Quality of life after mandibulectomy: the impact of the resected subsite.

The purpose of this study was to identify the factors that impact the quality of life (QOL) scores of patients undergoing mandibulectomy. All patients with a diagnosis of an oral cavity neoplasm involving the mandible who underwent a mandibulectomy between January 1, 2000 and December 31, 2015 and completed a University of Washington QOL questionnaire (UW-QOL) were included in the study. Fifty-eight patients fulfilled all inclusion criteria and completed the UW-QOL questionnaire. Forty patients (69%) underwent a segmental mandibulectomy and 18 patients underwent a marginal mandibulectomy. Forty-eight patients (82.7%) had a free flap reconstruction. There was no significant difference in the QOL scores between patients who underwent a marginal or a segmental mandibulectomy. In contrast, patients who underwent symphysial resection reported significantly worse scores in various domains compared to patients with body or ramus segmental mandibulectomy. Patients who underwent a segmental mandibulectomy that included the symphysis had worse outcomes in chewing, recreation, health-related and social QOL domains compared to those whose mandibulectomy did not include the symphysis.

[One stage combined endoscopic and per-oral buccal fat pad approach for large oro-antral-fistula closure with secondary chronic maxillary sinusitis].

There are numerous surgical approaches for oro-antral-fistula (OAF) closure. Secondary sinus disease is still considered by many experts a relative contra indication for primary closure. To describe a single-stage combined endoscopic sinus surgery and per-oral buccal fat pad (BFP) flap approach for large OAF causing chronic maxillary sinusitis. The records of all the patients with OAF and chronic manifestations of secondary rhinosinusitis that were treated between 2010 and 2013 in our tertiary care medical center were reviewed. The exclusion criteria were: OAF 5 mm, resolved sino-nasal disease, OAF secondary to malignancy, recurrent fistula, medical history that included radiotherapy to the maxillary bone and age <18 years. Each procedure was performed by a team consisting of a rhinologist and a maxillofacial surgeon. The surgical approach included an endoscopic middle antrostomy with maxillary sinus drainage, and a per-oral BFP regional flap for OAF closure. Total OAF closure, complications and need for revision surgeries. Forty-five patients that underwent OAF closure together with sinus surgery using a combined endoscopic sinus surgery (ESS) and BFP flap approach met the inclusion criteria. There were 28 males and 17 females with a mean ± SD age of 53.5 ± 14.9 years (range 22-80 years). The presenting signs and symptoms included purulent rhinorrhea (n = 22, 48.9%), foreign body in sinus (n = 10, 22.2%) nasal congestion (n = 7, 15.5%), halitosis (n = 6, 13.3%) and pain (n = 5, 12.2%). Surgical complications included local pain (n = 2, 4.4%), persistent rhinitis (n = 2, 4.4%) and synechia (n = 1, 2.2%). One patient required revision surgery due, to an unresolved OAF. The OAF of all the other 44 patients (97.8%) was closed after the first procedure and the paranasal sinuses on the treated side were completely recovered. The mean follow-up time for the group was 7.6 ± 4.3 months (7-21 months), and no untoward sequelae or recurrence were reported. Combined, one step, endoscopic Maxillary sinus drainage together with per-oral BFP flap approach is an efficacious surgical approach for safe closure of OAFs that are complicated with secondary chronic maxillary sinusitis.

[Fiberoptic endoscopic evaluation of swallowing--the Tel Aviv Voice and Swallowing Disorders Clinic].

Fiberoptic endoscopic evaluation of swallowing (FEES) involves passing a fiberoptic laryngoscope transnasally to visualize the hypopharynx, larynx, and proximal trachea in order to assess swallowing disorders. FEES has been compared with the modified barium swallow (MBS) (the presumed "gold standard"). To date, reports have demonstrated that FEES is as sensitive as, or even more sensitive, for use as a tool in swallowing assessment compared with the MBS. FEES provides the clinician with a safe, portable, effective, and valid means of evaluating individuals with swallowing disturbances. FEES allows the examiner to identify swallowing physiology, determine the safest and least restrictive level of oral intake, implement appropriate compensatory techniques, and identify a dysphagia rehabilitation plan. In this article we present the Tel-Aviv Voice and Swallowing Disorders Center experience. Out of 100 patients that were referred to our center for swallowing evaluation 97 patients underwent 102 FEES examinations. Three patients couldn't tolerate the examination. In 63% of the patients swallowing pathology was found. FEES were performed by teamwork involving a speech-language pathologist and otolaryngologist collaborating together thus optimally managing the individual with dysphagia safely and efficiently.

