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1.
Am J Otolaryngol ; 42(6): 103068, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33940252

RESUMO

The effects of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) exist on a spectrum. Clinical symptoms of smell and taste dysfunction are prominent features of COVID-19. The objective of this study was to elucidate the factors associated with smell and taste dysfunction amongst hospitalized COVID-19 patients. A retrospective review of a multi-hospital health network's COVID-19 database between March and June 2020 was performed. Patients with self-reported smell or taste loss were included. Demographic information, patient comorbidities, and mortality data was obtained. There were 2892 patients included in this analysis and 117 reported smell or taste loss (4.0%, 95% confidence interval [CI]: 3.4%-4.8%). The proportion of females with smell or taste loss was significantly higher than males (6.3% vs. 2.5%, P < 0.001), whereas no differences existed between ethnicity or smoking status. When compared with age of 30-40 years, the age group of 10-20 years were most likely to present with smell or taste dysfunction (odds ratio [OR] 6.59, 95% CI 1.32-26.12; P = 0.01). The majority of specific comorbidities were not associated with increased incidence of smell or taste dysfunction. Outpatient healthcare workers were more likely to present with smell or taste loss (OR 3.2, CI 1.8-5.47; P < 0.001). The mortality rate among COVID-19 patients with smell or taste dysfunction was significantly lower than those without (0% vs. 20.3%; P < 0.001). Smell or taste loss is more prevalent in women, younger age groups, and healthier individuals. It may be associated with lower mortality and a milder disease trajectory compared to the overall cohort.


Assuntos
COVID-19/complicações , COVID-19/fisiopatologia , Hospitalização , Transtornos do Olfato/etiologia , Transtornos do Olfato/fisiopatologia , Olfato/fisiologia , Distúrbios do Paladar/etiologia , Distúrbios do Paladar/fisiopatologia , Paladar/fisiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , COVID-19/mortalidade , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Olfato/epidemiologia , Transtornos do Olfato/mortalidade , Estudos Retrospectivos , Fatores Sexuais , Distúrbios do Paladar/epidemiologia , Distúrbios do Paladar/mortalidade , Adulto Jovem
2.
Artigo em Inglês | MEDLINE | ID: mdl-32596653

RESUMO

OBJECTIVE: To review indications and techniques for the endoscopic endonasal approach to the craniovertebral junction (CVJ), analyze postoperative outcomes, and discuss important technical considerations. METHODS: A retrospective analysis was performed on all patients undergoing endonasal endoscopic approaches to the CVJ from May 2007 to June 2017. Demographic information, presenting symptoms, imaging results, treatment course, postoperative functional status, and follow-up were recorded. RESULTS: There was a total of 30 patients in this series, with a mean follow-up of 11.7 months. The average age was 33.6 years (range, 5-75 years), with 18 females and 12 males. The majority of patients (n = 22, 73.3%) had Chiari malformation type 1 with basilar invagination and symptomatic cervicomedullary compression as the indication for surgery. Intraoperative cerebrospinal fluid leak (CSF) was noted in 3 cases of odontoid resection and a single case of skull base resection. There were no postoperative CSF leaks. Overall, 81% of patients resumed regular diet by post-operative day 2 (range, 0-8 days). Severe postoperative dysphagia occurred in two cases with one requiring gastrostomy tube placement and another utilizing total parenteral nutrition for support prior to eventual gastrostomy. On average, patients were extubated by postoperative day 0.93 (range 0-3 days), with 85% extubated by postoperative day 1. A tracheotomy was required in one patient. CONCLUSION: The endonasal endoscopic approach is a valuable technique for access to the CVJ with minimal disruption of respiratory and alimentary function.

3.
Artigo em Inglês | MEDLINE | ID: mdl-32596654

RESUMO

Endoscopic endonasal orbital surgery is evolving. With increasing knowledge, expertise, and technology, the historical limits of the endonasal endoscopic approach to the orbit have been redefined. This review discusses the clinical presentation and etiology, and highlights the pertinent anatomy, and discusses the diagnostic workup and surgical approach to orbital tumors and post-operative care. The role of the multidisciplinary team is not to be underestimated. The introduction of a classification system to ensure standardization of technical difficulty and outcome data will assist with international collaboration and further consolidate our attainment of knowledge in this developing field.

