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OBJECTIVE: To measure postoperative airway volumes among patients with craniofacial abnormalities and compare them to normative values. STUDY DESIGN: Retrospective, comparative study. SETTING: Academic Medical Center. METHODS: Retrospective analysis of imaging of children with craniofacial abnormalities treated at NYU Langone Health from January 2013 to February 2021. Upper airway volumes postcraniofacial surgery were measured using 3D processing software (Dolphin 3D, version 11.95). These values were compared with published normative values. RESULTS: Twenty-one subjects were identified and compared to normative values. The postoperative oropharyngeal volumes were on average 43.7% smaller than the normative values (P < .001), and the total upper airway volumes were 31.6% smaller (P = .003). No significant differences were observed in the nasopharyngeal or hypopharyngeal volumes of the study cohort compared to the normative data. Among children ages 12 to 17 years (n = 13), the mean oropharyngeal volumes were 47.6% smaller than normal (P < .001), and the mean total upper airway volumes were 34.6% smaller than normal (P < .001). Among children ages 7 to 11 years (n = 8), the mean oropharyngeal volumes were 35.1% smaller than normal (P = .049), but no difference in mean total upper airway volume was observed. CONCLUSION: In children with craniofacial anomalies, postoperative airway volumes remain lower than normative values. However, even a slight increase in airway volume can yield a substantial increase in flow rate. 3D airway evaluations are a valuable tool for surgical planning and analysis and can help with optimizing airway dynamics.
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Anomalías Craneofaciales , Humanos , Niño , Estudios Retrospectivos , Femenino , Masculino , Adolescente , Anomalías Craneofaciales/diagnóstico por imagen , Anomalías Craneofaciales/cirugía , Preescolar , Imagenología Tridimensional , Tomografía Computarizada por Rayos X , Periodo Posoperatorio , Orofaringe/diagnóstico por imagen , Tamaño de los ÓrganosRESUMEN
INTRODUCTION: The study aim was to analyze the presentation, management, and follow-up of renal transplant patients developing bladder calculi. METHODS: Patients who underwent renal transplant with postoperative follow-up at our institution were retrospectively analyzed (1984-2023) to assess for the development of posttransplant bladder stones. All bladder stones were identified by computerized tomography imaging and stone size was measured using this imaging modality. RESULTS: The prevalence of bladder calculi post-renal transplantation during the study window was 0.22% (N = 20/8,835) with a median time to bladder stone diagnosis of 13 years posttransplant. Of all bladder stone patients, 6 (30%) received deceased donor and 14 (70%) living donor transplants. There were 11 patients with known bladder stone composition available; the most common being calcium oxalate (N = 6). Eleven (55%) patients had clinical signs or symptoms (most commonly microhematuria). Fourteen of the bladder stone cohort patients (70%) underwent treatment including cystolitholapaxy in 12 subjects. Of these 14 patients, 9 (64%) were found to have nonabsorbable suture used for their ureteroneocystostomy closure. CONCLUSIONS: The prevalence of bladder stones post-renal transplant is low. The utilization of nonabsorbable suture for ureteral implantation was the main risk factor identified in our series. This technique is no longer used at our institution. Other factors contributing to bladder stone formation in this population warrant identification.
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OBJECTIVE: To investigate the impact of adjuvant radiotherapy in isolated locally advanced oral cavity cancers (pT3N0M0) without adverse features. METHODS: We selected all patients from the National Cancer Database (2004-2019) who underwent surgical treatment where the final pathology was T3N0M0 with negative margins. Demographics, details of treatment, and outcomes were abstracted. The impact of radiotherapy on survival was assessed with univariable, multivariable, and propensity score-matched analyses. RESULTS: We identified 571 patients in our survival cohort. Most were male (348, 60.9%), and median age was 65. Less than one-third (176, 30.8%) received adjuvant radiotherapy. The median length of follow-up was 29 months. Overall, adjuvant radiotherapy was associated with improved survival (87.2% vs. 77.7%, at 2 years, p < 0.01). On multivariable analysis controlling for age and comorbidities, this survival difference persisted (HR: 0.62, 95% CI: 0.43-0.90, p = 0.01). In a propensity score-matched population of 278 patients matched on age and comorbidities, adjuvant radiotherapy was still associated with longer survival (87.4% vs. 78.5%, p = 0.014). CONCLUSION: In our study, adjuvant radiotherapy was associated with improved survival in completely excised locally advanced oral cavity tumors (T3N0M0). However, a significant proportion of patients do not receive adjuvant radiotherapy. These findings highlight the need for continued efforts to promote guideline-recommended care. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:2236-2242, 2024.
