Microvascular free tissue transfer and cochlear implants: A case series and literature review.
Lindquist NR1, Vinh DB1, Appelbaum EN1, Vrabec JT2, Huang AT1.
Author information
1
Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.
2
Department of Otolaryngology, Houston Methodist Hospital, Houston, Texas, U.S.A.
Abstract
OBJECTIVE:
The use of microvascular free tissue transfer (MVFTT) for defects of the scalp and lateral temporal bone in patients with cochlear implants (CI) is uncommon. Herein, we report our experience with the utility, indications, and outcomes for MVFTT in patients with cochlear implants.

METHODS:
A retrospective review of patients at our institution from September 2016 to December 2017 identified subjects with coexistent cochlear implant and ipsilateral MVFTT of the lateral temporal bone or scalp. Information including demographics, indication for MVFTT, timing of CI and MVFTT, donor site, and previous radiation to the head and neck was collected. To assess the current literature on MVFTT in CI patients, a MEDLINE search was performed using key search terms.

RESULTS:
Two patients with cochlear implants and MVFTT of the ipsilateral temporal bone or scalp were identified. One patient underwent MVFTT for advanced device extrusion with stable audiometric parameters rather than locoregional reconstruction or device explantation. The second patient had primary cochlear implantation at oncologic lateral temporal bone resection (LTBR) and MVFTT for locally advanced squamous cell carcinoma and concurrent profound sensorineural hearing loss (SNHL). A literature review identifies MVFTT as an option for advanced device extrusion, treatment of osteoradionecrosis, and reconstruction after primary oncologic surgery.

CONCLUSION:
MVFTT is an important reconstructive tool for patients with functional, exposed cochlear implants. Cochlear implantation for severe to profound SNHL should be considered at the time of primary oncologic surgery and MVFTT of the lateral temporal bone or scalp.

LEVEL OF EVIDENCE:
IV Laryngoscope, 2019.

© 2019 The American Laryngological, Rhinological and Otological Society, Inc.

KEYWORDS:
Microvascular; cochlear implant; extrusion; free flap; free tissue transfer

PMID: 31654455 DOI: 10.1002/lary.28300
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Select item 31654451
22.
J Clin Pharm Ther. 2019 Oct 25. doi: 10.1111/jcpt.13049. [Epub ahead of print]
EMR quantity autopopulation removal on hospital discharge prescribing patterns: Implications for opioid stewardship.
Villwock JA1, Villwock MR1, New J1, Ator GA1.
Author information
1
Departments of Otolaryngology-Head and Neck Surgery and Clinical Informatics, University of Kansas Medical Center, Kansas City, Kansas.
Abstract
WHAT IS KNOWN AND OBJECTIVE:
Prescription drug stewardship is critical. Autopopulation(AP) of medication quantities may influence prescriber behaviour. We investigate the impact of AP removal(APR) on opioid prescribing.

METHODS:
Inpatient and emergency department(ED) discharges with opioid pain medications 2 years before and after APR were identified. Milligrams of morphine equivalents(MMEs) prescribed were recorded. Group comparisons were performed using Mann-Whitney U tests. Spearman's rho was used to analyse correlations between pain level and quantity of prescribed opioids. Mann-Kendall tests assessed trends in prescription patterns. Generalized estimating equations assessed trends in total quantity of prescribed MME.

RESULTS AND DISCUSSION:
A total of 53 608 patient encounters were included for analysis. In surgical patients, there were no trends in the frequency of prescriptions below, at or above the AP quantity pre-APR. Post-APR, there was a decrease in the percentage of prescriptions written for the AP quantity(τ = -.493, P = .001) and an increase in prescriptions for <30 tablets(τ = .468,P = .001). In non-operative patients, the pre-APR period was associated with a lower percentage of prescriptions >30 tablets and a greater percentage of prescriptions for <30 tablets. Interestingly, APR reversed this trend in prescriptions for >30 tablets and resulted in an increase in larger prescriptions. Multivariate analysis of the total prescribed quantity of MME found no significant trend across months for inpatients prior to and after APR (0.997, P = .065 and 1.003, P = .142; respectively). The ED model found a monthly downward trend in amount of prescribed MME prior to and after APR (0.986, P < .001 and 0.990, P < .001; respectively). In the inpatient setting, pain was positively correlated to discharge MME (ρ = .028, P < .001); with those reporting the highest pain receiving the greatest amount of opioids both pre- and post-APR. Interestingly, in the ED, this finding was negatively correlated (ρ = -.086, P < .001); with those reporting the lowest pain receiving the greatest amount of opioids both pre- and post-APR.

WHAT IS NEW AND CONCLUSIONS:
AP removal may have unintended consequences, such as increased prescriptions for greater quantities. To drive down prescription amounts, lower anchor values may be of more utility than APR. The poor correlation of pain values with prescribed medications warrants further investigation.

© 2019 John Wiley & Sons Ltd.