5.
Int Forum Allergy Rhinol ; 10(1): 53-58, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31600856

RESUMO

BACKGROUND: Nasal saline irrigations (NSIs) are commonplace in treatment of patients with sinonasal disorders. Contamination of both the water source and delivery bottle remains a challenge with this therapy. The goal of this study was to optimize a disinfection technique with various methods of preparation, disinfection, and delivery of NSIs. METHODS: Distilled and tap water sources in NSI bottles were contaminated by 4 bacterial strains: Bacillus subtilis, Staphylococcus aureus, Pseudomonas aeruginosa, and Legionella pneumophila. Contaminated bottles were cleaned with tap water, tap water with detergent, or microwave and swabbed for culture. Water-source disinfection was performed with reverse osmosis, distillation, activated carbon filtration, boiling, or ultraviolet (UV) light treatment. Test samples from each experimental group (n = 3/group) were cultivated on the appropriate media with colony-forming units (CFUs) reported. RESULTS: All methods of bottle cleaning with tap water with/without detergent and microwave significantly reduced bacterial load (CFUs) by >99% (p < 0.05). Distillation and boiling of the contaminated water source eliminated 100% of bacteria, whereas reverse osmosis and activated carbon filtration did not. A single UV treatment of contaminated water within a bottle eliminated 99% of bacteria within the water and 100% in the bottle. CONCLUSION: Cleansing of NSI bottles with tap water with/without detergent or microwave produced robust bacterial disinfection. Distillation and boiling of a contaminated water source completely eliminated all bacteria. UV light treatment was capable of simultaneous disinfection of both the water source and bottle, suggesting this may be a convenient, 1-step method of preparing NSIs for patients.


Assuntos
Contaminação de Equipamentos/prevenção & controle , Lavagem Nasal/instrumentação , Esterilização/métodos , Raios Ultravioleta , Bactérias/crescimento & desenvolvimento , Bactérias/efeitos da radiação , Carga Bacteriana/efeitos da radiação , Detergentes/farmacologia , Desinfecção/métodos , Equipamentos e Provisões Hospitalares/microbiologia , Micro-Ondas , Solução Salina/efeitos da radiação , Microbiologia da Água
6.
Laryngoscope ; 130(3): 584-589, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31120602

RESUMO

OBJECTIVES/HYPOTHESIS: Most patients who undergo endoscopic dacryocystorhinostomy (DCR) have a diagnosis of idiopathic nasolacrimal duct obstruction. The purpose of this study was to examine the impact of routine biopsy of the lacrimal sac performed at time of DCR on subsequent patient diagnosis and treatment. STUDY DESIGN: Retrospective review. METHODS: The histopathology of nasolacrimal specimens (n = 769), obtained from 654 consecutive patients undergoing endoscopic DCR by a single surgeon over a 30-year period, were reviewed. Specific focus included the identification of unanticipated pathologic findings as they related to pertinent patient demographics, clinical presentation, radiologic findings, and intraoperative observations. RESULTS: The study population was 69.6% female, with an average age of 56.1 ± 18.2 years. Pathological findings of tissue from the nasolacrimal sac, which was routinely sampled in all cases, showed inflammation (n = 566 [73.6%]), normal histology (n = 147 [19.1%]), granulomas (n = 8 [1.0%]), and neoplastic process (n = 7 [0.9%]). Patient history, preoperative CT scan, and/or intraoperative findings alerted the surgeon to the possibility of an unusual diagnosis in 12 of the 15 patients. An unsuspected neoplastic or granulomatous cause of lacrimal obstruction was identified on intraoperative biopsy in three patients (0.46%). CONCLUSIONS: Although neoplastic and granulomatous diseases are relatively rare causes of lacrimal obstruction necessitating DCR surgery, they may be identified by through patient evaluation in most cases and by routine intraoperative biopsy of the lacrimal sac in all cases. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:584-589, 2020.


