77.
Int Forum Allergy Rhinol. 2019 May;9(5):466-472. doi: 10.1002/alr.22275. Epub 2019 Jan 15.
Sinonasal risk factors for eustachian tube dysfunction: Cross-sectional findings from NHANES 2011-2012.
Abstract
BACKGROUND:
Sinonasal pathology is frequently cited as a cause of eustachian tube dysfunction (ETD), despite a lack of evidence. Using a large, nationally representative sample, we investigated whether abnormal tympanometry, an objective marker of ETD, was associated with infectious, allergic, and exposure-related sinonasal risk factors.
METHODS:
Relevant data were extracted from the 2011-2012 National Health and Nutrition Examination Survey (NHANES). Tympanometric types (A, B, and C) were determined using peak pressure and compliance values. Participants with a type B or C tympanogram in at least one ear were classified as having ETD. Demographic and clinicopathologic risk factors with putative associations with ETD were determined. Statistical analysis, including regression modeling, was performed using Stata (version 15.1) to determine the correlation between sinonasal factors and ETD.
RESULTS:
The final analysis included 1253 subjects and 19 variables. We controlled for demographic data including age, gender, race, and income. In both univariate and multivariate logistic regression, statistically significant correlations were found between abnormal tympanometric values and: (1) having a persistent cold/flu in the last 12 months (univariate: adjusted odds ratio [OR], 2.42; p = 0.006; multivariate: adjusted OR, 2.15; p = 0.006); and (2) experiencing "hay fever" (ie, allergic rhinitis) within the last 12 months (univariate: adjusted OR, 1.95; p = 0.021; multivariate: adjusted OR, 1.71; p = 0.039).
CONCLUSION:
Using a large, representative data set, we identified significant correlations between ETD and (1) persistent cold/flu symptoms and (2) self-reported allergic rhinitis.
© 2019 ARS-AAOA, LLC.
KEYWORDS:
Eustachian tube; Eustachian tube dysfunction; NHANES; acoustic impedance tests; nutritional surveys; otitis media; rhinitis, allergic; sinusitis; tympanometry
78.
Int Forum Allergy Rhinol. 2019 May;9(5):443-451. doi: 10.1002/alr.22268. Epub 2019 Jan 15.
Rhinogenic headache in pediatric and adolescent patients: an evidence-based review.
Abstract
BACKGROUND:
Although some causes of rhinogenic headache, such as acute sinusitis, have clear diagnostic criteria, others, such as "sinus headache" and mucosal contact points, are more nebulous. Misdiagnosis of these entities and primary headaches may result in unnecessary medical or surgical treatment. The purpose of this systematic review is to delineate current understanding of diagnosis and treatment of rhinogenic headaches, including sinus and mucosal contact point headaches, in children.
METHODS:
PubMed, SCOPUS, and the Cochrane databases were searched for studies on sinus headache and mucosal contact point headaches in children. Studies were assessed for level of evidence, and risk of bias was assessed by Methodological Index for Non-Randomized Studies (MINORS) scoring. Diagnostic criteria, management strategies, and other clinical data were analyzed.
RESULTS:
Eight studies met the inclusion criteria. Level of evidence was predominantly 4. Forty percent of pediatric patients with migraine had been previously misdiagnosed with sinus headache. Of 327 pediatric patients in two studies, between 55% and 73% had at least 1 cranial autonomic symptom associated with their migraine. For children with mucosal contact point headaches, surgical management in select patients improved headache intensity or severity in 17 (89%) cases.
CONCLUSION:
The majority of pediatric patients with sinus headache harbor a primary headache disorder, with migraine being most common. Physicians should suspect primary headache disorders in pediatric patients with chronic headaches and a normal exam. Although some case series are supportive of surgical management for mucosal contact point headaches in children, the level of evidence supporting these recommendations is insufficient. High-quality clinical trials are necessary for continuing to improve outcomes in patients with these clinical entities.
© 2019 ARS-AAOA, LLC.
KEYWORDS:
mucosal contact point headache; primary headache disorders; rhinogenic headache; sinus headache
79.
Int Forum Allergy Rhinol. 2019 May;9(5):538-544. doi: 10.1002/alr.22287. Epub 2019 Jan 10.
Investigating the correlation between mucus cytokine levels, inflammatory cell counts, and baseline quality-of-life measures in chronic rhinosinusitis.
Abstract
BACKGROUND:
It is hypothesized that uncontrolled inflammation is responsible for many of the manifestations and symptoms of chronic rhinosinusitis (CRS). Although earlier work has demonstrated an association between olfactory loss and mucus cytokines, the impact on other symptoms is unknown. In this study we investigated the relationship between cytokines, inflammatory cell counts, and patient-reported outcomes measures to better understand how the inflammatory microenvironment correlates with CRS symptomatology.
METHODS:
The 22-item Sino-Nasal Outcome Test (SNOT-22) and 8-item Short Form Health Survey (SF-8) were administered to 76 patients undergoing endoscopic sinus surgery for CRS. Mucus was collected intraoperatively from the middle meatus and tested for 17 cytokines using a multiplex flow cytometric bead assay. Eosinophil/neutrophil counts were obtained from histopathologic slide review. Spearman correlations between cytokines, cell counts, and quality-of-life subdomain scores were assessed without multiple comparisons correction due to the small sample size.
