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Journal of Otolaryngology - Head and Neck Surgery

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This is an Open Access Journal

Open Access journal
ISSN (Print) 1916-0216
Published by Biomed Central Ltd.

[258 journals]

Evaluation of the accuracy of Cone Beam Computerized Tomography (CBCT): medical imaging technology in head and neck reconstruction
- Authors: Heather Logan|Johan Wolfaardt|Pierre Boulanger|Bill Hodgetts|Hadi Seikaly
  First page: 25
  Abstract: Background: With the introduction, development and commercialization of Cone Beam Computerized Tomography (CBCT) technologies in the field of head and neck reconstruction, clinicians now have increased access to the technology. Given the growth of this new user group, there is an increasing concern regarding proper use, understanding, quality and patient safety. Methods: The present study was carried out to evaluate data acquisition of CBCT medical imaging technology and the accuracy of the scanning at three different machine warming times. The study also compared the accuracy of CBCT at 0.2 mm slice thickness and Computerized Tomography (CT) at 1 mm slice thickness. A control model was CT scanned at five random intervals, at 1 mm slice thickness and CBCT scanned at specialized intervals, at 0.2 mm slice thickness. The data was then converted and imported into a software program where a digital registration procedure was used to compare the average deviations of the scanned models to the control. Results: The study found that there was no statistically significant difference amongst the three CBCT machine warming times. There was a statistically significant difference between CT scanning with 1 mm slice thickness and CBCT scanning with 0.2 mm slice thickness. Conclusions: The accuracy of the i-CAT CBCT scans used in the present study with a parameter at voxel size 0.2, will remain consistent and reliable at any warming stage. Also the difference between the CBCT i-CAT scans and the CT scans was not clinically significant based on suggested requirements of clinicians in head and neck reconstruction.
  Citation: Journal of Otolaryngology - Head and Neck Surgery 2013, null:25
  PubDate: 2013-03-21T00:00:00Z
  DOI: 10.1186/1916-0216-42-25
  Issue No: Vol. ${item.volume} (2013)
MRI findings of radiation-induced changes of masticatory muscles: a systematic review
- Authors: Mohammed Al-Saleh|Jacob Jaremko|Humam Saltaji|John Wolfaardt|Paul Major
  First page: 26
  Abstract: Background: Radiotherapy to the head and neck regions can result in serious consequences to the temporomandibular joint (TMJ) and chewing muscles. Magnetic resonance imaging (MRI) demonstrates soft-tissue alterations after radiotherapy, such as morphology and signal intensity.ObjectiveThe purpose of this review is to critically and systematically analyse the available evidence regarding the masticatory muscles alterations, as demonstrated on MRI, after radiotherapy for head and neck cancer.Data sourcesElectronic search of MEDLINE, EMBASE, EBM reviews and Scopus.Inclusion criteria: Reports of any study design investigating radiation-induced changes in masticatory muscles after radiotherapy in patients with head and neck cancer were included.Results and synthesis methods: An electronic database search resulted in 162 papers. Sixteen papers were initially selected as potentially relevant studies; however, only four papers satisfied all inclusion criteria. The included papers focused on the MRI appearance of masticatory muscles following radiotherapy protocol. Two papers reported outcome based on retrospective clinical and imaging records, whereas the remaining two papers were case reports. Irradiated muscles frequently show diffuse increase in T2 signal and post-gadolinium enhancement post-irradiation. Also, muscle size changes were reported based on subjective comparison with the contralateral side. The quality of all included papers was considered poor with high risk of bias. Conclusion: There is no evidence that MRI interpretations indicate specific radiation-induced changes in masticatory muscles. There is a clear need for a cohort study comparing patients with pre- and post-radiotherapy MRI.
  Citation: Journal of Otolaryngology - Head and Neck Surgery 2013, null:26
  PubDate: 2013-03-28T00:00:00Z
  DOI: 10.1186/1916-0216-42-26
  Issue No: Vol. ${item.volume} (2013)
Convergence of two major pathophysiologic mechanisms in nasal polyposis: immune response to Staphylococcus aureus and airway remodeling
- Authors: Rogério Pezato|Leonardo Balsalobre|Milena Lima|Thiago Bezerra|Richard Voegels|Luis Gregório|Aldo Stamm|Thibaut Zele
  First page: 27
  Abstract: This review is addressed two pathophysiologic mechanisms implicated in the pathogenesis of nasal polyposis: the unique remodeling process found in nasal polyp tissue and the immune response of patients with nasal polyposis to Staphylococcus aureus.These two theories converge to the same direction in different aspects, including decreased extracellular matrix production, impaired T regulation and favoring of a Th2 immune response.In patients with nasal polyposis, an exaggerated immune response to Staphylococcus aureus may aggravate the airway remodeling process.
