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Journal Cover   Journal of Otolaryngology - Head and Neck Surgery
  [SJR: 0.571]   [H-I: 31]   [7 followers]  Follow
  This is an Open Access Journal Open Access journal
   ISSN (Print) 1916-0216
   Published by Biomed Central Ltd. Homepage  [271 journals]
  • Erratum to: Transoral laser microsurgery for the treatment of
           oropharyngeal cancer: the Dalhousie University experience

    • Authors: Jonathan Melong, Matthew Rigby, Martin Bullock, Robert Hart, Jonathan Trites, S. Taylor
      First page: 41
      Abstract: No description available
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2015, null:41
      PubDate: 2015-10-21T12:00:00Z
      DOI: 10.1186/s40463-015-0095-1
      Issue No: Vol. ${item.volume} (2015)
  • Surgeon-performed ultrasound guided fine-needle aspirate biopsy with
           report of learning curve; a consecutive case-series study

    • Authors: Vinay Fernandes, Robert De Santis, Danny Enepekides, Kevin Higgins
      First page: 42
      Abstract: Background: Fine-needle aspiration biopsy has become the standard of care for the evaluation of thyroid nodules. More recently, the use of ultrasound guided fine-needle aspiration biopsy (UG-FNAB) has improved adequacy of sampling. Now there has been improved access to UG-FNAB as ultrasound technology has become more accessible. Here we review the adequacy rate and learning curve of a single surgeon starting at the adoption of UG-FNAB into surgical practice. Methods: UG-FNABs performed at Sunnybrook Health Sciences Centre from 2010 to 2015 were reviewed retrospectively. Nodule characteristics were recorded along with cytopathology and final pathology reports. Chi-square analysis, followed by the reporting of odds ratios with confidence intervals, were used to assess the statistical significance and frequencies, respectively, of nodule characteristics amongst both diagnostic and non-diagnostic samples. A multiple regression analysis was conducted to determine if any nodule characteristic were predictive of adequacy of UG-FNABs. The learning curve was assessed by calculating the eventual adequacy rates across each year, and its statistical significance was measured using Fischer’s Exact Test. Results: In total 423 biopsies were reviewed in 289 patients. The average nodule size was 23.05 mm. When examining if each patient eventually received a diagnostic UG-FNAB, regardless of the number attempts, adequacy was seen to increase from 70.8 % in 2010 to, 81.0 % in 2011, 90.3 % in 2012, 85.7 % in 2013, 89.7 % in 2014, and 94.3 % in 2015 (Fischer’s Exact Test, p = 0.049). Cystic (χ 2  = 19.70, p
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2015, null:42
      PubDate: 2015-10-28T12:00:00Z
      DOI: 10.1186/s40463-015-0099-x
      Issue No: Vol. ${item.volume} (2015)
  • Outcome analysis of 215 patients with parotid gland tumors: a
           retrospective cohort analysis

    • First page: 43
      Abstract: Background: To identify prognostic factors in patients with parotid gland carcinomas who were treated at the Princess Margaret Hospital. Methods: Clinical outcome of two hundred fifteen patients with malignancies of the parotid gland was evaluated over a 16-year period. Results: Two-hundred-fifteen patients with adenoid cystic carcinoma (n = 20), adenocarcinoma (n = 19), acinic cell carcinoma (n = 62), basal cell adenocarcinoma (n = 7), carcinoma-ex-pleomorphic adenoma (n = 18), mucoepidermoid carcinoma (n = 70) and salivary duct carcinoma (n = 19) have been included. The 5- and 10-year overall and disease-free survivals were 80.62 %/69.48 % and 74.37 %/62.42 %, respectively. Multivariable analysis showed that age greater than 60 years, advanced pN classification, histopathological grade and the presence of lymphovascular invasion significantly worsened overall and disease-free survival. Univariable analysis revealed periparotid lymph node involvement was associated with decreased overall (p 
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2015, null:43
      PubDate: 2015-10-29T00:00:00Z
      DOI: 10.1186/s40463-015-0097-z
      Issue No: Vol. ${item.volume} (2015)
  • 3-phase dual-energy CT scan as a feasible salvage imaging modality for the
           identification of non-localizing parathyroid adenomas: a prospective study