RESULTS:
Interleukin-4 (IL-4) correlated significantly with the Rhinologic domain (Rs = 0.25, p = 0.03), whereas eosinophil and neutrophil counts were inversely correlated with the Extranasal Rhinologic domain (Rs = -0.32, p = 0.01; and Rs = -0.27, p = 0.03). Subgroup analysis for nasal polyposis (CRSwNP) showed significant correlations between IL-6 and Total SF-8 (Rs = 0.35, p = 0.02), General Health (Rs = 0.34, p = 0.03), and Emotional (Rs = 0.47, p = 0.002) scores. In patients without polyps (CRSsNP), IL-21 correlated positively with Extranasal Rhinologic Symptoms domain (Rs = 0.41, p = 0.01).
CONCLUSION:
This pilot study identifies possible pairwise correlations between mucus cytokine levels and baseline quality-of-life measures that need confirmation in larger, targeted studies. Due to the exploratory methodology, positive results may be spurious and should only be used as a starting point for future confirmatory work.
© 2019 ARS-AAOA, LLC.
KEYWORDS:
chronic disease; cytokines; paranasal sinuses; quality of life; sinusitis
80.
Int Forum Allergy Rhinol. 2019 May;9(5):545-555. doi: 10.1002/alr.22281. Epub 2019 Jan 10.
Clarithromycin for the treatment of adult chronic rhinosinusitis: a systematic review and meta-analysis.
Abstract
BACKGROUND:
The aim of this systematic review (SR) was to assess the safety and efficacy of oral clarithromycin for the treatment of chronic rhinosinusitis (CRS).
METHODS:
This SR and meta-analysis was conducted based on the recommendations outlined in the Cochrane Handbook for SR of Interventions. The protocol was registered on PROSPERO, an international prospective register of SRs. English and Chinese electronic databases were searched, and only randomized controlled trials were included.
RESULTS:
Seventeen studies with 1738 patients were included. Eleven studies evaluated whether adding oral clarithromycin to intranasal steroid spray with or without nasal saline irrigation was more effective than intranasal steroid spray alone. This combined treatment regimens statistically significantly improve clinical symptoms in the medium term (1 to 3 months), the endoscopic and computed tomography (CT) scores in both the short term (<1 month) and medium term, and clinical symptoms and the endoscopic score in the long term (>3 months). The incidence of adverse events did not increase with the use of this combination therapy. No significant difference was identified between treatment with oral clarithromycin and intranasal steroid spray alone groups in term of symptoms, endoscopic score, and CT score.
CONCLUSION:
For the treatment of CRS, adding oral clarithromycin to intranasal steroid spray with or without nasal saline irrigation may achieve better results than using intranasal steroid spray with or without nasal saline irrigation. There is insufficient evidence to confirm that oral clarithromycin alone may have similar efficacy as nasal glucocorticoid spray alone. High-quality evidence in this area is needed.
© 2019 ARS-AAOA, LLC.
KEYWORDS:
chronic rhinosinusitis; clarithromycin; macrolide; meta-analysis; systematic review
81.
Int Forum Allergy Rhinol. 2019 May;9(5):562-566. doi: 10.1002/alr.22278. Epub 2019 Jan 4.
Nasal branch of the anterior ethmoid artery: a consistent landmark for a midline approach to the frontal sinus.
Abstract
BACKGROUND:
Frontal sinusotomy can be challenging when significant scarring or distorted anatomy is present. Identifying a reliable anatomic structure, when traditional landmarks or navigation are absent, may assist the surgeon in revision and complicated frontal sinusotomies via a midline approach. We aimed to characterize the anatomic relationship of the nasal branch of the anterior ethmoid artery (NBAEA) to the frontal infundibulum, specifically the first olfactory fili, posterior frontal infundibulum, and anterior cribriform plate.
METHODS:
Dissection of the NBAEA was carried out in 11 cadaveric heads, resulting in a total of 21 dissections (1 aplastic frontal). Mean with standard deviation and a range were established for 7 relative measurements.
RESULTS:
The total length of NBAEA cleft when present (mean 2.43 mm), the anterior edge of NBAEA cleft to anterior infundibulum coronal plane (mean 1.71 mm), the posterior edge of NBAEA cleft to posterior infundibulum coronal plane (mean 3.33 mm), the posterior edge of NBAEA cleft to 1st olfactory fili (mean 2.86 mm), and the first olfactory fili to posterior infundibulum coronal plane (mean 0.48 mm) were consistent measurements supporting the use of the NBAEA as a consistent anatomical landmark for the correct surgical coronal trajectory into the midline frontal sinus.
CONCLUSION:
The NBAEA is a consistent anatomic landmark with minimal intercadaveric and intracadaveric variation. It can be used reliably as a "sentinel artery" notifying the surgeon when one is approaching the first olfactory fili, to determine the correct trajectory into the midline frontal sinus.
© 2019 ARS-AAOA, LLC.
KEYWORDS:
anatomic study; anterior ethmoid artery; cadaveric; cribriform plate; modified Lothrop procedure; nasal branch; skull base
82.
