Nasal airway preservation using the autospreader technique: analysis of outcomes using a disease-specific quality-of-life instrument.

OBJECTIVE: To measure the efficacy of a specific midvault reconstruction technique (the autospreader flap) in dorsal reductive rhinoplasty with a validated quality-of-life instrument. DESIGN: A prospective observational outcomes study of patients desiring reduction of the nasal dorsum who either (1) had no breathing obstruction, who underwent purely aesthetic rhinoplasty, or (2) had concomitant severe nasal obstruction due to septal deviation, internal valve narrowing, and/or turbinate hypertrophy, who subsequently underwent combined functional and aesthetic rhinoplasty. Preoperative and postoperative evaluation was performed using the Nasal Obstruction Symptoms Evaluation (NOSE) scale. RESULTS: Thirty-eight patients completed preoperative and postoperative evaluation. No complications occurred. Patients in the purely aesthetic group were noted to have low preoperative NOSE scores, with no change postoperatively. There was a significant improvement in mean NOSE score postoperatively for the combined functional and aesthetic group (P < .001). CONCLUSIONS: Midvault reconstruction using the autospreader graft may help prevent postoperative nasal obstruction due to midvault collapse. Combining this procedure with dorsal reduction in functional rhinoplasty patients with traditional airway reconstruction techniques is effective in improving nasal airway function as measured by a patient-based, disease-specific quality-of-life instrument.

Inhibition of the growth of squamous cell carcinoma by tetrathiomolybdate-induced copper suppression in a murine model.

OBJECTIVE: To determine whether long-term therapy with tetrathiomolybdate suppresses tumor growth in an animal model. DESIGN: In vivo murine model. SUBJECTS: Thirteen 8-week-old C3H/HeJ mice, randomly assigned to a tetrathiomolybdate treatment group (n = 7) or a control group (n = 6). INTERVENTIONS: To render the treatment group mice copper deficient, tetrathiomolybdate (0.7 mg/d per mouse) was added to their drinking water on days 1 through 20. Control group mice received only fresh drinking water. A flank injection of 1.5 x 10(5) SCCVII/SF cells was administrated to all mice on day 21. The treatment group mice continued to receive daily tetrathiomolybdate throughout the remainder of the experiment (70 days). Tumor volume measurements (square of the width x length x 0.52) were taken every other day beginning on day 40. MAIN OUTCOME MEASURES: Mean tumor volume differences. RESULTS: Mean +/- SD tumor volumes on day 40 were 146 +/- 263 mm3 (n = 7) and 274 +/- 331 mm3 (n = 6) for the treatment and control groups, respectively. By day 54, the mean tumor volume for the treatment group was 65 +/- 0 mm3, compared with 1716 +/- 960 mm3 for the control group (P<.001). Treatment was withheld on day 54, resulting in a dramatic increase in tumor growth in the treatment group mice such that by day 60, there was no significant difference in mean tumor volume between groups. CONCLUSION: This study demonstrates the ability of tetrathiomolybdate to maintain a significant and reversible suppression of long-term tumor growth in this murine model of squamous cell carcinoma, suggesting a potential application for the use of tetrathiomolybdate in human squamous cell carcinoma.

Recurrent laryngeal nerve monitoring in thyroid and parathyroid surgery: the University of Michigan experience.

OBJECTIVES/HYPOTHESIS: Intraoperative monitoring of the recurrent laryngeal nerve (RLN) is finding increasing acceptance during thyroidectomy. Recently, a laryngeal surface electrode was introduced to enable another form of noninvasive monitoring of the RLN. The present report examines the University of Michigan experience with RLN monitoring using the postcricoid surface electrode. STUDY DESIGN: All patients undergoing partial or total thyroidectomy or parathyroidectomy from January 1999 to July 2001 were considered candidates for the study. Audiologists trained in intraoperative electrophysiological techniques performed all of the monitoring. METHODS: Data collected on each patient included 1) stimulation threshold for a laryngeal compound muscle action potential on initial RLN identification, 2) stimulation threshold of the laryngeal compound muscle action potential on completion of the procedure, and 3) flexible fiberoptic evaluation of the larynx at the initial postoperative visit and at the 3-month follow-up visit. The average duration of follow-up was 9.8 months with a range of 3 to 60 months. RESULTS: The average minimum current required for stimulation on first identification of all nerves was 0.57 mA (+/-0.48 mA). After completion of the procedure a mean threshold level of 0.42 mA (+/-0.55 mA) was obtained during direct RLN stimulation. Post-dissection stimulation of the RLN on the side of tumor dissection was 0.92 mA (+/-0.65 mA) compared with a stimulation threshold of 0.76 mA (+/-0.57 mA) for the nontumor side. CONCLUSIONS: Electromyographic monitoring of the RLN using a postcricoid surface electrode provides a safe, simple, and effective method for intraoperative monitoring during thyroid or parathyroid surgery. Further, evoked electromyography confirms RLN integrity at the conclusion of surgery.

Elevated serum vascular endothelial growth factor and decreased survival in advanced laryngeal carcinoma.

PURPOSE: The purpose of this study was to determine whether serum vascular endothelial growth factor (s-VEGF) levels at the time of diagnosis correlate with any known tumor variables and overall survival in patients with advanced laryngeal squamous cell carcinoma. Comparisons with a cohort of normal healthy controls were also performed to determine the potential usefulness of s-VEGF as a screening tool. EXPERIMENTAL DESIGN: Serum from patients enrolled in the VA Laryngeal Cooperative Study #258 (n = 183), as well as normal healthy controls (n = 40) was used in this analysis. Quantitative enzyme-linked immunosorbent assays (ELISA) for VEGF were performed in duplicate on each serum sample. Demographic and survival data were available for each patient enrolled in the study. Univariate analyses, multivariate Cox regression analyses, and Kaplan-Meier survival analysis were used. RESULTS: The mean serum concentration of s-VEGF for the healthy control group was 47.83 +/- 0.13 pg/mL. For all patients enrolled in the VA Cooperative Study, regardless of treatment group, the mean s-VEGF level was 317.22 +/- 25.46 pg/mL. The patients randomly assigned to the surgical arm (n = 97) had a mean value of 315.44 +/- 30.44 pg/mL. Those randomly assigned to the induction chemotherapy arm (n = 86) had a mean s-VEGF level of 319.22 +/- 42.11 pg/mL. Serum VEGF levels were significantly elevated in patients with laryngeal carcinoma compared with healthy controls (p < .001). The serum VEGF levels in each arm of the trial were also elevated versus the healthy controls (p < .001, surgery arm plus radiotherapy; p < .001, chemotherapy plus radiotherapy). In a univariate analysis, elevated s-VEGF correlated with poor Karnofsky performance status for all patients with advanced laryngeal carcinoma (p < .008). High s-VEGF levels also correlated with a poor performance score in patients on the chemotherapy arm of the VA Laryngeal Trial (p < .004). Elevated s-VEGF levels in the surgical plus radiotherapy arm correlated with node-positive disease (p = .047) and supraglottic location of the tumor (p = .022). In a multivariate analysis using all known tumor variables and s-VEGF levels, elevated s-VEGF levels and infiltrating growth pattern correlated with decreased survival for all evaluated patients with advanced laryngeal carcinoma (p = .065, and p = .018, respectively). CONCLUSIONS: Serum VEGF levels are significantly elevated in patients with advanced laryngeal carcinoma versus healthy controls. Elevated pretreatment s-VEGF levels tended to indicate a more aggressive disease state and a poorer overall survival in advanced laryngeal carcinoma.