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Head And Neck Surgeon (head + and_neck_surgeon)
Selected AbstractsReadability and content of postoperative tonsillectomy instructions given to patients in ScotlandCLINICAL OTOLARYNGOLOGY, Issue 2 2004W.A. Clement Readability and content of postoperative tonsillectomy instructions given to patients in Scotland All NHS hospitals in Scotland where tonsillectomies were being performed routinely were contacted. Thirty-two wards were identified. A copy of each ward's postoperative tonsillectomy discharge information sheet was obtained, if available. Twenty-six information sheets were obtained. Of these, 13 were for adults, 11 for children and 2 for both adults and children. The information sheets were assessed for readability using two readability formulae. Content was also assessed. The average reading grade/age required to understand these information sheets was above those recommended by patient-education experts. Postoperative safety instructions were similar and overall of a good standard, but variations did arise in what information was included. None of the units had adopted the British Association of Otolaryngologists , Head and Neck Surgeons (BAO-HNS) tonsillectomy postoperative advice sheet. This advice sheet is evidence based and meets recommended readability criteria. [source] One-stop neck lump clinic: phase 2 of audit.CLINICAL OTOLARYNGOLOGY, Issue 6 2001How are we doing? One-stop neck lump clinic: phase 2 of audit. How are we doing? Regular monitoring and audit of a service are integral to ensuring maintenance of efficiency and standards. This is particularly important where the quality of the service is operator dependent, as is the case in the clinical diagnosis of neck lumps and fine needle aspiration cytology. The one-stop neck lump clinic has now been running in the department for more than 20 months. A previous article described the results of the first phase audit carried out at 6 months and had identified a waiting time to be seen that was longer than that recommended by the British Association of Otorhinolaryngologists, Head and Neck Surgeons. Measures were implemented to reduce this waiting time and a second audit was carried out after another 10 months with the aims of assessing if modification of the means of referral reduces waiting time and if the outcomes of clinical performance in phase 1 could be maintained or improved. We discuss the results of phase 2 in the audit spiral. [source] Searching the Literature Using Medical Subject Headings versus Text Word with PubMedTHE LARYNGOSCOPE, Issue 2 2006Angela A. Chang MD Abstract Objective/Hypothesis: This study was conducted to investigate the performance of two search strategies in the retrieval of information from the National Library of Medicine (NLM) on otolaryngology,head and neck surgery related conditions and diagnoses using PubMed. Methods: Two search strategies,one based on the use of Medical Subject Headings (MeSH) and the second based on text word searching,were compared. Results: The MeSH search provided a more efficient search than the text word search. Conclusions: Head and neck surgeons can most efficiently search the NLM using PubMed as a search engine by initiating the search with MeSH terms. Once a key article is identified, the searcher should use the "Related Articles" feature. [source] Sentinel Lymph Node Biopsy in Head and Neck Squamous Cell CarcinomaTHE LARYNGOSCOPE, Issue 12 2002Karen T. Pitman MD Abstract Objectives/Hypothesis Sentinel lymph node biopsy is a minimally invasive method to stage the regional lymphatics that has revolutionized the management of patients with intermediate-thickness cutaneous melanoma. Head and neck surgeons have been encouraged by the accuracy of sentinel lymph node biopsy in cutaneous melanoma and have applied the technique to patients with head and neck squamous cell carcinoma (HNSCC). The objectives of the study were 1) to study the feasibility and accuracy of sentinel lymph node biopsy as a method to stage the regional lymphatics in HNSCC and 2) to determine whether there are qualitative differences between the cutaneous and mucosal lymphatics that would affect the technique used in HNSCC. Study Design Two methods of investigation were employed: a prospective laboratory study using a feline model for sentinel lymph node biopsy and a retrospective review of patients who received lymphoscintigraphy before neck dissection and intraoperative identification of the sentinel lymph node. Methods Lymphoscintigraphy and a gamma probe were used in four felines to study the kinetics of technetium-labeled sulfa colloid (Tc-SC) in the mucosal lymphatics. In the second part of the feline study, eight subjects were studied intraoperatively. Tc-SC and isosulfan blue dye were used to study the injection technique for the mucosal lymphatics and to determine the time course of the dye and Tc-SC to the sentinel lymph node. In Part II of the present study, a retrospective review of 33 patients with HNSCC was conducted. Twenty patients (stage N0) whose treatment included elective neck dissection were studied with preoperative lymphoscintigraphy and underwent intraoperative identification of the sentinel lymph node to determine the accuracy and feasibility of sentinel lymph node biopsy. Eight patients with palpable neck disease and five patients with recurrent or second primary disease whose previous treatment included neck dissection were also studied with