Int Forum Allergy Rhinol. 2019 May;9(5):528-537. doi: 10.1002/alr.22274. Epub 2018 Dec 31.
Semaphorin 3A inhibits allergic inflammation by regulating immune responses in a mouse model of allergic rhinitis.
Abstract
BACKGROUND:
It has been reported that semaphorin 3A (sema3A) could improve allergic symptoms in allergic rhinitis (AR) mice. However, the immunomodulatory roles of sema3A in AR remain unclear. This study was performed to determine the immunoregulatory effects of sema3A on airway inflammation in an AR mice model.
METHODS:
First, sema3A expression was measured in the serum of AR patients and also in a mice model. Then, nasal symptoms, ovalbumin (OVA)-specific immunoglobulin E (IgE) production, cytokine levels, and histologic structure were analyzed in OVA-sensitized mice, sema3A mice, mice given saline, and controls. The percentages of CD4+ IL-4+ IFN-γ- Th2 cells, CD4+ IFN-γ+ IL-4- Th1 cells, CD4+ IL-17+ Th17 cells, and CD4+ CD25+ Foxp3+ Treg cells in the spleen were also analyzed.
RESULTS:
Serum sema3A levels in both AR patients and OVA-sensitized mice decreased significantly compared with controls. The intranasal administration of sema3A reduced allergic symptom scores, eosinophil infiltration, and OVA-specific IgE production in OVA-sensitized mice. In addition, levels of IL-4 and IL-17 as well as percentages of CD4+ IL-17+ Th17 cells were suppressed by sema3A administration. Levels of IFN-γ and IL-10 and ratios of CD4+ IFN-γ+ IL-4- Th1/CD4+ IL-4+ IFN-γ- Th2 cells, as well as percentages of CD4+ CD25+ Foxp3+ Treg cells, were increased by administration of sema3A.
CONCLUSION:
Our results demonstrate that sema3A suppressed allergic inflammation in AR via inhibition of Th2/Th17 responses and enhancement of Th1/Treg responses.
© 2018 ARS-AAOA, LLC.
KEYWORDS:
T lymphocytes; allergic reactions; cytokines; immune system; nasal mucosa; regulatory
83.
Int Forum Allergy Rhinol. 2019 May;9(5):556-561. doi: 10.1002/alr.22271. Epub 2018 Dec 21.
Analysis of anterior and posterior maneuvers to enhance intraconal exposure.
Lemos-Rodriguez AM1, Farzal Z1, Overton LJ1, Rawal RB1, Eftekhari K2, Sasaki-Adams D3, Ewend M3, Thorp BD1, Ebert CS Jr1, Zanation AM1,3.
Abstract
BACKGROUND:
The medial and inferior recti encompass the ideal surgical corridor to approach the intraconal space endonasally. Here, we describe 3 different maneuvers to achieve greater access to orbital contents through an expanded endonasal approach (EEA).
METHODS:
Four human cadaver heads were dissected bilaterally (n = 8). EEA to the medial intraconal orbit was executed. The following 3 maneuvers were performed: (1) anterior: extraocular muscles control (EOM); (2) posterior: annulus of Zinn (AZ) release; and (3) anterior/posterior combined. Measurements of the inferior and medial rectus corridor at the level of anterior ethmoidal artery (AEA) and posterior ethmoidal artery (PEA) and extent of optic nerve and medial rectus visualization was performed before and after each maneuver.
RESULTS:
Medial rectus length (MRL) and optic nerve length (ONL) achieved were 1.72 ± 0.28 cm and 0.85 ± 0.2 cm, respectively. Mean caudal-rostral distances between the rectus muscles at the level of the AEA and PEA were 3.45 ± 0.7 mm and 1.30 ± 0.3 mm, respectively. After EOM control, mean caudal-rostral distances at the same level were as follows: AEA 4.90 ± 1.15 mm (p = 0.009) and PEA 1.70 ± 0.20 mm (p = 0.016). With AZ release, MRL was 2.20 ± 0.7 cm (p = 0.002) and ONL was 1.30 ± 0.2 cm (p = 0.003), with mean rostral-caudal distance at the level of AEA at 4.03 ± 0.8 mm (p = 0.16) and PEA at 1.71 ± 0.36 mm (p = 0.039). Mean caudal-rostral distances achieved with AZ release and EOM control were as follows: AEA 5.6 ± 1.2 mm (p = 0.001) and PEA 2.15 ± 0.4 mm (p = 0.001).
CONCLUSION:
Progressive access to the orbital contents is afforded with the 3 delineated maneuvers. The magnitude of access is optimized with the combined maneuver. The actual anterior/posterior location of the target will determine which maneuvers are required.
© 2018 ARS-AAOA, LLC.
KEYWORDS:
FESS; endoscopic minimally invasive surgery of the skull base; endoscopic skull base surgery; endoscopy; orbital/ocular
84.
Endocr Relat Cancer. 2019 Feb 1;26(2):241-250. doi: 10.1530/ERC-18-0258.
Safety and efficacy of two starting doses of vandetanib in advanced medullary thyroid cancer.