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Neoplasias de la Boca , Humanos , Masculino , Anciano , Femenino , Radioterapia Adyuvante , Neoplasias de la Boca/radioterapia , Neoplasias de la Boca/cirugía , Estudios RetrospectivosRESUMEN
BACKGROUND: The present study aims to quantify the opportunity cost of training residents and fellows for head and neck surgery. METHODS: A 2005-2015 review of ablative head and neck surgical procedures was performed using the National Surgical Quality Improvement Program (NSQIP). Work relative value units (wRVU) generated per hour were compared among procedures performed by attendings alone, attendings with residents, and attendings with fellows. RESULTS: Among 34,078 ablative procedures, the rate of wRVU generation per hour was greatest for attendings alone (10.3), followed by attendings with residents (8.9) and attendings with fellows (7.0, p < 0.001). Resident and fellow involvement was associated with opportunity costs of $60.44 per hour (95% CI: $50.21-$70.66/h) and $78.98 per hour ($63.10-$94.87/h, 95% CI), respectively. CONCLUSION: wRVU-based physician reimbursement does not consider or adjust for the extra effort involved in training future head and neck surgeons. LEVEL OF EVIDENCE: NA Laryngoscope, 134:113-119, 2024.
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Internado y Residencia , Cirujanos , Humanos , Mejoramiento de la CalidadRESUMEN
OBJECTIVE(S): Previous literature has established a high prevalence of upper airway obstruction in children with craniofacial abnormalities. This study aims to perform quantitative airway volume measurements in patients with craniofacial abnormalities and compare them to age and sex-matched controls. METHODS: We performed a retrospective review of the records of all children with craniofacial abnormalities who underwent head-and-neck computed tomography (CT) imaging at a single tertiary-care center between 1/1/13 and 12/31/20 using the ICD-10 codes Q75.1, Q75.4, and Q87.0. These patients were then matched by age and sex to patients with isolated craniosynostosis (Q75.0). CT scans were imported into Dolphin Imaging software, and airway volumes were measured for the nasal cavity, nasopharynx, oropharynx, and hypopharynx. The primary outcome was the total airway volume, defined as the sum of these measurements. RESULTS: Thirty subjects with craniofacial syndromes were matched to 30 patients with isolated craniosynostosis (controls). In both groups, 18 subjects (60%) were male (p = 0.99). The average ages for syndromic patients and controls were 12.1 and 12.9 months, respectively (p = 0.84). On average, the total airway volumes of syndromic patients were 25% lower than those of controls (p = 0.02). Syndromic patients had 39% smaller nasal cavity volumes (p < 0.001) and 32% smaller nasopharyngeal volumes (p < 0.01). Significant volume differences were not observed for the oropharynx or hypopharynx. CONCLUSION: We present a unique technique to measure airway volumes in patients with craniofacial abnormalities. These findings will help practitioners to further understand the anatomy and pathophysiology of disturbed breathing in children with craniofacial syndromes. LEVEL OF EVIDENCE: III Laryngoscope, 2023.
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OBJECTIVES: Lacrimal gland cancer is a rare malignancy with little data known about its pathologic characteristics or optimal management. We performed a large database analysis using the National Cancer Database (NCDB) to elucidate this unusual condition. METHODS: Patients with lacrimal gland cancer diagnosed between 2004 and 2018 were included in the analysis. Using available clinical data, we excluded all patients with histologies likely reflective of lacrimal sac or duct cancer, which are coded similarly to lacrimal gland cancer in the NCDB. Kaplan-Meier analysis was used to estimate overall survival (OS), and Cox proportional hazards models were used to indicate covariates associated with survival. RESULTS: A total of 440 cases of lacrimal gland cancer were included in the analysis, with a median follow-up of 52.9 months. The five-year OS for the entire cohort was 65.0%. Adenoid cystic carcinoma was the predominant histology (47.3%). Cox models showed that improved OS was associated with surgical resection (UVA: p < 0.001; MVA: p = 0.035). A detriment in OS was associated with increasing age, Charlson-Deyo score of 1, T4 stage, and positive margins and on UVA for adenocarcinoma and malignant mixed tumor histology. CONCLUSION: Adenoid cystic carcinoma comprises the plurality of lacrimal gland cancers. About half of patients with lacrimal gland carcinoma will live beyond 10 years, underscoring the importance of reduced morbidity of treatment. Surgical management is associated with improved prognosis. Further study will elucidate the role of surgical excision and radiotherapy in lacrimal gland cancer.
