Otolaryngology

Otolaryngology

Case reportAbstract only

The etiology, pathogeneses, and treatment of objective tinnitus: Unique case series and literature review

Parsa P. Salehi, David Kasle, Sina J. Torabi, Elias Michaelides, Douglas M. Hildrew

In Press, Accepted Manuscript, Available online 5 April 2019

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Abstract

Abstract

We present two unique cases of myoclonus-induced objective tinnitus (OT), along with a comprehensive literature review on the topic. Primary goals include: explore the relationship between palatal myoclonus (PM) and middle ear myoclonus (MEM), highlight the embryologic, neurologic, and anatomical relationship between the involved peri-tubular muscles, exemplify the first case of OT which documents video evidence demonstrating the link between objective tinnitus and eustachian tube movement. Also, we discuss available treatment interventions and why they often do not fully resolve patients' symptoms. Finally we introduce a novel way to objectively quantify the severity of OT. Ultimately, our series hopes to inform future diagnostic and treatment guidelines.

select article Expression of vimentin (VIM) and metastasis-associated 1 (MTA1) protein in laryngeal squamous cell carcinoma are associated with prognostic outcome of patients

Research articleAbstract only

Expression of vimentin (VIM) and metastasis-associated 1 (MTA1) protein in laryngeal squamous cell carcinoma are associated with prognostic outcome of patients

Sotirios Karamagkiolas, Ioannis Giotakis, Efthimios Kyrodimos, Evangelos I. Giotakis, ... Andreas M. Lazaris

In Press, Accepted Manuscript, Available online 3 April 2019

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Abstract

Abstract

Purpose

Laryngeal squamous cell carcinoma (LSCC), a common type of head and neck cancer, is associated with high rates of metastasis and recurrence. In this study, we investigated the potential combinatorial prognostic value of NOTCH1, Vimentin (VIM), and Metastasis-associated 1 (MTA1) protein in LSCC, using immunohistochemistry.

Materials and methods

Tissue specimens from 69 patients with LSCC were immunohistochemically evaluated for the protein expression of NOTCH1, VIM, and MTA1. Then, biostatistical analysis was performed, in order to assess the prognostic value of the expression of each one of these proteins.

Results

NOTCH1 expression status was not a significant prognosticator in LSCC, as shown in Kaplan-Meier survival analysis. On the contrary, both VIM and MTA1 seem to have an important prognostic potential, independently of TNM staging and histological grade of the tumor. In fact, positive VIM expression was shown to predict patients' relapse and poor outcome regarding patients' overall survival, in contrast with MTA1, the positive expression of which predicts higher disease-free survival (DFS) and overall survival (OS) rates in LSCC.

Conclusions

VIM and MTA1 constitute potential tumor biomarkers in LSCC and could be integrated into a multiparametric prognostic model. Undoubtedly, their prognostic value needs further validation in larger cohorts of LSCC patients.

select article Spontaneous cervical chyle fistula: A case report

Case reportAbstract only

Spontaneous cervical chyle fistula: A case report

Swathi Appachi, Joseph B. Meleca, Paul C. Bryson

In Press, Accepted Manuscript, Available online 2 April 2019

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Abstract

Abstract

Background

Cervical chylous fistulae are rare complications usually occurring from iatrogenic injury to the thoracic duct. There have been no reported cases of spontaneous chyle leaks in surgical naïve necks.

Methods

Case report.

Results

A 50 year-old female presented with progressive left neck swelling without fever, dyspnea, or dysphagia. Imaging demonstrated extensive infiltrative changes of the left neck with retropharyngeal fluid extending into strap musculature and the mediastinum. Flexible laryngoscopy revealed posterior pharyngeal wall edema. Differential diagnosis included abscess versus necrotizing fasciitis. Broad-spectrum antibiotics were initiated and she was taken to the OR for neck exploration. Intra-operatively, milky fluid was present around the carotid sheath and in the retropharyngeal space. Fluid analysis demonstrated chylomicrons and triglycerides >2400 mg/dL. Repeat imaging of the neck, chest, and abdomen did not reveal malignancy or obstructive masses. A lymphangiogram showed dilated lymphatic vessels near the cervical thoracic duct. On post-operative day four, the patient was taken back to the OR for thoracic duct ligation and biopsy of nearby tissue. Pathology demonstrated benign lymph nodes with dilated sinusoids. A low-fat diet was started and she was discharged home on hospital day nine. She has followed up regularly with no signs of recurrence.

