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End-of-life decision making in geriatric terminal head and neck cancer

December 7, 2016  |  Kourosh Parham, MD, PhD, FACS; Karen M. Kost, MD, FRCSC

In the oncogeriatric setting, the comprehensive geriatric assessment has been recognized as providing useful information supplementary to what can be obtained via standard oncology status assessments.

Novel management of an isolated comminuted cricoid cartilage fracture

October 25, 2016  |  Aurora G. Standlee, MD, CPT, MC, USA; Derek J. Rogers, MD, MAJ, MC, USA


Laryngeal trauma is a rare occurrence that can result in significant morbidity and mortality. Isolated cricoid cartilage fractures are exceedingly rare, and their treatment is highly variable. We describe a case of an isolated comminuted, uncalcified cricoid cartilage fracture in a 34-year-old man that responded well to novel management with suture and 2-octylcyanoacrylate tissue adhesive fixation intraoperatively and topical ciprofloxacin/dexamethasone applied to the airway postoperatively. We discuss the novel application of cyanoacrylate glue in laryngeal trauma and the potential benefits of topical ciprofloxacin/dexamethasone application to the airway.

Prognostic factors in metastatic cutaneous squamous cell carcinoma of the head and neck

October 25, 2016  |  Gideon Bachar, MD; Aviram Mizrachi, MD; Naomi Rabinovics, MD; Dan Guttman, MD; Thomas Shpitzer, MD; Dean Ad-El, MD; Tuvia Hadar, MD


Metastatic cutaneous squamous cell carcinoma (SCC) of the head and neck poses a significant therapeutic challenge due to its aggressive biologic behavior. We conducted a retrospective study of 71 patients-58 men and 13 women, aged 28 to 88 years (mean: 71)-who had been treated at our university-affiliated tertiary care medical center for metastatic cutaneous SCC over a 15-year period. In addition to demographic data, we compiled and analyzed information on tumor characteristics, the site and extent of metastasis, treatment, follow-up, and outcome. Among the tumor factors, poorly differentiated carcinoma was an independent predictor of poorer disease-free survival, and older age was found to be an independent predictor of poorer overall survival. We found no significant difference in disease-free or disease-specific survival among patients with parotid involvement, neck involvement, or both. In our series, the site of nodal involvement appeared to have no prognostic significance in patients with metastatic cutaneous SCC of the head and neck.

More than 20 years of powered endoscopic ethmoidectomy

October 25, 2016  |  Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS

Current operative techniques continue to build on the foundation of functional endoscopic sinus surgery from the work of Messerklinger.

Stapes-pyramidal fixation by a bony bar

October 25, 2016  |  Kai-Chieh Chan, MD

Stapes fixation caused by an ossified stapedius tendon with normal mobility of the footplate, although rare, should be included in the differential diagnosis of conductive hearing loss with a normal tympanic membrane.

Spontaneous laryngeal barotrauma depicted on CT

October 25, 2016  |  Daniel T. Ginat, MD

Laryngeal injuries may result from  external laryngeal trauma or, less often, internal processes such as iatrogenic causes and sneezing with a closed airway.

Clinical course of acute laryngeal hematoma associated with vocal fold fixation

October 25, 2016  |  Wan-Chun Tsai, MD; Jih-Chin Lee, MD; Chih-Hung Wang, MD, PhD; Hsin-Chien Chen, MD, PhD

Disruptions of the anterior commissure, multiple displaced cartilage fractures, and larger open lacerations require open laryngeal exploration.