Hu MI1, Elisei R2, Dedecjus M3, Popovtzer A4, Druce M5, Kapiteijn E6, Pacini F7, Locati L8, Krajewska J9, Weiss R10, Gagel RF1.
Abstract
Vandetanib is an oral tyrosine kinase inhibitor approved for treatment of advanced symptomatic or progressive medullary thyroid cancer (MTC). The current study (Nbib1496313) evaluated the benefit-risk of two starting doses of vandetanib in patients with symptomatic or progressive MTC. Patients were randomized 1:1 to receive vandetanib 150 or 300 mg daily and followed for a maximum of 14 months (Part A), with the option to then enter an open-label phase (Part B) investigating vandetanib 100, 150, 200 and 300 mg daily doses. Efficacy was assessed in Part A, and safety and tolerability during Parts A and B up to 2 years post randomization. Eighty-one patients were randomized in Part A and 61 patients entered Part B, of whom 37 (60.7%) received 2 years of treatment. Overall, 25% of patients experienced an objective response (OR) at 14 months (OR rate, 0.29 (95% CI, 0.176-0.445) for 300 mg, and 0.20 (95% CI, 0.105-0.348) for 150 mg; one-sided P value approximately 0.43). The most common adverse events (AEs) included diarrhea, hypocalcemia, asthenia, QTc prolongation, hypokalemia and keratopathy, all at generally higher incidence with 300 vs 150 mg (Part A). Part B safety and tolerability was consistent with Part A. OR was observed with both vandetanib doses; the 300 mg dose showed a more favorable trend vs 150 mg as initial dose. Thus, for most patients, 300 mg vandetanib is the most appropriate starting dose; dose reductions to manage AEs and lower initial doses for patients with particular comorbidities can be considered.
KEYWORDS:
efficacy; medullary thyroid cancer; safety; vandetanib
85.
Int Forum Allergy Rhinol. 2019 May;9(5):514-521. doi: 10.1002/alr.22266. Epub 2018 Dec 12.
Alternaria-induced barrier dysfunction of nasal epithelial cells: role of serine protease and reactive oxygen species.
Abstract
BACKGROUND:
Upper airway barrier dysfunction has been associated with chronic rhinosinusitis and allergic rhinitis. Alternaria is commonly found in nasal secretion and plays a role in the pathogenesis of airway diseases. The aim of this study was to investigate the effects of Alternaria on the junctional complex of nasal epithelial cells.
METHODS:
Air-liquid interface nasal epithelial cultures from the inferior turbinate of septal surgery patients were stimulated with Alternaria alternate. Production of intracellular reactive oxygen species (ROS) and transepithelial resistance (TER) was measured. The expression of tight junction (TJ) and adherens junction (AJ) molecules was determined using real-time reverse transcriptase-polymerase chain reaction, Western blot analysis, and confocal microscopy. Protease activity in Alternaria was determined using protease inhibitors and heat inactivation.
RESULTS:
Alternaria enhanced the production of ROS and reduced the TER. Alternaria decreased the messenger RNA and protein expression of TJs (zonula occludens-1, occludin, and claudin-1), but did not influence the AJ molecule. When Alternaria was pretreated with serine protease inhibitor and heat inactivation, ROS, TER, and TJ molecule expression returned to their nonstimulated levels.
CONCLUSION:
Serine protease in Alternaria altered nasal epithelial barrier function. Intracellular ROS induced by Alternaria may influence the barrier function of nasal epithelial cells and enhance the inflammatory process of nasal mucosa.
© 2018 ARS-AAOA, LLC.
KEYWORDS:
Alternaria; adherence junction; nasal epithelial cell; protease; reactive oxygen species; tight junctions
86.
Head Neck. 2018 Dec;40(12):2606-2611. doi: 10.1002/hed.25334. Epub 2018 Nov 28.
Use of surgical sealant in the prevention of pharyngocutaneous fistula after total laryngectomy.
Abstract
BACKGROUND:
Pharyngocutaneous fistula is a major wound complication of total laryngectomy. Surgical sealants may be used to increase the strength and/or integrity of surgical repairs. The purpose of this study was to present our evaluation of the feasibility and utility of the application of sealant to the pharyngeal repair with the aim of reducing pharyngocutaneous fistula incidence.
METHODS:
This was a prospective single-blind randomized controlled study; patients undergoing primary total laryngectomy for advanced carcinoma of the larynx were randomized into control and treatment (albumin-polyaldehyde sealant applied to pharyngeal repair) groups. Relevant patient, disease, and management-related factors were recorded.
RESULTS:
Forty-five patients were included (23 controls and 22 who received treatments). No difference in the incidence of pharyngocutaneous fistula was observed between the 2 groups. No treatment-related complications occurred.
CONCLUSION:
Feasibility of application of an albumin-polyaldehyde surgical sealant to the pharyngeal repair was demonstrated, however, a pharyngocutaneous fistula-preventative effect was not observed. Larger animal and clinical studies are encouraged to clarify this finding.
© 2018 Wiley Periodicals, Inc.
KEYWORDS:
laryngectomy; pharyngocutaneous fistula; prophylactic; surgical sealant; tissue adhesive
87.