[The reflux symptom index--a clinical tool for the diagnosis of laryngopharyngeal reflux].

BACKGROUND: Laryngopharyngeal reflux (LPR) refers to the backflow of stomach contents into the throat. Patients with LPR suffer from hoarseness, throat discomfort, dysphonia, chronic cough, chronic throat clearing and dysphagia. In 2001 Koufman et al. published the self-administered nine-item reflux symptom index (RSI) to assist clinicians in detecting and documenting the presence of LPR. This instrument appears to be valid and highly reproducible. OBJECTIVE: To develop the Hebrew version of the Reflux Symptom Index (RSI). METHODS: Validation of the Hebrew questionnaire included translation of the original instrument from English to Hebrew by three independent translators and retranslation back from Hebrew to English by three other translators. In the United States, patients completed the original and back-translated questionnaires. Scores correlation of the two instruments was performed using correlation coefficient analysis. Validation of the questionnaire was performed by measuring the association between the mean RSI score and the reflux findings upon flexible endoscopy. A control group of 9 patients with no clinical signs of reflux was chosen for our outpatient clinic. RESULTS: A total of '14 patients in the United States completed the original and the back-translated questionnaires. The correlation coefficient (r) was 0.92 (p < 0.001). In the second part of the study. 21 consistent Israeli patients that were referred to our voice center because of voice problems were requested to complete the questionnaire. History and endoscopic examinations did not reveal tumors, paralysis, functional voice problems or smoking. The mean age was 53 years (range 37-69 years). There were 14 women in the study group. Twenty patients had RSI higher then 10 (considered positive to the presence of reflux disease). Examination of the larynx demonstrated presence of reflux (e.g. edema of the vocal cords, posterior commissure hypertrophy, arythenoids edema, subglottic edema) in 19 cases (90.5% of patients). All the patients in the control group had a RSI lower then 10. CONCLUSIONS: The Hebrew RSI is an easy self-administered and reliable instrument that can help the clinician detect patients suffering from LPR and monitor their treatment.

Acute mastoiditis in infancy: the Soroka experience: 1990-2000.

UNLABELLED: Acute mastoiditis (AM) is an uncommon but serious complication of acute otitis media (AOM). In the pre-antibiotic era, AM was seen more frequently than it is today, but it was rare in infants. However, in the last two decades an increase in the incidence of AM in infancy has been reported in the literature. During the years 1990-2002, we treated 113 patients with 128 episodes of AM; of them, 24 were infants (median age 6 months; 18 males) who suffered from 26 episodes of AM. Twenty developed AM as a complication of their first episode of AOM. One of the four infants with a prior history of AOM suffered from common variable immunodeficiency. A significant increase in the incidence of AM in infants was recorded during the study period (P = 0.01). The most common presenting clinical signs were post-auricular swelling and fever >38 degrees C (77% and 77%, respectively, of all patients). Seventeen episodes of AM were not treated with prior antibiotics. Tympanocentesis was performed in all episodes of AM. Middle ear fluid culture was positive in 17 (65%) of the 26 AM episodes. The most common pathogens cultured were Streptococcus pneumoniae (10 infants, 58% of all pathogens, 3/10 intermediately susceptible to penicillin) followed by Streptococcus pyogenes (4, 23%), non-typable H. influenzae (2, 12%) and S. aureus (1, 6%). Temporal bone CT showed bone destruction in 14 patients; 3 infants had subperiosteal abscesses and 3 lateral sinus thrombosis. Ten infants underwent mastoid surgery due to non-resolution of symptoms and signs with antibiotic therapy. Eight underwent cortical mastoidectomy with two patients undergoing ventilation tube introduction only. The remainder of the infants healed with conservative treatment. CONCLUSIONS: (1) A significant increase in the incidence of AM in infants was recorded over the last decade, though a specific reason for this trend remains uncertain; (2) Most of the cases of AM followed the infant's initial AOM episode, and most of the infants had not received prior antibiotic therapy; (3) The clinical signs and symptoms of AM were more severe in infants than in older patients; (4) While S. pneumonia was the most common pathogen isolated in middle ear fluid cultures, the involvement of S. pyogenes in AM was higher than that reported in AOM.

Repair of traumatic inferior orbital wall defects with nasoseptal cartilage.

