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  • 1
    In: Journal of Neurological Surgery Part B: Skull Base, Georg Thieme Verlag KG, Vol. 84, No. 03 ( 2023-06), p. 232-239
    Abstract: Objectives Although adjuvant radiotherapy may be indicated in patients with sinonasal squamous cell carcinoma (SNSCC) following primary surgery, some patients choose to forgo recommended postoperative radiation therapy (PORT). This study aimed to elucidate factors associated with patient refusal of recommended PORT in SNSCC and examine overall survival. Methods Retrospective analysis of patients with SNSCC treated with primary surgery from the National Cancer Database diagnosed between 2004 and 2016. A multivariable logistic regression model was created to determine the association between clinical or demographic covariates and likelihood of PORT refusal. Unadjusted Kaplan–Meier estimates, log-rank tests, and a multivariable Cox proportional hazard model were used to assess overall survival. Results A total of 2,231 patients were included in the final analysis, of which 1,456 (65.3%) were males and 73 (3.3%) refused recommended PORT. Patients older than 74 years old were more likely to refuse PORT than those younger than 54 (odds ratio [OR] 3.43, 95% confidence interval [CI] : 1.84–6.62). Median survival among the entire cohort, those who received recommended PORT, and those who refused PORT was 83.0 months (95% CI: 74.6–97.1), 83.0 months (95% CI: 74.9–98.2), and 63.6 months (95% CI: 37.3–101.4), respectively. Refusal of PORT was not associated with overall survival (hazard ratio: 0.99, 95% CI: 0.69–1.42). Conclusions PORT refusal in patients with SNSCC is rare and was found to be associated with several patient factors. The decision to forgo PORT is not independently associated with overall survival in this cohort. Further study is required to determine the clinical implications of these findings as the treatment decisions are complex.
    Type of Medium: Online Resource
    ISSN: 2193-6331 , 2193-634X
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2023
    detail.hit.zdb_id: 2653367-4
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  • 2
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Otology & Neurotology Vol. 38, No. 8 ( 2017-09), p. 1153-1157
    In: Otology & Neurotology, Ovid Technologies (Wolters Kluwer Health), Vol. 38, No. 8 ( 2017-09), p. 1153-1157
    Abstract: Malignancy of the middle ear is a rare condition with limited data available for clinical guidance. Study Design: Retrospective evaluation of a large national database. Setting: Deidentified national cancer database. Patients: Subjects with diagnosis of malignancy of the middle ear in the National Cancer Database between 2004 and 2012. Main Outcome Measures: Demographic information and tumor characteristics were evaluated. The primary endpoint of interest is overall survival. Results: The most common histology was squamous cell carcinoma (SCC) (50%). Multivariable Cox proportional hazard analysis found the following variables had a significant negative impact on overall survival: age (HR 1.04 95% CI [1.02–1.05]), squamous cell carcinoma, not otherwise specified (NOS) (HR 2.08 95% CI [1.30–3.32] ), squamous cell carcinoma, keratinizing, NOS (HR 4.20 95% CI [2.14–8.24]), embroynal rhabdomyosarcoma, NOS (HR 4.96 95% CI [1.17–21.11] ), and unknown extension (HR 2.87 95% CI [1.22–6.74]). For patients of SCC who underwent surgery, 30 had positive margins and 29 underwent adjuvant radiation. For these, no survival advantage was found with the addition of chemotherapy, regardless of node status. Conclusion: Malignancy of the middle ear is a rare condition with prognosis that depends on histology. The most common histology, SCC, is associated with the poorest overall survival. Evaluation of large national datasets can add significantly to the understanding of such uncommon tumors.