    • Authors: Michael Roskies, Xiaoyang Liu, Michael Hier, Richard Payne, Alex Mlynarek, Veronique Forest, Mark Levental, Reza Forghani
      First page: 44
      Abstract: ObjectivesAccurate pre-operative imaging of parathyroid adenomas (PAs) is essential for successful minimally invasive surgery; however, rates of non-localizing PAs can be as high as 18 %. Multiphasic dual-energy CT (DECT) has the potential to increase accuracy of PA detection by enabling creation of paired material maps and spectral tissue characterization. This study prospectively evaluated the utility of 3-phase DECT for PA identification in patients with failed localizatio n via standard imaging. Methods: Patients with primary hyperparathyroidism and non-localizing PAs underwent a 3 phase post-contrast DECT scan acquired at 25, 55, and 85 s. The scans were prospectively evaluated by two head and neck radiologists. Pre-operative localization was compared to intraoperative localization and final histopathology. A post-hoc DECT spectral density characterization was performed on pathologically-proven PAs. Results: Out of 29 patients with primary hyperparathyroidism and non-localized PAs, DECT identified candidates in 26. Of the 23 patients who underwent parathyroidectomy, DECT provided precise anatomic localization in 20 patients (PPV = 87.0 %), one with multi-gland disease. The virtual unenhanced images were not found to be useful for diagnosis but successful diagnosis was made without an unenhanced phase regardless. Spectral analysis demonstrated a distinct spectral Hounsfield attenuation curve for PAs compared to lymph nodes on arterial phase images. Conclusion: 3-phase DECT without an unenhanced phase is a feasible salvage imaging modality for previously non-localizing parathyroid adenomas. Optimal interpretation is achieved based on a combination of perfusion characteristics and other morphologic features. Advanced spectral DECT analysis has the potential for further increasing accuracy of PA identification in the future.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2015, null:44
      PubDate: 2015-10-31T00:00:00Z
      DOI: 10.1186/s40463-015-0098-y
      Issue No: Vol. ${item.volume} (2015)
  • Algorithm based patient care protocol to optimize patient care and
           inpatient stay in head and neck free flap patients

    • First page: 45
      Abstract: ObjectiveTo determine if rigid adherence (where medically appropriate) to an algorithm/checklist-based patient care pathway can reduce the duration of hospitalization and complication rates in patients undergoing head and neck reconstruction with free tissue transfer. Methods: Study design was a retrospective case-control study of patients undergoing major head and neck cancer resections and reconstruction at a tertiary referral centre. The intervention was rigid adherence to a pre-existing care pathway including flow algorithms and multidisciplinary checklists incorporated into patient charting and care orders. 157 patients were enrolled prospectively and were compared to 99 patients in a historical cohort. Patient charts were reviewed and information related to the patient, procedure, and post-operative course was extracted. The two groups were compared for number of major and minor complications (using the Clavien-Dindo system) and length of stay in hospital. Results: Comparing pre- and post-intervention groups, no significant difference was identified in duration of hospital stay (21.5 days vs. 20.5 days, p = 0.750), the rate of major complications was significantly higher in the pre-intervention cohort (25.3 % vs. 14.0 %, p = 0.031), the rate of minor complications was not significantly higher (34.3 % vs 30.8 %, p = 0.610). Conclusion: Rigid adherence to our patient care pathway, and improved charting techniques including flow algorithms and multidisciplinary checklists has improved patient care by showing a significant reduction in the rate of major complications.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2015, null:45
      PubDate: 2015-11-02T12:00:00Z
      DOI: 10.1186/s40463-015-0090-6
      Issue No: Vol. ${item.volume} (2015)
  • The usefulness of routine histopathology of bilateral nasal polyps
           – a systematic review, meta-analysis, and cost evaluation