  Citation: Journal of Otolaryngology - Head and Neck Surgery 2013, null:27
  PubDate: 2013-03-28T00:00:00Z
  DOI: 10.1186/1916-0216-42-27
  Issue No: Vol. ${item.volume} (2013)
The impact of clinical versus pathological staging in oral cavity carcinoma¿a multi-institutional analysis of survival
- Authors: Vincent Biron|Daniel O¿Connell|Hadi Seikaly
  First page: 28
  Abstract: Objectives: To evaluate any disparity in clinical versus pathological TNM staging in oral cavity squamous cell carcinoma (OCSCC) patients and any impact of this on survival.DesignDemographic, survival, staging, and pathologic data on all patients undergoing surgical treatment for OCSCC in Alberta between 1998 and 2006 was collected. Clinical and pathological TNM staging data were compared. Patients were stratified as pathologically downstaged, upstaged or unchanged.Setting: Tertiary care centers in Alberta, Canada.Main outcome measures: Survival differences between groups were analyzed using Kaplan-Meier and Cox regression models. Results: Patients with clinically early stage tumors were pathologically upstaged in 21.9% of cases and unchanged in 78.1% of cases. Patients with clinically advanced stage tumors were pathologically downstaged in 7.9% of cases and unchanged in 92.1% of cases. Univariate and multivariate estimates of disease-specific survival showed no statistically significant differences in survival when patients were either upstaged or downstaged. Conclusions: Some disparity exists in clinical versus pathological staging in OCSCC, however, this does not have any significant impact on disease specific survival.
  Citation: Journal of Otolaryngology - Head and Neck Surgery 2013, null:28
  PubDate: 2013-04-11T00:00:00Z
  DOI: 10.1186/1916-0216-42-28
  Issue No: Vol. ${item.volume} (2013)
Epithelium and stroma from nasal polyp mucosa exhibits inverse expression of TGF-beta1 as compared with healthy nasal mucosa
- Authors: Leonardo Balsalobre|Rogério Pezato|Claudina Perez-Novo|Maria Alves|Rodrigo Santos|Claus Bachert|Luc Weckx
  First page: 29
  Abstract: ObjectiveTo evaluate TGF-beta1 expression in polypoid mucosa (epithelium and stroma) of patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). Methods: Cross-sectional study with two groups: 17 patients with nasal polyposis and 11 controls. Polyps and normal nasal mucosa were processed by immunohistochemical methods for TGF-beta1 visualization. Then, the percentage of TGF-beta1 expression in stroma and epithelium was objectively quantified using UT Morph software. Results: A lower percentage of positive expression was found in the epithelium of CRSwNP patients (32.44%) versus normal controls (55.91%) (p < 0.001), and a higher percentage of positive expression in the stroma of CRSwNP patients (23.24%) versus controls (5.88%) (p < 0.001). Conclusion: The lower percentage of TGF-beta1 expression in the nasal epithelium of CRSwNP patients may have an impact on epithelium-directed topical treatments employed in this patient population.