Assuntos
Dacriocistorinostomia/métodos , Neoplasias Oculares/diagnóstico , Granuloma/diagnóstico , Doenças do Aparelho Lacrimal/diagnóstico , Obstrução dos Ductos Lacrimais/diagnóstico , Adulto , Idoso , Biópsia/métodos , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Ducto Nasolacrimal/patologia , Ducto Nasolacrimal/cirurgia , Estudos Retrospectivos
8.
Clin Otolaryngol ; 44(6): 887-897, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31580530

RESUMO

BACKGROUND: Chronic rhinosinusitis (CRS) is the downstream manifestation of heterogeneous pathophysiologic mechanisms leading to chronic sinonasal inflammation. Traditional grouping of patients by symptoms or clinical findings/phenotypes is being replaced by classification of CRS patients based on the underlying pathophysiologic mechanisms: endotypes. OBJECTIVE OF REVIEW: To provide an up-to-date review on the current knowledge of CRS endotypes with a focus on how the pathophysiologic mechanisms defined by each endotype may be targeted therapeutically. Special emphasis is placed on the clinical relevance of the material and how it may inform the current practice of otolaryngologists. TYPE OF REVIEW: A systematic review of contemporary literature review focusing on the latest studies examining the role of endotypes in the management and treatment of CRS. SEARCH STRATEGY: A MEDLINE and PubMed Central search were undertaken to perform this review using the keywords "Endotype" and "Sinusitis." EVALUATION METHOD: Articles containing the keywords, as well as the references of those articles, were then examined for relevance. RESULTS: The endotypes for CRS are often defined based on the balance of T-helper cell patterns of inflammation and can be grouped into Th2 and non-Th2 inflammation. These groups have shown a variable response to medical and surgical therapy, demonstrating that existing mainstream treatments can be tailored to patients with specific endotypes. The inflammatory mediators of Th2 inflammation, IL-4, IL-5 and IL-13 as well as IgE, are targeted by available biologic drugs that can be used for treatment of refractory disease. CONCLUSIONS: Increased understanding of CRS endotypes has led to the identification of biomarkers that define these endotypes and act as targets for potential therapeutics. Increasing knowledge about characteristics associated with these endotypes and their responses to treatments, including both established mainstream CRS treatments and novel biologic medications, has allowed incorporation of CRS endotypes into the current clinical decision-making. Treatment of CRS patients based on consideration of their endotypes is therefore not only presently possible but may improve clinical outcomes of those patients as well.


Assuntos
Rinite/etiologia , Rinite/fisiopatologia , Sinusite/etiologia , Sinusite/fisiopatologia , Doença Crônica , Humanos , Rinite/terapia , Sinusite/terapia
9.
J Surg Oncol ; 120(7): 1259-1265, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31549410

RESUMO

BACKGROUND AND OBJECTIVES: The reported risk of nodal metastasis in hard palate and upper gingival squamous cell carcinoma (SCC) has been inconsistent with inadequate consensus regarding the utility of neck dissection in the clinically negative (cN0) neck. MATERIALS AND METHODS: Using the National Cancer Database, cN0 patients diagnosed with SCC of the head and neck with the subsites of the hard palate and upper gingiva were identified from 2004 to 2014. RESULTS: A total of 1830 patients were identified, and END was performed on 422 patients with cN0 tumors. Pathologically positive nodes occurred in 14% (59/422) of patients in this cohort. Higher tumor stage, academic hospital type, and large hospital volume (>28 cancer-specific cases/year) were associated with a higher likelihood of END both in univariate and multivariate analyses (P < .05). Patients >80 years of age were less likely to receive END on multivariate analysis (OR 0.52, 0.32-0.84). No variables, including advanced T stage, predicted occult metastases. Cox proportional hazards regression analysis showed that patients who underwent END demonstrated improved OS over an 11-year period (hazard ratio 0.75, P = .002). On subgroup analysis, this improvement was significant in patients with both stage T1 and T4 tumors. CONCLUSIONS: Tumor stage, hospital type, and hospital volume were associated with higher rates of END for patients with cN0 hard palate SCC and after controlling for clinical factors, END was associated with improved overall survival.


