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Journal of Otolaryngology - Head and Neck Surgery    [6 followers]  Follow    
  This is an Open Access Journal Open Access journal
     ISSN (Print) 1916-0216
     Published by Biomed Central Ltd. Homepage  [265 journals]   [SJR: 0.564]   [H-I: 11]
  • Long-term functional donor site morbidity of the free radial forearm flap
           in head and neck cancer survivors
    • Authors: Jason Orlik, Peter Horwich, Clark Bartlett, Jonathan Trites, Robert Hart, S Taylor
      First page: 1
      Abstract: Background: To assess the functional donor site morbidity of the forearm free flap in patients surviving at least 2 years after ablative head and neck cancer surgery in a tertiary care centre. Methods: This study involved nine long-term survivors (2 year post-operative) who had forearm free flaps to reconstruct head and neck defects. All flaps were raised from the non-dominant arm. The non-donor side acted as a control for all patients. Objective measurements were as follows: grip, tip pinch and key pinch strength measured with dynamometers; flexion, extension, radial and ulnar deviation and pronation and supination range of motion at the wrist measured with goniometry; A timed manual dexterity task was performed with a grooved pegboard test, and sensation of the radial nerve was tested with Semmes Weinstein monofilaments. Subjective measurements included a validated patient questionnaire of hand function and opinions of scar appearance as well as a validated scar assessment from two different observers. Results: Pronation at the wrist, manual dexterity and sensation were found to be significantly reduced in the donor side compared to the non-donor side. Inter-rater agreement between the two observers was found to be poor, except for an acceptable correlation between overall scar opinions. No correlations were found between any subjective or objective items or between the patient's and the observers' subjective evaluations. Conclusions: Donor site morbidity can be demonstrated with objective testing however this is accepted and well tolerated by head and neck cancer patients.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:1
      PubDate: 2014-01-13T00:00:00Z
      DOI: 10.1186/1916-0216-43-1
      Issue No: Vol. ${item.volume} (2014)
  • The relationship between survival and socio-economic status for head and
           neck cancer in Canada
    • Authors: James McDonald, Stephanie Johnson-Obaseki, Euna Hwang, Chris Connell, Martin Corsten
      First page: 2
      Abstract: Background: Human papilloma virus (HPV) is emerging as the primary cause for some head and neck cancers. The objective of this study was to investigate the association between head and neck cancer (HNC) survival and socioeconomic status (SES) in Canada, and to investigate changes in the relationship between HNC survival and SES from 1992 to 2005. Methods: Cases were drawn from the Canadian Cancer Registry (1992–2005), and were categorized into three subsites: oropharynx, oral cavity, and “other” (hypopharynx, larynx, and nasopharynx). Demographic and socioeconomic information were extracted from the Canadian Census of Population data for the study period, which included three census years: 1991, 1996 and 2001. We linked cases to income quintiles (InQs) according to patients’ postal codes. Results: Overall survival, without controlling for smoking, for oropharyngeal cancer increased dramatically from 1992–2005 in Canada. This increase in survival for oropharynx cancer was eliminated by the introduction of controls for smoking. Survival for all head and neck cancer subsites was strongly correlated with SES, as measured by income quintile, with lower InQ’s having lower survival than higher. Lastly, the magnitude of the difference in survival between the highest and lowest income quintiles increased significantly over the time period studied for oropharynx cancer, but did not statistically significantly change for oral cavity cancer or other head and neck cancers. Conclusions: These data confirm a significant impact of socioeconomic deprivation on overall survival for head and neck cancers in Canada, and may provide indirect evidence that HPV-positive head and neck cancers are more common in higher socioeconomic groups.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:2
      PubDate: 2014-01-14T00:00:00Z
      DOI: 10.1186/1916-0216-43-2
      Issue No: Vol. ${item.volume} (2014)
  • Reviewer acknowledgement 2013
    • Authors: Hadi Seikaly, Erin Wright
      First page: 3
      Abstract: Contributing reviewersThe Editors of Journal of Otolaryngology - Head & Neck Surgery would like to thank all our reviewers who have contributed to the journal in Volume 42 (2013).