KEYWORDS:
autopopulate; autopopulate removal; autopopulation; opioid prescriptions; opioids; prescribing patterns

PMID: 31654451 DOI: 10.1111/jcpt.13049
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Select item 31654445
23.
Laryngoscope. 2019 Oct 25. doi: 10.1002/lary.28343. [Epub ahead of print]
Primary laryngectomy versus salvage laryngectomy: A comparison of outcomes in the chemoradiation era.
Sullivan CB1, Ostedgaard KL2, Al-Qurayshi Z1, Pagedar NA1, Sperry SM3.
Author information
1
Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A.
2
Department of Otolaryngology-Head and Neck Surgery, University of California at Davis, Sacramento, California, U.S.A.
3
Department of Otolaryngology-Head and Neck Surgery, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, U.S.A.
Abstract
OBJECTIVE:
To compare primary total laryngectomy (TL) versus salvage TL and analyze the functional outcomes, complications, recurrence rates, and survival.

STUDY DESIGN:
Case series with chart review.

SETTING:
Tertiary care center.

SUBJECTS AND METHODS:
Fifteen-year retrospective analysis of 208 patients with laryngeal squamous cell carcinoma treated by TL was completed. Outcome measures included survival, swallowing rehabilitation, speech rehabilitation, complications, and assessment of comorbidity. Survival estimates were analyzed with Kaplan-Meier method, and regression analysis utilized the Cox proportional hazards model.

RESULTS:
Alaryngeal speech was not significantly different between primary TL and salvage TL, 68% versus 82% (P = 0.14). Comparing primary and salvage TL, the perioperative complication rate was 33% versus 48% (P = 0.036). Thirty-six percent of primary TL patients had recurrence compared to 26% of salvage patients. Five-year overall survival rates between primary TL and salvage TL were not significantly different (P = 0.68). Comorbidity was an independent predictor of survival.

CONCLUSIONS:
Development of a functional voice was not significantly different between salvage and primary TL patients, with a majority achieving alaryngeal speech. Perioperative complications were more prevalent in the salvage TL group. Recurrence and survival are significantly associated with comorbidity status.

LEVEL OF EVIDENCE:
4 Laryngoscope, 2019.

© 2019 The American Laryngological, Rhinological and Otological Society, Inc.

KEYWORDS:
Larynx; outcomes; swallowing/dysphagia; voice

PMID: 31654445 DOI: 10.1002/lary.28343
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Select item 31654440
24.
Laryngoscope. 2019 Oct 25. doi: 10.1002/lary.28321. [Epub ahead of print]
Social determinants of health and oral cavity cancer treatment and survival: A competing risk analysis.
Agarwal P1, Agrawal RR1, Jones EA2, Devaiah AK1,3,4.
Author information
1
Boston University School of Medicine, Boston, Massachusetts, U.S.A.
2
Boston University Clinical and Translational Science Institute (CTSI), Boston, Massachusetts, U.S.A.
3
Department of Otolaryngology-Head and Neck Surgery, Neurological Surgery, and Ophthalmology, Boston Medical Center, Boston Medical Center, Boston, Massachusetts, U.S.A.
4
Boston University Institute for Health System Innovation and Policy, Boston, Massachusetts, U.S.A.
Abstract
OBJECTIVE:
Competing risk analysis is a powerful assessment for cancer risk factors and covariates. This method can better elucidate insurance status and other social determinants of health covariates in oral cavity cancer treatment, survival, and disparities.

STUDY DESIGN:
Retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database.

METHODS:
Data regarding patient characteristics, clinical stage at diagnosis, treatment, and survival data for 20,271 patients diagnosed with oral cavity cancer was extracted from the SEER 18 Regs Research Data including Hurricane Katrina Impacted Louisiana Cases from 1973 to 2014. All statistical analyses were performed using SAS 9.5 (SAS Institute Inc., Cary, NC). The Fine-Gray method for assessing impact, risk, and covariates was employed.

RESULTS:
Medicaid patients presented with later stage disease, larger tumor size, more distant metastases, and more lymph node involvement at diagnosis compared to insured patients. Medicaid patients were less likely to receive cancer-directed surgery. Medicaid status was also associated with worse cancer-specific survival (subhazard ratios 1.87, 95% confidence interval 1.72-2.04, P < .0001) after adjustment for all covariates.

CONCLUSION:
This is the first study examining specifically how Medicaid status and social determinants of health covariates impact oral cavity cancer treatment and outcomes and is the first using methods validated for complex covariates. Patients with Medicaid present with more extensive oral cavity disease burden are less likely to receive definitive therapy and have significantly worse overall survival than those with other forms of insurance. This better identifies disparities and the need for improving health literacy, specifically for the at-risk Medicaid population, and can guide clinicians.

LEVEL OF EVIDENCE:
NA Laryngoscope, 2019.

© 2019 The American Laryngological, Rhinological and Otological Society, Inc.

KEYWORDS:
healthcare disparities; Oral cavity cancer; insurance, socioeconomic; social determinants of health

PMID: 31654440 DOI: 10.1002/lary.28321
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Select item 31654439
25.
Laryngoscope. 2019 Oct 25. doi: 10.1002/lary.28355. [Epub ahead of print]
The prevalence of cognitive impairment in laryngology treatment-seeking patients.
Leclerc AA1, Gillespie AI2, Tadic SD3, Smith LJ4, Rosen CA5.
Author information
1
Division of Otolaryngology-Head and Neck Surgery, University of Montreal, Montreal, Quebec, Canada.
2
Department of Otolaryngology, Emory Voice Center, Emory University School of Medicine, Atlanta, Georgia, U.S.A.
3
Division of Geriatric Medicine and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
4
Department of Otolaryngology, University of Pittsburgh Voice Center, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
5
UCSF Voice and Swallowing Center, Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A.
Abstract
OBJECTIVES/HYPOTHESIS:
The incidence of cognitive impairment (CI) in the elderly general population is 10% to 20%. The incidence of CI in the elderly laryngology treatment-seeking population is unknown, and CI may impact decision making for elective medical/surgical treatment and negatively impact the outcome of voice/swallowing therapy. We sought to determine the prevalence of CI in elderly patients who are seeking laryngology care and to evaluate the feasibility of administering a cognitive screening instrument.