Conclusion

A cervical chylous fistula usually results from iatrogenic injury to the thoracic duct. To our knowledge, this is the first reported case of a spontaneous cervical chyle leak.

select article Does cervical range of motion affect the outcomes of canalith repositioning procedures for posterior canal benign positional paroxysmal vertigo?

Research articleAbstract only

Does cervical range of motion affect the outcomes of canalith repositioning procedures for posterior canal benign positional paroxysmal vertigo?

Salvatore Martellucci, Giuseppe Attanasio, Massimo Ralli, Vincenzo Marcelli, ... Andrea Gallo

In Press, Accepted Manuscript, Available online 2 April 2019

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Abstract

Abstract

Purpose

Canalith repositioning procedure (CRP) for posterior canal benign positional paroxysmal vertigo (BPPV), also known as Epley maneuver, is a common procedure for the treatment of BPPV. This maneuver entails flexion, extension and rotation of the patient's neck. This study aims to investigate the impact of cervical range of motion (C-ROM) on CRP efficacy.

Materials and methods

The study included 47 patients with posterior canal BPPV treated by CRP. The procedure was considered successful if vertigo and nystagmus disappeared at the post-treatment evaluation. If CRP resulted ineffective, it was repeated up to three times per session. C-ROM was measured at BPPV diagnosis before treatment. Patients were followed up for 30 days.

Results

The first CRP was successful in 29 patients (61.7%), while it was ineffective in 18 patients (38.3%) requiring multiple repositioning maneuvers. Patients who needed two or more CRP showed lower C-ROM in extension (p = .003) and flexion (p = .042), and earlier recurrences (p = .006). Univariate regression analysis showed that lower cervical extension was significantly associated with the failure of the first CRP (OR: 0.899, 95% CI 0.831–0.973, p = .008).

Conclusions

Our data suggest that a reduced C-ROM can require multiple CRPs to successfully treat BPPV and increase the risk of early recurrences.

select article Total vs hemithyroidectomy for intermediate risk papillary thyroid cancer: A 23 year retrospective study in a tertiary center

Research articleAbstract only

Total vs hemithyroidectomy for intermediate risk papillary thyroid cancer: A 23 year retrospective study in a tertiary center

Kwan Pok Tsui, Wai Yin Kwan, Tam Lin Chow

In Press, Accepted Manuscript, Available online 2 April 2019

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Abstract

Abstract

Background

There is much debate in the literature over the extent of surgery for patients with intermediate risk papillary thyroid cancer. We herein report our results in a local tertiary hospital.

Method

We identify from our database patients with papillary thyroid cancer who underwent surgery in our hospital and were stratified to be of intermediate risk from the GAMES stratification system. Patients' demographic data, surgical and pathological details were recorded. Primary end points were disease specific survival (DSS) and recurrence free survival (RFS).

Results

From January 1993 to December 2016, 231 patients with papillary thyroid cancer underwent surgery of which 137 (59%) were of intermediate risk. 45 (33%) patients had hemithyroidectomy and 92 (67%) patients had total thyroidectomy. In the total thyroidectomy group, patients had a higher tumor (T) (p value = 0.009) and nodal (N) staging (p value = 0.001). They were also predicted to have a higher risk of recurrence according to the American Thyroid Association (ATA) classification (p value = 0.005). The 5 year DSS in both groups were 100%. The 5 year RFS in the total thyroidectomy and hemithyroidectomy groups were 92% and 100% respectively and were significantly different by the log rank test (p value = 0.02). The median follow up time was 54 months (range 4–276 months).

Conclusion

The 5 year survival in intermediate risk papillary thyroid cancer is favorable. Hemithyroidectomy is an acceptable choice of operation in intermediate risk patients with a better risk profile.

select article Translation and validation of the Parotidectomy Outcome Inventory 8 (POI-8) to Spanish

Research articleAbstract only

Translation and validation of the Parotidectomy Outcome Inventory 8 (POI-8) to Spanish

Carlos Miguel Chiesa-Estomba, Elizabeth Ninchritz, Teresa Rivera Schmitz, Jose Angel González-García, ... Xabier Altuna-Mariezcurrena

In Press, Accepted Manuscript, Available online 2 April 2019

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Abstract

Abstract

Introduction

There are >400 million of native Spanish speakers around the world, being the second most spoken language in regard to the number of native speakers. For this reason, a valid questionnaire to access the quality of our patients after parotidectomy is necessary.

