomes of end-to-side (ETS) anastomoses for microvascular reconstruction of the head and neck is limited. This series reviews ETS in free tissue transfer (FTT) across multiple institutions to better understand their usage and associated outcomes.
STUDY DESIGN: Retrospective review of 2482 consecutive patients across three tertiary institutions.
METHODS: Adult patients (> 18) who received a FTT from 2006 to 2019 were included.
RESULTS: Two hundred and twenty-one FTT were identified as requiring at least one ETS anastomosis. These ETS cases had a failure rate of 11.2% in comparison to 3.8% in a cohort of end-to-end (ETE) cases (P < .001). ETS cases were significantly more likely to have a prior neck dissection (P < .001), suggesting the ETS method was utilized in select circumstances. A second ETS anastomosis improved survival of the FTT (P = .006), as did utilization of a coupler over suture (P = .002). Failure due to venous thrombosis was significantly more common with one ETS anastomosis instead of two ETS anastomoses (P = .042).
CONCLUSIONS: ETS is effective but is often used as a secondary technique when ETE is not feasible; as such, in this series, ETS was associated with higher failure. A second anastomosis and the use of the coupler for completing the anastomoses were associated with lower rates of failure.
2020-10-19T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/59
https://jdc.jefferson.edu/context/otofp/article/1068/viewcontent/lary.29134.pdf
http://creativecommons.org/licenses/by-nc-nd/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
Adult
Aged
Aged
80 and over
Anastomosis
Surgical
Carcinoma
Squamous Cell
Female
Head
Head and Neck Neoplasms
Humans
Male
Microvessels
Middle Aged
Neck
Reconstructive Surgical Procedures
Retrospective Studies
Treatment Outcome
Vascular Surgical Procedures
Aged, 80 and over
Anastomosis, Surgical
Carcinoma, Squamous Cell
Medicine and Health Sciences
Otolaryngology
oai:jdc.jefferson.edu:otofp-1069
2021-09-16T19:57:15Z
publication:oto
publication:jmc
publication:otofp
Assessment of narcotic use in management of post-op pain after functional endoscopic sinus surgery.
Gill, Kurren S.
Chitguppi, Chandala
Haggerty, Michelle
Khoury, Tawfiq
Fastenberg, Judd
Nyquist, Gurston
Toskala, Elina
Rosen, Marc
Rabinowitz, Mindy
Objectives: Pain and analgesic requirements after functional endoscopic sinus surgery (FESS) vary widely. This study aims to quantify pain after routine FESS and determine the most commonly used pain management regimen.
Methods: Retrospective chart review of 100 patients who underwent FESS from Oct 2017 to May 2019. Patients prospectively completed a daily pain diary and reported pain levels that were categorized into no pain (0), mild (1-3), moderate (4-7), or severe (8-10). Patients were categorized into narcotics, non-narcotics, combination, or none based on type of analgesic used.
Results: Sixty-nine patients were included. Majority of patients reported either mild (39%) or no pain (28%) during the first 5 PODs. Mean POD1 pain score was 3.98, which decreased with each subsequent POD. On POD1, 37% used opioids (n = 37), 32% used non-opioids (n = 32), 22% used a combination (n = 22), and 9% used no pain meds (n = 9). Mean number of narcotic pills used within the first 5 PODs was 2 pills on any given day. Age was inversely associated with reported POD1 pain scores (P = .003) and use of preoperative steroids in patients with sinonasal polyposis was associated with lower POD1 pain scores (P = .03).
Conclusions: Even on POD1, majority of patients experienced either mild or no pain, and this decreases with each POD. Narcotics are grossly overprescribed and underutilized by patients postoperatively after FESS. We advocate for more judicious prescribing habits of narcotics by Otolaryngologists after FESS, and emphasize relying on non-narcotic alternatives like Acetaminophen or NSAIDS to diminish narcotic use and abuse in the postoperative period.
Level of Evidence: 4.
2021-01-09T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/58
https://jdc.jefferson.edu/context/otofp/article/1069/viewcontent/lio2.519.pdf
http://creativecommons.org/licenses/by-nc-nd/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
adult rhinology
allergy/rhinology
clinical practice guidelines
Medicine and Health Sciences
Otolaryngology
oai:jdc.jefferson.edu:neurosurgeryfp-1167
2021-10-21T20:04:32Z
publication:neurosurgeryfp
publication:oto
publication:neurosurgery
publication:jmc
publication:otofp
publication:tju
publication:library
publication:jeffoapubs
publication:oapubfund
Management of Coincident Pituitary Macroadenoma and Cavernous Carotid Aneurysm: A Systematic Literature Review.
Piper, Keenan J.
Karsy, Michael
Barton, Blair
Rabinowitz, Mindy
Rosen, Marc R.
Nyquist, Gurston G.
Evans, James J.
Tjoumakaris, Stavropoula
Farrell, Christopher J.