STUDY DESIGN:
Prospective, Cross-sectional.

METHODS:
One hundred fifty patients (≥65 years old) without a previous diagnosis of CI, seeking laryngology evaluation, were administered the Montreal Cognitive Assessment (MoCA) test by a trained physician. Other members of the clinical team were blinded to the MoCA results.

RESULTS:
Twenty-five percent of participants obtained a score diagnostic for at least mild CI. The results showed a correlation between the MoCA scores and 1) the time needed to complete the test, 2) participant age, and 3) participant education level. No differences were observed between gender, alcohol consumption, or use of medications that can affect cognition and MoCA score.

CONCLUSION:
One in four elderly laryngology treatment-seeking patients were found to have undiagnosed CI. This finding warrants consideration for CI screening for these patients being evaluated for voice therapy and elective surgery. Treatment decision making in this population may benefit from additional family involvement.

LEVEL OF EVIDENCE:
2c Laryngoscope, 2019.

© 2019 The American Laryngological, Rhinological and Otological Society, Inc.

KEYWORDS:
Cognitive impairment; Montreal Cognitive Assessment; dementia; laryngology

PMID: 31654439 DOI: 10.1002/lary.28355
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Select item 31654435
26.
Laryngoscope. 2019 Oct 25. doi: 10.1002/lary.28374. [Epub ahead of print]
What is the optimal duration of antibiotic prophylaxis in clean-contaminated head and neck surgery?
Gu K1, Khariwala SS1.
Author information
1
Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A.
PMID: 31654435 DOI: 10.1002/lary.28374
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Select item 31654182
27.
Eur Arch Otorhinolaryngol. 2019 Oct 25. doi: 10.1007/s00405-019-05698-w. [Epub ahead of print]
Value of pre- and intraoperative diagnostic methods in suspected glottic neoplasia.
Mehlum CS1, Kjaergaard T2, Grøntved ÅM3, Lyhne NM4, Jørkov APS5, Homøe P5, Tvedskov JF6, Bork KH6, Möller S7, Jørgensen G3, Philipsen BB3, Godballe C3.
Author information
1
Department of ORL Head and Neck Surgery and Audiology, Odense University Hospital, J. B. Winsløwsvej 4, 5000, Odense, Denmark. Camilla.mehlum@rsyd.dk.
2
Department of Otorhinolaryngology-Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark.
3
Department of ORL Head and Neck Surgery and Audiology, Odense University Hospital, J. B. Winsløwsvej 4, 5000, Odense, Denmark.
4
Department of Head and Neck Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.
5
Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark.
6
Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University Hospital of Copenhagen and University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
7
OPEN-Open Patient Data Explorative Network and Department of Clinical Research, Odense University Hospital and University of Southern Denmark, J. B. Winsløwsvej 9, 5000, Odense, Denmark.
Abstract
PURPOSE:
To evaluate the individual and combined ability of videostroboscopy (VS), high-speed digital imaging (HSDI), enhanced endoscopy (EE) and saline infusion (SI) to predict neoplasia, defined as glottic precursor lesion (GPL) or T1a glottic cancer, in patients suspected for glottic neoplasia.

METHODS:
A nationwide prospective cohort study of patients treated by cordectomy for suspected GPL or T1a glottic cancer from August 1st 2016 to October 31st 2018 was conducted in the five Danish University Departments of Head and Neck surgery. Sensitivity, specificity, negative and positive predictive values, and area under Receiver Operating Curves (AUC-ROC) were calculated with 95% confidence intervals with respect to the histological diagnosis. Logistic regression with an imputation model for missing data was applied.

RESULTS:
261 patients aged 34-91 years participated; 79 (30.3%) with non-neoplasia (i.e., inflammation, papilloma, hyperkeratosis) and 182 (69.7%) neoplasia, hereof 95 (36.4%) with GPL and 87 (33.3%) with T1a glottic cancer. Data from 188 VS, 60 HSDI, 100 preoperative EE, 209 intraoperative EE, and 234 SI were analyzed. In the complete case analysis the AUC-ROC of each diagnostic test was low, but increased when the tests were combined and especially if the combination included EE. However, multinomial logistic regression with imputation showed significant association (p < 0.05) only between age, male gender, and perpendicular vasculature in intraoperative EE, and the endpoint neoplasia.

CONCLUSIONS:
Intraoperative EE was the most accurate diagnostic method in detecting neoplasia. The prediction ability of methods applied preoperatively was more limited, but improved when test modalities were combined.