  Citation: Journal of Otolaryngology - Head and Neck Surgery 2013, null:29
  PubDate: 2013-04-15T00:00:00Z
  DOI: 10.1186/1916-0216-42-29
  Issue No: Vol. ${item.volume} (2013)
Survival outcomes of patients with advanced oral cavity squamous cell carcinoma treated with multimodal therapy: a multi-institutional analysis
- Authors: Han Zhang|Peter Dziegielewski|Vince Biron|Jacek Szudek|Khaled Al-Qahatani|Daniel O¿Connell|Jeffrey Harris|Hadi Seikaly
  First page: 30
  Abstract: Background: The oral cavity is the most common site for head and neck squamous cell carcinoma. Treatment of advanced stage oral cavity squamous cell carcinoma (OCSCC) has classically involved surgical resection with postoperative adjuvant radiotherapy (S-RT).Despite this aggressive dual modality therapy, the disease outcomes have remained poor. The treatment options expanded in 2004 when two international trials showed the addition of postoperative chemotherapy to radiation improved outcomes. These trials were, however not oral cavity site specificObjectiveTo assess survival outcomes of advanced OCSCC treated by differing modalities. The primary goal was to determine if the addition of postoperative chemotherapy (S-CRT) improves survival compared to other treatment regimens. Methods: Demographic, pathologic, treatment, and survival data was obtained from patients diagnosed with OCSCC from 1998--2010 in Alberta, Canada. 222 patients were included in the final analysis from 895 OCSCC patients. Actuarial overall, disease-specific, disease-free, and metastasis-free survivals were estimated with Kaplan-Meier and Cox regression analyses. Patients were grouped by treatment. Results: Patients receiving S-CRT had improved overall, disease-specific, disease-free, and metastasis-free survival compared to S-RT, CRT or RT(p < 0.05). Two and five year estimated overall survival was significantly higher in the S-CRT group at 77 and 58% (p < 0.05), versus S-RT with 55 and 40% rates(p < 0.05). Results were similar for disease-specific, disease-free, and metastasis free survival with S-CRT being favoured. Patients with extracapsular spread (ECS) treated with S-CRT versus S-RT had 55% survival advantage at 5 years (p < 0.05). Conclusion: This study shows that adding adjuvant chemotherapy to S-RT improves survival outcomes in advanced OCSCC, especially in patients with ECS.
  Citation: Journal of Otolaryngology - Head and Neck Surgery 2013, null:30
  PubDate: 2013-04-19T00:00:00Z
  DOI: 10.1186/1916-0216-42-30
  Issue No: Vol. ${item.volume} (2013)
Primary surgery versus chemoradiotherapy for advanced oropharyngeal cancers: a longitudinal population study
- Authors: Daniel O¿Connell|Hadi Seikaly|Russell Murphy|Charles Fung|Tim Cooper|Aaron Knox|Rufus Scrimger|M Deutschmann|Jeffrey Harris
  First page: 31
  Abstract: Background: Treatment for advanced stage oropharyngeal squamous cell carcinoma (OPSCC) includes combined chemoradiation therapy or surgery followed by radiation therapy alone or in combination with chemotherapy. The goal of this study was to utilize available evidence to examine survival outcome differences in patients with advanced stage OPSCC treated with these different modalities. Methods: Patients with advanced stage OPSCC were identified. Primary outcome measurements were disease specific and overall survival rates with differences examined via Kaplan-Meier and logistic regression analysis. Results: 344 patients were enrolled. 94 patients underwent triple modality therapy inclusive of surgery followed by adjuvant combined chemotherapy and radiation therapy (S-CRT). 131 had surgery and radiation therapy (S-RT), while 56 had chemoradiation (CRT) therapy as their primary treatment. A total of 63 patients had single modality radiation therapy and were excluded from analysis due to the large number of palliative patients.Kaplan-Meier overall survival analysis showed that therapy with S-CRT had the highest disease specific survival at five years (71.1%). This is contrasted against S-RT and CRT, with five year survival rates at 53.9%, and 48.6%, respectively.Cox regression showed that the comparison of S-CRT vs. S-RT, and CRT is associated with statistically significant increased hazard ratios of 1.974, and 2.785, indicating that both S-RT and CRT are associated with a reduced likelihood of survival at 5 years when compared to S-CRT. Conclusions: In this population based cohort study S-CRT is associated with a 17--22% 5 year disease specific survival benefit compared to CRT or S-RT.