Introduction
Pituitary adenomas are a common intracranial pathology with an incidence of 15 to 20% in the population while cerebral aneurysms are less common with a prevalence of 1:50 patients. The incidence of aneurysms in patients with pituitary adenoma has been estimated at 2.3 to 5.4% of patients; however, this remains unclear. Equally, the management of concomitant lesions lacks significant understanding.
Methods
A case report is presented of a concomitant cerebral aneurysm and pituitary adenoma managed by minimally invasive endovascular and endoscopic methods, respectively. A systematic review of the literature for terms "pituitary adenoma" and "aneurysm" yielded 494 studies that were narrowed to 19 relevant articles.
Results
We report a case of a 67-year-old patient with an enlarging pituitary macroadenoma, cavernous carotid aneurysm, and unilateral carotid occlusion. After successful treatment of the aneurysm by a pipeline flow diverter, the pituitary adenoma was surgically resected by an endoscopic transsphenoidal approach.
Conclusion
The use of a pipeline flow diverter and endonasal approach was feasible in the treatment of our patient. This is the first report to our knowledge of the use of pipeline flow diversion in the management of a cavernous carotid aneurysm prior to pituitary adenoma treatment.
2021-09-29T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/neurosurgeryfp/163
https://jdc.jefferson.edu/context/neurosurgeryfp/article/1167/viewcontent/s_0041_1735904.pdf
http://creativecommons.org/licenses/by-nc-nd/4.0/
Department of Neurosurgery Faculty Papers
English
Jefferson Digital Commons
cavernous carotid aneurysm
endoscopic
intracranial aneurysm
macroadenoma
pipeline
pituitary adenoma
transphenoidal
Medicine and Health Sciences
Neurology
Surgery
oai:jdc.jefferson.edu:otofp-1070
2021-12-22T19:41:30Z
publication:oto
publication:jmc
publication:otofp
Multi-Institutional Study Validates Safety of Intraoperative Cesium-131 Brachytherapy for Treatment of Recurrent Head and Neck Cancer
Luginbuhl, Adam J.
Calder, Alyssa
Kutler, David
Zender, Chad
Wise-Draper, Trisha
Patel, Jena
Cheng, Michael
Karivedu, Vidhya
Zhan, Tingting
Parashar, Bhupesh
Gulati, Shuchi
Yao, Min
Lavertu, Pierre
Takiar, Vinita
Tang, Alice
Johnson, Jennifer
Keane, William M.
Curry, Joseph
Cognetti, David
Bar-Ad, Voichita
Introduction: Surgery is the primary treatment for resectable, non-metastatic recurrent head and neck squamous cell carcinoma (HNSCC). We explore the safety and oncologic benefit of intraoperative Cesium-131 (Cs-131) brachytherapy combined with salvage local and/or regional surgical resection.
Methods and materials: Findings were reported from a single arm multi-institutional prospective phase 1/2 trial involving surgery plus Cs-131 (surgery + Cs-131) treatment. The results of two retrospective cohorts-surgery alone and surgery plus intensity modulated radiation therapy (surgery + ReIMRT)-were also described. Included patients had recurrent HNSCC and radiation history. Safety, tumor re-occurrence, and survival were evaluated.
Results: Forty-nine patients were enrolled in the surgery + Cs-131 prospective study. Grade 1 to 3 adverse events (AEs) occurred in 18 patients (37%), and grade 4 AEs occurred in 2 patients. Postoperative percutaneous endoscopic gastrostomy (PEG) tubes were needed in 10 surgery + Cs-131 patients (20%), and wound and vascular complications were observed in 12 patients (24%). No cases of osteoradionecrosis were reported in the surgery + Cs-131 cohort. We found a 49% 2-year disease-free survival at the site of treatment with a substantial number of patients (31%) developing metastatic disease, which led to a 31% overall survival at 5 years.
Conclusions: Among patients with local/regional recurrent HNSCC status-post radiation, surgery + Cs-131 demonstrated acceptable safety with compelling oncologic outcomes, as compared to historic control cohorts.
Clinical trial registration: ClinicalTrials.gov, identifiers NCT02794675 and NCT02467738.
2021-11-26T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/60
https://jdc.jefferson.edu/context/otofp/article/1070/viewcontent/fonc_11_786216.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
Cesium-131
brachytherapy
head and neck cancer
recurrent
reirradiation head and neck
surgery
Medicine and Health Sciences
Oncology
Otolaryngology
oai:jdc.jefferson.edu:otofp-1071
2022-02-03T15:45:43Z
publication:oto
publication:jmc
publication:otofp
publication:covid-19
Otitis Media Practice During the COVID-19 Pandemic.
