Predictors of quality of life after treatment for oral cavity and oropharyngeal carcinoma.

BACKGROUND: Treatment for head and neck cancer, including surgery, radiation, and chemotherapy, can impact quality of life. DESIGN: Patients seen at an academic institution and treated for oral cavity and oropharyngeal carcinoma were asked to participate. The standardized University of Michigan Head and Neck Specific Quality of Life questionnaire was distributed. RESULTS: Eighty-seven patients completed the questionnaire. The majority had squamous cell carcinoma (94%), stage III or IV disease (53%), and a history of tobacco or alcohol dependence (59%), and were male (62%). Eighteen percent had free-tissue transfer (fibula free flap in 8% and radial forearm free flap in 10%). Predictors of worse quality of life included advanced stage, gastrostomy-tube dependence, complication, or recurrence. CONCLUSION: Stage, gastrostomy-tube dependence, complication, recurrence, and treatment modality influence quality of life. A better understanding of the impact of oral cavity and oropharyngeal cancer treatment on quality of life will enable us to better advise our patients.

Otolaryngologist-head and neck surgeon-performed ultrasonography for parathyroid adenoma localization.

OBJECTIVE: To demonstrate the efficacy of otolaryngologist-head and neck surgeon-performed ultrasonography (US) for the preoperative localization of parathyroid adenomas. METHODS: A retrospective chart review of all patients evaluated by office-based US for the localization of surgery-proven parathyroid adenomas from October 2004 through February 2007. RESULTS: A total of 29 patients underwent preoperative US localization. Twenty-three (79%) were females, and six (21%) were males. The age of patients ranged from 27 to 85 years of age. The size range of adenomas detected as measured by US was 0.5 to 2.7 cm. Pathology specimen measurements ranged from 0.3 to 3.4 cm. A total of 30 parathyroid adenomas were found. US identified 90% of the parathyroid adenomas to the correct side, left or right. In addition, US localized the parathyroid adenomas to the correct quadrant, superior or inferior, 83% of the time. Challenges in accurate localization were associated with patient obesity, presence of thyroid carcinoma, and multinodular thyroid disease. For comparison, sestamibi scans performed on the same patients localized the parathyroid adenoma to the correct side only 71% of the time and to the correct quadrant 61% of the time. CONCLUSIONS: Otolaryngologist-head and neck surgeon-performed US can accurately identify the location of parathyroid adenomas and is a useful tool for preoperative planning.

Applications of porcine dermal collagen (ENDURAGen) in facial plastic surgery.

The facial plastic and reconstructive surgeon has a variety of options for tissue augmentation and soft tissue support. These options include autologous materials such as fat and cartilages, solid implant materials, and injectable materials. Recently, malleable sheets of collagen-based matrix have become available. This review focuses on the potential applications of acellular collagen matrices and their various applications in rhinoplasty, facial slings for static reanimation, scar revision, soft tissue volume restoration, and periorbital reconstruction.

Adenoid cystic carcinoma of the major salivary glands treated with surgery and radiation.

OBJECTIVE: To examine patient characteristics, pathologic features, and treatment outcomes of adenoid cystic carcinoma of the major salivary glands. STUDY DESIGN: Retrospective review of patients in an academic medical center. METHOD: Review of medical records regarding demographics, extent of tumor, stage, histologic characteristics, and treatment outcomes of patients treated with surgery and postoperative radiation. RESULTS: Of the 33 patients, 19 (58%) were male, and 14 (42%) were female. The average age of presentation was 49 (range 22-81) years. Of the 29 patients fully staged at the time of diagnosis, 7 (24%) presented at American Joint Committee on Cancer stage I, 9 (31%) at stage II, 4 (14%) at stage III, and 9 (31%) at stage IV. The cribriform histologic subtype was predominant (64%). The majority originated in the parotid gland (21, 64%), with the remaining originating in either the submandibular gland (10, 30%) or the sublingual gland (2, 6%). Local control was 94% at 5 years and 73% at 10 years. Metastatic control was 82% at 5 years and 63% at 10 years. Four patients failed locally and nine failed distally. Overall survival was 85% at 5 years and 69% at 10 years, with a median of 12.9 years. CONCLUSION: Surgical excision with postoperative radiation provides a long period of disease-free survival. Patients were more likely to fail with metastases than with local recurrence.

Embolization for the treatment of idiopathic posterior epistaxis.

BACKGROUND: The goal of this study was to examine safety and efficacy of transarterial embolization for the treatment of idiopathic posterior epistaxis. METHODS: A retrospective chart review was conducted to characterize the underlying conditions of eighty-one consecutive patients for whom complete records were available presenting with posterior epistaxis, the associated risk factors for patients with idiopathic posterior epistaxis, and the success rate of embolization in this patient population. RESULTS: One hundred consecutive patients undergoing embolization for epistaxis were identified and 81 patients were included in the analysis. Nineteen patients did not have sufficient and retrievable medical records to be included in the study. Idiopathic posterior epistaxis was the most common underlying etiology of patients with refractory posterior epistaxis (34%). Hypertension, vascular disease, and diabetes were frequently detected comorbid diseases. Patients were equally as likely to be hypertensive as normotensive at the time of presentation (45 and 55%, respectively). Most patients (83%) had failed at least one prior treatment modality. Few patients had a recurrence of epistaxis within 72 hours (three patients [12%]) or had an adverse effect associated with embolization (three patients [12%]). CONCLUSION: Embolization for the treatment of posterior epistaxis is a safe and effective treatment modality.

Otolaryngologic manifestations of human immunodeficiency virus infection.

The otolaryngologist is uniquely positioned to detect and pursue manifestations of HIV in the head and neck. The presentation of problems subsequent to HIV infection is quite varied, but close investigation will often reveal treatable problems.

Contemporary issues in rhinosinusitis and HIV infection.

The medical issues involving patients infected with HIV continue to evolve dramatically. As they live longer sustained on antiretroviral therapy, their prevalence of acute and chronic sinusitis has increased. The common infectious causes of rhinosinusitis found in the general population are often the culprits in HIV-infected patients. However, as their CD4 counts dip below 200 cells/mm, these patients become susceptible to more opportunistic infections and neoplasms. The diagnostic and therapeutic measures used should reflect the physician's suspicion for these usual causes. The otolaryngologist should manage these patients aggressively because sinusitis can have a significant impact on the patients' quality of life as well as survival. Selected patients with either recurrent or chronic sinusitis may benefit from endoscopic sinus surgery.