Assuntos
Carcinoma de Células Escamosas/mortalidade , Procedimentos Cirúrgicos Eletivos/mortalidade , Neoplasias Gengivais/mortalidade , Neoplasias Maxilares/mortalidade , Esvaziamento Cervical/mortalidade , Palato Duro/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Bases de Dados Factuais , Feminino , Seguimentos , Neoplasias Gengivais/patologia , Neoplasias Gengivais/cirurgia , Humanos , Masculino , Neoplasias Maxilares/patologia , Neoplasias Maxilares/cirurgia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Palato Duro/patologia , Estudos Retrospectivos , Taxa de Sobrevida
10.
J Neurol Surg B Skull Base ; 80(4): 371-379, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31316883

RESUMO

Objectives Determining surgical trends and outcomes for sinonasal tumors is challenging given their low incidence and heterogeneous pathology. This study utilized the National Cancer Database (NCDB) to identify trends and outcomes associated with surgical management of sinonasal tumors. Design Retrospective database analysis. Setting National Cancer Database. Participants Patients with sinonasal malignancies identified from the NCDB between 2010 and 2015. Main Outcome Measures The primary outcome was the choice of surgical therapy used for sinonasal tumor resection: endoscopic versus open approach. Each was cohort analyzed with respect to various demographic and clinicopathologic factors. A treatment effect model was used to identify potential differences between surgical approaches. Survival was evaluated using Kaplan-Meier analysis. Results A total of 10,193 patients with sinonasal malignancies were identified in the NCDB database; of these, 2,292 had a documented subsite, histology, and definitive surgical treatment with documented surgical approach and were included in the analysis. About 71.9% of patients had an open approach and 28.1% a purely endoscopic procedures. Tumor histology, treatment facility type, margin status, and length of stay were all variables that were associated with significant differences between the open and endoscopic cohort. Five-year survival rates for the open and endoscopic cohorts were not significantly different (59.6 and 60.8%, respectively). Conclusions Assessment of the NCDB revealed that 28% patients with sinonasal malignancy were selected for endoscopic surgery. These patients had comparable oncologic outcomes to open resection.

11.
Head Neck ; 41(10): 3551-3563, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31294897

RESUMO

BACKGROUND: Timely postoperative radiation therapy (RT) within 50 days of surgery for head and neck cancers provides a survival advantage. METHODS: Using the National Cancer Database, we performed a propensity score-matched analysis comparing patients undergoing open or endoscopic surgery for squamous cell carcinoma (SCC) of the nasal cavity and paranasal sinuses from 2010 to 2015. RESULTS: Among 168 pairs, patients undergoing endoscopic surgery had shorter time to surgery (24.2 vs 36.7 days, P < .001) and shorter postoperative time to RT (PTTR, 51.2 vs 58.4 days, P = .02). On multivariable linear regression, endoscopic surgery predicted shorter PTTR (ß = -7.6, P = .01). Using the Kaplan-Meier method, patients in the longest PTTR quartile had decreased overall survival (OS; Q1 vs Q4, 3-year OS 76.5% vs 53.3%, P = .007), a durable finding when adjusted for covariates (Q1 vs Q4, HR 0.50, P = .008). CONCLUSIONS: Patients undergoing endoscopic surgery for sinonasal SCC experience shorter PTTR. Shorter PTTR is associated with extended OS.