Marom, Tal
Pitaro, Jacob
Shah, Udayan
Torretta, Sara
Marchisio, Paola
Kumar, Ayan
Barth, Patrick
Tamir, Sharon Ovnat
The global coronavirus disease-2019 (COVID-19) pandemic has changed the prevalence and management of many pediatric infectious diseases, including acute otitis media (AOM). Coronaviruses are a group of RNA viruses that cause respiratory tract infections in humans. Before the COVID-19 pandemic, coronavirus serotypes OC43, 229E, HKU1, and NL63 were infrequently detected in middle ear fluid (MEF) specimens and nasopharyngeal aspirates in children with AOM during the 1990s and 2000s and were associated with a mild course of the disease. At times when CoV was detected in OM cases, the overall viral load was relatively low. The new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative pathogen responsible for the eruption of the COVID-19 global pandemic. Following the pandemic declaration in many countries and by the World Health Organization in March 2020, preventive proactive measures were imposed to limit COVID-19. These included social distancing; lockdowns; closure of workplaces; kindergartens and schools; increased hygiene; use of antiseptics and alcohol-based gels; frequent temperature measurements and wearing masks. These measures were not the only ones taken, as hospitals and clinics tried to minimize treating non-urgent medical referrals such as OM, and elective surgical procedures were canceled, such as ventilating tube insertion (VTI). These changes and regulations altered the way OM is practiced during the COVID-19 pandemic. Advents in technology allowed a vast use of telemedicine technologies for OM, however, the accuracy of AOM diagnosis in those encounters was in doubt, and antibiotic prescription rates were still reported to be high. There was an overall decrease in AOM episodes and admissions rates and with high spontaneous resolution rates of MEF in children, and a reduction in VTI surgeries. Despite an initial fear regarding viral shedding during myringotomy, the procedure was shown to be safe. Special draping techniques for otologic surgery were suggested. Other aspects of OM practice included the presentation of adult patients with AOM who tested positive for SARS-2-CoV and its detection in MEF samples in living patients and in the mucosa of the middle ear and mastoid in post-mortem specimens.
2022-01-07T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/61
https://jdc.jefferson.edu/context/otofp/article/1071/viewcontent/fcimb_11_749911.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
COVID-19
Child
Communicable Disease Control
Humans
Otitis Media
Pandemics
SARS-CoV-2
Medicine and Health Sciences
Otolaryngology
oai:jdc.jefferson.edu:otofp-1072
2022-03-16T15:24:44Z
publication:oto
publication:jmc
publication:otofp
Tadalafil Enhances Immune Signatures in Response to Neoadjuvant Nivolumab in Resectable Head and Neck Squamous Cell Carcinoma
Luginbuhl, Adam J.
Johnson, Jennifer
Harshyne,, Larry
Linnenbach, Alban J
Shukla, Sanket Kumar
Alnemri, Angela
Kumar, Gaurav
Cognetti, David
Curry, Joseph
Kotlov, Nikita
Antysheva, Zoya
Degryse, Sandrine
Mannion, Kyle
Gibson, Michael K
Netterville, James
Brown, Brandee
Axelrod, Rita S.
Zinner, Ralph G.
Tuluc, Madalina
Gargano, Stacey
Leiby, Benjamin E
Shimada, Ayako
Mahoney, M G
Martinez-Outshoorn, Ubaldo E.
Rodeck, Ulrich
Kim, Young J
South, Andrew P.
Argiris, Athanassios
Purpose: We hypothesize that the addition of the phosphodiesterase-5 inhibitor tadalafil to the PD-1 inhibitor nivolumab, is safe and will augment immune-mediated antitumor responses in previously untreated squamous cell carcinoma of the head and neck (HNSCC).
Patients and methods: We conducted a two-arm multi-institutional neoadjuvant randomized trial in any-stage resectable HNSCC (NCT03238365). Patients were stratified at randomization by human papillomavirus (HPV) status. Patients in both arms received nivolumab 240 mg intravenously on days 1 and 15 followed by surgery on day 28. Those in the combination therapy arm also received tadalafil 10 mg orally once daily for 4 weeks. Imaging, blood, and tumor were obtained pretreatment and posttreatment for correlative analysis.
Results: Neoadjuvant therapy was well-tolerated with no grade 3 to 5 adverse events and no surgical delays. Twenty-five of 46 (54%) evaluable patients had a pathologic treatment response of ≥20%, including three (7%) patients with a complete pathologic response. Regardless of HPV status, tumor proliferation rate was a negative predictor of response. A strong pretreatment T-cell signature in the HPV-negative cohort was a predictor of response. Tadalafil altered the immune microenvironment, as evidenced by transcriptome data identifying enriched B- and natural killer cell gene sets in the tumor and augmented effector T cells in the periphery.
Conclusions: Preoperative nivolumab ± tadalafil is safe in HNSCC and results in more than 50% of the patients having a pathologic treatment response of at least 20% after 4 weeks of treatment. Pretreatment specimens identified HPV status-dependent signatures that predicted response to immunotherapy while posttreatment specimens showed augmentation of the immune microenvironment with the addition of tadalafil.