Head Neck. 2018 Dec;40(12):2664-2669. doi: 10.1002/hed.25453. Epub 2018 Nov 26.
Evaluating a shortened interpretation criterion for intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism: 5-minutes criterion in primary hyperparathyroidism and intraoperative algorithm.
Abstract
BACKGROUND:
Most criteria require a parathyroid hormone (PTH) decline of ≥50% within 10 minutes after excision of the gland during surgery for primary hyperparathyroidism. The aim was to evaluate a model allowing earlier prediction of cure.
METHODS:
One thousand eighteen patients with primary hyperparathyroidism were included. A ≥50% decline from baseline within 10 minutes after excision intraoperatively predicted complete removal of hypersecreting tissue. The data were reanalyzed regarding a criterion, requiring a ≥50% decline after 5 minutes. Based on the data and the present literature, an algorithm was created.
RESULTS:
Assay predicted cure in 854 patients (true-positive; 83.89%) after 10 minutes (false-positive [FP] in 13 patients; 1.52%). Nevertheless, only 14 (1.83%) showed persisting disease. According to the "5 minutes" criterion, 723 patients (71.02%) showed a ≥50% decline from baseline within 5 minutes and 10 (1.38%) patients had a FP decline (sensitivity 0.75, specificity 0.86).
CONCLUSION:
Using a modified criterion, surgery can be discontinued 5 minutes earlier in 71%.
© 2018 Wiley Periodicals, Inc.
KEYWORDS:
Vienna criterion; intraoperative parathyroid hormone monitoring; parathyroid surgery; primary hyperparathyroidism
88.
Head Neck. 2018 Dec;40(12):E100-E106. doi: 10.1002/hed.25392. Epub 2018 Nov 26.
Exceptional responses to pertuzumab, trastuzumab, and docetaxel in human epidermal growth factor receptor-2 high expressing salivary duct carcinomas.
Abstract
BACKGROUND:
Alterations in the human epidermal growth factor receptor-2 (HER2) pathway have been identified in a subset of salivary duct carcinomas. Dual HER2 inhibition with trastuzumab and pertuzumab has superior antitumor efficacy to trastuzumab monotherapy in HER2-positive breast cancer, yet its efficacy in HER2-positive salivary duct carcinoma is unknown.
METHODS:
We report 2 cases of exceptional responses of HER2-positive salivary duct carcinomas to dual HER2 blockade and docetaxel combination and their molecular characteristics.
RESULTS:
A 54-year-old man with recurrent metastatic HER2 expressing salivary duct carcinoma of the parotid gland after definitive concurrent chemoradiation achieved a complete response (CR) after 6 cycles of trastuzumab, pertuzumab, and docetaxel (TPH). A 42-year-old woman with HER2-positive salivary duct carcinoma of the parotid gland with bone and liver metastases had CR with TPH and remains in remission on maintenance trastuzumab and pertuzumab.
CONCLUSION:
Dual HER2 blockage resulted in CR in patients with HER expressing salivary duct carcinoma and warrants further evaluation in this patient population.
© 2018 Wiley Periodicals, Inc.
KEYWORDS:
dual blockade; human epidermal growth factor receptor 2 (HER2); pertuzumab; salivary duct carcinoma; trastuzumab
89.
Head Neck. 2018 Dec;40(12):2733-2748. doi: 10.1002/hed.25508. Epub 2018 Nov 26.
Diagnosis and treatment of oropharyngeal dysphagia after total laryngectomy with or without pharyngoesophageal reconstruction: Systematic review.
Abstract
BACKGROUND:
This systematic review qualitatively summarizes the current literature on diagnosis and treatment of oropharyngeal dysphagia (OD) after total laryngectomy (TLE).
METHODS:
Electronic databases PubMed, Embase, and the Cochrane Library were used. Two independent reviewers carried out the literature search and assessed the methodological quality of the included studies using a critical appraisal tool.
RESULTS:
Forty-four articles met the inclusion criteria. Of these, 35 studies were on diagnosis, four on therapy, and five on both diagnosis and treatment of OD following TLE. Study aims, swallowing-assessment methods, and main findings of the included studies were summarized and presented.
CONCLUSIONS:
The reviewers found heterogeneous outcomes and serious methodological limitations, which prevented us from pooling data to identify trends that would assist in designing best clinical practice protocols for OD following TLE. Further research should focus on several remaining gaps in our knowledge on diagnosis and treatment interventions for OD following TLE.
© 2018 The Authors. Head & Neck published by Wiley Periodicals, Inc.
KEYWORDS:
deglutition disorders; dysphagia; pharyngolaryngectomy; swallowing disorder; total laryngectomy
90.
Head Neck. 2018 Dec;40(12):2701-2703. doi: 10.1002/hed.25348. Epub 2018 Nov 26.
Operative technique: Lateral neck dissection.
91.
Head Neck. 2018 Dec;40(12):E107-E113. doi: 10.1002/hed.25438. Epub 2018 Nov 26.
Massive aneurysmal bone cyst of the skull base treated with denosumab.
Abstract
BACKGROUND:
Aneurysmal bone cysts are rare, benign expansile tumors most commonly involving long bones and vertebrae in patients younger than age 20. Skull base involvement is rare. Aneurysmal bone cysts shares radiological and histological features with other bone tumors, posing a diagnostic challenge.