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Objectives Few studies have assessed the role of socioeconomic health care disparities in skull base pathologies. We compared the clinical history and outcomes of pituitary tumors at private and public hospitals to delineate whether health care disparities exist in pituitary tumor surgery. Methods We reviewed the records of patients who underwent transsphenoidal pituitary tumor resection at NYU Langone Health and Bellevue Hospital. Seventy-two consecutive patients were identified from each hospital. The primary outcome was time-to-surgery from initial recommendation. Secondary outcomes included postoperative diabetes insipidus, cerebrospinal fluid (CSF) leak, and gross total resection. Results Of 144 patients, 23 (32%) public hospital patients and 24 (33%) private hospital patients had functional adenomas ( p = 0.29). Mean ages for public and private hospital patients were 46.5 and 51.1 years, respectively ( p = 0.06). Private hospital patients more often identified as white ( p < 0.001), spoke English ( p < 0.001), and had private insurance ( p < 0.001). The average time-to-surgery for public and private hospital patients were 46.2 and 34.8 days, respectively ( p = 0.39). No statistically significant differences were found in symptom duration, tumor size, reoperation, CSF leak, or postoperative length of stay; however, public hospital patients more frequently required emergency surgery ( p = 0.03), developed transient diabetes insipidus ( p = 0.02), and underwent subtotal resection ( p = 0.04). Conclusion Significant socioeconomic differences exist among patients undergoing pituitary surgery at our institution's hospitals. Public hospital patients more often required emergency surgery, developed diabetes insipidus, and underwent subtotal tumor resection. Identifying these differences is an imperative initial step in improving the care of our patients.
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OBJECTIVE: This systematic review and meta-analysis aimed to identify studies reporting the incidence of Bell's Palsy after vaccination against coronavirus disease 2019 (Covid-19) and assess whether this incidence is greater than among the general population. DATA SOURCES: PubMed, Embase, CINAHL, and Web of Science. REVIEW METHODS: A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Databases were searched from inception to May 9, 2022, for studies reporting the incidence of Bell's Palsy among individuals vaccinated against Covid-19 and control populations. Meta-analyses of odds ratios (ORs) were performed to compare the incidence of Bell's Palsy in these groups. RESULTS: We identified 7 studies reporting the incidence of Bell's Palsy after vaccination and among the general population, including 20,234,931 total vaccinated patients. The length of postvaccination follow-up ranged from 7 to 43 days in these studies. The incidence of Bell's Palsy was not significantly greater among vaccinated individuals (OR: 1.06; 95% confidence interval [CI]: 0.65-1.71; p = .82). Stratifying by dose, the incidence of Bell's Palsy was not significantly greater after receiving either the first dose (OR: 0.84; 95% CI: 0.47-1.49; p = .54) or second dose (OR: 1.02; 95% CI: 0.58-1.79; p = .96). CONCLUSION: Among the available evidence, the incidence of Bell's Palsy after vaccination against Covid-19 is comparable to that of the general unvaccinated population. Patient counseling should provide reassurance that there is no known association between Bell's Palsy and Covid-19 vaccination.
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Parálisis de Bell , COVID-19 , Parálisis Facial , Humanos , Parálisis de Bell/epidemiología , Parálisis de Bell/etiología , Vacunas contra la COVID-19/efectos adversos , COVID-19/epidemiología , COVID-19/prevención & control , IncidenciaRESUMEN
OBJECTIVE: To compare treatment outcomes for T4b head and neck adenoid cystic carcinoma (ACC). STUDY DESIGN: Historical cohort study. SETTING: National Cancer Database (NCDB). METHODS: Identified all T4b ACC of head and neck origin diagnosed 2004 to 2019 in the NCDB. Demographics, clinical characteristics, treatment details, and survival were analyzed. Treatment outcomes were analyzed using univariable and multivariable Cox regression. RESULTS: We identified 606 cases of T4b ACC. Less than half (284, 47.0%) underwent curative-intent treatment. Among these, most were treated with primary surgery: surgery + radiotherapy (RT) (122, 43.0%) or surgery + chemoradiotherapy (CRT) (42, 14.8%). The positive margin rate was 78.7%, and 90-day postoperative mortality was zero. Nonsurgical patients were treated with definitive RT (60, 21.1%) or definitive CRT (60, 21.1%). The median follow-up was 51.5 months. Overall survival was 77.8% at 3 years. Three-year survival was higher for patients treated with surgery compared to those treated nonsurgically (84% vs 70%; p = .005). Surgical treatment remained associated with higher survival on multivariable analysis (hazard ratio [HR]: 0.47, p = .005). This effect was most pronounced for oral cavity tumors (HR: 0.17, p = .01). Among matched cohorts of surgically treated patients, there was no difference in 3-year survival between clinical T4a and T4b tumors (83.3% vs 83.0%, p = .99). CONCLUSION: Long-term survival for T4b ACC of the head and neck could be expected. Primary surgical treatments can be performed safely and are associated with longer survival. A carefully selected subset of patients with very advanced ACC might benefit from the consideration of surgical treatments.