2022-03-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/62
https://jdc.jefferson.edu/context/otofp/article/1072/viewcontent/915.pdf
http://creativecommons.org/licenses/by-nc-nd/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
phosphodiesterase-5 inhibitor tadalafil
PD-1 inhibitor nivolumab
human papillomavirus (HPV)
squamous cell carcinoma of the head and neck (HNSCC)
Medicine and Health Sciences
Otolaryngology
oai:jdc.jefferson.edu:otofp-1073
2022-04-27T20:24:49Z
publication:oto
publication:jmc
publication:otofp
publication:covid-19
Otolaryngology Subspecialty Surgical Rescheduling Rates During the COVID-19 Pandemic
Sagalow, Emily S
Duffy, Alexander
Selvakumar, Priyanga
Cognetti, David
Objective: In the beginning of the COVID-19 pandemic in spring 2020, elective and oncologic surgical cases were cancelled. After adequate safety protocols were established, each subspecialty within otolaryngology faced unique challenges in reengaging patients for surgical scheduling.
Study design: Retrospective review from March to May 2020.
Setting: Single academic institution.
Methods: Patients whose otolaryngology surgery was cancelled due to COVID-19 hospital precautions were identified. Rescheduling rates were analyzed by subspecialty. Case completion was determined as the percentage of initially cancelled cases that were completed within 6 months of their original planned dates.
Results: Of 833 otolaryngology cases scheduled between March 16 and May 29, 2020, a total of 555 (66.63%) were cancelled due to COVID-19 precautions, and 71.17% were rescheduled within 6 months. Cancellation and rescheduling rates per subspeciality were as follows, respectively: head and neck surgery, 42.79% and 88.76%; sleep surgery, 83.92% and 64.07%; rhinology and skull base, 72.67% and 64.80%; facial plastic and reconstructive surgery, 80.00% and 74.17%; otology and neurotology, 71.05% and 66.67%; and laryngology, 68.57% and 79.17%. The case completion rates were as follows: head and neck surgery, 95.2%; laryngology, 85.7%; facial plastic and reconstructive surgery, 79.3%; otology and neurotology, 76.3%; rhinology and skull base, 74.4%; and sleep surgery, 69.9%.
Conclusion: Differences for surgical rescheduling rates during the COVID-19 pandemic shutdown exist among otolaryngology subspecialties. Our experience suggests that subspecialties that functioned on an elective nature were more likely to face lower rates of case completion.
2022-03-30T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/63
https://jdc.jefferson.edu/context/otofp/article/1073/viewcontent/2473974x221091156.pdf
http://creativecommons.org/licenses/by-nc/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
COVID-19
case rescheduling
otolaryngology
pandemic
Medicine and Health Sciences
Otolaryngology
oai:jdc.jefferson.edu:otofp-1074
2022-10-24T21:30:40Z
publication:oto
publication:jmc
publication:otofp
Impact of adjuvant radiation therapy after definitive surgery in senior adults >80 years old with advanced head and neck squamous cell carcinoma on overall survival.
Butkus, Joann M
Crippen, Meghan
Bar-Ad, Voichita
Luginbuhl, Adam
Background: Adjuvant radiotherapy (RT) following surgical resection confers a survival benefit for adult patients with locally advanced head and neck squamous cell carcinoma (HNSCC). We aim to investigate if adjuvant RT provides a similar survival advantage to patients ages 80+ through a national curated database.
Methods: This retrospective cohort study queried the National Cancer Database (NCDB) for all cases of HNSCC between 2004-2016. Patients treated with surgical resection alone were compared to those treated with surgery plus adjuvant RT. Overall survival (OS) was compared within adult (age <80 >years) and senior adult (age ≥80 years) cohorts using Kaplan-Meier analysis. Hazard ratios (HR) were assessed using Cox proportional hazards to account for differences in patient characteristics, primary site, and HNSCC stage.
Results: NCDB identified 16,504 locally advanced HNSCC treated with definitive surgery with 9,129 (55.3%) also receiving adjuvant RT. The mean age was 63.8 years (SD = 12.0) with 88.7% of patients ages11.3% ages ≥80 years. In the adult cohort, adjuvant RT was associated with a significant increase in OS compared to surgery alone at 1 year (88.4% vs. 83.8%, p=
Conclusion: The addition of adjuvant RT in senior patients (age ≥80 years) may not provide a similar OS benefit to that observed in younger patients. Further research is needed to best guide shared-decision making in this population.
2022-09-30T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/64
https://jdc.jefferson.edu/context/otofp/article/1074/viewcontent/Impact_of_adjuvant_radiation_therapy.pdf
https://jdc.jefferson.edu/context/otofp/article/1074/filename/0/type/additional/viewcontent/Data_Sheet.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
adjuvant radiotherapy
head and neck cancer
National Cancer Database
senior adult
survival
Medicine and Health Sciences
Otolaryngology
oai:jdc.jefferson.edu:otofp-1075
2022-11-23T16:53:49Z
publication:oto
publication:jmc
publication:otofp
Metformin Increases Natural Killer Cell Functions in Head and Neck Squamous Cell Carcinoma Through CXCL1 Inhibition
Crist, McKenzie
Yaniv, Benyamin
Palackdharry, Sarah
Lehn, Maria A.
Medvedovic, Mario
Stone, Timothy
Gulati, Shuchi
Karivedu, Vidhya
Borchers, Michael
Fuhrman, Bethany
Crago, Audrey
Curry, Joseph
Martinez-Outschoorn, Ubaldo
Takiar, Vinita
Wise-Draper, Trisha M.