Material and methods

Validation and cross-cultural adaptation of the POI-8 questionnaire to the Spanish language. Internal consistency of Sp-POI 8 measured with Cronbach α.

Results

35 patients met the inclusion criteria during the mentioned period. Mean age was 59 ± 15,37 (Min: 18/Max: 87). 20 patients (57,1%) were male and 15 (42,9%) were female. Internal consistency with Cronbach α was 0.868. The intraclass correlation coefficient was 0.830 [CI] (95%: 0,791–925). Hypoesthesia was the most severely weighted problem (0,91) and xerostomia was the second (0,89). However, the high score was for fear of revision surgery (1,26).

Conclusion

The Spanish Language is the second most spoken language with regard to the number of native speakers and the Sp-POI 8 translation represents a valid option for the Spanish-speaking medical community, from which a large number of patients can benefit.

select article Sex-specific enlarged vestibular aqueduct morphology and audiometry

Research articleAbstract only

Sex-specific enlarged vestibular aqueduct morphology and audiometry

Jeremy Ruthberg, Mustafa S. Ascha, Armine Kocharyan, Amit Gupta, ... Todd D. Otteson

In Press, Accepted Manuscript, Available online 29 March 2019

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Abstract

Abstract

Objective

Enlargement of the vestibular aqueduct (EVA) is one of the most common congenital malformations in pediatric patients presenting with sensorineural or mixed hearing loss. The relationship between vestibular aqueduct (VA) morphology and hearing loss across sex is not well characterized. This study assesses VA morphology and frequency-specific hearing thresholds with sex as the primary predictor of interest.

Materials and methods

A retrospective, longitudinal, and repeated-measures study was used. 47 patients at an academic tertiary care center with hearing loss and a record of CT scan of the internal auditory canal were candidates, and included upon meeting EVA criteria after confirmatory measurements of vestibular aqueduct midpoint and operculum widths. Audiometric measures included pure-tone average and frequency-specific thresholds.

Results

Of the 47 patients (23 female and 24 male), 79 total ears were affected by EVA; the median age at diagnosis was 6.60 years. After comparing morphological measurements between sexes, ears from female patients were observed to have a greater average operculum width (3.25 vs. 2.70 mm for males, p = 0.006) and a greater average VA midpoint width (2.80 vs. 1.90 mm for males, p = 0.004). After adjusting for morphology, male patients' ears had pure-tone average thresholds 17.6 dB greater than female patients' ears (95% CI, 3.8 to 31.3 dB).

Conclusions

Though females seem to have greater enlargement of the vestibular aqueduct, this difference does not extend to hearing loss. Therefore, our results indicate that criteria for EVA diagnoses may benefit from re-evaluation. Further exploration into morphological and audiometric discrepancies across sex may help inform both clinician and patient expectations.

select article Clinical and audiometric outcomes of palisade cartilage myringoplasty under local anesthetic in an office setting

Research articleAbstract only

Clinical and audiometric outcomes of palisade cartilage myringoplasty under local anesthetic in an office setting

Nael M. Shoman

In Press, Accepted Manuscript, Available online 29 March 2019

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Abstract

Abstract

Objective

Assess clinical and functional outcomes of a modified palisade cartilage-perichondrium graft myringoplasty under local in an office setting.

Study design

Retrospective case series.

Setting

Tertiary care facility.

Patients

Patients with a tympanic membrane perforation presenting between March 2013 and October 2017. Inclusion criteria included age ≥ 7 years, entire perforation margin visualized through a transcanal view, and the ability to lie supine for up to 45 min. Exclusion criteria included a conductive hearing loss larger than expected, and presence of active infection.

Intervention

In-office modified myringoplasty technique under local anesthesia without sedation.

Main outcome measures

Complete perforation closure rate and audiometric outcomes.