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Carcinoma Adenoide Quístico , Carcinoma , Neoplasias de Cabeza y Cuello , Neoplasias de la Boca , Humanos , Carcinoma Adenoide Quístico/cirugía , Estudios de Cohortes , Neoplasias de la Boca/cirugía , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
BACKGROUND: To determine maternal and neonatal risk factors for, and incidence of, neonatal early-onset group B streptococcus (EOGBS) and late-onset (LOGBS) infection in South Australia (SA) and the Northern Territory (NT). METHODS: A case-control study with 2:1 matched controls to cases. The study included tertiary hospitals in South Australia and the Northern Territory, Australia. Retrospective data were collected from a 16-year epoch (2000-2015). RESULTS: Of a total of 188 clinically suspected or confirmed cases, 139 were confirmed, of which 56.1% (n = 78) were EOGBS and 43.9% (n = 61) were LOGBS. The incidence of clinically suspected and confirmed cases of EOGBS was 0.26/1000 live births in SA and 0.73/1000 live births in the NT, and the incidence of confirmed cases was 0.19/1000 for SA and 0.36/1000 for the NT. The incidence of clinically suspected or confirmed LOGBS was 0.18/1000 live births in SA and 0.16/1000 for the NT. The majority of infants with GBS presented with sepsis, pneumonia, or meningitis. Developmental delay was the most commonly recorded long-term complication at 1 year old. Risk factors for EOGBS included maternal GBS carriage, previous fetal death, identifying as Aboriginal and/or Torres Strait Islander, and maternal fever in labor/chorioamnionitis. CONCLUSIONS: GBS remains a leading cause of neonatal morbidity and mortality. Adding previous fetal death to GBS screening guidelines would improve GBS prevention. The introduction of maternal GBS vaccination programs should be guided by country-specific disease epidemiology.
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Complicaciones Infecciosas del Embarazo , Infecciones Estreptocócicas , Embarazo , Recién Nacido , Lactante , Femenino , Humanos , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Profilaxis Antibiótica , Estudios de Casos y Controles , Estudios Retrospectivos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Infecciones Estreptocócicas/tratamiento farmacológico , Streptococcus agalactiae , Northern Territory/epidemiología , Incidencia , Muerte FetalRESUMEN
BACKGROUND: The present study characterizes national trends in the utilization of adjuvant chemotherapy to treat salivary gland malignancies. METHODS: The National Cancer Database was queried for salivary gland malignancies treated by surgery with radiation in 2004-2019. Proportions of patients receiving adjuvant chemotherapy over the study period were analyzed by linear regression. The impact of chemotherapy on overall survival was assessed using Kaplan-Meier and Cox proportional hazards analyses. RESULTS: Among 15 965 patients meeting inclusion criteria, 2355 (14.8%) received adjuvant chemotherapy. Chemotherapy utilization significantly increased from 4.9% to 16.5% over the study period (p < 0.001). No survival benefit was observed with adjuvant chemotherapy on propensity score-matched Kaplan-Meier analysis (HR: 0.98; 95% CI: 0.86-1.11; p = 0.72) or multivariable Cox regression (HR: 0.92; 95% CI: 0.78-1.09; p = 0.34). CONCLUSIONS: Adjuvant chemotherapy has been increasingly utilized to treat salivary gland malignancies in recent years. Our findings highlight the importance of obtaining high-quality prospective data regarding the benefit of chemotherapy.