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:3
      PubDate: 2014-02-25T17:41:54Z
      DOI: 10.1186/1916-0216-43-3
      Issue No: Vol. ${item.volume} (2014)
  • Management of locally advanced laryngeal cancer
    • Authors: Alexander Karatzanis, Georgios Psychogios, Frank Waldfahrer, Markus Kapsreiter, Johannes Zenk, George Velegrakis, Heinrich Iro
      First page: 4
      Abstract: Background: Management of advanced laryngeal cancer is complex and ideal strategy is yet to be defined. This study evaluates the experience of a single head and neck oncologic centre in the management of T4 laryngeal cancer. Methods: Retrospective assessment of cases primarily treated for T4a squamous cell carcinoma of the larynx, between 1980 and 2007, at a tertiary referral center. Results: A total of 384 cases were studied. Five-year disease specific survival was 56.2% and local control 87.4%. Regional and distal control estimates were 90.3% and 88.3% respectively. Prognosis was significantly superior for cases treated with primary surgery compared to cases solely managed with non-surgical modalities. Positive surgical margins and regional disease worsened prognosis. Conclusion: This study suggests that primary surgery remains a key element in the treatment of advanced laryngeal cancer. The need for well-designed, prospective, randomised studies in order to further evaluate the remaining role of primary surgery in the modern management of locally advanced laryngeal lesions is emphasized.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:4
      PubDate: 2014-01-28T00:00:00Z
      DOI: 10.1186/1916-0216-43-4
      Issue No: Vol. ${item.volume} (2014)
  • Validation of 1-hour post-thyroidectomy parathyroid hormone level in
           predicting hypocalcemia
    • Authors: Trung Le, Paul Kerr, Donna Sutherland, Pascal Lambert
      First page: 5
      Abstract: Background: Prior work by our group suggested that a single one hour post-thyroidectomy parathyroid hormone (1 hr PTH) level could accurately stratify patients into high and low risk groups for the development of hypocalcemia. This study looks to validate the safety and efficacy of a protocol based on a 1 hr PTH threshold of 12 pg/ml.Study design: Retrospective analysis of consecutive cohort treated with standardized protocol. Methods: One hundred and twenty five consecutive patients underwent total or completion thyroidectomy and their PTH level was drawn 1-hour post operatively. Based on our previous work, patients were stratified into either a low risk group (PTH < 12 pg/ml) or a high risk group (PTH >= 12 pg/ml). Patients in the high risk group were immediately started on prophylactic calcium carbonate (5-10 g/d) and calcitriol (0.5-1.0 mcg/d). The outcomes were then reviewed focusing mainly on how many low risk patients developed hypocalcemia (false negative rate), and how many high risk patients failed prophylactic therapy. Results: Thirty one patients (25%) were stratified as high risk, and 94 (75%) as low risk. Five (16%) of the high risk patients became hypocalcemic despite prophylactic therapy. Two of the low risk group became hypocalcemic, (negative predictive value = 98%). None of the hypocalcemic patients had anything more than mild symptoms. Conclusions: A single 1-hour post-thyroidectomy PTH level is a very useful way to stratify thyroidectomy patients into high and low risk groups for development of hypocalcemia. Early implementation of oral prophylactic calcium and vitamin D in the high risk patients is a very effective way to prevent serious hypocalcemia. Complex protocols requiring multiple calcium and PTH measurements are not required to guide post-thyroidectomy management.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:5
      PubDate: 2014-01-29T00:00:00Z
      DOI: 10.1186/1916-0216-43-5
      Issue No: Vol. ${item.volume} (2014)
  • CO2 laser versus cold steel margin analysis following endoscopic excision
           of glottic cancer
    • Authors: Fawaz Makki, Matthew Rigby, Martin Bullock, Timothy Brown, Robert Hart, Jonathan Trites, Michael Hinni, S Taylor
      First page: 6