METHODS/RESULTS:
We report the case of a 32-year-old man who presented with facial pain, epistaxis, and cranial neuropathies secondary to a massive tumor of the maxillary sinus and anterior skull base. The tumor was originally misdiagnosed as osteosarcoma. However, genomic analysis revealed a rearrangement in the USP6 gene, elucidating a diagnosis of primary aneurysmal bone cysts. The patient was treated with denosumab. Within 5 months, the patient was asymptomatic with CT showing ossification of the tumor.
CONCLUSIONS:
This case highlights (1) the utility of genomic analysis in aggressive bone tumors when the diagnosis is unclear and (2) the effectiveness of denosumab as a treatment for aneurysmal bone cysts when surgical resection is unfavorable.
© 2018 Wiley Periodicals, Inc.
KEYWORDS:
USP6 rearrangement; aneurysmal bone cyst; bone tumor; denosumab; skull base
92.
Head Neck. 2018 Dec;40(12):2565-2573. doi: 10.1002/hed.24856. Epub 2018 Nov 26.
Postoperative radiotherapy for T1/2N0M0 mucoepidermoid carcinoma positive for CRTC1/3-MAML2 fusions.
Okumura Y1,2, Murase T1, Saida K1,2, Fujii K1, Takino H1, Masaki A1, Ijichi K3, Shimozato K2, Tada Y4, Nibu KI5, Inagaki H1.
Abstract
BACKGROUND:
The National Comprehensive Cancer Network (NCCN) guidelines recommend considering postoperative radiotherapy (PORT) for completely resected T1/2N0M0 salivary mucoepidermoid carcinomas when they show tumor spillage, perineural invasion, or intermediate/high-grade histology. CRTC1/3-MAML2 fusions have been associated with a favorable clinical outcome.
METHODS:
Forty-seven T1/2N0M0 mucoepidermoid carcinoma cases positive for CRTC1/3-MAML2 fusions were completely resected and were not treated with PORT.
RESULTS:
Pathologically, none of the cases showed tumor spillage or perineural invasion. Cases with intermediate/high-grade histology numbered 9 (19%) to 26 (55%) with the currently used 3 different grading systems. During the follow-up (median 60 months), locoregional tumor recurrence occurred in 4 cases, which were treated with surgery alone. At the last follow-up (median 60 months; 7-160), all patients were alive with no evidence of disease.
CONCLUSION:
An excellent prognosis may be achieved without PORT in T1/2N0M0 mucoepidermoid carcinoma patients positive for CRTC1/3-MAML2 fusions when the tumors are completely resected without tumor spillage.
© 2018 Wiley Periodicals, Inc.
KEYWORDS:
CRTC1/3-MAML2; National Comprehensive Cancer Network (NCCN) guidelines; T1/2N0M0; mucoepidermoid carcinoma; postoperative radiotherapy
93.
Head Neck. 2018 Dec;40(12):2657-2663. doi: 10.1002/hed.25391. Epub 2018 Nov 22.
Diagnosis, anatomy, and electromyography profiles of 73 nonrecurrent laryngeal nerves.
Abstract
BACKGROUND:
The purpose of this work was to compare methods of detecting nonrecurrent laryngeal nerves (NRLNs).
METHODS:
Specificity and sensitivity were compared in three NRLN detection methods: CT, electromyography (EMG), and A-B point comparison.
RESULTS:
A total of 73 intraoperative pictures and 36 CT details of NRLNs are presented. Incidence of NRLN was 0.39%. Type I NRLN accounted for 50.7%, type IIA 45.2%, type IIB 4.1%. The NRLN median latency was 2.13 ms vs 3.00 ms median in an RLN control group (P < .001). When the threshold was set to 2.5 ms, EMG latency detection had 96.7% sensitivity and 91.6% specificity for detecting NRLN, and the A-B point comparison algrithm had 97.3% sensitivity and 92.5% specificity. Combining EMG latency detection with A-B point comparison achieved 100% sensitivity and specificity for detecting NRLN.
CONCLUSION:
This is the largest series of NRLN presented in the literature. Latency shorter than 2.50 ms combined with the A-B point comparison method is the ideal algorithm procedure for early NRLN identification.
© 2018 Wiley Periodicals, Inc.
KEYWORDS:
amplitude; anatomy; embryology; identification; latency; neuromonitoring; nonrecurrent laryngeal nerve
94.
Head Neck. 2018 Dec;40(12):2677-2684. doi: 10.1002/hed.25517. Epub 2018 Nov 20.
Gamma Knife radiosurgery for glomus tumors: Long-term results in a series of 30 patients.
Abstract
BACKGROUND:
Glomus tumors are rare and benign hypervascular tumors. Surgery represented the mainstay of their treatment, even if it has been associated with high morbidity and mortality rates. Recently, the treatment shifted to a multimodal approach and Gamma Knife radiosurgery represents one of the treatment options.
METHODS:
Authors retrospectively analyzed the clinical and radiological outcome of a series of patients who underwent Gamma Knife radiosurgery for glomus tumors.