    Type of Medium: Online Resource
    ISSN: 1531-7129 , 1537-4505
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2058738-7
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  • 3
    In: JAMA Otolaryngology–Head & Neck Surgery, American Medical Association (AMA), Vol. 142, No. 12 ( 2016-12-01), p. 1184-
    Type of Medium: Online Resource
    ISSN: 2168-6181
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2016
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  • 4
    Online Resource
    Online Resource
    Wiley ; 2022
    In:  World Journal of Otorhinolaryngology - Head and Neck Surgery Vol. 8, No. 3 ( 2022-09), p. 224-238
    In: World Journal of Otorhinolaryngology - Head and Neck Surgery, Wiley, Vol. 8, No. 3 ( 2022-09), p. 224-238
    Abstract: Otolaryngologists are at increased occupational risk of Coronavirus Disease 2019 (COVID‐19) infection due to exposure from respiratory droplets and aerosols generated during otologic, nasal, and oropharyngeal examinations and procedures. There have been a variety of guidelines and precautions developed to help mitigate this risk. While many reviews have focused on the personal protective equipment (PPE) and preparation guidelines for surgery in the COVID‐19 era, none have focused on the more creative and unusual solutions designed to limit viral transmission. This review aims to fill that need. Data Sources PubMed, Ovid/Medline, and Scopus Methods A comprehensive review of literature was performed on September 28, 2020 using PubMed, Ovid/Medline, and Scopus databases. All English‐language studies were included if they proposed or assessed novel interventions developed for Otolaryngology practice during the COVID‐19 pandemic. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed. Results A total of 41 papers met inclusion criteria and were organized into 5 categories (‘General Recommendations for Otolaryngologic Surgery’, ‘Equipment Shortage Solutions’, ‘Airway Procedures’, ‘Nasal Endoscopy and Skull Base Procedures’, and ‘Otologic Procedures’). Articles were summarized, highlighting the innovations created and evaluated during the COVID‐19 pandemic. Creative solutions such as application of topical viricidal agents, make‐shift mask filters, three‐dimensional (3‐D) printable adapters for headlights, aerosol containing separation boxes, and a variety of new draping techniques have been developed to limit the risk of COVID‐19 transmission. Conclusions Persistent risk of COVID‐19 exposure remains high. Thus, there is an increased need for solutions that mitigate the risk of viral transmission during office procedures and surgeries, especially given that most COVID‐19 positive patients present asymptomatically. This review examines and organizes creative solutions that have been proposed and utilized in the otolaryngology. These solutions have a potential to minimize the risk of viral transmission in the current clinical environment and to create safer outpatient and operating room conditions for patients and healthcare staff.
    Type of Medium: Online Resource
    ISSN: 2095-8811 , 2589-1081
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2999715-X
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  • 5
    In: Head & Neck, Wiley, Vol. 40, No. 4 ( 2018-04), p. 756-762
    Abstract: Leiomyosarcoma is a rare neoplasm of the head and neck. The purpose of this study was to present our single‐institution case series of head and neck leiomyosarcoma and a review of cases in the National Cancer Data Base (NCDB). Methods Patients with head and neck leiomyosarcoma at the University of Pennsylvania and in the NCDB were identified. Demographic characteristics, tumor factors, treatment paradigms, and outcomes were evaluated for prognostic significance. Results Nine patients with head and neck leiomyosarcoma from the institution were identified; a majority had high‐grade disease and cutaneous leiomyosarcoma, with a 5‐year survival rate of 50%. Two hundred fifty‐nine patients with leiomyosarcoma were found in the NCDB; macroscopic positive margins and high‐grade disease were associated with poor prognosis ( P 〈 .01), and positive surgical margins were related to adjuvant radiation ( P 〈 .001). Conclusion Head and neck leiomyosarcoma presents at a high grade and is preferentially treated with surgery. Several demographic and tumor‐specific factors are associated with outcomes and prognosis.
    Type of Medium: Online Resource
    ISSN: 1043-3074 , 1097-0347
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 2001440-5
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  • 6
    Online Resource
    Online Resource
    Wiley ; 2008
    In:  Otolaryngology–Head and Neck Surgery Vol. 139, No. 5 ( 2008-11), p. 713-717
    In: Otolaryngology–Head and Neck Surgery, Wiley, Vol. 139, No. 5 ( 2008-11), p. 713-717
    Abstract: To test the feasibility of laser tissue welding (LTW) in creating an endoscopic transluminal repair of esophageal perforation. Study Design Animal model. Subjects and Methods A diode laser was used to create an endoluminal rabbit esophageal perforation repair. Burst pressures were compared with open incision, external suture, and external laser‐augmented suture closure. Comparisons were performed five times and analyzed with Kruskal‐Wallis analysis of variance and a post hoc Dunn method. Results The burst threshold of the endoluminal weld (54.78 ± 5.84 mm Hg) was significantly higher than that of the open incision (6.5 ± 1–94 mm Hg) and not significantly different than that of the external suture (37.18 ± 1.97 mm Hg) or the laser‐augmented suture group (71.60 ± 7.58 mm Hg). Conclusion Laser welding is a feasible method of creating endoluminal repairs with burst strengths comparable with external suture repair, which may allow a subset of patients to avoid traditional open approaches. This is the first reported animal model of LTW for endoscopic closure of iatrogenic esophageal perforation.
