Acoustic rhinometry and video endoscopic scoring to evaluate postoperative outcomes in endonasal spreader graft surgery with septoplasty and turbinoplasty for nasal valve collapse.

BACKGROUND: Nasal obstruction is a common complaint seen by otolaryngologists. The internal nasal valve (INV) is typically the narrowest portion of the nasal cavity, and if this area collapses on inspiration the patient experiences significant symptoms of nasal obstruction. The nasal obstruction is further compounded if the INV is narrower than normal. Previous studies have evaluated the effectiveness of techniques to alleviate structural nasal obstruction, but none have looked specifically at spreader grafts measured by acoustic rhinometry or validated grading assessment of dynamic INV collapse. Our objective was to evaluate the application of acoustic rhinometry coupled with visual endoscopic grading of the INV, and validated subjective measurements, in patients undergoing endonasal spreader graft surgery with septoplasty and turbinoplasty. METHODS: This is a prospective clinical study conducted within a tertiary care rhinoplasty practice. Patients undergoing septoplasty and bilateral inferior turbinoplasty with bilateral endonasal spreader graft placement for observed internal nasal valve collapse were recruited. Baseline, early and intermediate postoperative measures were obtained. The primary outcome was grading of the INV collapse on video endoscopy. Secondary outcomes included cross-sectional area at the INV measured by acoustic rhinometry, subjective Nasal Obstruction Symptom Evaluation (NOSE) and Sino-Nasal Outcome Tool (SNOT-22) scores. RESULTS: A total of 17 patients, average age of 34.5 ± 12.2 years, undergoing septoplasty, bilateral endonasal spreader grafts, and bilateral turbinoplasty were included in the study. Postoperative measurements were performed at an average of 8.1 ± 1.6 weeks and 17.7 ± 4.2 weeks. Patients had significant improvement for INV collapse grading, cross-sectional area, NOSE and SNOT-22 scores in both the early and intermediate follow up. Endoscopic grading had moderate inter-rater agreement (κ = 0.579) and average intra-rater agreement (κ = 0.545). CONCLUSIONS: This study is the first to demonstrate a statistically significant improvement of objective measurement of internal nasal valve function, both static and dynamic, and subjective improvements. This supports endonasal cartilagenous spreader grafts with septoplasty and inferior turbinoplasty for patients with nasal obstruction with internal nasal valve collapse.

Survival outcomes of First Nations patients with oral cavity squamous cell carcinoma (Poliquin 2014).

BACKGROUND: Oral cavity squamous cell carcinoma (OCSCC) is the most common head and neck cancer, affecting approximately 2000 Canadians yearly. Analysis of Canadian Cancer Registry data has shown that the incidence of oral cavity cancer is decreasing and survival outcomes are improving. There are significant health disparities in First Nations (FN) people in Canada. The incidence of cancer in FN groups is significantly lower when compared to the general population, but the cancer-related morbidity and mortality is significantly higher. There is no Canadian literature currently for OCSCC, or any other head and neck cancer, that compares survival outcomes of FN to the overall population. Therefore, the objective of this study is to determine whether there is a difference in epidemiology and survival outcomes between FN and non-FN patients with OCSCC. METHODS: This is a retrospective study of a population-based, prospectively-collected database from Alberta Cancer Registry (ACR). Patients with OCSCC, diagnosed and treated in Alberta between 1998 and 2009 were included. ACR data collected included patient gender, age at diagnosis, tobacco and alcohol use, FN status, TNM staging, performance status, date of death, cause of death, and follow-up. FN status was identified through the Alberta Health and Wellness registry and through postal code correlation for those who live on reserves. RESULTS: A total of 583 patients with OCSCC were included in this study. Of these, 19 were identified as being FN, leaving 564 non-FN patients. When comparing the FN and non-FN groups, there is no significant difference in baseline demographics. Estimated yearly incidences for OCSCC in the Alberta population (all ages) and FN patients are 1.74/100,000 and 1.32/100,000 respectively (p = 0.23). Significant differences are seen in overall survival (OS) (5-year OS 58.1% for non-FN and 33.7% for FN) and for disease-specific survival (DSS) (5-year DSS 67.8% for non-FN and 44.5% for FN). Multivariate analysis confirmed FN patients have a significant increase risk of death in OS and DSS, with hazard ratios of 4.20 (p = 0.01) and 4.57 (p = 0.02), respectively. CONCLUSIONS: The overall survival and disease specific survival are significantly lower in FN patients compared to non-FN patients with OCSCC.

Factors associated with the morphological type of laryngomalacia and prognostic value for surgical outcomes.