Assuntos
Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/cirurgia , Endoscopia/métodos , Neoplasias dos Seios Paranasais/mortalidade , Neoplasias dos Seios Paranasais/cirurgia , Adulto , Idoso , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/radioterapia , Terapia Combinada , Bases de Dados Factuais , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Neoplasias dos Seios Paranasais/patologia , Neoplasias dos Seios Paranasais/radioterapia , Pontuação de Propensão , Radioterapia Adjuvante , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Fatores de Tempo
12.
Int Forum Allergy Rhinol ; 9(6): 601-606, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30702220

RESUMO

BACKGROUND: The objective of this study was to evaluate the impact of bilateral inferior turbinate reduction (BITR) on patient-reported quality of life (QOL) following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). METHODS: This was a prospective cohort study. Patients with CRS, who were recruited from 10 different otolaryngologic practices between 2011 and 2014, completed the 22-item Sino-Nasal Outcome Test (SNOT-22), Chronic Sinusitis Survey (CSS), and EuroQol 5 Dimension (EQ-5D) survey at baseline, and at 12, 24, 36, and 48 months after ESS. A total of 113 patients who underwent ESS with BITR were compared to 788 patients who underwent ESS without BITR. RESULTS: Significant demographic and comorbid differences between BITR and non-BITR cohorts included age (41 vs 49 years, p < 0.0001), presence of asthma (19% vs 36%, p < 0.0001), prior sinus surgery (22% vs 53%, p < 0.0001), and concurrent septoplasty (80% vs 53%, p < 0.0001), respectively. On univariate analysis, patients who underwent ESS with or without BITR were found to have statistically significant improvement in disease-specific (SNOT-22 and CSS) and general (EQ-5D) QOL scores at years 1 through 4 (p < 0.05). On multivariate regression, however, the performance of BITR was not associated with any improvements in these outcome measures. CONCLUSION: Patients undergoing ESS achieve similar long-term improvement in both disease-specific and general QOL regardless of the performance of concurrent BITR.


Assuntos
Cirurgia Endoscópica por Orifício Natural/psicologia , Seios Paranasais/cirurgia , Qualidade de Vida , Rinoplastia/psicologia , Conchas Nasais/cirurgia , Adulto , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seios Paranasais/patologia , Estudos Prospectivos , Qualidade de Vida/psicologia , Rinite/psicologia , Rinite/cirurgia , Teste de Desfecho Sinonasal , Sinusite/psicologia , Sinusite/cirurgia , Conchas Nasais/patologia
13.
J Craniofac Surg ; 30(3): 800-802, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30614990

RESUMO

Lesions involving the masseteric and buccal spaces have traditionally required transoral or transcervical approaches. Herein, the authors describe the successful endonasal endoscopic resection of a juvenile nasopharyngeal angiofibroma (JNA) with significant extension into the masseteric and buccal spaces facilitated by transoral finger retraction. Juvenile nasopharyngeal angiofibromas are hypervascular tumors originating in the pterygopalatine fossa (PPF) with complex relationships to skull base and orbital structures. Endoscopic approaches have allowed for resection of JNAs with excellent visualization and without traditional transfacial approaches, decreasing morbidity and reducing incidence of facial deformity with similar outcomes as open approaches. While the endonasal endoscopic approach to the masseteric and buccal spaces is unconventional, encapsulated tumors in these regions can be delivered into the nasal cavity through the maxilla and PPF with the use of transoral finger-retraction. The authors present a case of a 10-year-old male referred to their tertiary care center with left-sided epistaxis, nasal obstruction, and facial swelling. Imaging demonstrated a vascular lesion in the PPF involving the left nasal cavity and paranasal sinuses, with extension into left middle cranial fossa, infratemporal fossa, orbit, and deep spaces of the neck including the masticator, masseteric, and buccal spaces. The patient underwent preoperative embolization and endoscopic endonasal surgical resection with transoral finger-retraction without complication. Transoral finger-retraction represents a supplemental technique that allows for encapsulated lesions involving the masseteric and buccal spaces to be delivered into the nasal cavity for endoscopic resection in a safe and effective fashion, preventing the need for transfacial incisions.