RESULTS:
Thirty patients underwent Gamma Knife radiosurgery. Mean tumor volume was 7.69 cc (range 0.36-24.6). Mean tumor margin dose was 16 Gy (range 13-18). Median follow-up was of 91 months (mean 90; range 11-172). Overall clinical control rate was 100%; overall volumetric tumor control rate was 96.6%. Patients' and tumors' characteristics, treatment data, and outcome have been analyzed.
CONCLUSION:
Gamma Knife radiosurgery represents a safe and effective treatment for glomus tumors. Longer follow-up and larger cohort studies are needed to definitively outline the role of Gamma Knife radiosurgery for glomus tumors.
© 2018 Wiley Periodicals, Inc.
KEYWORDS:
Gamma Knife; chemodectoma; glomus tumor; radiosurgery; skull base
95.
Head Neck. 2018 Dec;40(12):2596-2605. doi: 10.1002/hed.25335. Epub 2018 Nov 17.
Prognostic factors and survival in adenoid cystic carcinoma of the sinonasal cavity.
Mays AC1, Hanna EY1, Ferrarotto R2, Phan J3, Bell D4, Silver N1, Mulcahy CF1, Roberts D1, Abdelmeguid ASA1, Fuller CD3, Frank SJ3, Raza SM5, Kupferman ME1, DeMonte F5, Su SY1.
Abstract
BACKGROUND:
Optimal treatment and prognostic factors affecting long-term survival in patients with sinonasal adenoid cystic carcinoma (ACC) have yet to be clearly defined.
METHODS:
We conducted a retrospective review of patients treated with curative intent from 1980-2015 at MD Anderson Cancer Center.
RESULTS:
One hundred sixty patients met inclusion criteria, including 8 who were treated with radiotherapy alone. Median follow-up time was 55 months. The 5-year overall survival (OS) and disease-free survival (DFS) rates were 67.0% and 49.0%, respectively. The 10-year OS and DFS rates were 44.8% and 25.4%, respectively. Factors that portended for poor survival on multivariate analysis were recurrent disease, any solid type histology, epicenter in the sinus cavity, the presence of facial symptoms, or the original disease not treated with surgery. There was no association between surgical margin status or nodal status and survival.
CONCLUSION:
In this large cohort of patients with sinonasal ACC with extended follow-up, long-term survival is better than reported in prior literature. Future research should target patients with adverse risk factors.
© 2018 Wiley Periodicals, Inc.
KEYWORDS:
adenoid cystic carcinoma; perineural invasion; prognostic factors; sinonasal tumor; skull base surgery
96.
Head Neck. 2018 Dec;40(12):2642-2647. doi: 10.1002/hed.25370. Epub 2018 Nov 14.
Increased salivary AKR1B10 level: Association with progression and poor prognosis of oral squamous cell carcinoma.
Abstract
BACKGROUND:
Aldo-keto reductase family 1 member B10 (AKR1B10) expression in oral squamous cell carcinoma (OSCC) tissue specimens is correlated with the progression and prognosis of OSCC.
METHODS:
Saliva samples were obtained from 35 normal controls and 86 patients with OSCC before cancer surgery. The AKR1B10 levels were determined using enzyme-linked immunosorbent assay (ELISA).
RESULTS:
The mean salivary AKR1B10 levels were significantly higher in the patients with OSCC than in the normal controls (P < .001). Higher salivary AKR1B10 levels were significantly associated with larger tumor size, more advanced clinical stage, and areca quid chewing habit. Patients with OSCC with a higher salivary AKR1B10 level (>646 pg/mL) had a significantly poorer survival than those with a lower (≤646 pg/mL) salivary AKR1B10 level (P = .026).
CONCLUSION:
The salivary AKR1B10 level may be a promising biomarker for screening high-risk patients with OSCC and monitoring the progression of OSCC.
© 2018 Wiley Periodicals, Inc.
KEYWORDS:
AKR1B10; areca quid; oral squamous cell carcinoma; prognosis; saliva
97.
Head Neck. 2018 Dec;40(12):2621-2632. doi: 10.1002/hed.25355. Epub 2018 Nov 13.
Patterns of failure after postoperative intensity-modulated radiotherapy for locally advanced buccal cancer: Initial masticator space involvement is the key factor of recurrence.
Lin YW1,2, Chen YF3, Yang CC1,2, Ho CH4,5, Wu TC6, Yen CY7, Lin LC1, Lee SP8, Lee CC9,10,11,12,13, Tai MH2.
Abstract
BACKGROUND:
The purpose of this study was to determine failure patterns and clinicopathologic prognostic factors in patients with locally advanced buccal cancer after postoperative intensity-modulated radiotherapy (IMRT).
METHODS:
Eighty-two patients with locally advanced (American Joint Committee on Cancer [AJCC] stage III/IV) buccal cancer who underwent surgery followed by postoperative IMRT between January 2007 and October 2012 were retrospectively analyzed.
RESULTS:
Eighteen patients had local recurrences as the first recurrent site and 11 had supramandibular notch recurrences; the majority of recurrences were classified as marginal failures. The median time from the first local or regional recurrence to death was 5.9 months. In multivariate analyses of survivals, the initial masticator space involvement was the most important prognostic factor. Masticator space involvement, N classification, and maxillectomy were the significant prognostic predictors for supramandibular notch recurrences.