IMPORTANCE: The classic presentation of laryngomalacia (LM) is stridor, but alternate presentations include snoring and/or sleep-disordered breathing (S-SDB) and swallowing dysfunction (SWD). Several classification schemes have been developed for LM, but to our knowledge, none have been successfully investigated as to the ability to predict parameters of patients with LM or surgical outcomes. OBJECTIVE: To compare parameters of patients with different types of LM and determine whether the type has prognostic value for surgical outcomes and to explore if any variable predicts or correlates with the type of LM. DESIGN, SETTING, AND PARTICIPANTS: Retrospective case series from a single tertiary pediatric otolaryngology practice. Patients with LM treated with supraglottoplasty (SGP) were eligible. We included patients with confirmed diagnosis of LM who underwent a cold steel SGP and had complete resolution of symptoms or at least 3 months of follow-up, with complete data. INTERVENTIONS: Investigations and treatment of the patients were followed as per routine practice for the senior author (H.E.). MAIN OUTCOMES AND MEASURES: Demographics, type of LM, secondary airway lesions, secondary diagnosis, primary presentation (stridor, S-SDB, SWD), and outcome of SGP were collected. Correlation and multiple regression analysis were performed. RESULTS: A total of 125 children with LM who underwent SGP for LM were identified. Of these procedures, 119 were cold steel technique, and 8 were repeated procedures. Ninety patients met criteria and were included (mean [SD] age, 1.46 [2.34] years [range, <6 months to 15 years]; male to female ratio, 1.9:1). The primary presentation was stridor in 66 children, S-SDB in 14, and SWD in 10. The type of LM correlated significantly with age (-0.9), and presentation (0.49). Sex and presence of neurological diagnosis (correlation coefficient [SE], -0.317 [0.136], P = .02; and -0.968 [0.361], P <.01, respectively) were associated with outcome. Presentation and obesity were associated with type of LM (-0.251 [0.071], P <.001; and 0.593 [0.296], P = .048, respectively). CONCLUSIONS AND RELEVANCE: Type of LM varies by age and primary presentation. Outcome of management is poorer for males and in the presence of a neurological diagnosis. The findings of the present study may help in counseling parents on the risks and benefits of SGP surgery as well as on expected outcomes postoperatively. Further work is required in validating an existing classification scheme for LM or developing a new, validated classification system with may be used for future outcomes research.

Primary Presentations of Laryngomalacia.

IMPORTANCE: Laryngomalacia (LM) classically presents with stridor in early infancy but can present atypically with snoring and/or sleep-disordered breathing (S-SDB) or swallowing dysfunction (SwD). The epidemiology of these atypical presentations has not been established in the literature. OBJECTIVE: To document the primary modes of presentation for LM in a consecutive series of children and to compare the characteristics of each subgroup. DESIGN, SETTING, AND PARTICIPANTS: Retrospective case series in a single tertiary pediatric otolaryngology practice. Outpatient and surgical records were searched for patients diagnosed as having LM from 2002 to 2009. We included all children with endoscopically confirmed LM without prior documentation of the diagnosis (n = 88). INTERVENTIONS: Patients were investigated and managed according to the routine practice pattern of the senior author. MAIN OUTCOMES AND MEASURES: The primary outcome measure was the proportion of the various primary presentations of LM. Age, sex, type of LM, management, and secondary diagnoses were also collected. Subgroup analysis was performed. RESULTS: Of 117 potentially eligible patients identified, 88 children had a confirmed diagnosis of LM and were thus included (1.9:1 male to female sex ratio; mean [SD] age, 14.5 [23.0] months; age range, 0.2-96.0 months). Fifty-six children (64%) presented primarily with awake stridor and variable respiratory distress; 22 (25%) with S-SDB; and 10 (11%) with SWD. The difference in mean (SD) age for each group was statistically significant by analysis of variance: stridor, 3.5 (2.8) months; S-SDB, 46.0 (27.2) months; and SwD, 4.8 (4.6) months (P < .001). By χ2 analysis, sex distribution was not significantly different between subgroups (P = .29), nor was the proportion of children who underwent supraglottoplasty (P = .07). The difference in proportion of types of LM between the stridor and atypical presentations was statistically significant (χ2P < .05), with type 1 LM predominating in children presenting with S-SDB. CONCLUSIONS AND RELEVANCE: Because LM may present primarily with S-SDB and SwD in a significant proportion of children, the diagnosis must be considered in patients presenting with these upper airway complaints. The morphologic type of LM may vary by presentation.

Idiopathic vocal cord paralysis in the radiated neck: a harbinger for malignant peripheral nerve sheath tumour.

OBJECTIVE: Patients with previous neck external beam radiotherapy (XRT) diagnosed with idiopathic vocal cord paralysis (VCP) can harbour sinister pathology. A case series of such patients found to have vagal malignant peripheral nerve sheath tumours (MPNSTs) is presented and combined with a literature review. Management and survival outcomes are analyzed. DESIGN: Case series and systematic literature review. SETTING: Academic tertiary care cancer centre. METHODS: The University of Alberta's head and neck mass database was gleaned for vagal XRT-induced MPNSTs (2001-2011). Charts were reviewed for patient and tumour demographics, diagnostic methods, pathology, treatment, and survival. A systematic literature review identified similar patients. MAIN OUTCOME MEASURES: Kaplan-Meier estimated actuarial survival rates were the primary outcome. Secondary outcomes included the mean time from XRT to presentation and to tumour recurrence as well as a summary of patient/tumour characteristics, diagnostic methods, and treatment options. RESULTS: Two institutional and seven additional literature-wide cases were found. The median age was 34 years, the median time from XRT to MPNST was 22 years, and all patients were surgically treated. The median time from surgery to recurrence was 2.5 years. Estimated 2- and 5-year survival rates were 71% and 54%, respectively. CONCLUSION: XRT-induced MPNST can present as idiopathic VCP two decades post-XRT. Treatment is surgical and offers acceptable survival.