Results

250 patients underwent the procedure, of whom 13 had bilateral sequential procedures (total 263 ears). Of those, 197 were primary and 66 revision. Average age was 46.3 years. Perforation sizes were categorized as small (32), moderate (109), large (78), and subtotal (44). Complete perforation closure was evident in 219 of the 250 cases (88%). Preoperative mean air pure tone average (PTA) was 56.7 dB and mean bone PTA was 27.5 dB (pre-operative ABG 29.2 dB). AC-PTA significantly improved to 35.0 dB (p < 0.0001), and ABG to 9.6 dB (p < 0.0001). Only subtotal perforations showed a statistically significant negative relationship with outcome (p = 0.04).

Conclusion

The modified palisade cartilage-perichondrium graft myringoplasty under local anesthetic is a highly successful procedure well tolerated by adult and pediatric patients with variable perforation sizes. This may have significant potential patient benefits, as well as cost savings to the health care system.

select article Cricoarytenoid joint abscess associated with rheumatoid arthritis

Case reportAbstract only

Cricoarytenoid joint abscess associated with rheumatoid arthritis

Megan J. Foggia, Henry T. Hoffman

In Press, Corrected Proof, Available online 28 March 2019

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Abstract

Abstract

Cricoarytenoid joint arthritis is an uncommon manifestation of rheumatoid arthritis. We encountered a 68-year-old woman with rheumatoid arthritis who presented with odynophagia, dysphagia, and progressive shortness of breath. Examination findings showed diminished mobility of the left vocal cord and right arytenoid swelling associated with an immobile right vocal cord. Computed tomography (CT) imaging identified a ring-enhancing lesion of the right lateral cricoarytenoid joint. Microdirect laryngoscopy with drainage of the cricoarytenoid abscess and tracheotomy were performed. Development of a laterally based cricoarytenoid joint abscess is identified as a complication of chronic rheumatoid arthritis with successful management described.

select article Delayed laryngeal implant infection and laryngocutaneous fistula after medialization laryngoplasty

Case reportAbstract only

Delayed laryngeal implant infection and laryngocutaneous fistula after medialization laryngoplasty

Joseph B. Meleca, Paul C. Bryson

In Press, Corrected Proof, Available online 27 March 2019

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Abstract

Abstract

Background

Medialization laryngoplasty is a common procedure for voice rehabilitation in patients with unilateral vocal fold paralysis. Complications are uncommon and delayed infections involving implants are rare. We report a delayed infectious complication following an animal scratch resulting in a laryngocutaneous fistula.

Methods

Case report.

Results

A 73-year-old female underwent a successful and uneventful medialization laryngoplasty for idiopathic unilateral vocal fold paralysis using a silastic implant. More than one year after surgery, she presented with an anterior neck infection following an animal scratch with CT neck findings of a left strap muscle abscess. After incision and drainage, cultures grew methicillin-resistant Staphylococcus aureus. Despite culture-directed antibiotic therapy, the neck continued to drain persistently. Laryngoscopy with stroboscopy revealed a medialized vocal fold with no obvious granulation tissue and normal mucosal pliability.

The patient underwent neck exploration revealing a laryngocutaneous fistula. Thus, both the fistulous tract and implant were removed. The wound was closed with a strap muscle advancement into the laryngoplasty window. One month after surgery and antibiotics, the patient had no signs of recurrent neck infection, with a well-healing wound and stroboscopic findings of complete glottic closure, symmetric vocal fold oscillation and acceptable phonation with mild supraglottic compression.

Conclusions

Delayed complications of medialization laryngoplasty are rarely reported. This case demonstrates a delayed infection of a laryngeal implant after an animal scratch requiring implant removal, local tissue reconstruction, and culture-directed antibiotic therapy.

select article Conservative thyroidectomy for papillary thyroid microcarcinoma

Research articleAbstract only

Conservative thyroidectomy for papillary thyroid microcarcinoma

Hyun Joo Nahm, Sung Jun Choi, Young Chang Lim

In Press, Corrected Proof, Available online 21 March 2019

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Abstract

Abstract

Objective

According to American Thyroid Association (ATA) guideline, thyroid lobectomy is recommended for the management of papillary thyroid microcarcinomas (PTMC) with a diameter lesser than 1 cm. However, this procedure is associated with a risk of potential complications such as vocal cord palsy. Thus, we considered the applicability of conservative thyroidectomy, involving partial removal of the thyroid cancer lesion, not the entire ipsilateral thyroid lobe.