PURPOSE: This study evaluated the effectiveness of nasoseptal cartilage for repairing traumatic orbital floor defects. PATIENTS AND METHODS: Autogenous septal cartilage was used in 20 patients. They were evaluated for the presence or absence of diplopia, enophthalmus, infraorbital nerve paresthesia, and ocular motility disorders. Surgical indications for orbital exploration included entrapment of orbital tissues, large orbital defect (greater than 50% of the orbital floor or more than 8 mm), or orbital floor defects with involvement of other zygomaticofrontal complex fractures. RESULTS: All patients were successfully treated by restoration of the orbital wall continuity. Follow-up at 1 week to 6 months showed 1 patient with postoperative enophthalmos and 1 patient with lower lid edema. There were no donor site and graft infections or graft extrusion. CONCLUSIONS: Nasal septal cartilage is a readily accessible autogenous tissue that should be considered when an autogenous graft is needed for orbital floor defect reconstruction.

The subcranial approach for the treatment of cerebrospinal fluid rhinorrhea: a report of 10 cases.

PURPOSE: Because of the likelihood of meningitis and other intracranial complications, optimal treatment for a cerebrospinal fluid (CSF) fistula is to close the leak. The neurosurgical approach to the management of CSF rhinorrhea has been by intracranial access. Extracranial approaches are now gaining acceptance as the preferred method for initial treatment of CSF leakage, because the success rates are reasonable, and the morbidity is lower. This report describes the results of using such an approach. PATIENTS AND METHODS: The extended subcranial approach was used in 10 patients with CSF rhinorrhea. Selection criteria included defects of the anterior skull base greater than 15 mm in diameter, defects not accessible by endoscopes, fistula sites that could not be localized preoperatively, and multiple and transverse fractures of the cribriform region. Follow-up ranged from 8 to 23 months, with a mean of 17 months. RESULTS: Resolution of rhinorrhea was achieved in 9 (90%) of the patients. Anosmia was the only postoperative complication, occurring in 8 patients. CONCLUSION: The authors conclude that the extended subcranial approach to the anterior skull base is a safe, versatile, and effective procedure for the surgical treatment of CSF rhinorrhea involving the anterior skull base.

Detection of sinus-induced orbital mycosis with standardized orbital ultrasonography: a case report.

Fungal involvement of the paranasal sinuses is frequently observed in the immunocompromised host, and it can become life-threatening if it is not diagnosed. Although the definitive diagnosis is made by tissue biopsy and culture, imaging is of vital importance in the clinical workup and in planning treatment. We present a case of fulminant ethmoidal sinusitis caused by Aspergillus flavus with orbital involvement in an immunocompromised patient. Standard computed tomography of the paranasal sinuses was complemented by the use of standardized orbital ultrasonography, which was able to identify the intraorbital extension. We discuss the role of standardized orbital ultrasonography as a complementary imaging modality in the diagnosis of fungal sinusitis and in the assessment of local extension. To the best of our knowledge, the role of SOU in diagnosing an orbital extension of a fungal infection of the paranasal sinuses has not been previously discussed in the literature.

Neoangiogenesis in squamous cell carcinoma of the larynx - biological and prognostic associations.

Tumor angiogenesis has been related to tumor growth and an increased probability of metastatic spread. Previous studies have led to conflicting views regarding the prognostic significance of angiogenesis in squamous cell carcinoma of the head and neck. To evaluate the role of tumor angiogenesis in the biology of squamous cell carcinoma of the larynx, we quantified the microvascular network in 59 primary laryngeal carcinomas and looked for an association with outcome. Microvessels were stained immunohistochemically using antibodies for factor VIII-related antigen and the antibody JC70 (CD-31). In each case, microvessels were counted in three fields at x200 magnification, in areas of most intense neovascularization. We found a significantly higher number of microvessels in tumors showing deeper levels of invasion.

Identification and typing of human papillomavirus (HPV) in squamous cell carcinoma of the oral cavity and oropharynx.

Recent epidemiological research has raised the possibility of a connection between viral infection by the human papilloma virus (HPV) and the existence of squamous cell carcinoma of the oral cavity and oroharynx (SCCa). Some 60 subtypes have been identified to date, and specific subtypes are associated with lesions or infections at specific tissue sites. Twenty-three patients with SCCa of the oral cavity were studied for the presence of HPV in their tumours. HPV DNA (all type 16) was isolated from four specimens (17.3 per cent) using the Polymerase Chain Reaction (PCR) method. The four patients were all over age 50, and had advanced tumours (two T3 and two T4) that originated in the oropharynx. Our data supports other reports in the literature, demonstrating the presence of HPV DNA type 16 within cells from oropharyngeal SCCa. We conclude that the PCR method is a useful and reliable method for the detection of HPV DNA within tumour cells.