BACKGROUND: Metformin slows tumor growth and progression in vitro, and in combination with chemoradiotherapy, resulted in high overall survival in patients with head and neck cancer squamous cell carcinoma (HNSCC) in our phase 1 clinical trial (NCT02325401). Metformin is also postulated to activate an antitumor immune response. Here, we investigate immunologic effects of metformin on natural killer (NK) and natural killer T cells, including results from two phase I open-label studies in patients with HNSCC treated with metformin (NCT02325401, NCT02083692).
METHODS: Peripheral blood was collected before and after metformin treatment or from newly diagnosed patients with HNSCC. Peripheral immune cell phenotypes were evaluated using flow cytometry, cytokine expression by ELISA and/or IsoLight, and NK cell-mediated cytotoxicity was determined with a flow-based NK cell cytotoxicity assay (NKCA). Patient tumor immune infiltration before and after metformin treatment was analyzed with immunofluorescence. NK cells were treated with either vehicle or metformin and analyzed by RNA sequencing (RNA-seq). NK cells were then treated with inhibitors of significant pathways determined by RNA-seq and analyzed by NKCA, ELISA, and western blot analyses.
RESULTS: Increased peripheral NK cell activated populations were observed in patients treated with metformin. NK cell tumor infiltration was enhanced in patients with HNSCC treated with metformin preoperatively. Metformin increased antitumorigenic cytokines ex vivo, including significant increases in perforin. Metformin increased HNSCC NK cell cytotoxicity and inhibited the CXCL1 pathway while stimulating the STAT1 pathway within HNSCC NK cells. Exogenous CXCL1 prevented metformin-enhanced NK cell-mediated cytotoxicity. Metformin-mediated NK cell cytotoxicity was found to be AMP-activated protein kinase independent, but dependent on both mechanistic target of rapamycin and pSTAT1.
CONCLUSIONS: Our data identifies a new role for metformin-mediated immune antitumorigenic function through NK cell-mediated cytotoxicity and downregulation of CXCL1 in HNSCC. These findings will inform future immunomodulating therapies in HNSCC.
2022-11-03T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/65
https://jdc.jefferson.edu/context/otofp/article/1075/viewcontent/Curry_11.23.22.pdf
http://creativecommons.org/licenses/by-nc/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
humans
squamous cell carcinoma of head and neck
head and neck neoplasms
carcinoma
squamous cell
metformin
killer cells
natural
cytokines
chemokine CXCL1
Humans
Squamous Cell Carcinoma of Head and Neck
Head and Neck Neoplasms
Carcinoma, Squamous Cell
Metformin
Killer Cells, Natural
Cytokines
Chemokine CXCL1
Medicine and Health Sciences
Oncology
Otolaryngology
oai:jdc.jefferson.edu:otofp-1076
2023-02-16T21:24:28Z
publication:oto
publication:jmc
publication:otofp
Accrual-Monitoring Practices for Various Disease Trials among AACI Member Cancer Centers
Elliott, Zachary T
Goldberg, Zachary N.
Philips, Ramez
Johnson, Jennifer
Kasner, Margaret
Kelly, William Kevin
Osipowicz, Sarah
Dampman, Rachael
Curry, Joseph
Progress in the management of rare diseases, including rare cancers, is dependent upon clinical trials; however, as many as 32% of rare-disease trials go uncompleted or unpublished due to insufficient accrual. Monitoring practices may differ between institutions. We sought to survey the regulatory standards for various trial types among major U.S. cancer centers. A 10-question survey was designed using Qualtrics assessment software. The survey was sent via email to an internal server of member institutions of the Association of American Cancer Institutes (AACI). Of 103 AACI centers, 31% completed the survey (n = 32). Respondents differed in their definitions of a rare disease, minimum expectations for rare tumor studies, and frequency of accrual monitoring by their institutional Protocol Review and Monitoring Committee. Seventy-three percent of respondents did not close trials based on low accrual. Strategies to optimize accrual included investigator incentives for high accrual and penalties for low accrual in 37% and 13% of respondents, respectively.
2022-08-31T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/66
https://jdc.jefferson.edu/context/otofp/article/1076/viewcontent/clinpract_12_00072.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
accrual and monitoring
clinical trials
rare diseases
Medicine and Health Sciences
Otolaryngology
oai:jdc.jefferson.edu:otofp-1077
2023-03-14T16:11:25Z
publication:oto
publication:jmc
publication:otofp
Rare Case of Nasal Vault Oncocytic Cystadenoma
Agarwal, Aarti
McClain, Kathleen
Banker, Karen
Chikwava, Kudakwashe
Shah, Udayan K.
Background: Oncocytic Cystadenomas are a rare benign pathology often found to arise from the salivary glands, reported more commonly in minor salivary glands, but even more rarely in major salivary glands and the larynx. This is the first known report of a nasal vault oncocytic cystadenoma in a pediatric patient.
Methods: Case Report and Literature Review.