KEYWORDS:
Diagnostic accuracy; Glottic; Neoplasia; Precursor lesion; Premalignant

PMID: 31654182 DOI: 10.1007/s00405-019-05698-w
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Select item 31654181
28.
Eur Arch Otorhinolaryngol. 2019 Oct 25. doi: 10.1007/s00405-019-05692-2. [Epub ahead of print]
Modified approach of the anterior commissure for transoral cordectomy in case of difficult exposure: a surgical innovation.
Mattei A1,2, Boulze C3,4, Santini L3, Le Flem M3,4, Dessi P3,5, Fakhry N3,6, Giovanni A3,6.
Author information
1
Department of Oto-Rhino-Laryngology and Head and Neck Surgery, APHM, La Conception University Hospital, 147 bd baille, 13385, Cedex Marseille, France. alexia.mattei@laposte.net.
2
Aix Marseille Univ, CNRS, LPL, UMR 7309, Aix-en-Provence, France. alexia.mattei@laposte.net.
3
Department of Oto-Rhino-Laryngology and Head and Neck Surgery, APHM, La Conception University Hospital, 147 bd baille, 13385, Cedex Marseille, France.
4
Aix Marseille Univ, Marseille, France.
5
Aix-Marseille Univ, CNRS, EFS, ADES, Marseille, France.
6
Aix Marseille Univ, CNRS, LPL, UMR 7309, Aix-en-Provence, France.
Abstract
PURPOSE:
To propose, in patients presenting a difficult laryngeal exposure, a surgical innovation allowing to perform a transoral laser cordectomy for cancers reaching the anterior commissure or the anterior third of vocal folds (according to the European Laryngological Society classification of laryngeal endoscopic cordectomies).

METHODS:
Our surgical technique consisted of adding to conventional cordectomies a modified relaxation thyroplasty proposed by Isshiki (type III), also called relaxation thyroplasty by a medial approach in the European Laryngological Society classification system. The anterior commissure retrusion is usually employed in the management of high-pitched voice disorders, but can also allow a better exposure of the anterior commissure.

RESULTS:
We described here this surgical innovation through the example of our first two patients. For both patients, the definitive histologic analysis showed negative microscopic margins and there was no post-operative complication. There was no need for a tracheostomy. They were allowed to take a normal diet after 2 days and were discharged after 4 days. The voice was breathy and hoarse as expected in case of extended cordectomy.

CONCLUSIONS:
This surgical innovation corresponding to the addition of an anterior commissure retrusion by a bilateral thyrotomy could be useful in the ELS classification of endoscopic cordectomies. It should allow surgeons to carry out a transoral CO2 laser cordectomy in patients with a T1 and sometimes T2 glottic carcinoma, even with a difficult laryngeal exposure.

KEYWORDS:
Cordectomy; Difficult exposure; Glottic cancer; Glottoplasty; Laser; Thyroplasty

PMID: 31654181 DOI: 10.1007/s00405-019-05692-2
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Select item 31654180
29.
Eur Arch Otorhinolaryngol. 2019 Oct 25. doi: 10.1007/s00405-019-05706-z. [Epub ahead of print]
Cochlear function after type-1 tympanoplasty: endoscopic versus microscopic approach, a comparative study.
Botti C1, Fermi M2, Amorosa L3, Ghidini A4, Bianchin G5, Presutti L2, Fernandez IJ2.
Author information
1
Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Modena, Italy. botceci@gmail.com.
2
Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Modena, Italy.
3
Department of Otorhinolaryngology Head and Neck Surgery, Ospedale Maggiore, Bologna, Italy.
4
Otorhinolaryngology Unit, Department of Surgery, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.
5
Department of Audiology, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.
Abstract
PURPOSE:
To investigate and compare the effect of endoscopic and microscopic type 1 tympanoplasty on the cochlear function, to determine if they have a different impact on the inner ear function.

METHODS:
72 ears treated by transcanal endoscopic type 1 tympanoplasty and 84 ears treated by microscopic type 1 tympanoplasty in 3 tertiary referral centers were enrolled in the study. Microscopic type 1 tympanoplasty were performed by transcanal or retroauricular approach. Only patients with mobile and intact ossicular chain were involved in the study. A retrospective chart review was performed. Main outcome measures were: (1) change in bone conduction thresholds at 250, 500, 1000, 2000, 4000 Hz; (2) change in bone conduction Pure Tone Audiometry; (3) correlation of audiometric outcomes with surgical technique, graft type and graft position.

RESULTS:
A mild postoperative bone conduction threshold shift was observed at 2000 Hz and 4000 Hz in both groups, without significant differences between the two groups. No statistically significant modifications in bone conduction were observed at any frequencies in patients operated by transcanal endoscopic approach compared with those who underwent transcanal or retroauricular microscopic type 1 tympanoplasty. Moreover, neither the placement nor the type of the graft seemed to influence the cochlear function preservation.

CONCLUSIONS:
The endoscopic and the microscopic approaches have a similar impact on the bone conduction threshold during type 1 tympanoplasty. In particular, the one-handed manipulation of the ossicular chain during the endoscopic technique did not show an increased risk of inner ear damage.