Methods

A retrospective analysis of all PTMC patients who underwent conservative thyroidectomy at Konkuk University Hospital between August 2008 and February 2014 was performed. Oncologic results of these patients along with the incidence of postoperative complications were evaluated. Seventy-nine patients who underwent conservative thyroidectomy for the treatment of PTMC were enrolled in the present study.

Results

Four of the 79 patients (5.0%) showed recurrence, 2 local (2.5%) and 2 regional (2.5%), respectively. All of these patients consequently underwent surgery alone and were salvaged. Temporary postoperative complications such as vocal cord palsy and hypocalcemia developed in 1 and 1 case, respectively, but completely recovered over time.

Conclusions

Conservative thyroidectomy is an oncologically and functionally safe procedure for surgical treatment of PTMC and can be considered as an alternative to thyroid lobectomy for the surgical management of PTMC.

select article Histopathologic analysis in chronic rhinosinusitis: Impact on quality of life outcomes

Research articleAbstract only

Histopathologic analysis in chronic rhinosinusitis: Impact on quality of life outcomes

Feng Wang, Yang Yang, Qihan Wu, Haihong Chen

In Press, Corrected Proof, Available online 21 March 2019

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Abstract

Abstract

Objective

This study investigates the impact of histopathologic parameters on quality of life outcomes in patients with chronic rhinosinusitis.

Setting

Hospital of Zhejiang University.

Study design

Retrospective analysis of collected data.

Subjects and methods

One hundred and twenty patients with chronic rhinosinusitis (CRS) who underwent endoscopic sinus surgery were recruited. Clinical features, CT evaluation, pre and postoperative SNOT-22 scores and histopathologic findings were collected. Tissue eosinophils and mucosal remodeling were analyzed relative to clinical features and outcomes 12 months postoperatively.

Results

Symptom improvement was seen for the entire population. Eosinophilic CRS had significantly worse preoperative and postoperative SNOT-22 scores than non- eosinophilic CRS. Symptom improvement in eosinophilic CRS after surgery was less than that of non-eosinophilic CRS. There was no significant association between preoperative and postoperative SNOT-22 scores and remodeling markers. However, patients with basement membrane thickening showed less reductions of SNOT-22 score postoperatively.

Conclusions

Presence of mucosal eosinophilia and basal membrane thickening appear to be the main factors adversely affect the symptom control of surgical intervention. Routine histopathology analysis can provide meaningful information for prognostication of surgical outcome.

select article Vestibulotoxicity in a patient without renal failure after inhaled tobramycin

Case reportAbstract only

Vestibulotoxicity in a patient without renal failure after inhaled tobramycin

Adam C. Kaufman, Steven J. Eliades

In Press, Corrected Proof, Available online 19 March 2019

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Abstract

Abstract

Aminoglycoside antibiotics have a long history of use in the control of gram-negative bacterial infections, but their systemic use has been complicated by known ototoxicity and nephrotoxicity. Because of the utility of these medications in patients with frequent pulmonary infections, there has been a move towards the use of inhaled agents, in particular tobramycin, due to a lower rate of systemic complications. Inhaled tobramycin is generally consider to be safe from otologic complications, with only two previous reports of ototoxicity, both in patients who had underlying chronic renal disease. Here we present the first case of a patient developing isolated vestibular toxicity, without associated hearing loss or evidence of renal insufficiency, in a patient receiving inhaled tobramycin. This is an extremely rare complication of an inhaled aminoglycoside and underscores the importance of careful monitoring despite perceived safety.

select article Transdermal lidocaine as treatment for chronic subjective tinnitus: A pilot study

Research articleAbstract only

Transdermal lidocaine as treatment for chronic subjective tinnitus: A pilot study

Daniel C. O'Brien, Aaron D. Robinson, Nancy Wang, Rodney Diaz

In Press, Corrected Proof, Available online 18 March 2019

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Abstract

Abstract

Objective

To assess the efficacy of transdermal lidocaine as a treatment for chronic subjective tinnitus as measured by the Tinnitus Functional Index (TFI).