Case presentation: A 10-year-old female presented with a mass involving the left nasal vestibule that caused nasal obstruction and a visible external abnormality. MRI imaging revealed a cystic lesion in the anterior nasal cavity that was rim enhancing with a bright T2 signal that appeared to arise from the nasal mucosa. She was taken to the operating room for endoscopic-assisted removal of the lesion. Pathology showed an oncocytic cystadenoma. On follow-up clinic visit, she is doing well with no signs or symptoms of recurrence.
Conclusion: The authors present the first reported case of a pediatric patient with nasal vault oncocytic cystadenoma. In other head and neck locations, these cysts are generally benign and only cause symptoms related to their location and proximity to other vital structures. Surgical endoscopic management was effective for resection.
2023-02-14T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/67
https://jdc.jefferson.edu/context/otofp/article/1077/viewcontent/1_s2.0_S2468548823000140_main.pdf
http://creativecommons.org/licenses/by-nc-nd/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
Medicine and Health Sciences
Otolaryngology
Pediatrics
oai:jdc.jefferson.edu:otofp-1078
2023-04-03T21:37:29Z
publication:oto
publication:jmc
publication:otofp
Molecular Diagnostics in the Evaluation of Thyroid Nodules: Current Use and Prospective Opportunities
Patel, Jena
Klopper, Joshua
Cottrill, Elizabeth E.
Thyroid cancer is the most common endocrine malignancy with an estimated 43,800 new cases to be diagnosed in 2022 and representing the 7th most common cancer in women. While thyroid nodules are very common, being identified in over 60% of randomly selected adults, only 5-15% of thyroid nodules harbor thyroid malignancy. Therefore, it is incumbent upon physicians to detect and treat thyroid malignancies as is clinically appropriate and avoid unnecessary invasive procedures in patients with benign asymptomatic lesions. Over the last 15-20 years, rapid advances have been made in cytomolecular testing to aid in thyroid nodule management. Initially, indeterminate thyroid nodules, those with Bethesda III or IV cytology and approximately a 10-40% risk of malignancy, were studied to assess benignity or malignancy. More recently, next generation sequencing and micro-RNA technology platforms have refined the diagnostic capacity of thyroid nodule molecular testing and have introduced opportunities to glean prognostic information from both cytologically indeterminate and malignant thyroid nodules. Therefore, clinicians can move beyond determination of malignancy, and utilize contemporary molecular information to aid in decisions such as extent of surgery and post-therapy monitoring plans. Future opportunities include molecularly derived information about tumor behavior, neo-adjuvant treatment opportunities and response to thyroid cancer therapies.
2023-02-24T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/68
https://jdc.jefferson.edu/context/otofp/article/1078/viewcontent/Cottrill.4.3.23.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
thyroid nodule
thyroid cancer (TC)
diagnosis
prognosis
targeted therapy
molecular markers
Medicine and Health Sciences
Oncology
Otolaryngology
oai:jdc.jefferson.edu:otofp-1079
2023-06-24T21:21:48Z
publication:oto
publication:jmc
publication:otofp
Postoperative Radiotherapy and Facial Nerve Outcomes Following Nerve Repair: A Systematic Review
Kenny, Hannah L.
Jonas, Rachel H.
Oyer, Samuel L.
OBJECTIVE: To compare outcomes of facial nerve repair or grafting following facial nerve-sacrificing procedures among patients treated with and without postoperative radiotherapy (RT).
DATA SOURCES: PubMed, OVID, Conference Papers Index, Cochrane Library, ClinicalTrials.gov.
REVIEW METHODS: Databases were searched using terms including "facial nerve," "graft," "repair," and "radiotherapy." Abstracts mentioning facial nerve repair and evaluation of facial nerve function were included for full-text review. Studies that utilized the House-Brackmann or similar validated scale for evaluation of postoperative facial nerve function were selected for review. All identified studies were included in a pooled t test analysis.
RESULTS: Twelve studies with 142 patients were included in the systematic review. All 12 studies individually demonstrated no significant difference in facial nerve outcomes between patients who received postoperative radiation and patients who did not. A pooled t test of data from all studies also demonstrated no significant difference in postoperative facial nerve function between the postoperative RT and non-RT groups (t stat = 0.92, p = .36).
CONCLUSION: This analysis, including 12 studies, demonstrated that among patients undergoing facial nerve grafting or repair, there was no significant difference in postoperative facial nerve function between postoperative RT and non-RT patients. Due to the small sample size and variability in study methods, further studies directly comparing outcomes between patients with and without postoperative RT would be beneficial.
2023-06-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/69
https://jdc.jefferson.edu/context/otofp/article/1079/viewcontent/Post_op_Radiotherapy_Nerve_Outcomes_Following_Nerve_Repair.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
Humans
Facial Nerve
Treatment Outcome
Facial Nerve Injuries
Face
Neurosurgical Procedures
Medicine and Health Sciences
Otolaryngology
oai:jdc.jefferson.edu:otofp-1080
2023-08-07T21:41:10Z
publication:oto
publication:jmc
publication:otofp
Improving Surgeon-Patient Communication in Thyroid Cancer Diagnosis and Treatment Discussions: A Narrative Review
Schlegel, Lauren
Perry, Roberta S.