Assuntos
Angiofibroma/cirurgia , Endoscopia/métodos , Neoplasias Nasofaríngeas/cirurgia , Neoplasias Nasais/cirurgia , Neoplasias dos Seios Paranasais/cirurgia , Angiofibroma/diagnóstico por imagem , Criança , Dedos , Humanos , Masculino , Boca , Cavidade Nasal , Neoplasias Nasofaríngeas/diagnóstico por imagem , Fossa Pterigopalatina
14.
J Clin Neurosci ; 60: 167-169, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30385164

RESUMO

The nasoseptal flap (NSF) has become the workhorse of endoscopic skull base reconstruction (ESBR). With the increase in endoscopic skull base procedures, there has also been the need for staged and revision procedures where the use of the NSF is no longer an option. These cases have posed new and interesting challenges to skull base surgeons especially with regards to reconstructive options. While free mucosal or turbinate grafts may be too small for certain defects, others such as the pericranial flap require an open procedure with added morbidity. We describe the use of a random nasoseptal flap for the reconstruction of a skull base defect.


Assuntos
Septo Nasal , Procedimentos de Cirurgia Plástica/métodos , Base do Crânio/cirurgia , Retalhos Cirúrgicos , Adenoma/patologia , Adenoma/cirurgia , Adulto , Feminino , Humanos , Neuroendoscopia/métodos , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgia
15.
Am J Rhinol Allergy ; 33(1): 8-16, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30280585

RESUMO

BACKGROUND: The number of rhinology fellowship programs has grown rapidly over the past decade. To date, no standardization or accreditation process exists, raising the potential for disparate programs. The attitudes of faculty regarding training are important to elucidate the educational experience of rhinology fellowship. METHODS: An anonymous, web-based survey of rhinology faculty assessed the subjective attitudes toward various domains of fellowship training including surgery, office-based procedures, research, and career development. A 5-point Likert-type scale assessing importance was used (1-not at all important, 5-extremely important). RESULTS: A total of 34 faculty (response rate 35.8%) completed the survey. The surgical procedures that received the highest mean importance scores were endoscopic surgery for advanced inflammatory disease (median = 5), cerebrospinal fluid leak closure (5), and extended endoscopic sinus surgery (5). The procedures with the lowest scores were nasal valve repair (2), inferior turbinate surgery (3), and open approaches to the sinuses (4). A wide range of responses was noted for the minimum target number of fellow cases for the surveyed procedures. Higher importance scores were noted for direct attending supervision (5) when compared to fellow autonomy (4, P < .001) or shadowing (3.5, P < .001) in the operating room. Higher scores were noted for career preparation in academic (4) versus private practice (3, P < .001) and providing opportunities for clinical (4) versus basic science research (2, P < .001). The majority of faculty felt that there were too many fellowship positions with respect to the market place for private practice (58.8%), academic jobs (85.3%), and overall societal need (61.8%). CONCLUSION: A range of faculty attitudes with respect to fellowship training was noted in this study. Continued assessment and refinement of the educational experience in rhinology fellowships is necessary.


Assuntos
Educação , Docentes de Medicina , Bolsas de Estudo , Otolaringologia , Desempenho Acadêmico , Atitude , Mobilidade Ocupacional , Educação de Pós-Graduação em Medicina , Humanos , Inquéritos e Questionários
16.
J Surg Oncol ; 119(1): 130-142, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30466166

RESUMO

BACKGROUND: Esthesioneuroblastoma (ENB) is a rare neuroendocrine tumor. The purpose of this study was to compare the Kadish, tumor-node-metastasis (TNM), and Dulguerov's modified TNM staging in order to determine the impact of the stage on primary surgical treatment selection, margin status, and survival. METHODS: The National Cancer Database (NCDB) was used to identify patients diagnosed with ENB between 2004 to 2015. Patients were excluded based on the ability to properly stage their disease as well as the availability of treatment data. RESULTS: Eight-hundred eighty-three patients had sufficient data for analysis. On multivariate analysis, age and government insurance were associated with primary surgical treatment, whereas tumor stage, gender, race, hospital type and volume, and comorbidity score were not. Age, charlson-deyo comorbidity (CDCC) score, hospital volume, and nodal status were found to be predictors of survival. Multivariate-analysis controlling for stage failed to demonstrate clear survival differences between staging in both TNM and Kadish systems. T-stage and the presence of regional nodal metastasis were associated with an increased risk of positive margins on multivariate analysis. CONCLUSION: Although primary surgical management and positive margins can be predicted by certain patient and tumor factors, clinical staging systems for ENB poorly predict prognosis over a 10-year horizon.