Interleukin 8 in middle ear fluid during acute otitis media: correlation with aetiology and bacterial eradication.

OBJECTIVES: To study the concentration of interleukin 8 (IL-8) in the middle ear fluid of children with acute otitis media and the association between IL-8 concentrations, aetiology of acute otitis media, and bacteriological sterilisation. STUDY DESIGN: Middle ear fluid was obtained by tympanocentesis at enrollment (day 1) and on day 4-5 in 81 children aged 3-36 months with acute otitis media who received antibiotic treatment. IL-8 concentrations were measured by enzyme linked immunosorbent assay. RESULTS: 101 samples were obtained on day 1 and 47 samples on day 4-5. 94 pathogens were isolated in 79 of 101 samples obtained on day 1: 56 Haemophilus influenzae, 35 Streptococcus pneumoniae, 2 Moraxella catarrhalis, and 1 Streptococcus pyogenes. Among 40 paired, initially culture positive samples, sterilisation was achieved on day 4-5 in 22 but not in 18 (13 H influenzae, 2 S pneumoniae, and 3 H influenzae and S pneumoniae concomitantly). IL-8 was detected in 96 of 101 and 46 of 47 samples obtained on days 1 and 4-5, respectively. Mean (SD) IL-8 concentration on day 1 was significantly higher in culture positive than in negative samples (12,636 (23,317) v 5,920 (7,080) pg/ml). In paired samples, IL-8 concentration fell in 12 of 22 ears in which sterilisation was achieved and in 9 of 21 ears with persistent or new infection. Mean (SD) IL-8 concentrations on day 4-5 were significantly higher in culture positive than in negative samples (15,420 (15,418) v 6,695 (5,092) pg/ml). CONCLUSIONS: Higher IL-8 concentrations are found in culture positive middle ear fluid in acute otitis media. Bacterial eradication is associated with a fall in these concentrations.

Bacteriologic efficacies of oral azithromycin and oral cefaclor in treatment of acute otitis media in infants and young children.

A prospective, open-label, randomized study was conducted in order to determine the bacteriologic efficacies of cefaclor and azithromycin in acute otitis media (AOM). Tympanocentesis was performed on entry into the study and 3 to 4 days after initiation of treatment. Bacteriologic failure after 3 to 4 days of treatment with both drugs occurred in a high proportion of culture-positive patients, especially in those in whom AOM was caused by Haemophilus influenzae (16 of 33 [53%] of those treated with azithromycin and 13 of 34 [52%] of those treated with cefaclor). Although a clear correlation of the persistence of the pathogen with increased MICs of the respective drugs could be demonstrated for Streptococcus pneumoniae, no such correlation was found for H. influenzae. It is proposed that susceptibility breakpoints for H. influenzae should be considerably lower than the current ones for both cefaclor and azithromycin for AOM caused by H. influenzae.

[The subcranial approach to the anterior skull base. Retrospective study of 75 cases]. / La voie d'abord sous-crâniale de l'étage antérieur de la base du crâne. Etude rétrospective de 75 patients.

We reviewed the cases of 75 patients who underwent an extended subcranial approach to the anterior skull base for treatment of various tumors (35 patients), repair of craniofacial trauma injury (33 patients), or cerebrospinal fluid leakage (10 patients). Preoperative evaluation and surgical procedures were reassessed. Significant complications in the oncology group consisted of one hematoma requiring aspiration, 2 cases of transient pneumocephalus, 2 osteocutaneous fistulae and 2 epiphoras. In the trauma group, one patient died from intracerebral damage, 2 presented with transient pneumocephalus, 5 with telecanthus and 5 with enophthalmy. The most frequent late complication in all three groups was anosmia. Based on this review, we feel that this technique is a safe and effective procedure for the surgical treatment of various pathological conditions involving the anterior skull base.

Desmoid tumor (aggressive fibromatosis) of the neck.

Desmoid tumors are histologically benign fibrous neoplasms arising from the musculoaponeurotic structures throughout the body. There is similar biological behaviour between benign fibrous proliferations and fibrosarcoma. These neoplasms have the tendency to locally invade and erode adjacent muscular tissue and bone. Within the head and neck area they also tend to encase vital structures. We present a case of a 28-year-old white female with a five-month history of a painful mass in her left posterior cervical triangle who was treated by excisional biopsy of the lesion with preservation of the accessory nerve and post-operative radiation. The histopathologic characteristics of desmoid tumors and treatment of these lesions are also reviewed.