Cottrill, Elizabeth
Background and Objective: Patient experience is greatly influenced by physician-patient communication. Yet, unmet communication needs continue to be well documented in patients with thyroid cancer. This review discusses factors that may impact this communication and presents communication interventions that are currently being used with thyroid cancer patients.
Methods: A narrative review of articles on the physician-patient relationship and communication in thyroid cancer published between 1985 and 2022 was conducted through PubMed and Google. An additional review of the articles referenced in the bibliography of the included articles was performed.
Key Content and Findings: This review discusses communication components impacting the patientphysician relationship including physician communication skills and patient communication priorities. Additionally, modern communication interventions such as the use of pamphlets, decision aids, and multimedia platforms are reviewed.
Conclusions: Developing a strong physician-patient relationship is a complex process influenced by verbal, paraverbal, and nonverbal communication. Tools such as communication training for physicians, shared decision-making approaches, and multimedia platforms have shown promise in improving communication between physicians and patients. Further study into the barriers of communication, effectiveness of adjunct tools, and patient satisfaction as it relates to communication will continue to improve outcomes.
2023-05-30T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/70
https://jdc.jefferson.edu/context/otofp/article/1080/viewcontent/7287_PB5_6132_R2.pdf
http://creativecommons.org/licenses/by-nc-nd/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
communication
thyroid cancer
patient satisfaction
patient experience
Medicine and Health Sciences
Oncology
Otolaryngology
oai:jdc.jefferson.edu:otofp-1081
2023-09-14T19:32:58Z
publication:oto
publication:jmc
publication:otofp
A Narrative Review of Scars After Surgery: What to Expect
Landers, Kathryn
Hwang, Michelle
Cottrill, Elizabeth
Background and Objective: For most surgical procedures, postoperative scars are inevitable. Scars that heal with poor cosmetic appearance or physical symptoms such as pain, pruritis, or tethering can have a negative impact on a patient’s quality of life. This review aims to identify current techniques for prevention of unfavorable scar formation and treatment of unfavorable scars.
Methods: A narrative review of the literature was conducted using our institution’s Primo search engine to search online databases including PubMed and EBSCO, among others. Included references were selected by the first author based on relevance to the subject matter and availability in English.
Key Content and Findings: Wound healing occurs as a series of complex phases: hemostasis, inflammation, proliferation, and remodeling. Deviation from the normal progression through these phases can contribute to unfavorable scar formation. Intraoperatively, meticulous tissue handling as well as suture selection can help decrease the likelihood of unfavorable scar formation. Topical silicone and pressure dressings can be used to prevent unfavorable scars as well as to treat unfavorable scars in their early stages. Laser resurfacing, dermabrasion, and intralesional corticosteroid injections can improve unfavorable scars weeks to months after they occur. Finally, surgical excision and revision is an option for unfavorable scars that do not improve with more conservative therapies.
Conclusions: There are preventative measures to consider in the intraoperative and early postoperative period to help prevent the formation of unfavorable scars. Despite these efforts, unfavorable scars can still form in some patients. Understanding normal wound healing and scar formation, factors that contribute to unfavorable scar formation, and the options to revise and improve unfavorable scars can help improve patient outcomes.
2023-06-30T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/71
https://jdc.jefferson.edu/context/otofp/article/1081/viewcontent/7324_PB1_7376_R1__1_.pdf
http://creativecommons.org/licenses/by-nc-nd/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
Jefferson Digital Commons
thyroid
scar
revision
hypertrophy
keloid
Medicine and Health Sciences
Otolaryngology
oai:jdc.jefferson.edu:otofp-1082
2024-02-03T18:32:06Z
publication:oto
publication:jmc
publication:otofp
Standardized Pre-clinical Surgical Animal Model Protocol to Investigate the Cellular and Molecular Mechanisms of Ischemic Flap Healing
Aksamitiene, Edita
Heffelfinger, Ryan
Hoek, Jan
Pribitkin, Edmund
BACKGROUND: Some of the most complex surgical interventions to treat trauma and cancer include the use of locoregional pedicled and free autologous tissue transfer flaps. While the techniques used for these reconstructive surgery procedures have improved over time, flap complications and even failure remain a significant clinical challenge. Animal models are useful in studying the pathophysiology of ischemic flaps, but when repeatability is a primary focus of a study, conventional in-vivo designs, where one randomized subset of animals serves as a treatment group while a second subset serves as a control, are at a disadvantage instigated by greater subject-to-subject variability. Our goal was to provide a step-by-step methodological protocol for creating an alternative standardized, more economical, and transferable pre-clinical animal research model of excisional full-thickness wound healing following a simulated autologous tissue transfer which includes the primary ischemia, reperfusion, and secondary ischemia events with the latter mimicking flap salvage procedure.