lymphoscintigraphy before neck dissection. Results In the feline study, both Tc-SC and isosulfan blue dye traversed the lymphatics rapidly, appearing in the sentinel lymph node in less than 5 minutes. Modification of the injection technique used for cutaneous melanoma was required to depict the sentinel lymph node of the base of tongue. In the human study, the sentinel lymph node was accurately identified in 19 of 20 (95%) N0 patients. On average, 2.9 sentinel lymph nodes (range, 1,5) were identified in 2.2 (range, 1,4) levels of the neck. Sentinel lymph nodes were bilateral in 4 of 19 patients. When the sentinel lymph node was identified, it accurately predicted the pathological nodal status of the regional lymphatics. Three of 20 patients had cervical metastases, and the sentinel lymph node was identified in 2 of 3 patients with pathologic nodes (pN+). Focal areas of radiotracer uptake were identified in seven of eight patients with palpable disease. These areas corresponded to the level with palpable disease in four patients. The lymphatics delineated by lymphoscintigraphy in the five patients with previous neck dissection were outside the levels that had been dissected. Lymphoscintigraphy depicted collateral patterns of lymphatic drainage. Conclusions Sentinel lymph node biopsy is technically feasible and is a promising, minimally invasive method for staging the regional lymphatics in patients with stage N0 HNSCC. Lymphoscintigraphy alone may determine the levels that require treatment in patients with disrupted or previously operated cervical lymphatics. [source] Importance of patient examination to clinical quality assurance in head and neck radiation oncology,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2006David I. Rosenthal MD Abstract Background. When quality assurance programs in clinical radiation oncology focus mainly on the technical aspects of treatment, they tend to underplay questions of therapeutic process and outcome. We determined the value of clinical peer review in radiation therapy for head and neck cancer that involved head and neck examination. Methods. Data were collected prospectively on 134 consecutive patients with preliminary radiation therapy (RT) plans. Peer review was performed that included head and neck examination and imaging review to confirm target localization. Results. Peer review led to changes in treatment plans for 66% of patients. Most changes were minor, but 11% of changes were major and thought to be of a magnitude that could potentially affect therapeutic outcome or normal tissue toxicity. Most changes involved target delineation based on physical findings Conclusions. Peer review of radiation target localization in RT plans led to changes that could potentially affect rates of cancer control or complication in about 10% of patients. We suggest that the accuracy of head and neck radiation oncology treatment plans might be increased by co-examination by another head and neck cancer specialist, typically a radiation oncologist or head and neck surgeon, to confirm RT target volumes. © 2006 Wiley Periodicals, Inc. Head Neck, 2006 [source] Risk factors for wound infection in head and neck cancer surgery: A prospective studyHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 6 2001Nicolas Penel MD Abstract Background The goal of this prospective study is to determine risk factors for wound infections (WI) for patients with head and neck cancer who underwent surgical procedure with opening of upper aerodigestive tract mucosa. Methods One hundred sixty-five consecutive surgical procedures were studied at Oscar Lambret Cancer Center within a 24-month interval. Twenty-five variables were recorded for each patient. Statistical evaluation used X2 test analysis (categorical data) and Mann,Whitney test (continuous variables). Results The overall rate of WI was 41.8%. Univariate analysis indicated that five variables were significantly related to the likelihood of WI: tumor stage (p = .044), previous chemotherapy (p = .008), duration of preoperative hospital stay (p = 022), permanent tracheostomy (p = .00008), and hypopharyngeal and laryngeal cancers (p = .008). Conclusions Despite antibiotic prophylaxis, WI occurrence is high. These data inform the head and neck surgeon, when a patient is at risk for WI and may help to design future prospective studies. © 2001 John Wiley & Sons, Inc. Head Neck 23: 447,455, 2001. [source] The Preauricular Sinus: A Review of its Clinical Presentation, Treatment, and AssociationsPEDIATRIC DERMATOLOGY, Issue 3 2004Noah S. Scheinfeld M.D. Usually asymptomatic, they manifest as small dells adjacent to the external ear near the anterior margin of the ascending limb of the helix, most frequently on the right side. Preauricular sinuses can be either inherited or sporadic. When inherited, they show an incomplete autosomal dominant pattern with reduced penetrance and variable expression. They may be bilateral, increasing the likelihood of being inherited, in 25,50% of cases. Preauricular sinuses are features of other conditions or syndromes in 3,10% of cases, primarily in association with deafness and branchio-oto-renal (BOR) syndrome. When other congenital anomalies coexist with these sinuses, auditory testing and renal ultrasound should be considered. Sinuses may become infected, most commonly with gram-positive bacteria, in which case their exudates should be cultured and appropriate antibiotics administered. Recurrent infection is a clear indication