Study design

Pilot, prospective efficacy trial.

Setting

Tertiary care hospital.

Patients

Men and women, over the age of 18 with chronic subjective tinnitus for >6 months.

Intervention

Daily application of commercially available transdermal lidocaine patch.

Outcome measure

Change in the TFI.

Results

The average pre-treatment TFI score was 56.2. After 1 month the average TFI decreased to 41 (p < 0.05). The scores dropped to 34 and 35 after 2 and 3 months of treatment respectively. Despite improvement in symptoms of tinnitus, most patients did not continue the study after the first month, dropping out due to the size, discomfort, and appearance of the lidocaine patch, failure to follow-up and lack of perceived benefit from treatment.

Conclusions

In this preliminary study, 5% transdermal lidocaine appears to be a potential treatment for chronic subjective tinnitus. The majority of subjects who completed 1 month of treatment had clinically significantly improved tinnitus. These findings are confounded however by the small sample size and significant drop out rate.

select article PEAK PlasmaBlade versus monopolar electrocautery tonsillectomy in adults: A prospective double-blinded randomized controlled trial

Research articleAbstract only

PEAK PlasmaBlade versus monopolar electrocautery tonsillectomy in adults: A prospective double-blinded randomized controlled trial

Alvin Tan Kah Leong, Sanjay Ganhasan, Peter Lu Kuo Sun, Yuen Heng Wai, ... Chan Yiong Huak

In Press, Accepted Manuscript, Available online 18 March 2019

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Abstract

Abstract

Objective

To evaluate the efficacy and compare postoperative pain and recovery following PEAK PlasmaBlade and monopolar electrocautery tonsillectomy in adults.

Study design

Prospective double-blinded randomized controlled trial.

Methods

Fifty-eight patients were recruited and randomized into 2 groups: PEAK PlasmaBlade (n = 29) or monopolar electrocautery (n = 29) tonsillectomy. Postoperative pain, complications, patient satisfaction, number of tablets of analgesia taken and days taken to return to soft diet, normal diet, normal activities and achieve pain-free swallowing were compared and analysed, with the aid of a pain diary given to patients. Statistical analysis was performed with SPSS 13.0 with statistical significance set at P < 0.05.

Results

Patients in the PEAK PlasmaBlade group were able to achieve pain-free swallowing in a shorter time compared to the electrocautery group (13.28 versus 15.76 days, P = 0.035). Patients were also more satisfied with PEAK PlasmaBlade tonsillectomy (P = 0.046). No significant differences in the incidence of postoperative haemorrhage, daily visual analog score for pain, number of tablets of analgesia taken and time taken to return to soft diet, normal diet and activities were seen for both groups.

Conclusions

This study showed that PEAK PlasmaBlade tonsillectomy has a faster recovery period in terms of time taken to achieve pain-free swallowing and may offer advantages when compared to monopolar electrocautery tonsillectomy.

Level of evidence

1b.

select article Mild hypothermia is associated with improved outcomes in patients undergoing microvascular head and neck reconstruction

Research articleAbstract only

Mild hypothermia is associated with improved outcomes in patients undergoing microvascular head and neck reconstruction

Benjamin M. Laitman, Yue Ma, Bryan Hill, Marita Teng, ... Brett A. Miles

In Press, Corrected Proof, Available online 16 March 2019

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Abstract

Abstract

Objective

Microvascular free tissue transfer has become the standard for reconstruction for large defects. With long operative times and an increased surface area exposed, transient hypothermia is common, but it is unclear how this impacts surgical outcomes. This study evaluated the impact of core body temperature on free tissue flap outcomes in patients undergoing microvascular reconstruction.

Study design

Retrospective data analysis.

Setting

Mount Sinai Hospital; NYC, NY; 2007–2016.

Subjects and methods

Demographic information, mean/minimum/maximum body temperatures, and the presence of flap complications (venous thrombosis, arterial insufficiency, flap death, wound infection/dehiscence, fistula, chyle leak, hematoma/seroma) of 519 free tissue transfer patients were documented. Binomial logistic regression was used to examine associations between the presence of flap complications and mean temperature. Statistical analysis used SPSS, with p-values ≤0.05 deemed statistically significant.