      Abstract: ObjectiveTo compare the suitability of CO2 laser with steel instruments for margin excision in transoral laser microsurgery. Methods: Prospective randomized blinded study. Patients with glottic cancer undergoing laser resection were randomized to margin excision by either steel instruments or CO2 laser. Margins were analyzed for size, interpretability and degree of artifact by a pathologist who was blinded to technique. Results: 45 patients were enrolled in the study with 226 total margins taken. 39 margins taken by laser had marked artifact and 0 were uninterpretable. 20 margins taken by steel instruments had marked artifact, and 2 were uninterpretable. Controlling for margin size, the laser technique was associated with increasing degrees of margin artifact (p = 0.210), but there was no difference in crude rates of uninterpretability (p = 0.24). Conclusion: Laser margin excision is associated with a greater degree of artifact than steel instrument excision, but was not associated with higher rate of uninterpretability.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:6
      PubDate: 2014-02-06T00:00:00Z
      DOI: 10.1186/1916-0216-43-6
      Issue No: Vol. ${item.volume} (2014)
  • High definition video teaching module for learning neck dissection
    • Authors: Adrian Mendez, Hadi Seikaly, Kal Ansari, Russell Murphy, David Cote
      First page: 7
      Abstract: IntroductionVideo teaching modules are proven effective tools for enhancing student competencies and technical skills in the operating room. Integration into post-graduate surgical curricula, however, continues to pose a challenge in modern surgical education. To date, video teaching modules for neck dissection have yet to be described in the literature.Purpose: To develop and validate an HD video-based teaching module (HDVM) to help instruct post-graduate otolaryngology trainees in performing neck dissection. Methods: This prospective study included 6 intermediate to senior otolaryngology residents. All consented subjects first performed a control selective neck dissection. Subjects were then exposed to the video teaching module. Following a washout period, a repeat procedure was performed. Recordings of the both sets of neck dissections were de-identified and reviewed by an independent evaluator and scored using the Observational Clinical Human Reliability Assessment (OCHRA) system. Results: In total 91 surgical errors were made prior to the HDVM and 41 after exposure, representing a 55% decrease in error occurrence. The two groups were found to be significantly different. Similarly, 66 and 24 staff takeover events occurred pre and post HDVM exposure, respectively, representing a statistically significant 64% decrease. Conclusion: HDVM is a useful adjunct to classical surgical training. Residents performed significantly less errors following exposure to the HD-video module. Similarly, significantly less staff takeover events occurred following exposure to the HDVM.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:7
      PubDate: 2014-03-25T00:00:00Z
      DOI: 10.1186/1916-0216-43-7
      Issue No: Vol. ${item.volume} (2014)
  • The effect of topically applied tissue expanders on radial forearm skin
           pliability: a prospective self-controlled study
    • Authors: Jeffson Chung, James Bonaparte, Michael Odell, Martin Corsten
      First page: 8
      Abstract: Background: The use of pre-operatively applied topical tissue expansion tapes have previously demonstrated increased rates of primary closure of radial forearm free flap donor sites. This is associated with a reduced cost of care as well as improved cosmetic appearance of the donor site. Unfortunately, little is known about the biomechanical changes these tapes cause in the forearm skin. This study tested the hypothesis that the use of topically applied tissue expansion tapes will result in an increase in forearm skin pliability in patients undergoing radial forearm free flap surgery. Methods: Twenty-four patients scheduled for head and neck surgery requiring a radial forearm free flap were enrolled in this prospective self-controlled observational study. DynaClose tissue expansion tapes (registered Canica Design Inc, Almonte, Canada) were applied across the forearm one week pre-operatively. Immediately prior to surgery, the skin pliability of the dorsal and volar forearm sites were measured with the Cutometer MPA 580 (registered Courage-Khazaka Electronic GmbH, Cologne, Germany) on both the treatment and contralateral (control) arms. Paired t-tests were used to compare treatment to control at both sites, with p < 0.025 defined as statistically significant. Results: There was a statistically significant increase in pliability by a mean of 0.05 mm (SD = 0.09 mm) between treatment and control arms on the dorsal site (95% CI [0.01, 0.08], p = 0.018). This corresponded to an 8% increase in pliability. In contrast, the volar site did not show a statistically significant difference between treatment and control (mean difference = 0.04 mm, SD = 0.20 mm, 95% CI [-0.04, 0.12], p = 0.30). Conclusions: This result provides evidence that the pre-operative application of topical tissue expansion tapes produces measurable changes in skin biomechanical properties. The location of this change on the dorsal forearm is consistent with the method of tape application. While this increase in skin pliability may account for the improved rate of primary donor site closure reported using this technique, the results did not reach our definition of clinical significance.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:8
