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Efficacy of allograft fascia lata in tympanic membrane repair

April 30, 2016  |  Ashley O'Connell Forster, MD; Joel Jones, MD; John Davis, AuD; Brittany Weber, MD; Mary Hawkshaw, RN, BSN, CORLN; Robert T. Sataloff, MD, DMA, FACS


We conducted a retrospective study to determine the efficacy of allograft fascia lata in both primary and revision tympanic membrane surgery (myringoplasty). Our patient population included 64 patients-31 men and 33 women, aged 19 to 98 years (mean: 49.5)-who had undergone tympanic membrane surgery with allograft fascia lata. Patients were grouped according to whether they had undergone primary surgery (n = 47) or revision surgery (n = 17). Data were compiled at preoperative and immediate postoperative visits, as well as at 3, 6, 9, and 12 months postoperatively. Residual perforations were defined as those present for less than 6 weeks postoperatively, and recurrent perforations were defined as those that occurred more than 6 weeks postoperatively. A residual perforation was found in only 1 patient (1.6%), a primary surgery patient. Recurrent perforations were found in 8 of the 64 patients (12.5%), including 5 in the primary group (10.6%) and 3 in the revision group (17.6%). We conclude that allograft fascia lata is a comparable alternative to other graft materials for performing myringoplasty.

Commentary on "The aging physician and surgeon" by Sataloff et al

April 30, 2016  |  Richard V. Homan, MD

Is unenhanced 18F-FDG-PET/CT better than enhanced CT in the detection of retropharyngeal lymph node metastasis in nasopharyngeal carcinoma?

April 30, 2016  |  Iuan-Sheng Wu, MD; Guang-Uei Hung, MD; Bo-Ling Chang, MD; Chi-Kuang Liu, MD; Tung-Hao Chang, MD; Hong-Shen Lee, PhD; Mu-Kuan Chen, MD, MS, PhD


Positron-emission tomography/computed tomography (PET/CT) has been proposed as a means to enhance the pretreatment evaluation of cervical lymph node status in patients with nasopharyngeal carcinoma (NPC). We conducted a prospective study to compare PET/CT and enhanced CT for the detection of retropharyngeal lymph node (RLN) metastasis in NPC, and to ascertain the factors that affect its diagnostic performance. Our study population was made up of 33 patients-24 men and 9 women, aged 30 to 81 years (mean: 52)-with newly diagnosed NPC who had been treated over a 2-year period. All patients underwent enhanced CT first, followed by unenhanced 18F-fluorodeoxyglucose (FDG) PET/CT. The detection rate of RLN metastasis on PET/CT was significantly lower than that on enhanced CT (36.4 vs. 75.8%; p < 0.001). A total of 25 of 26 nodes with a discordant finding were negative on PET/CT; they included 13 metastatic lymph nodes with low FDG uptake, 9 that were located close to the primary tumor, 2 that were confluent RLNs, and 1 that was adjacent to the physiologic FDG-avid prevertebral muscle. The maximum standardized uptake value (SUVmax) of RLNs was positively correlated with the minimum axial diameter (r = 0.803, p < 0.001). The PET/CT detection rate was 0% for lymph nodes smaller than 5 mm, 9% for those 5 to 10 mm, and 73% for those 1 cm or larger. The detection rate of PET/CT at level C1 was significantly lower than that at C2 (22 vs. 67%; p = 0.035). We conclude that unenhanced PET/CT is markedly inferior to enhanced CT for detecting RLN metastasis in NPC, especially in lymph nodes with a minimum axial diameter of less than 1 cm and those in proximity to the primary tumor. Using enhanced CT in PET/CT is justified to improve the recognition of RLN metastasis in patients with NPC.

Effectiveness of steroid injections for bamboo nodules: A case report

April 30, 2016  |  Mitsuyoshi Imaizumi, MD, PhD; Yasuhiro Tada, MD; Wataru Okano, MD; Akiko Tani, MD; Koichi Omori, MD


Vocal nodules are generally caused by vocal abuse, and conservative treatments such as voice therapy have been advocated as a first-choice treatment for vocal nodules. Reports of vocal fold lesions related to autoimmune diseases, such as bamboo nodules, are rare in the literature. Here we report a very rare case of bamboo nodules in a 30-year-old woman treated by steroid injection into the vocal folds by videoendoscopic laryngeal surgery in an outpatient setting. She was successfully treated without further recurrence. This report indicates that a steroid injection into bamboo nodules might be a useful treatment option, especially in patients who have not shown any improvement after conservative treatments.

The rare fourth branchial cleft anomaly

April 30, 2016  |  Jonathan A. Harounian, MD; David Goldenberg, MD; Jason G. May, MD

The treatment for fourth branchial anomalies is complete surgical excision because of the risk of infection and life-threatening abscesses.