CONCLUSION:
Postoperative IMRT for buccal cancer should not include the surgical beds alone, rather, it should be based on the potential patterns of spread.
© 2018 Wiley Periodicals, Inc.
KEYWORDS:
adjuvant radiotherapy; buccal cancer; oral cavity cancer; patterns of failure; postoperative intensity-modulated radiotherapy (IMRT)
98.
Head Neck. 2018 Dec;40(12):2749-2756. doi: 10.1002/hed.25514. Epub 2018 Nov 2.
Melanotic neuroectodermal tumor of infancy of the jaw bones: Update on the factors influencing survival and recurrence.
Pontes FSC1, de Souza LL1, Uchôa DCC1, Joaquim AMC1, do Nascimento LS1, da Mata Rezende DDS2, Pontes HAR1.
Abstract
The aim of the present study was to integrate the available data published on melanotic neuroectodermal tumor of infancy (MNTI) of the jaw bones. An electronic search was undertaken in April 2018. Hundred forty-seven publications and 371 patients were included. The lesion was more prevalent in males and in the second to sixth months of life. The lesions mostly presented as a rapidly growing bluish swelling and the most commonly involved was the anterior maxilla. The mean follow-up was 51.1 months (range 1-408 months). Age (P ≤ .0001), location (P = .007), occurrence of lymph node metastasis (P ≤ .0001), treatment (P = .001), recurrence (P ≤ .0001), and distant metastasis (P = .0001) were independently associated with survival. Recurrence was significantly correlated with age (P = .0001), distant metastasis (P = .0001), and treatment (P = .0001). Patients older than 12 months, with lesions in the mandible, positive regional lymph node metastasis, treated with chemotherapy, recurrence, or distant metastasis presented the worst prognosis.
© 2018 Wiley Periodicals, Inc.
KEYWORDS:
bone lesion; jaw bones; melanotic neuroectodermal tumor of infancy; recurrence; survival
99.
Head Neck. 2018 Dec;40(12):2670-2676. doi: 10.1002/hed.25470. Epub 2018 Nov 2.
Efficacy and safety of lower extremity nerve blocks for postoperative analgesia at free fibular flap donor sites.
Abstract
BACKGROUND:
We evaluated the utility of combined femoral and common peroneal nerve blocks in patients undergoing free fibular flap-based oromandibular reconstruction.
METHODS:
Forty patients undergoing reconstructive surgeries with free fibular flaps were randomly divided into nerve block and control groups (NB and C). In group NB, both femoral and common peroneal nerve blocks with 0.33% ropivacaine were used. In group C, sham blocks were performed with saline. The primary outcomes were sufentanyl consumption during the 0- to 24-hour and 24-to 48-hour intervals and cumulative consumption during the 48-hour postoperative period.
RESULTS:
Sufentanyl consumption for the 0-to 24-hour interval and cumulative sufentanyl consumption were significantly lower in group NB than in group C. Moreover, more patients in group NB than in group C were satisfied with the pain management.
CONCLUSION:
Lower extremity nerve blocks reduce sufentanyl use and improve patient satisfaction when used for postoperative analgesia at the free fibular flap donor site.
© 2018 Wiley Periodicals, Inc.
KEYWORDS:
donor site; fibular flap; maxillofacial tumor; nerve block; postoperative analgesia
100.
Head Neck. 2018 Dec;40(12):2724-2732. doi: 10.1002/hed.25486. Epub 2018 Nov 2.
Oral and pharyngeal cancer risk associated with occupational carcinogenic substances: Systematic review.
Abstract
BACKGROUND:
Oral and pharyngeal cancers (OPC) represent the seventh most common type of cancer and the seventh leading cause of deaths by cancer worldwide. Few studies have assessed the occupational exposure risks associated with OPC and in many cases the results are conflicting. The aim of this study was to determine, through a systematic review, the association of OPC and exposure to different occupational carcinogenic substances.
METHODS:
The addressed focused question was "Is there an association of occupational carcinogenic substances with OPC?" PubMed, MEDLINE, EMBASE, and ISI Web of Science databases were searched between January 1995 up to and including July 2016 using the keywords "oral cancer," "pharyngeal cancer," "pharyngeal neoplasms," "oral neoplasms," "occupational disease," "occupational exposure," and "occupational risk factor" in various combinations. Letters to the Editor, review articles, case reports, and unpublished articles were excluded.
RESULTS:
Fourteen original articles were included. Majority of the studies were conducted in European countries and used a case-control design. The results showed a significant association between formaldehyde, wood dust, coal dust, asbestos, welding fumes, and risk of developing OPC, while marginal association was observed with metal and leather dust. No associated risk was observed for textile fibers.
CONCLUSION:
There is some evidence to suggest associations of occupational substances with OPC, particularly in the pharynx. Future well-designed studies are required to confirm or rule out with confidence the associated exposure risk of these substances.
© 2018 Wiley Periodicals, Inc.
KEYWORDS:
cancer; carcinogen; occupation; risk; systematic review
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