KEYWORDS:
Endoscopic ear surgery; Myringoplasty; Tympanoplasty; Type 1 tympanoplasty; chronic otitis media

PMID: 31654180 DOI: 10.1007/s00405-019-05706-z
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Select item 31654012
30.
Br Dent J. 2019 Oct;227(8):735-739. doi: 10.1038/s41415-019-0859-5.
A cross sectional study of dental implant service provision in British and Irish dental hospitals.
James M1, Taylor C2.
Author information
1
Speciality Registrar in Restorative Dentistry, University Dental Hospital of Manchester, Manchester Universities NHS Foundation Trust, UK. martin.james6@nhs.net.
2
Consultant in Restorative Dentistry, University Dental Hospital of Manchester, Manchester Universities NHS Foundation Trust, UK.
Abstract
Introduction There are multiple ways in which treatment using dental implants is provided in a secondary care setting, not only in terms of the groups of patients treated, but also the clinicians who provide that care.Methods An online survey was circulated to speciality registrars in restorative dentistry in all UK dental hospitals and to postgraduate students in prosthodontics in the Republic of Ireland, consisting of nine questions aimed at understanding which patient groups are treated using dental implants in a hospital setting, how cases are planned, executed and to explore the underlying reasons for each unit's method of provision.Results Completed surveys were received from 67% of dental hospitals in Britain and Ireland. Treatment planning was undertaken by the restorative team alone in 64% of units in patients with hypodontia, 57% with trauma and 71% with an atrophic edentulous ridge and by a multi-disciplinary team in 50% of units for patients with cleft lip and palate (CLP) and 45% with head and neck (H&N) cancer. The restorative team place all or most of the implant fixtures in 50% of units in patients with CLP, 71% in trauma patients, 71% in hypodontia patients, 64% in edentulous patients and 43% in H&N oncology patients. Stents are produced and used by the restorative team in 64% of units for edentulous patients, 79% of patients with hypodontia, 79% of those suffering trauma, 58% of CLP patients and 50% of patients with H&N cancer. Twenty-one percent of responding units had stents made by the restorative team and used by the surgical team. The median percentage of implant-supported restorations that are screw retained is 90% (SD: 4.93, range: 25-95%) and the median percentage of zirconia abutments being used is 22.5% (SD: 5.24, range: 0-50%). Use of zygomatic implants varies hugely between responding units with 43% of them not placing any zygomatic implants.Conclusions There is a wide range of protocols and team members involved in the provision of dental implant rehabilitations throughout the British Isles reflecting the lack of any single evidence-based approach. A multi-disciplinary team approach with the restorative dentist as a key member is likely to yield the most favourable long term outcomes.

PMID: 31654012 DOI: 10.1038/s41415-019-0859-5
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Select item 31654001
31.
Br Dent J. 2019 Oct;227(8):689-692. doi: 10.1038/s41415-019-0851-0.
The reconstructive oral cancer patient: what the general dental practitioner needs to know.
Araghi AS1, Nasry H2.
Author information
1
OMFS, DCT 2, UK. ariyanaraghi@live.co.uk.
2
Consultant Restorative Dentist, North Manchester General Hospital, Oral Surgery Department, Delaunays Rd, Crumpsall, Manchester, M8 5RB, UK.
Abstract
The rate of oral cancer is on the rise; lesions are often being picked up late meaning it is necessary for patients to undergo multidisciplinary head and neck reconstruction. Working in a specialist head and neck oncology unit this year has opened my eyes as to how this patient subgroup is managed, with regards to both a surgical and restorative basis. This article has been written to help inform GDPs about the upcoming NHS guidelines, 'The NHS Oral Cancer Toolkit', in the management of oral cancer patients. Furthermore, I hope that the reader gains an appreciation for what the oral cancer patient endures on their toilsome journey. This article is designed as a refresher on the restorative management of the oral cancer patient. After having read this article you will have an improved awareness of the '8-step' oral cancer screen and an insight as to what happens when the patient is sent on the urgent cancer pathway. Most importantly, this paper will refresh your learning on what the GDP needs to do in the preoperative and postoperative phases with regards to the oral health and wellbeing of the reconstructive oral cancer patient.

PMID: 31654001 DOI: 10.1038/s41415-019-0851-0
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Select item 31653934
32.
Sci Rep. 2019 Oct 25;9(1):15357. doi: 10.1038/s41598-019-51813-6.
Increased nasal matrix metalloproteinase-1 and -9 expression in smokers with chronic rhinosinusitis and asthma.
Huang CC1,2, Wang CH3, Wu PW1,4, He JR3, Huang CC1,2, Chang PH1,2, Fu CH1,2, Lee TJ5,6.
Author information
1
Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
2
Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
3
Department of Thoracic Medicine, Chang Gung Memorial Hospital and Medicine of College, Chang Gung University, Taoyuan, Taiwan.
4
Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan.
5
Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. entlee@cgmh.org.tw.
6
Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, China. entlee@cgmh.org.tw.
Abstract
A potential mechanism underlying cigarette smoke-induced airway disease is insufficient tissue repair via altered production of matrix metalloproteinases (MMPs). Osteitis is a signature feature of recalcitrant chronic rhinosinusitis (CRS) and often results in revision surgery. The present study aimed to investigate MMP expression in the nasal tissues of asthmatic patients with CRS and any association with cigarette smoking and osteitis. Thirteen smokers with CRS and asthma, 16 non-smokers with CRS and asthma, and seven non-smoker asthmatic patients without CRS were prospectively recruited. The expression of MMPs and associated immunological factors in surgically-obtained nasal tissues was evaluated via real-time PCR and western blotting. Maximal bone thickness of the anterior ethmoid (AE) partition was measured in axial sinus computed tomography (CT) sections. MMP-1 and MMP-9 expression was increased in the nasal tissues of smokers with asthma and CRS via real-time PCR and western blot. Maximal AE partition bone thickness was greater in smokers with CRS and asthma than in non-smokers with CRS and asthma. MMP-1 and MMP-9 levels were correlated with maximal AE bone thickness. Cigarette smoking was associated with the up-regulation of MMP-1 and MMP-9 in the nasal tissues of patients with airway inflammatory diseases, and with AE osteitis, and with therapeutic resistence.