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Neoplasias de las Glándulas Salivales , Humanos , Radioterapia Adyuvante , Estudios Prospectivos , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Neoplasias de las Glándulas Salivales/patología , Quimioterapia Adyuvante , Estadificación de NeoplasiasRESUMEN
Importance: Over time, the American Thyroid Association (ATA) guidelines have increasingly promoted more limited treatments for well-differentiated thyroid cancers. Objective: To determine whether the 2009 and 2015 ATA guidelines were associated with changes in the management of low-risk papillary thyroid carcinomas on a national scale. Design, Setting, and Participants: This historical cohort study used the National Cancer Database. All papillary thyroid carcinomas diagnosed from 2004 to 2019 in the National Cancer Database were selected. Patients with tumors of greater than 4 cm, metastases, or clinical evidence of nodal disease were excluded. Data were analyzed from August 1, 2021, to September 1, 2022. Main Outcomes and Measures: The primary aim was to tabulate changes in the rates of thyroid lobectomy (TL), total thyroidectomy (TT), and TT plus radioactive iodine (RAI) therapy after the 2009 and 2015 ATA guidelines. The secondary aim was to determine in which settings (eg, academic vs community) the practice patterns changed the most. Results: A total of 194â¯254 patients (155â¯796 [80.2%] female patients; median [range] age at diagnosis, 51 [18-90] years) who underwent treatment during the study period were identified. Among patients who underwent surgery, rates of TL decreased from 15.1% to 13.7% after the 2009 guidelines but subsequently increased to 22.9% after the 2015 changes. Among patients undergoing TT, rates of adjuvant RAI decreased from 48.7% to 37.1% after 2009 and to 19.3% after the 2015 guidelines. Trends were similar for subgroups based on sex and race and ethnicity. However, academic institutions saw larger increases in TL rates (14.9% to 25.7%) than community hospitals (16.3% to 19.5%). Additionally, greater increases in TL rates were observed for tumors 1 to 2 cm (6.8% to 18.9%) and 2 to 4 cm (6.6% to 16.0%) than tumors less than 1 cm (22.8% to 29.2%). Conclusions and Relevance: In this cohort study among patients with papillary thyroid carcinomas up to 4 cm, ATA guideline changes corresponded with increased TL and reduced adjuvant RAI. These changes were primarily seen in academic institutions, suggesting an opportunity to expand guideline-based care in the community setting.
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Radioisótopos de Yodo , Neoplasias de la Tiroides , Humanos , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Masculino , Cáncer Papilar Tiroideo/terapia , Estudios de Cohortes , Radioisótopos de Yodo/uso terapéutico , Neoplasias de la Tiroides/cirugíaRESUMEN
OBJECTIVE: Aloe vera is a cost-effective, accessible wound care adjunct with a minimal risk profile. Despite its centuries-long history being used to treat varying wound types, published reports remain inconclusive on its efficacy. In this article, the authors report the results of a systematic review assessing the efficacy of topical aloe vera products in wound care applications, as well as a meta-analysis of its utility in burn healing where data are most robust. DATA SOURCES: In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors searched PubMed, EMBASE, and Cochrane CENTRAL for randomized controlled trials assessing the use of aloe vera in healing various wound types. STUDY SELECTION: The database search identified 91 articles. After duplicates were removed, 74 articles were screened, and of those, 47 were assessed for eligibility. Ultimately, 28 articles were included in the qualitative synthesis, and 4 studies assessing second-degree burns were included in the meta-analysis. DATA EXTRACTION: The following data points were collected from each study: number of participants/wounds, treatment type, adjunctive therapy (if any), and primary outcomes. DATA SYNTHESIS: Risk-of-bias analysis was conducted on included articles, and results were compiled. A meta-analysis was undertaken for studies focusing on the treatment of burns. Cumulatively, these studies had a total of 133 patients with 163 wounds being assessed. Analysis revealed a statistically significant mean difference in time to healing of 4.44 days in favor of aloe vera treatment (P = .004). CONCLUSIONS: Topical aloe vera usage for second-degree burn wound healing demonstrated significantly faster time to healing compared with other treatments.