Results

393 soft-tissue and 125 osteocutaneous flaps were included. 19.8% (n = 103) patients had the presence of ≥1 flap complication, while 80.2% (n = 416) did not. Average temperature for all patients was 36.12 ± 0.84 °C, with minimum at 34.43 ± 0.97 °C and maximum at 37.24 ± 1.23 °C. After controlling for several factors including: tumor stage, radiation, diabetes, BMI, age, sex, and flap type, there was a significant association between flap complications and mean intraoperative temperature (Exp(B) = 1.559, p = 0.004).

Conclusion

Higher intraoperative temperatures were associated with worse outcomes. A mild relative hypothermia may improve flap outcomes in this population. This represents the largest study to date evaluating the impact of intraoperative temperature on free tissue transfer outcomes.

select article Angiolymphoid hyperplasia with eosinophilia of the external ear

Case reportAbstract only

Angiolymphoid hyperplasia with eosinophilia of the external ear

Brian C. Deutsch, Zachary G. Schwam, Vivian Z. Kaul, George B. Wanna

In Press, Corrected Proof, Available online 12 March 2019

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Abstract

Abstract

Herein we present the rare case of angiolymphoid hyperplasia with eosinophilia of the external ear treated by surgical resection and full-thickness skin graft. Current diagnosis and management options are reviewed.

select article Thyroid cancer in patients undergoing surgery for hyperthyroidism

Research articleNo access

Thyroid cancer in patients undergoing surgery for hyperthyroidism

Yogesh More, Aly Bernard Khalil, Huda Mustafa, Manjiri Gupte, ... Shaikh Irfan Basha

In Press, Accepted Manuscript, Available online 11 March 2019

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select article Seed and soil? - Pharyngeal Merkel cell carcinoma after radiotherapy for laryngeal squamous cell carcinoma

Case reportOpen access

Seed and soil? - Pharyngeal Merkel cell carcinoma after radiotherapy for laryngeal squamous cell carcinoma

Monica K. Rossi, D. Anand Rajan Kanagasabapathy, Henry T. Hoffman

In Press, Corrected Proof, Available online 9 March 2019

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Abstract

Abstract

Merkel cell carcinoma (MCC) is a neuroendocrine cutaneous malignancy that may present as metastatic disease without a known primary site but, most commonly originates in the sun-exposed skin of the head, neck, and extremities. We present a 66-year-old male treated with chemo-radiation for T3N2cM0 laryngeal squamous cell carcinoma (SCCa) six years before he was diagnosed with MCC isolated to the radiated laryngopharynx. Mucosal MCC is rare and radiation-induced MCC has been hypothesized to occur in previously radiated tissue but, never before to the laryngopharynx. Implications regarding cancer biology and management is focused with discussion on relevant advances in pathologic assessment and immunotherapy.

select article A systematic review of the nasal septal turbinate: An overlooked surgical target

Review articleAbstract only

A systematic review of the nasal septal turbinate: An overlooked surgical target

William J. Moss, Farhoud Faraji, Aria Jafari, Adam S. DeConde

In Press, Accepted Manuscript, Available online 4 March 2019

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Abstract

Abstract

Objective

The nasal septal turbinate (NST) is a conspicuous structure located in the anterior nasal cavity that impacts the internal nasal valve. Its structure and function is often thought to be poorly characterized, and it is rarely addressed surgically. The authors perform a systematic review in an attempt to synthesize what has been learned of this structure and to evaluate its potential as a treatment target.

Methods

A query of the Medline, Embase, Web of Science and Cochrane databases was undertaken in search of studies evaluating the NST. This qualitative systematic review was performed in accordance with PRISMA guidelines. Study quality and risk of bias were assessed with established criteria.

Results

Of the initial 1069 hits from the four databases, 16 articles were ultimately included in the review, which varied in quality and risk of bias. The included articles consisted predominantly of radiographic and histopathologic studies. Four studies evaluated NST treatment outcomes. The NST represents a fusiform-shaped region of erectile tissue, similar in structure and function to that of the turbinates. Preliminary treatment outcomes suggest the NST represents an important surgical target in nasal airway surgery.

Conclusion

When evaluating nasal obstruction patients, surgeons should assess the NST and consider addressing it surgically.