Evaluating the Association of Clinical Factors With Symptomatic Recurrence of Idiopathic Subglottic Stenosis.

Importance: Idiopathic subglottic stenosis (iSGS) is a progressive and potentially life-threatening condition with very few targeted treatment options. Objective: To characterize the clinical factors of patients with iSGS, including body mass index (BMI, calculated as weight in kilograms divided by height in meters squared), and evaluate their association with iSGS symptomatic recurrence. Design, Setting, and Participants: This retrospective medical record review included 186 adult patients with iSGS treated at a single tertiary referral center between January 1, 1989, and December 31, 2015. All data analysis took place from January 1, 2018 to June 30, 2018. Main Outcomes and Measures: The 3 BMI categories were examined for their association with iSGS recurrence. Outcome measurements included time to first symptomatic recurrence (TTFR) and recurrence-free survival (RFS). Comorbidities were recorded. Results: Of the 186 patients in the study, 182 (98%) were women; mean (interquartile range) patient age, 49 (41-60) years. At iSGS diagnosis, 65 (35%) patients were underweight or normal weight; 45 (24%) were overweight; and 76 (41%) were obese (class 1, 2, or 3). Median BMI was 27.4. Ninety-one patients experienced TTFR at a median of 14 months. Compared with underweight or normal-weight patients, the hazard ratios for the associations of overweight, obese class 1, and obese class 2/3 patients with recurrence were 1.14 (95% CI, 0.65-1.99), 1.74 (95% CI, 1.04-2.93), and 1.04 (95% CI, 0.54-1.99), respectively. No differences in concomitant medical treatment regimens were found. While several comorbidities (gastroesophageal reflux disease, hypertension, hyperlipidemia, and diabetes mellitus) were associated with increasing BMI, they were not associated with iSGS symptomatic recurrence on multivariable analysis. Conclusions and Relevance: Results of this retrospective review show that class 1 obesity was associated with an increased rate of iSGS symptomatic recurrence compared with underweight or normal-weight patients. This association was not seen in class 2 or class 3 obesity. Patients with class 1 obesity should be counseled about this risk to aid in the assessment and management of symptoms.

Atypical cartilaginous tumor/chondrosarcoma, grade 1, of the mastoid in three family members: A new entity.

We present a case series of a family with three members having cartilaginous tumors of the mastoid. All patients presented between the ages of 9 to 12 years with acute onset facial nerve paralysis. Histologic analysis of all tumors showed similar features, consistent with atypical cartilaginous tumors/chondrosarcoma, low-grade. Conventional cytogenetic analysis performed on one of the sons' tumor showed no evidence of chromosomal abnormality. High-resolution array comparative genomic hybridization performed on the same patient's blood also showed no unbalanced chromosomal abnormality. This is the first report of family members with this unusual combination of clinical, radiologic, and histologic finding. Laryngoscope, 126:E310-E313, 2016.

Vocal fold motion impairment in multiple system atrophy.

OBJECTIVES/HYPOTHESIS: Multiple system atrophy (MSA) is a degenerative neurologic disorder that can affect vocal fold mobility. Our aim was to further elucidate the impact of vocal fold motion impairment (VFMI) in MSA. STUDY DESIGN: Retrospective case series. METHODS: We undertook a retrospective review of all MSA patients reporting voice or respiratory symptoms from 1975 to 2010 at Mayo Clinic Rochester who also received otolaryngologic examination. RESULTS: Thirty-eight MSA patients demonstrated VFMI. Median duration of vocal or respiratory symptoms prior to diagnosis of MSA was 12.0 months (range, 1-60 months). Stridor was present in 25 (68%) of patients. There was bilateral VFMI in 32 (82.4%) of the patients and isolated VFMI of the left true vocal fold (TVF) in six (17.6%) of the patients. No patients had isolated right VFMI. There was isolated unilateral or bilateral paresis in 21 (55.3%) of the patients and unilateral or bilateral complete paralysis in 15 (39.5%) of the patients. One patient presented with left TVF paralysis and right TVF paresis, whereas one other patient had findings of right TVF paralysis and left TVF paresis comprising the remaining 5.2% of patients with VFMI. The median survival after diagnosis of VFMI was 51.6 months. Unilateral or bilateral TVF paralysis was statistically associated with a decreased overall survival (P = .0384). The presence of stridor was not associated with adverse prognosis. CONCLUSIONS: The increasing severity of VFMI negatively impacts overall survival in patients with MSA. Therefore, otolaryngologic examination is warranted at the time of MSA diagnosis.

Robotic microlaryngeal surgery: feasibility using a newly designed retractor and instrumentation.

OBJECTIVES/HYPOTHESIS: Robotic surgery is increasingly used for a variety of head and neck surgical procedures but has yet to be adapted for routine robotic microlaryngeal surgery (RMLS). Current retractor technology is limited by the following: poor tongue retraction, poor oral commissure retraction, poor larynx visualization, and laryngeal blades that do not take advantage of the robot's ability to operate without line-of-site exposure. Additionally, adequate instrumentation for RMLS is lacking. STUDY DESIGN: Feasibility study. METHODS: We performed a feasibility study of RMLS using a newly designed robotic retractor in a cadaver model with the goal of routinely exposing the glottis. Microlaryngeal instrumentation was also adapted for the da Vinci Surgical Robot effector arms. RESULTS: RMLS surgery was successfully performed including microflap elevation, anterior commissure surgery, false cordectomy, true cordotomy/cordectomy, and arytenoidectomy. Photographic and video documentation was obtained demonstrating feasibility. CONCLUSIONS: We present a newly designed laryngeal robotic retractor and novel microlaryngeal instrumentation in a cadaveric model. This allows for glottic and anterior commissure exposure, effector arm access to the glottis, and performance of delicate endolaryngeal procedures with the robot. The overall efficacy of our retractor will need to be examined in an in vivo human model. LEVEL OF EVIDENCE: NA.

Community-acquired methicillin-resistant Staphylococcus aureus necrotizing fasciitis in a healthy adolescent male.

Recently, the rate of severe, invasive community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection has been increasing in healthy children. The single most common cause of necrotizing fasciitis in children is group A Streptococcus. Empiric therapy is usually targeted at this organism, which is uniformly sensitive to penicillin. Necrotizing fasciitis caused by CA-MRSA is a potentially life-threatening infection that has not been extensively reported in the U.S. pediatric population. The limited literature includes reports of neonatal cases and reports of pediatric cases embedded in articles about adults with underlying risk factors. We present a case of CA-MRSA necrotizing fasciitis in a previously healthy 11-year-old male with no risk factors.