      PubDate: 2014-04-16T00:00:00Z
      DOI: 10.1186/1916-0216-43-8
      Issue No: Vol. ${item.volume} (2014)
  • Rates of thyroid malignancy by FNA diagnostic category
    • Authors: Blair Williams, Martin Bullock, Jonathan Trites, S Taylor, Robert Hart
      First page: 61
      Abstract: Background: Fine needle aspiration (FNA) of thyroid nodules is a cornerstone of surgical decision making in thyroid cancer. The most widely utilized system for reporting thyroid FNA results is the Bethesda System, which includes predicted malignancy rates for each FNA category. To date there have been few studies to determine whether these predictions are widely applicable. Methods: All thyroid FNA results at the Queen Elizabeth II Health Science Centre from 2006-2010 were included in this study. The results were tabulated by FNA category and the health records were reviewed to determine whether the patient went on to have surgery and the result of surgical histopathology. Rates of malignancy were calculated and compared to published values. Results: A total of 1491 thyroid FNAs were included in the study, representing 1117 individual patients with available health records. The majority of these FNAs were Benign, but the proportion of Unsatisfactory FNAs was higher than predicted while Malignant and Suspicious for Malignancy were lower than predicted. Surgery was performed on 388 patients and 110 were positive for malignancy (28%). The malignancy rate for each FNA category was higher than predicted based on literature values. Conclusions: The proportions of FNA diagnoses and the rates of malignancy for each FNA category at our institution were not consistent with predicted values. It is important for clinicians to base their surgical recommendations on institution specific malignancy rates, not solely on literature values.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2013, null:61
      PubDate: 2013-12-20T00:00:00Z
      DOI: 10.1186/1916-0216-42-61
      Issue No: Vol. ${item.volume} (2013)
  • FOCUS harmonic scalpel compared to conventional haemostasis in open total
           thyroidectomy_ a prospective randomized study
    • Authors: Yun-fei Duan, Wei Xue, Feng Zhu, Dong-lin Sun
      First page: 62
      Abstract: Background: Hemostasis in thyroid surgery is of utmost importance for a successful surgery and an uneventful postoperative course. Our aim was to evaluate the effectiveness of the FOCUS Harmonic Scalpel in patients undergoing open total thyroidectomy. Methods: In this study, 778 patients were randomized into 2groups based on the surgical technique used: group I comprised the conventional clamp-and-tie technique, group II comprised patients in whom the FOCUS Harmonic Scalpel was used exclusively. The groups were compared in regard to surgical time, complications, and hospital stay. Results: Surgical time was significantly lower in group II compared with group I (79 +/- 21.5 min vs.125 +/- 30.4, respectively, P < 0.001). Twenty-seven patients (6.94%) in group I experienced symptomatic hypocalcemia requiring calcium and/or vitamin D therapy versus 14 patients (3.6%) in group II, with statistically significant difference (P < 0.05). Mean post-operative hospital stay was significantly lower in group II compared with group I (2.6 +/- 0.9 vs. 2.9 +/- 1.0; P < 0.001). Conclusions: The FOCUS Harmonic Scalpel can shorten operative time and hospital stay, reduce incidence of symptomatic hypocalcaemia but not transient hypoparathyroidism, and show no significance on recurrent nerve injury. FOCUS Harmonic Scalpel is supposed to be a more reliable and safe instrument that can take place of the clamp-and-tie techniquein total thyroidectomy.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2013, null:62
      PubDate: 2013-12-20T00:00:00Z
      DOI: 10.1186/1916-0216-42-62
      Issue No: Vol. ${item.volume} (2013)
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