Nasal polyp with osseous metaplasia

April 30, 2016  |  Jacky Wai-Kei Lam, MBBS(HK), FHKCORL, FHKAM(ORL); Leah Lai Lau, MBBS(HK)

The differential diagnosis of sinonasal pathologies with highly radiodense materials includes rhinolith, mycetoma, inverted papilloma with calcifications, chondrosarcoma, osteosarcoma, and fibro-osseous lesions.

Primary NK/T-cell lymphoma of the larynx: Report of 2 cases and review of the English-, Japanese-, and Chinese-language literature

April 30, 2016  |  Su-Yu Zhu, MD; Yuan Yuan, MD; Ke Liu, MD, MSc; Liang Zeng, MD, PhD; Ju-Mei Zhou, MD, PhD; Qiong-Hui Lu, MD; Zai-Jie Huang, MD


Natural killer/T (NK/T) -cell lymphoma in the larynx is extremely rare, as only 29 cases have been previously reported in the English-language, Japanese-language, and Chinese-language literature. Its characteristics have never been systematically illustrated. We report 2 new cases of laryngeal NK/T-cell lymphoma, and we discuss the process of the diagnosis of this disease, the choice of treatment, and treatment outcomes. We also summarize all 31 cases reported thus far. Symptoms of laryngeal NK/T-cell lymphoma are difficult to differentiate from those of other laryngeal diseases. The most common laryngeal subsite in the reported cases was the supraglottis, and roughly one-third of these cases involved the cervical lymph nodes. Because of our limited experience with this disease and the difficulties encountered in interpreting the pathologic findings, most patients required multiple biopsies over a few months before their diagnosis was confirmed. The outcome of treatment was generally poor. Radiotherapy, alone or combined with chemotherapy, was superior to chemotherapy alone in treating this disease in its early stages. In view of the frequency of local lymph node metastasis, irradiation fields should cover the entire cervical area. We believe that prompt diagnosis and treatment with radiotherapy are both critical to improving survival for patients with laryngeal NK/T-cell lymphoma.

Synchronous bilateral tonsillar squamous cell carcinoma related to human papillomavirus: Two case reports and a brief review of the literature

April 30, 2016  |  Allison Rasband-Lindquist, MD; Yelizaveta Shnayder, MD; Maura O'Neil, MD


Human papillomavirus (HPV) was recently identified as a risk factor for oropharyngeal squamous cell carcinoma (SCC) independent of tobacco and alcohol use. The prognosis of patients with HPV-related oropharyngeal carcinomas is better than that for patients with non-HPV-related cancers. Researchers and clinicians can test for HPV infection in cancer by (1) testing directly for HPV DNA and (2) testing for overexpression of the downstream p16 protein; there is currently no consensus regarding which is the better test. The chances of developing a reliable oropharyngeal HPV screening test for high-risk populations are promising. Such a test would allow for secondary prevention by identifying individuals with precursor or early-stage cancerous lesions that are more amenable to treatment. HPV testing has particular significance in SCC of an unknown primary site in head and neck cancer. Successful HPV testing of nodal metastasis can localize cancer specifically to the oropharynx. The optimal evaluation for SCC of an unknown primary in the head and neck has yet to be determined. Some studies have shown that the tonsillar fossa is the most probable primary site, followed closely by the base of the tongue. Biopsies often miss tonsillar carcinoma in the deep crypts of the lymph tissue, as well as in those rare cases in which the primary tumor is located contralateral to the metastatic lymph node. Recently, there has been an increase in the number of reports of diagnosed synchronous bilateral HPV-related tonsillar carcinomas. This increase has profound implications for the surgical approach of SCC of an unknown primary site in the head and neck and in tonsillar carcinoma, and it supports the need for bilateral tonsillectomy. We present 2 cases of incidentally discovered synchronous bilateral tonsillar carcinoma, and we review the literature.

Intramuscular hemangiomas of the head and neck: Three case reports

April 30, 2016  |  Omer Aydin, MD; Gurkan Keskin, MD; Mete Iseri, MD; Arif Ulubil, MD; Fatma Demir Kuru, MD; Abdulkadir Oran, MD; Serhan Derin, MD


Hemangiomas are tumors of vascular origin that frequently occur on the skin and mucosal surfaces in the pediatric age group. Hemangiomas located in skeletal muscles are called intramuscular hemangiomas. Intramuscular hemangiomas mostly occur in the extremities and the trunk. In this article, 3 cases of surgically treated intramuscular hemangiomas that could not be diagnosed by routine preoperative investigations are presented in light of recent literature.

Ear and temporal bone meningioma

April 30, 2016  |  Lester D. Thompson, MD

Because of anatomic restrictions, most tumors are smaller than 1.5 cm, removed in multiple, gritty tissue fragments.