for complete excision and provides the only definitive cure. Recurrence rates after surgery range from 9% to 42%. Meticulous excision by an experienced head and neck surgeon minimizes the risk of recurrence. [source] Management of Neck Metastasis with Carotid Artery Involvement,THE LARYNGOSCOPE, Issue 1 2004Stephen B. Freeman MD Abstract Objectives To demonstrate aggressive management of neck metastasis adherent to the internal or common carotid artery using sound oncologic principles while minimizing the significant risk of complications. Study Design Our 13 year experience of treating patients with recurrent or residual neck metastasis adherent to the internal or common carotid artery was retrospectively reviewed. Methods Angiography was used in patients who demonstrated fixation of the carotid artery on examination or imaging, followed by balloon test occlusion and single photon emission computer tomography (SPECT) scanning. The majority of carotid resections were reconstructed with a vein graft, especially if there was insufficient collateral cerebral circulation. Radical resection of the soft tissue including the carotid artery was performed followed by 15 to 20 Gray of electron beam delivered directly to the deep tissue. More recently, the carotid has been permanently occluded preoperatively, if possible. The assessment of the cerebral circulation and management of the carotid artery were analyzed as was survival, site of recurrence, and complications. Results Fifty-eight charts were reviewed. The majority of patients (41) had their carotid artery reconstructed at time of resection, and the remaining had either the artery ligated or permanently occluded preoperatively. Strokes occurred in 11 patients. The median disease-specific survival was 12 months, with 24% of patients dying from distant metastasis. Conclusions The high risk of complications, loss of life's quality, and mortality must be balanced against the natural history of the disease if left untreated. The decision is a heavy burden for the patient, family, and head and neck surgeon. [source] Obstructive Sleep Apnea: A Comparison of Black and White SubjectsTHE LARYNGOSCOPE, Issue 7 2002Keith Meetze MD Abstract Objective To determine if the severity of obstructive sleep apnea syndrome (OSA) differs by racial group. Study Design Cross-sectional retrospective review. Setting University-based sleep disorders laboratory. Methods The study reviewed the results of 280 adult (>18 y) patients diagnosed with obstructive sleep apnea syndrome by overnight polysomnogram between July 1, 1999, and June 30, 2000. Factors analyzed included age, sex, race, presence of hypertension, body mass index (kg/m2), respiratory disturbance index (RDI), and lowest oxygen saturation level. Results Blacks with OSA are significantly more obese and have significantly higher rates of hypertension than white subjects with OSA. Black females with OSA are significantly younger than white females at the time of diagnosis (P = .005). Black males with OSA have significantly lower oxygen saturations than white males (P = .025). Conclusion Black males who present to the otolaryngologist-head and neck surgeon for evaluation of sleep-disordered breathing may be at increased risk of severe OSA. [source] Osseous Tissue Engineering With Gene Therapy for Facial Bone Reconstruction,THE LARYNGOSCOPE, Issue 7 2001William H. Lindsey MD Abstract Objective Facial osseous defects remain a major functional and esthetic challenge for the head and neck surgeon. Tissue engineering may provide advantageous alternatives to conventional therapies. The objective of the study was to evaluate the efficacy of gene therapy in the repair of osseous facial defects. Study Design Blinded, controlled, prospective animal experiment. Methods Thirty adult athymic nude rats were divided into five groups of six animals. Three groups were used as control subjects. Two groups were treated with 3.75 × 108 viral particles containing recombinant type 5 adenoviral vectors. One group received viruses that coded for ,-galactosidase production, another received viruses that coded for bone morphogenetic protein (BMP-2) production. After 120 days rats were examined at necropsy with precise planimetry, histological analysis of new bone growth, and radio-densitometric analysis of bone thickness. Results Radio-densitometric measurements showed that BMP-2,treated nude athymic rats had significantly enhanced osseous repair compared with control subjects when evaluated by both radio-densitometry and histological examination. Conclusion Gene therapy,treated, immunosuppressed rodents had an enhanced osteoinductive repair of a dorsal osseous nasal defect. [source] Surgical margin determination in head and neck oncology: Current clinical practice.HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2005Neck Society Member Survey, The results of an International American Head Abstract Background. Our aim was to investigate the ways in which surgeons who perform head and neck ablative procedures on a regular basis define margins, how they use frozen sections to evaluate margins, and the effect of chemoradiation on determining tumor margins. Methods. A custom-designed questionnaire was mailed to members of the American Head and Neck Society asking members how they evaluate and define tumor margins. Results. Of 1500 surveys mailed, 476 completed surveys were received. The most common response for distance of a clear pathologic margin was >5 mm on