Assuntos
Estesioneuroblastoma Olfatório/patologia , Cavidade Nasal/patologia , Neoplasias Nasais/secundário , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estesioneuroblastoma Olfatório/cirurgia , Feminino , Seguimentos , Humanos , Metástase Linfática , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Cavidade Nasal/cirurgia , Estadiamento de Neoplasias , Neoplasias Nasais/cirurgia , Prognóstico , Taxa de Sobrevida
17.
Laryngoscope ; 128(3): 722-726, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28561306

RESUMO

OBJECTIVES: First, to determine if prosthesis length plays a role in optimizing successful hearing outcomes in stapedotomy surgery; and second, to determine if patient factors such as height are correlated with prosthesis length. STUDY DESIGN: Retrospective chart review. METHODS: Retrospective chart review of patients undergoing stapedotomy surgeries with adequate follow up. Length of prosthesis, pre-/postoperative audiograms, and follow-up data were obtained. RESULTS: The primary group consisted of 227 cases. The prosthesis length ranged from 3.75 mm to 4.75 mm (median 4.25 mm). The greatest improvement in postoperative air-bone gap (ABG) occurred in the 4.25 mm group, and the least in the 3.75 mm group. Patient height showed a positive, although weak, correlation with prosthesis length. No findings reached statistical significance. CONCLUSION: Accurate measurement of prosthesis length is important for successful postoperative hearing outcomes. There is a positive but not significant correlation between patient height and prosthesis length. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:722-726, 2018.


Assuntos
Limiar Auditivo/fisiologia , Condução Óssea/fisiologia , Audição/fisiologia , Prótese Ossicular/normas , Otosclerose/cirurgia , Cirurgia do Estribo/instrumentação , Audiometria de Tons Puros , Seguimentos , Humanos , Otosclerose/fisiopatologia , Desenho de Prótese , Estudos Retrospectivos
18.
Int J Pediatr Otorhinolaryngol ; 93: 97-99, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28109507

RESUMO

Kniest dysplasia is a type II collagen disorder that arises from a genetic mutation of the COL2A1 gene that results in short stature, midface anomalies, tracheomalacia, and hearing loss. Disruption of the normal collagen pathway can lead to many changes given its critical role in the body, and can cause complications with respect to wound healing. We present a case in which a patient with Kniest dysplasia successfully underwent multiple procedures in the head and neck region including cochlear implantation, mandibular distraction, palatoplasty, and laryngotracheal reconstruction. All procedures did not have any associated complications with respect to wound healing, indicating that surgery in this population can take place as indicated and surgery should not be contraindicated or delayed.


Assuntos
Fissura Palatina/cirurgia , Implante Coclear , Doenças do Colágeno/cirurgia , Nanismo/cirurgia , Face/anormalidades , Doença da Membrana Hialina/cirurgia , Avanço Mandibular , Procedimentos Cirúrgicos Ortognáticos , Osteocondrodisplasias/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos , Cicatrização , Face/cirurgia , Humanos , Lactente , Masculino , Avanço Mandibular/métodos , Osteogênese por Distração
19.
J Neurosurg ; 124(5): 1328-38, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26566205