PMID: 31653934 DOI: 10.1038/s41598-019-51813-6
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Select item 31653916
33.
Sci Rep. 2019 Oct 25;9(1):15362. doi: 10.1038/s41598-019-51724-6.
Protection from noise-induced cochlear synaptopathy by virally mediated overexpression of NT3.
Hashimoto K1,2,3, Hickman TT4,5, Suzuki J1,2,3, Ji L6,7, Kohrman DC6,7, Corfas G6,7, Liberman MC1,2.
Author information
1
Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA.
2
Eaton-Peabody Laboratories, Massachusetts Eye & Ear, Boston, MA, USA.
3
Department of Otorhinolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
4
Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA. Tyler_Hickman@meei.harvard.edu.
5
Eaton-Peabody Laboratories, Massachusetts Eye & Ear, Boston, MA, USA. Tyler_Hickman@meei.harvard.edu.
6
Kresge Hearing Research Institute, University of Michigan, Ann Arbor, MI, USA.
7
Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
Abstract
Noise exposures causing only transient threshold shifts can destroy auditory-nerve synapses without damaging hair cells. Here, we asked whether virally mediated neurotrophin3 (NT3) overexpression can repair this damage. CBA/CaJ mice at 6 wks were injected unilaterally with adeno-associated virus (AAV) containing either NT3 or GFP genes, via the posterior semicircular canal, 3 wks prior to, or 5 hrs after, noise exposure. Controls included exposed animals receiving vehicle only, and unexposed animals receiving virus. Thresholds were measured 2 wks post-exposure, just before cochleas were harvested for histological analysis. In separate virus-injected animals, unexposed cochleas were extracted for qRT-PCR. The GFP reporter showed that inner hair cells (IHCs) were transfected throughout the cochlea, and outer hair cells mainly in the apex. qRT-PCR showed 4- to 10-fold overexpression of NT3 from 1-21 days post-injection, and 1.7-fold overexpression at 40 days. AAV-NT3 delivered prior to noise exposure produced a dose-dependent reduction of synaptopathy, with nearly complete rescue at some cochlear locations. In unexposed ears, NT3 overexpression did not affect thresholds, however GFP overexpression caused IHC loss. In exposed ears, NT3 overexpression increased permanent threshold shifts. Thus, although NT3 overexpression can minimize noise-induced synaptic damage, the forced overexpression may be harmful to hair cells themselves during cochlear overstimulation.

PMID: 31653916 DOI: 10.1038/s41598-019-51724-6
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Select item 31653808
34.
J Neurosurg. 2019 Oct 25:1-8. doi: 10.3171/2019.8.JNS191285. [Epub ahead of print]
Risk of internal carotid artery stenosis or occlusion after single-fraction radiosurgery for benign parasellar tumors.
Graffeo CS1, Link MJ1,2, Stafford SL3, Parney IF1, Foote RL3, Pollock BE1,3.
Author information
1
Departments of1Neurologic Surgery.
2
2Otolaryngology-Head and Neck Surgery, and.
3
3Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
Abstract
OBJECTIVE:
Stereotactic radiosurgery (SRS) is an accepted treatment option for patients with benign parasellar tumors. Here, the authors' objective was to determine the risk of developing new or progressive internal carotid artery (ICA) stenosis or occlusion after single-fraction SRS for cavernous sinus meningioma (CSM) or growth hormone-secreting pituitary adenoma (GHPA).

METHODS:
The authors queried their prospectively maintained registry for patients treated with single-fraction SRS for CSM or GHPA in the period from 1990 to 2015. Study criteria included no prior irradiation and ≥ 12 months of post-SRS radiological follow-up. Pre-SRS grading of ICA involvement was applied according to the 1993 classification schemes of Hirsch for CSM or Knosp for GHPA.

RESULTS:
The authors conducted a retrospective review of 283 patients, 155 with CSMs and 128 with GHPAs. Ninety-three (60%) CSMs were Hirsch category 2 and 3 tumors; 97 (76%) GHPAs were Knosp grade 2-4 tumors. Median follow-up after SRS was 6.6 years (IQR 1-24.9 years). No GHPA or category 1 CSM developed ICA stenosis or occlusion. Three (5.2%) patients with category 2 CSMs had asymptomatic ICA stenosis (n = 2) or occlusion (n = 1); 1 (1.1%) category 2 CSM patient had transient ischemic symptoms. Five (14.3%) category 3 CSMs progressed to ICA occlusion (4 asymptomatic, 1 symptomatic). The median time to stenosis/occlusion was 4.8 years (IQR 1.8-7.6). Five- and 10-year risks of ICA stenosis/occlusion in category 2 and 3 CSM patients were 7.5% and 12.4%, respectively. Five- and 10-year risks of ischemic stroke from ICA stenosis/occlusion in category 2 and 3 CSM patients were both 1.2%. Multivariate analysis showed patient age (HR 0.92, 95% CI 0.86-0.98, p = 0.01), meningioma pathology (HR and 95% CI not defined, p = 0.03), and pre-SRS carotid category (HR 4.51, 95% CI 1.77-14.61, p = 0.004) to be associated with ICA stenosis/occlusion. Internal carotid artery stenosis/occlusion was not related to post-SRS tumor growth (HR and 95% CI not defined, p = 0.41).