microscopic evaluation. A margin containing carcinoma in situ was considered a positive margin by most, but most did not consider a margin containing dysplasia a positive margin. When initial frozen section margins are positive for tumor and further resection results in negative frozen section margins, 90% consider the patient's margin negative. Most surgeons sample the frozen section from the surgical bed rather than from the main specimen. Nearly half use wider margins when resecting tumors treated with neoadjuvant therapy. When resecting recurrent or residual tumors treated with previous chemoradiation therapy, most resect to the pretreatment margin. Conclusions. No uniform criteria to define a clear surgical margin exist among practicing head and neck surgeons. Most head and neck surgeons consider margins clear if resection completed after an initial positive frozen section margin reveals negative margins, but this view is not shared by all. Most surgeons take frozen sections from the surgical bed; however, error may occur when identifying the positive margin within the surgical bed. The definition of a clear tumor margin after chemoradiation is unclear. These questions could be addressed in a multicenter prospective trial. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Early Oral Feeding Following Total Laryngectomy,,THE LARYNGOSCOPE, Issue 3 2001Jesus E. Medina MD Abstract Objectives The time to begin oral feeding after total laryngectomy remains a subject of debate among head and neck surgeons. The prevailing assumption is that early initiation of oral feeding may cause pharyngocutaneous fistula; thus, the common practice of initiating oral feeding after a period of 7 to 10 days. The objective of the study was to demonstrate the feasibility and safety of oral feeding 48 hours after total laryngectomy. Study Design Two-part study includes, first, a sequential study and, second, a prospective analysis of our practice. Methods Patients undergoing total laryngectomy without partial pharyngectomy or radiation treatment (except irradiation through small ports for a T1 or T2 glottic carcinoma) were included. In the first, sequential part of the study (part I), a group of 18 patients who were fed 7 to 10 days after total laryngectomy (control group) was compared with a group of 20 patients who received oral feeding within 48 hours. To confirm the results of part I, a prospective analysis of this practice was conducted (part II) in which 35 additional patients who met the above criteria were fed within 48 hours after surgery. Results In part I, pharyngocutaneous fistula occurred in one patient (5%) in the early feeding group and in two patients (11%) in the control group. In part II, pharyngocutaneous fistula occurred in one patient (2.8%). Overall, fistula occurred in two patients in the combined early feeding group (3.6%). This rate of pharyngocutaneous fistula compares favorably with the fistula rate in the control group of 18 patients. Pharyngeal stricture that required dilation occurred in three of our patients in the study group and two in the control group (5.5% vs. 11%, respectively). The length of hospital stay was significantly shortened from 12 to 7 days. Conclusion Our results indicate that in this patient population initiation of oral feeding 48 hours after total laryngectomy is a safe clinical practice. [source] Calciphylaxis: Is There a Role for Parathyroidectomy?,THE LARYNGOSCOPE, Issue 4 2000Mark D. Kriskovich MD Abstract Objective Calciphylaxis, a rare disorder typically affecting renal failure patients, results in vascular calcification with subsequent skin necrosis, gangrene, and often death from sepsis. Parathyroid hormone is thought to act as a tissue sensitizer leading to these soft tissue changes. As such, parathyroidectomy is often advocated to control this complicated condition. A discussion of calciphylaxis does not exist in the otolaryngology literature, and head and neck surgeons performing parathyroidectomy should be aware of this phenomenon. This study evaluates the success of parathyroidectomy in reversing the ill effects of calciphylaxis in both our patient population and the literature. Study Design Retrospective study and review of the literature. Methods Five patients with calciphylaxis treated at our institution were evaluated for mortality, surgical and perioperative complications, wound healing, and predictors of patient outcomes. Results Two patients died from sepsis and infectious complications of their calciphylaxis shortly after surgery. Of the three survivors, two later died (15 and 18 mo after surgery) from causes not directly related to calciphylaxis. The other long-term survivor required partial amputation of a leg for osteomyelitis. There was one operative complication, a wound infection requiring antibiotic therapy, drainage, and packing. Postoperative hypocalcemia required treatment in two patients. Immediate perioperative survival was more likely in patients with leukocyte counts less than 20,000 cells/mL. Conclusions Calciphylaxis is a serious disease and patients often succumb to sepsis and infectious complications. Patients with extremely high leukocyte counts from coexistent infections may have a worse prognosis. Although a conclusive effective therapy does not exist, parathyroidectomy can be safely performed and may benefit some patients with what is often an otherwise fatal disease. The literature to date generally confirms our findings. [source] | ||||||||||