  Citation: Journal of Otolaryngology - Head and Neck Surgery 2013, null:31
  PubDate: 2013-04-22T00:00:00Z
  DOI: 10.1186/1916-0216-42-31
  Issue No: Vol. ${item.volume} (2013)
Medial Mandibulotomies: Is there sufficient space in the midline to allow a mandibulotomy without compromising the dentition'
- Authors: Tulika Shinghal|Eric Bissada|Hon Chan|Robert Wood|Eshetu Atenafu|Dale Brown|Ralph Gilbert|Patrick Gullane|Jonathan Irish|John Waldron|David Goldstein
  First page: 32
  Abstract: Objectives: The objective of this study was to determine the frequency of complications in median and paramedian mandibulotomies. In addition, the interdental space in the median and paramedian region was calculated.Study design: Retrospective study.Setting: Tertiary care center. Methods: A retrospective chart review was performed for all cases where a mandibulotomy was performed from 2002 to 2010. 117 charts (61 paramedian and 56 median) were identified. We included data on complications, which fell in the following 2 categories: plate and dental complications. For our second objective, we evaluated 40 different patients with base of tongue or tonsillar cancer treated with intensity modulated radiation therapy (IMRT). The interdental space between the lateral incisors and the canines was electronically calculated on the digital Panorex images.Main outcome measures: Dental and plate complications were evaluated. We also assessed interdental space. Results: Patient characteristics were not significantly different. The median group had significantly more dental complications (p=0.0375, RD=0.19 and 95% CI (0.0139-0.3661)). The paramedian group had significantly more plate complications (p=0.0375, RD=0.082 and 95% CI (0.0131-0.1508). The distance between the central incisors was significantly less than the distance between the lateral incisors and canines both at the crestal and apical levels (p=0.0086 and p
  Citation: Journal of Otolaryngology - Head and Neck Surgery 2013, null:32
  PubDate: 2013-05-02T00:00:00Z
  DOI: 10.1186/1916-0216-42-32
  Issue No: Vol. ${item.volume} (2013)
Canadian Otolaryngology - Head and Neck Surgery clerkship curricula: evolving toward tomorrow's learners
- Authors: Kate Kelly|Kevin Fung|Laurie McLean
  First page: 33
  Abstract: Background: Increasing focus is being placed on Clerkship curriculum design and implementation in light of new undergraduate medical education research and accreditation standards. Canadian Otolaryngology-Head and Neck Surgery (OTOHNS) Clerkship programs are continually but independently evolving towards a common goal of improving Clerkship curriculum. Methods: An electronic survey was sent to undergraduate OTOHNS directors at all Canadian medical schools (n = 17) examining their Clerkship curricula. Themes included Clerkship format, teaching methods, faculty support and development, program strengths, and barriers. Results: Survey response rate was 76%. All responding schools had OTOHNS Clerkship programs ranging in type (mandatory, selective or elective) and length (
  Citation: Journal of Otolaryngology - Head and Neck Surgery 2013, null:33
  PubDate: 2013-05-03T00:00:00Z
  DOI: 10.1186/1916-0216-42-33
  Issue No: Vol. ${item.volume} (2013)
Vocal cord paralysis secondary to spontaneous internal carotid dissection: case report and systematic review of the literature
- Authors: TT Nguyen|Han Zhang|Peter Dziegielewski|Robert Seemann
  First page: 34
  Abstract: ObjectivesTo present a rare case of unilateral vocal cord paralysis (VCP) secondary to spontaneous internal carotid artery dissection and to perform a literature review.Case reportA 35-year-old male presented to the emergency department with acute onset hoarseness and dysphagia. History, physical exam and laryngoscopy revealed left sided VCP withoutobvious cause. Magnetic Resonance Imaging (MRI) demonstrated a left internal carotid artery dissection of unknown etiology. Neurovascular surgery was consulted and treatment with aspirin was initiated. The dysphagia and hoarseness resolved in 12 weeks with long-termneurosurgery follow-up as the management plan. Methods: Systematic literature review was conducted by 3 independent reviewers. Since 1988 only 9 cases of VCP due to internal carotid artery dissection have been reported. These werereviewed for: demographics, diagnostic method, treatment and vocal cord function. Results: 7 patients had unilateral while 2 had bilateral VCP. MRI was used for diagnosis in 7 cases and 5 cases utilized a type of angiography. All received antithrombotic treatment with 5 outof the 9 patients experiencing vocal cord recovery in an average of 7.2 weeks. Conclusion: MRI is crucial in the work-up of idiopathic VCP. If an ipsilateral internal carotid artery dissection is found, antithrombotic treatment is initiated with an expectation that vocal cord mobility is likely to return.
  Citation: Journal of Otolaryngology - Head and Neck Surgery 2013, null:34
  PubDate: 2013-05-13T00:00:00Z
  DOI: 10.1186/1916-0216-42-34
  Issue No: Vol. ${item.volume} (2013)