CONCLUSIONS:
New or progressive ICA stenosis/occlusion was common after SRS for CSM but was not observed after SRS for GHPA, suggesting a tumor-specific mechanism unrelated to radiation dose. Pre-SRS ICA encasement or constriction increases the risk of ICA stenosis/occlusion; however, the risk of ischemic complications is very low.

KEYWORDS:
CSM = cavernous sinus meningioma; GHPA = growth hormone–secreting pituitary adenoma; ICA = internal carotid artery; PA = pituitary adenoma; SRS = stereotactic radiosurgery; cavernous sinus meningioma; complications; internal carotid artery; occlusion; pituitary adenoma; pituitary surgery; stenosis; stereotactic radiosurgery

PMID: 31653808 DOI: 10.3171/2019.8.JNS191285
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Select item 31653637
35.
BMJ Case Rep. 2019 Oct 25;12(10). pii: e231989. doi: 10.1136/bcr-2019-231989.
A nose out of joint: first reported case of prison-acquired marijuana-based rhinolith.
Smith M1, Wong E2, Ahmadi N1, Singh NP1.
Author information
1
Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia.
2
Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia eugene.hl.wong@gmail.com.
Abstract
Rhinoliths are calcareous concretions of the nasal cavity formed around a nidus that may be endogenous (eg, dislodged tooth) or an exogenous foreign body (eg, plastic bead inserted by a child). Rhinoliths are often found incidentally on endoscopy or imaging to assess for other pathologies. The incidence is estimated to be 1 in 10 000 of all otolaryngology outpatient presentations, but this is likely to be an underestimate due to the often asymptomatic nature of this condition. We describe the unique case of a rhinolith that developed from a marijuana-filled balloon that the patient attempted to smuggle into a correctional facility. After inserting the package into his nostril, the patient then mistakenly believed it had been accidentally swallowed. Despite experiencing persistent symptoms of nasal obstruction and recurrent sinonasal infections, the marijuana package was only discovered 18 years after insertion following imaging for an unrelated indication.

© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.

KEYWORDS:
ear, nose and throat/otolaryngology; otolaryngology / ENT

PMID: 31653637 DOI: 10.1136/bcr-2019-231989
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Conflict of interest statement
Select item 31653634
36.
BMJ Case Rep. 2019 Oct 25;12(10). pii: e231278. doi: 10.1136/bcr-2019-231278.
Ectomesenchymal chondromyxoid tumour: an uncommon characteristic tumour of the anterior tongue.
Riju J1, Ahamed S2, Thomas R2, Telugu RB3.
Author information
1
Department of Head and Neck Surgery, Christian Medical College, Vellore, India jjriju@yahoo.co.in.
2
Department of ENT, Christian Medical College, Vellore, India.
3
Department of General Pathology, Christian Medical College, Vellore, India.
Abstract
Ectomesenchymal chondromyxoid tumour (ECMT) is a rare benign tumour which classically presents in the anterior tongue. This tumour is grossly under-reported due to lack of immunohistochemical staining in many centres. We report a 46-year-old man who presented with mass in the anterior tongue and was diagnosed with ECMT. Further management of this lesion is explained with a review of the literature.

© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.

KEYWORDS:
head and neck cancer; head and neck surgery; medical education; otolaryngology / ENT

PMID: 31653634 DOI: 10.1136/bcr-2019-231278
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Conflict of interest statement
Select item 31653630
37.
BMJ Case Rep. 2019 Oct 25;12(10). pii: e231091. doi: 10.1136/bcr-2019-231091.
Heterochromia irides and mistaken identity of retinoblastoma.
Abu-Ain MS1,2, Shatnawi R3, Yousef YA4, Watts P5.
Author information
1
Ophthalmology, Hashemite University Faculty of Medicine, Zarqa, Jordan abuain@hotmail.co.uk.
2
Ophthalmology Department, Prince Hamzah Hospital, Amman, Jordan.
3
Ophthalmology, Hashemite University Faculty of Medicine, Zarqa, Jordan.
4
King Hussein Cancer Center, Amman, Jordan.
5
Ophthalmology Department, University Hospital of Wales, Cardiff, UK.
Abstract
Retinoblastoma is the most common intraocular malignancy of infancy which frequently manifests with a white pupillary reflex. We report a case of delayed presentation of a child with retinoblastoma in his left eye because parents thought the change in iris colour in this eye was due to the innocent heterochromia irides that was previously diagnosed in his elder sibling. This late presentation necessitated enucleation of the affected eye followed by chemotherapy.

© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.