    • Authors: Jay SM Wong, Stephanie Hoffbauer, David Yeh, Brian Rotenberg, Michael Gupta, Doron Sommer
      First page: 46
      Abstract: Background: Controversy regarding the usefulness of routine histopathological examination of bilateral nasal polyps removed during endoscopic sinus surgery to identify occult diagnoses still exists. There is a paucity of high-level evidence in the literature. Methods: A systematic review and meta-analysis was conducted. Two independent reviewers were used. Pooled proportions and numbers needed to screen were calculated. A cost per life year model was generated based on varying survival benefits and compared to other Canadian screening programs to provide financial context. Results: Six studies (n = 3772 patients) were included. Of the 3772 patients, 3751 had a pre-operative clinical and post-operative pathological diagnosis of inflammatory nasal polyps. Agreement proportion was 99.44 %. There were 18 unexpected benign and three unexpected malignant diagnoses identified. This translated to a proportion of 0.48 and 0.08 % respectively. Number needed to screen was 210 and 1258 respectively. Pooled proportion for expected findings using a random effect model was 0.99 (95 % CI = 0.99–1). Pooled proportion for unexpected benign findings using a random effect model was 0.00522 (95 % CI = 0.00133–0.01). Pooled proportion for unexpected malignant findings using a random effect model was 0.00107 (95 % CI = 0.000147–0.00283). The cost to pick up one unexpected benign diagnosis was $14557.2. The cost to pick up 1 unexpected malignant diagnosis was $87204.56. Cost per quality life year calculated ranged from 3211.83 to $64677.58 based on varying assumptions on the survival benefits of identifying an unexpected malignancy. Conclusions: Routine pathological examination in screening for neoplasia may be low yield, however, no compelling evidence was found to cease such practice. Surgeons should exercise individual judgment in requesting routine examination.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2015, null:46
      PubDate: 2015-11-04T00:00:00Z
      DOI: 10.1186/s40463-015-0100-8
      Issue No: Vol. ${item.volume} (2015)
  • The Allen’s test: revisiting the importance of bidirectional
           testing to determine candidacy and design of radial forearm free flap
           harvest in the era of trans radial endovascular access procedures

    • Authors: Andrew Foreman, John de Almeida, Ralph Gilbert, David Goldstein
      First page: 47
      Abstract: Background: The radial forearm free flap is a workhorse free flap. The radial artery, which supplies it, is increasingly being used for endovascular access. A complication of this is radial artery occlusion. Although often asymptomatic it can compromise future free tissue transfer.Case PresentationTwo patients who underwent RFFF harvest for head and neck reconstruction are presented; both of who likely had distal radial artery occlusion.The first patient had failure of flap perfusion, presumed secondary to radial artery occlusion from prior endovascular access at the distal radial artery. In the second case, we used the Allen’s test in reverse to identify the same scenario and successfully redesigned the harvest. Conclusion: The Allen’s test is a simple bedside test that should be performed bidirectionally to exclude radial artery occlusion, which may compromise flap harvest. Radial artery occlusion will become increasingly common as the radial artery is used more frequently for endovascular access procedures.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2015, null:47
      PubDate: 2015-11-04T00:00:00Z
      DOI: 10.1186/s40463-015-0096-0
      Issue No: Vol. ${item.volume} (2015)
  • “Clinicopathological features and treatment outcomes of
           differentiated thyroid cancer in Saudi children and adults”