Cervical metastasis in squamous cell carcinoma of the hard palate and maxillary alveolus

October 25, 2016  |  Yekaterina Koshkareva, MD; Jeffrey C. Liu, MD; Miriam Lango, MD; Thomas Galloway, MD; John P. Gaughan, PhD; John A. Ridge, MD, PhD


We conducted a retrospective study to determine the incidence and treatment outcomes of neck metastases in patients with squamous cell carcinoma (SCC) of the hard palate and/or maxillary alveolus after surgical excision of the primary tumor. We also sought to identify any risk factors for recurrence. Our study population was made up of 20 patients-9 men and 11 women, aged 46 to 88 years (mean: 72.6)-who had undergone excision of an SCC of the hard palate and/or maxillary alveolus at a tertiary care cancer center over a 7-year period. Half of all patients were former tobacco users. Of the 20 tumors, 10 involved the maxillary alveolus, 4 involved the hard palate, and 6 involved both sites. Three patients were clinically categorized as T1, 9 as T2, 6 as T3, and 2 as T4; pathologically, 8 tumors were categorized as T4a. In addition to maxillectomy, a neck dissection was performed in 7 patients-4 therapeutically and 3 electively. Eight of 20 patients experienced a recurrence: 4 local, 6 regional, and 2 distant (several patients had a recurrence at more than one site). Univariate analysis identified perineural invasion (p = 0.04) as a statistically significant risk factor for recurrence. Of 14 patients with a clinicopathologically negative neck, 5 (36%) developed a cervical recurrence, and 4 of them died of their disease. An advanced stage (T4 vs. <T4) was not significantly correlated with the risk of regional metastasis (p = 0.58). The rate of occult nodal metastasis in clinically and radiologically N0 necks was high. Clinical and radiologic understaging was common, and regional recurrences frequently resulted in death. We conclude that elective nodal evaluation and treatment of the neck warrants strong consideration for most patients with cancer of the hard palate and/or maxillary alveolus.

Posterior epistaxis: Common bleeding sites and prophylactic electrocoagulation

October 25, 2016  |  Juan Liu, MD; Xicai Sun, MD; Limin Guo, MD; Dehui Wang, MD


Posterior epistaxis is a frequent emergency, and the key to efficient management is identification of the bleeding point. We performed a retrospective study of 318 patients with posterior epistaxis treated with endoscopic bipolar electrocautery during a 4-year period. Distribution of the bleeding sites was recorded. Patients with no definite bleeding sites in the first operation were assigned to Group A (n = 39) and Group B (n = 34). Patients in Group A were only observed in the ward. Patients in Group B were given prophylactic electrocoagulation at the common bleeding points. Of the 318 patients, bleeding sites were successfully identified and coagulated in 263 patients. All of them were located posteriorly, with 166 on the lateral nasal wall, 86 on the septum, and 11 on the anterior face of the sphenoid sinus. The rebleeding rate of Group B (8.8%) was lower than that of Group A (38.5%) (p < 0.01).

Chronic otitis media with effusion following radiation therapy

October 25, 2016  |  Anya Miller, MD; Francis Hall, MBChB, FRACS; Syed Ahsan, MD, FACS


The incidence of chronic otitis media with effusion (COME) after radiotherapy for nasopharyngeal or sinonasal tumors is relatively high. It is often a difficult-to-treat problem in these patients. In this retrospective study, we sought to describe the clinical course of COME in 51 patients-33 men and 18 women, aged 39 to 90 years (mean: 58.9 ± 15)-who had been referred to the Henry Ford Health System in Detroit between 2001 and 2011 for management of a tumor that had involved either the nasopharyngeal area or the sinonasal area. The median length of follow-up from the time of cancer diagnosis was 32 months. Of the 51 patients, 23 (45.1%) developed COME before, during, or after radiation therapy. Of these 23 patients, 13 (56.5%) did not experience any improvement after treatment with various combinations of therapies, including myringotomy, tympanostomy tube placement, otic drops, oral antibiotics, and corticosteroid nasal sprays. No patient- or tumor-specific factors were found to be significantly associated with the incidence of COME after irradiation to the sinonasal area. Older age and squamous cell tumor pathology were found to be significant factors for the resolution of COME after it had developed, whereas treatments with tympanostomy tubes and ear drops were not. Because of the high incidence of COME after radiotherapy and the high rate of COME's failure to resolve after tympanostomy tube insertion, we suggest that these patients require an alternative treatment.