KEYWORDS:
glaucoma; head and neck cancer; ophthalmology; paediatric oncology; retina

PMID: 31653630 DOI: 10.1136/bcr-2019-231091
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Conflict of interest statement
Select item 31653626
38.
BMJ Case Rep. 2019 Oct 25;12(10). pii: e230926. doi: 10.1136/bcr-2019-230926.
Myoepithelioma of nasal septum: a rare minor salivary gland tumour.
Gourh G1, Arora RD1, Hussain N2, Nagarkar N1.
Author information
1
ENT Department, AIIMS, Raipur, Chhattisgarh, India.
2
Department of Pathology and Lab Medicine, AIIMS, Raipur, Chhattisgarh, India.
Abstract
Myoepithelioma is rare benign neoplasm, usually involves salivary glands and very less often seen in minor salivary glands of nose. Clinically it resembles like other tumour masses and thus posed challenge to clinician and pathologist. It becomes very difficult to diagnose due to its varied presentation and propensity for malignant transformation. We reported a case of a male patient with pink fleshy mass in the left nose with epistaxis and nasal obstruction. Preliminary biopsy and contrast-enhanced CT were done to delineate tumour size and type and then patient underwent endoscopic en-bloc resection. Histopathology and immunohistochemistry were found to be consistent for myoepithelioma. No recurrence was seen during a 6-month follow-up period. Its rarity should be a part of differential diagnosis among nasal tumours. Many of the tumour recurrences are associated with incomplete surgical resection so wide local excision with regular follow-up is essential for this rare entity.

© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.

KEYWORDS:
Ear, Nose And Throat; Head And Neck Cancer

PMID: 31653626 DOI: 10.1136/bcr-2019-230926
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Conflict of interest statement
Select item 31653620
39.
BMJ Case Rep. 2019 Oct 25;12(10). pii: e229655. doi: 10.1136/bcr-2019-229655.
Impacted denture in the oesophagus: review of the literature and its management.
Mughal Z1, Charlton AR2, Dwivedi R3, Natesh B2.
Author information
1
Department of Otolaryngology Head & Neck Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK zahir5019@gmail.com.
2
Department of Otolaryngology Head & Neck Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
3
Department of Otolaryngology Head & Neck Surgery, NHS Greater Glasgow and Clyde, Glasgow, UK.
Abstract
Foreign body impaction in the oesophagus is a common cause of acute dysphagia. Oesophageal impaction of sharp objects such as dentures can be life threatening due to the risk of oesophageal perforation. This condition requires urgent treatment, and therefore prompt diagnosis and management is vital to avoid complications. Diagnosing oesophageal foreign body can be challenging due to its poor localising symptoms. We describe a case of an impacted denture in which considerable delays to treatment were encountered, and discuss the pitfalls and lessons learnt. This case and review of the literature draw attention to clinical assessment, investigation and treatment options for oesophageal foreign body impaction.

© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.

KEYWORDS:
ear, nose and throat/otolaryngology; endoscopy; head and neck surgery; oesophagus

PMID: 31653620 DOI: 10.1136/bcr-2019-229655
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Conflict of interest statement
Select item 31653606
40.
Braz J Otorhinolaryngol. 2019 Oct 3. pii: S1808-8694(19)30113-2. doi: 10.1016/j.bjorl.2019.08.006. [Epub ahead of print]
Does topical application of tranexamic acid reduce intraoperative bleeding in sinus surgery during general anesthesia?
Kang H1, Hwang SH2.
Author information
1
The Catholic University of Korea, College of Medicine, Department of Otolaryngology-Head and Neck Surgery, Seoul, Republic of Korea.
2
The Catholic University of Korea, College of Medicine, Department of Otolaryngology-Head and Neck Surgery, Seoul, Republic of Korea. Electronic address: yellobird@catholic.ac.kr.
Abstract
INTRODUCTION:
Tranexamic acid is a hemostatic agent, which inhibits fibrin degradation, which may be beneficial in controlling bleeding during surgery.

OBJECTIVES:
The purpose of this study was to provide a meta-analysis and review of the effects of tranexamic acid on hemorrhage and surgical fields and side effects on patients during endoscopic sinus surgery.

METHODS:
Two authors independently searched six databases (Medline, SCOPUS, Embase, Web of Science, Google Scholar and Cochrane library) from the start of article collection until July 2018. Postoperative complications such as intraoperative bleeding, operative time, hypotension, nausea, vomiting, and coagulation profile were included in the analysis of tranexamic acid (Treatment Group) and placebo (Control Group) during the operation.

RESULTS:
The amount of blood loss during surgery was statistically lower in the treatment group compared to the placebo group, and the surgical field quality was statistically higher in the treatment group than in the placebo group. On the other hand, there was no significant difference in operation time, hemodynamics, or coagulation profile between groups. In addition, tranexamic acid had no significant effect on vomiting and thrombosis compared to the Control Group.

CONCLUSION:
This meta-analysis has shown that topical administration of tranexamic acid can reduce the amount of bleeding during surgery and improve the overall quality of the surgery. Hemodynamic instability during surgery, vomiting after surgery, or abnormal clotting profile were not reported. Additional studies are needed to confirm the results of this study because there are fewer studies.

Copyright © 2019 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

KEYWORDS:
Cirurgia endoscópica do seio nasal; Endoscopic sinus surgery; Meta-analysis; Meta-análise; Operative bleeding; Revisão sistemática; Sangramento operatório; Systematic review; Tranexamic acid; Ácido tranexâmico

PMID: 31653606 DOI: 10.1016/j.bjorl.2019.08.006