    • Authors: Khalid AL-Qahtani, Mutahir Tunio, Mushabbab Al Asiri, Naji Aljohani, Yasser Bayoumi, Khalid Riaz, Wafa AlShakweer
      First page: 48
      Abstract: IntroductionAge is an important prognostic factor in differentiated thyroid cancer (DTC). Our aim was to evaluate differences in clinicopathological features and treatment outcomes among children and adult patients with DTC.Materials and methodsWe studied 27 children (below 18 years) with DTC treated during the period 2000–2012 and were compared with (a) 78 adults aged 19–25 years and (b) 52 adults aged 26–30 years treated during the same period in terms of their clinicopathological features and long term treatment outcomes. Locoregional recurrence (LRR), locoregional control (LRC), distant metastasis (DM), distant metastasis control (DMC), disease free survival (DFS) and overall survival (OS) rates were evaluated. Results: Mean age of children was 13.5 years (range: 5–18), while mean age of adults was 24.6 years (range: 19–30). In children, female: male ratio was 2.85:1, and in adults female: male ratio was 7.1:1 (P = 0.041). No significant difference in tumor size was seen between the two groups (P = 0.653). According to American Thyroid Association (ATA) risk stratification classification, the children (85.2 %) were found to have at high risk as compared to adults P = 0.001. Post-thyroidectomy complications and RAI induced toxicities were observed more in children than adults (P = 0.043 and P = 0.041 respectively). LRR occurred in 6 (22.2 %), 9 (11.5 %) and 3 (5.8 %) in age groups of
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2015, null:48
      PubDate: 2015-11-06T12:00:00Z
      DOI: 10.1186/s40463-015-0102-6
      Issue No: Vol. ${item.volume} (2015)
  • Computerized tomography based tumor-thickness measurement is useful to
           predict postoperative pathological tumor thickness in oral tongue
           squamous cell carcinoma

    • First page: 49
      Abstract: Background: Tumor thickness has been shown in oral tongue squamous cell carcinoma (OTSCC) to be a predictor of cervical metastasis. The postoperative histological measurement is certainly the most accurate, but it would be of clinical interest to gain this information prior to treatment planning. This retrospective study aimed to compare the tumor thickness measurement between preoperative, CT scan, and surgical specimens . Methods: We retrospectively included 116 OTSCC patients between 2001 and 2013. Thickness was measured on computer tomography imaging and again surgical specimens. Results: The median age was 66 years. 62.8 % of patients were smokers with a mean of 31.4 pack-years. Positive nodal disease was reported in 41.2 %. Mean follow-up time was 33.1 months. The correlation between CT scan-based tumor thickness and surgical specimens based thickness was significant (Spearman rho = 0.755, P 
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2015, null:49
      PubDate: 2015-11-16T12:00:00Z
      DOI: 10.1186/s40463-015-0089-z
      Issue No: Vol. ${item.volume} (2015)
  • Identification of altered protein abundances in cholesteatoma matrix via
           mass spectrometry-based proteomic analysis

    • Authors: Derrick Randall, Phillip Park, Justin Chau
      First page: 50
      Abstract: Background: Cholesteatoma are cyst-like structures lined with a matrix of differentiated squamous epithelium overlying connective tissue. Although epithelium normally exhibits self-limited growth, cholesteatoma matrix erodes mucosa and bone suggesting changes in matrix protein constituents that permit destructive behaviour. Differential proteomic studies can measure and compare the cholesteatoma proteome to normal tissues, revealing protein alterations that may propagate the destructive process. Methods: Human cholesteatoma matrix, cholesteatoma-involved ossicles, and normal middle ear mucosa, post-auricular skin, and non-involved ossicles were harvested. These tissues were subjected to multiplex peptide labeling followed by liquid chromatography and tandem mass spectrometry analysis. Relative protein abundances were compared and evaluated for ontologic function and putative involvement in cholesteatoma. Results: Our methodology detected 10 764 peptides constituting 1662 unique proteins at 95 % confidence or greater. Twenty-nine candidate proteins were identified in soft tissue analysis, with 29 additional proteins showing altered abundances in bone samples. Ontologic functions and known relevance to cholesteatoma are discussed, with several candidates highlighted for their roles in epithelial integrity, evasion of apoptosis, and immunologic function. Conclusion: This study produced an extensive cholesteatoma proteome and identified 58 proteins with altered abundances contributing to disease pathopathysiology. As well, potential biomarkers of residual disease were highlighted. Further investigation into these proteins may provide useful options for novel therapeutics or monitoring disease status.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2015, null:50
      PubDate: 2015-11-25T12:00:00Z
      DOI: 10.1186/s40463-015-0104-4
      Issue No: Vol. ${item.volume} (2015)
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