Diagnosis and management of posttraumatic oculorrhea.

Posttraumatic cranio-orbital cerebrospinal fluid (CSF) fistula is very rare. Diagnosis of these fistulas may be difficult, and it is possible that this complication of craniofacial injury is underdiagnosed. Early recognition and adequate treatment is of paramount importance to prevent hazardous complications. The authors report the case of a 20-year-old woman in whom a CSF leak developed through the medial canthus area of her eye after she sustained a mild sports-related injury. Clinical examination and chemical analysis of the fluid led to the correct diagnosis, and the leak was stopped with conservative treatment. It is proposed that a CSF leak through the eye be termed "oculorrhea" as compared with otorrhea and rhinorrhea. The mechanism of the fistula in this patient is discussed, as is the pertinent radiologically demonstrated anatomy and the mechanism of injury. Management and controversies are also discussed.

Harvesting large fascia lata sheaths: a rational approach.

This article describes an "S"-shaped incision for the open approach of harvesting wide sheets of fascia lata with reference to the important anatomical landmarks. Forty-three patients required dural replacement in cases of tumors, trauma, or cerebrospinal fluid leak involving the anterior skull base. The extended anterior suberanial approach to the skull base was used for all patients. Early functional status of the operated limb in seven of the patients treated first was assessed by physical examination and then by means of the computerized Kinetic Communicator (Kin-Com; Medex Diagnostics, Canada) dynamometer. None of these patients suffered any significant immediate complications and had good results at the preliminary functional assessment. All other patients were evaluated clinically for functional deficits of the operated lower limb to further assess its morbidity. The technique described herein was shown to enhance the case and control of fascia lata harvesting. It affords low complication rate and donor limb morbidity. Donor limb morbidity did not have any deleterious effect on the patients' normal daily activities and only became apparent during strenuous physical activity.

Mycobacterial cervical lymphadenitis: the histological features of non-tuberculous mycobacterial infection.

AIMS: The distinction between nontuberculous mycobacterial (NTM) lymphadenitis and other causes of cervical lymphadenitis is critical, as different entities call for different treatments. Despite modern diagnostic techniques for NTM infections their prompt and accurate diagnosis is still difficult. We assessed the value of different histological features in diagnosing clinically suggestive NTM cervical lymphadenitis in cases of granulomatous cervical lymphadenitis. METHODS AND RESULTS: A retrospective study of 30 patients with a clinical diagnosis of NTM cervical lymphadenitis was carried out. The patients were divided into three subgroups and several histological parameters were examined in each subgroup. A comparison was made with cases of proven tuberculous lymphadenitis. Four histological features (presence of microabscesses, ill-defined granulomas, noncaseating granulomas and a small number of giant cells) were found with significant statistical difference when comparison was made between the NTM group and the tuberculosis group. CONCLUSIONS: A rapid and accurate diagnostic procedure for NTM lymphadenitis is not yet available. Therefore, in the presence of a suggestive clinical picture for NTM lymphadenitis, we propose four histological features which support this diagnosis, thus allowing prompt therapeutic intervention.

The bacteriology of the nasopharynx in childhood.

Non-typeable Haemophilus influenzae and Streptococcus pneumoniae (Pnc) are frequently isolated from the nasopharynx (NP) of young healthy children. Colonization of the NP may be detected in early infancy with peaks toward the second year of life. NP carriage of Pnc and especially of antibiotic-resistant Pnc is common and plays an important role in its spread in children, its prevalence increases in those coming into close contact, such as children attending day-care facilities. Several studies show that the presence of older siblings, antibiotic treatment during the month preceding the culture and the attendance at a large day-care center are associated with carriage of drug-resistant Pnc. Significant changes may occur early during antibiotic treatment, and these changes may vary with the use of different antibiotics. Also new strains of Pnc not detected initially emerge, and newly detected organisms are most often resistant to the administered drug. Nasopharyngeal colonization with resistant bacteria was shown to be associated with an increased incidence of acute otitis media with resistant organisms and growing incidence of unresolved otitis media. Preliminary studies show that conjugate pneumococcal vaccine might reduce the nasopharyngeal pneumococcal carriage in general, and of resistant organisms in particular.