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Aloe , Quemaduras , Traumatismos de los Tejidos Blandos , Humanos , Fitoterapia/métodos , Quemaduras/tratamiento farmacológico , Cicatrización de HeridasRESUMEN
BACKGROUND: The recent trends in education and geographic distribution of the head and neck surgery workforce have not been studied extensively. METHODS: We reviewed publicly available sources to locate all fellowship-trained head and neck surgeons and recent graduates. The number of surgeons in each state was compared against head and neck cancer incidence data from the Centers for Disease Control. RESULTS: The number of graduates increased annually by 1 per 100 000 000 people from 2011-2020. The average number of fellowship-trained surgeons per state was 10 (SD: 12). The average number of new head and neck cancer cases per surgeon was 247 (SD: 135). Ten states (20%) had cases >1 SD above the national average/surgeon, while 3 (6%) had cases >1 SD below the national average. CONCLUSION: Head and neck surgeons are located in most states, but not uniformly. Most states have approximately average density of surgeons; however, several states are outliers.
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Neoplasias de Cabeza y Cuello , Oncología Quirúrgica , Cabeza , Neoplasias de Cabeza y Cuello/epidemiología , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Cuello , Estados Unidos , Recursos HumanosRESUMEN
Objective: Previous studies have questioned the safety and efficacy of minor salivary gland biopsy in the diagnosis of Sjögren's syndrome, citing complications and difficulty of pathologic evaluation. This study aims to determine the rate of biopsy specimen adequacy and the risk of complications after minor salivary gland biopsy. Study Design: Case series. Setting: Single tertiary care center. Methods: We reviewed the records of all patients who underwent minor salivary gland biopsy at our institution from October 1, 2016, to September 1, 2021. Demographics, comorbidities, symptoms, and serologic results were recorded. The primary outcome was adequacy of the tissue sample. Complications of the procedure were recorded. Biopsies with at least one focus of ≥50 lymphocytes per 4-mm2 sample were considered positive. Results: We identified 110 patients who underwent minor salivary gland biopsy. Ninety-three (85%) were female, and the median age was 49.1 years (range, 18.7-80.5). Seventy-seven procedures (70%) were performed in the office setting, and 33 (30%) were performed in the operating room. Nearly all biopsy samples (n = 108, 98%) were adequate, and 33 (31%) were interpreted as positive. Four patients (4%) experienced temporary lip numbness, which resolved with conservative management. No permanent complications were reported after lip biopsy. Nineteen (58%) patients with positive biopsy results had no Sjögren's-specific antibodies. Most patients with positive biopsy results (n = 20, 61%) subsequently started immunomodulatory therapy. Conclusion: Minor salivary gland biopsy can be performed safely and effectively in both the office and the operating room. This procedure provides clinically meaningful information and can be reasonably recommended in patients suspected to have Sjögren's syndrome.
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BACKGROUND: Few studies have investigated the needs of head and neck surgery trainees and areas for improvement of fellowship programs. METHODS: We conducted a qualitative study by interviewing a nationally representative sample of program directors and national leaders in head and neck surgery. We asked about the current state and strengths of training; and areas for further improvement. All interviews were independently coded and analyzed by two reviewers. RESULTS: All experts (100%) believed that the current training provides a strong foundation and furthermore, a standardized curriculum is beneficial. Multidisciplinary training (80%), participation in tumor boards (75%), and a syllabus (60%) were the most frequently mentioned components. Most believed that a formal certification process would be beneficial (73%), though there was no consensus on the format. CONCLUSION: Experts in head and neck surgery are generally in favor of a standardized curriculum. Further discussions of a formal certification process might be warranted.
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Oncología Quirúrgica , Curriculum , Testimonio de Experto , Becas , Humanos , Cuello , Evaluación de NecesidadesRESUMEN
Sinonasal glomangiopericytoma is a rare vascular tumor of the respiratory epithelium. Treatment consists mainly of surgical resection, though there is no consensus regarding the use of adjuvant therapies or preoperative endovascular embolization. The postsurgical prognosis is favorable, though there is a high risk of delayed recurrence. Here, we present the case of a patient who underwent endoscopic resection of a sinonasal glomangiopericytoma and a review of the literature.
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Sinonasal undifferentiated carcinoma (SNUC) is a rapidly growing malignancy with a propensity for extensive local invasion. Multimodal therapy, including surgery, radiotherapy, and chemotherapy, is the standard approach to treatment, but the optimal sequence and combination of these modalities are uncertain. Induction chemotherapy is being increasingly utilized based on recent reports that show better outcomes for patients who respond to chemotherapy and the ability to determine further course of treatment. We present a unique case of a patient with locally advanced SNUC that did not respond to induction chemotherapy and a review of the available literature relating to the management of this rare malignancy.