RESUMO

OBJECT Juvenile nasopharyngeal angiofibromas (JNAs) are formidable tumors because of their hypervascularity and difficult location in the skull base. Traditional transfacial procedures do not always afford optimal visualization and illumination, resulting in significant morbidity and poor cosmesis. The advent of endoscopic procedures has allowed for resection of JNAs with greater surgical freedom and decreased incidence of facial deformity and scarring. METHODS This report describes a graduated multiangle, multicorridor, endoscopic approach to JNAs that is illustrated in 4 patients, each with a different tumor location and extent. Four different surgical corridors in varying combinations were used to resect JNAs, based on tumor size and location, including an ipsilateral endonasal approach (uninostril); a contralateral, transseptal approach (binostril); a sublabial, transmaxillary Caldwell-Luc approach; and an orbitozygomatic, extradural, transcavernous, infratemporal fossa approach (transcranial). One patient underwent resection via an ipsilateral endonasal uninostril approach (Corridor 1) only. One patient underwent a binostril approach that included an additional contralateral transseptal approach (Corridors 1 and 2). One patient underwent a binostril approach with an additional sublabial Caldwell-Luc approach for lateral extension in the infratemporal fossa (Corridors 1-3). One patient underwent a combined transcranial and endoscopic endonasal/sublabial Caldwell-Luc approach (Corridors 1-4) for an extensive JNA involving both the lateral infratemporal fossa and cavernous sinus. RESULTS A graduated multiangle, multicorridor approach was used in a stepwise fashion to allow for maximal surgical exposure and maneuverability for resection of JNAs. Gross-total resection was achieved in all 4 patients. One patient had a postoperative CSF leak that was successfully repaired endoscopically. One patient had a delayed local recurrence that was successfully resected endoscopically. There were no vascular complications. CONCLUSIONS An individualized, multiangle, multicorridor approach allows for safe and effective surgical customization of access for resection of JNAs depending on the size and exact location of the tumor. Combining the endoscopic endonasal approach with a transcranial approach via an orbitozygomatic, extradural, transcavernous approach may be considered in giant extensive JNAs that have intracranial extension and intimate involvement of the cavernous sinus.


Assuntos
Angiofibroma/cirurgia , Cicatriz/prevenção & controle , Endoscopia/métodos , Estética , Neoplasias Nasofaríngeas/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Neoplasias da Base do Crânio/cirurgia , Adolescente , Angiofibroma/diagnóstico por imagem , Angiofibroma/patologia , Embolização Terapêutica , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias Nasofaríngeas/diagnóstico por imagem , Neoplasias Nasofaríngeas/patologia , Invasividade Neoplásica , Cuidados Pré-Operatórios , Neoplasias da Base do Crânio/patologia , Tomografia Computadorizada por Raios X , Carga Tumoral , Adulto Jovem
20.
Otolaryngol Head Neck Surg ; 153(1): 54-9, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25917664

RESUMO

OBJECTIVE: Papillary squamous cell carcinoma has emerged as a distinct entity from the more common keratinizing squamous cell carcinoma. The basis behind this distinction relates not only to its histologic variation but also to its overall prognosis and survival. The objective of this study was to demonstrate the incidence, demographics, and long-term survival of laryngeal papillary squamous cell carcinoma (LPSCC) and how it relates to other laryngeal malignancies using a population-based database. STUDY DESIGN: Analysis of a population-based tumor registry. METHODS: The United States National Cancer Institute's Surveillance, Epidemiology, and End Results registry was used to perform a retrospective analysis. Patients diagnosed with LPSCC from 1973 to 2011 were identified. Data endpoints extracted included patient demographics, incidence, and survival. RESULTS: Three-hundred seventy cases of LPSCC were identified, corresponding to 0.5% of all laryngeal tumors. There was a 3:1 male predilection, without a significant racial preference. Most tumors identified were localized (T1) and at stage 1. The 1-year, 5-year, and 10-year disease-specific survival (DSS) for LPSCC was 97.1%, 83.1%, and 73.9%, respectively, compared with 87.9%, 64.5%, and 50.5% for other laryngeal malignancies (P values <.0001). Surgery was associated with a higher overall DSS in both LPSCC (87.4% vs 78.8%) and other laryngeal malignancies (70% vs 59.4%) when compared with other treatment modalities. CONCLUSION: This analysis of the largest sample of LPSCC demonstrates a better prognosis for this pathology compared with other laryngeal malignancies.


Assuntos
Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Neoplasias Laríngeas/epidemiologia , Neoplasias Laríngeas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/terapia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Programa de SEER , Distribuição por Sexo , Taxa de Sobrevida , Estados Unidos/epidemiologia , Adulto Jovem
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