RESULTS: Unlike in the most frequently used classical unilateral McFarlane's caudally based dorsal random pattern skin flap model, in the herein described bilateral epigastric fasciocutaneous advancement flap (BEFAF) model, one flap heals under normal and a contralateral flap-under perturbed conditions or both flaps heal under conditions that vary by one within-subjects factor. We discuss the advantages and limitations of the proposed experimental approach and, as a part of model validation, provide the examples of its use in laboratory rat (Rattus norvegicus) axial pattern flap healing studies.
CONCLUSIONS: This technically challenging but feasible reconstructive surgery model eliminates inter-subject variability, while concomitantly minimizing the number of animals needed to achieve adequate statistical power. BEFAFs may be used to investigate the spatiotemporal cellular and molecular responses to complex tissue injury, interventions simulating clinically relevant flap complications (e.g., vascular thrombosis) as well as prophylactic, therapeutic or surgical treatment (e.g., flap delay) strategies in the presence or absence of confounding risk factors (e.g., substance abuse, irradiation, diabetes) or favorable wound-healing promoting activities (e.g., exercise). Detailed visual instructions in BEFAF protocol may serve as an aid for teaching medical or academic researchers basic vascular microsurgery techniques that focus on precision, tremor management and magnification.
2024-01-17T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/72
https://jdc.jefferson.edu/context/otofp/article/1082/viewcontent/Standardized_Pre_clinical_Surgical_Animal_Model_Protocol.pdf
https://jdc.jefferson.edu/context/otofp/article/1082/filename/0/type/additional/viewcontent/Animal_perioperative_and_post_operative_record.pdf
https://jdc.jefferson.edu/context/otofp/article/1082/filename/1/type/additional/viewcontent/ADDITIONAL_FILE_2___Supplemental_Figures.pdf
https://jdc.jefferson.edu/context/otofp/article/1082/filename/2/type/additional/viewcontent/Examples_of_statistical_flap_data_analysis_and_visualization.pzfx
http://creativecommons.org/licenses/by/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
excisional wound healing
bilateral flap
pedicled flap
fasciocutaneous flap
superficial inferior epigastric vessels
axial pattern flap survival
primary ischemia
reperfusion injury
secondary ischemia
autologous tissue transfer
Medicine and Health Sciences
Otolaryngology
oai:jdc.jefferson.edu:otofp-1083
2024-03-12T18:47:24Z
publication:oto
publication:jmc
publication:otofp
CROS or Hearing Aid? Selecting the Ideal Solution for Unilateral CI Patients with Limited Aidable Hearing in the Contralateral Ear
Lively, Sarah
Agrawal, Smita
Stewart, Matthew
Dwyer, Robert
Strobel, Laura
Marcinkevich, Paula
Hetlinger, Chris
Croce, Julia
A hearing aid or a contralateral routing of signal device are options for unilateral cochlear implant listeners with limited hearing in the unimplanted ear; however, it is uncertain which device provides greater benefit beyond unilateral listening alone. Eighteen unilateral cochlear implant listeners participated in this prospective, within-participants, repeated measures study. Participants were tested with the cochlear implant alone, cochlear implant + hearing aid, and cochlear implant + contralateral routing of signal device configurations with a one-month take-home period between each in-person visit. Audiograms, speech perception in noise, and lateralization were evaluated. Subjective feedback was obtained via questionnaires. Marked improvement in speech in noise and non-implanted ear lateralization accuracy were observed with the addition of a contralateral hearing aid. There were no significant differences in speech recognition between listening configurations. However, the chronic device use questionnaires and the final device selection showed a clear preference for the hearing aid in spatial awareness and communication domains. Individuals with limited hearing in their unimplanted ears demonstrate significant improvement with the addition of a contralateral device. Subjective questionnaires somewhat contrast with clinic-based outcome measures, highlighting the delicate decision-making process involved in clinically advising one device or another to maximize communication benefits.
2024-02-23T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/otofp/73
https://jdc.jefferson.edu/context/otofp/article/1083/viewcontent/CROS_or_hearing_aid.pdf
https://jdc.jefferson.edu/context/otofp/article/1083/filename/0/type/additional/viewcontent/S1.Dataset.Individual_data_for_all_participants.xlsx
https://jdc.jefferson.edu/context/otofp/article/1083/filename/1/type/additional/viewcontent/S1_File.zip
https://jdc.jefferson.edu/context/otofp/article/1083/filename/2/type/additional/viewcontent/PONE_D_23_13205_review.docx
https://jdc.jefferson.edu/context/otofp/article/1083/filename/3/type/additional/viewcontent/Response_to_Reviewers.docx
http://creativecommons.org/licenses/by/4.0/
Department of Otolaryngology - Head and Neck Surgery Faculty Papers
English
Jefferson Digital Commons
humans
hearing aids
prospective studies
sound localization
hearing
cochlear implants
cochlear implantation
speech perception
Humans
Hearing Aids
Prospective Studies
Sound Localization
Hearing
Cochlear Implants
Cochlear Implantation
Speech Perception
Medicine and Health Sciences
Otolaryngology