    Type of Medium: Online Resource
    ISSN: 0194-5998 , 1097-6817
    Language: English
    Publisher: Wiley
    Publication Date: 2008
    detail.hit.zdb_id: 2008453-5
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  • 7
    In: Otolaryngology–Head and Neck Surgery, Wiley, Vol. 164, No. 1 ( 2021-01), p. 146-156
    Abstract: (1) To estimate the association between neck dissection lymph node yield (LNY) and survival among patients with surgically treated human papilloma virus (HPV)–associated oropharyngeal squamous cell carcinoma (OPSCC). (2) To identify a clinically relevant quality metric for surgical treatment of HPV‐related OPSCC. Study Design Retrospective cohort study. Setting National Cancer Database. Subjects and Methods From the National Cancer Database, 4130 patients were identified with HPV‐associated OPSCC treated with primary surgery from 2010 to 2016. Based on prior literature, an adequate neck dissection LNY was defined as ≥18 lymph nodes. To determine whether LNY is associated with survival, univariable and multivariable Cox proportional hazards regression was performed. Analysis was stratified by adjuvant therapy regimen. Results A total of 2113 patients (51.2%) underwent surgery with or without adjuvant radiation (S ± RT), and 2017 patients (48.8%) underwent surgery with adjuvant chemoradiation. LNY ≥18 was associated with a 5‐year survival benefit of 7.15% (91.7% for LNY ≥18, 84.5% for LNY 〈 18, P =. 004) for the S ± RT cohort on unadjusted survival analysis. For the S ± RT group, LNY ≥18 was associated with decreased hazard of death (hazard ratio, 0.45; 95% CI, 0.29‐0.70; P 〈 . 001) after adjustment for patient characteristics, TNM staging, surgical margins, extranodal extension, and treating facility characteristics. For surgery with adjuvant chemoradiation, the adjusted hazard ratio estimate for LNY ≥18 was 0.64 (95% CI, 0.41‐1.00), but the result was not statistically significant ( P =. 052). Conclusion An adequate LNY from a neck dissection may affect survival when HPV‐related OPSCC is treated with up‐front surgery.
    Type of Medium: Online Resource
    ISSN: 0194-5998 , 1097-6817
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2008453-5
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  • 8
    In: Head & Neck, Wiley, Vol. 42, No. 2 ( 2020-02), p. 230-237
    Abstract: Unplanned readmissions have become a metric for measuring quality of care. We analyzed the factors associated with 30‐day unplanned readmission (30dUR) following head and neck cancer resections that included free tissue reconstruction (FTR). Methods The 2012‐2014 ACS‐National Surgical Quality Improvement Program (NSQIP) data set was queried. Univariate and multivariate logistic regression analyses were performed. Results Out of 1114 cases, 121 had a 30dUR. The most common reasons were wound complications, including incisional infections, hematoma, and hemorrhage. A significant independent risk factor for 30dUR included a clean/contaminated wound class (odds ratio [OR], 2.27; 95% confidence interval [CI] , 1.20‐4.76). Patients receiving an osseous FTR had lower readmission rates (OR, 0.51; CI, 0.27‐0.91). Discharge destination had no statistical significance. Conclusions Based on the NSQIP data set, 10.9% of patients receiving an FTR for head and neck malignancy had a 30dUR. Although large, population‐based data sets have limitations, these results elucidate that these patients are at an increased risk for unplanned readmissions, which can guide patient expectations and discharge planning.
    Type of Medium: Online Resource
    ISSN: 1043-3074 , 1097-0347
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2001440-5
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  • 9
    Online Resource
    Online Resource
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2010
    In:  Journal of Neurosurgery: Spine Vol. 12, No. 1 ( 2010-01), p. 13-18
    In: Journal of Neurosurgery: Spine, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 12, No. 1 ( 2010-01), p. 13-18
    Abstract: The goal of this study was to determine the potential role and current limitations of the da Vinci surgical robot in transoral decompression of craniocervical junction (CCJ). Methods The da Vinci Surgical System was used in 2 cadaver heads with neck and clavicles intact. Both neurosurgeons and otolaryngologists familiar with the open microscopic procedure, as well as the transoral robotic surgical procedure, undertook dissection and decompression of the CCJ. Results The robotic system provided superb illumination and 3D depth perception even several centimeters deep to the posterior oropharyngeal mucosa. The 30° endoscope improved cephalad visualization, eliminating the need to split the soft palate for exposure of the lower clivus. The “intuitive” nature of the da Vinci surgical robot arms provided an advantage in allowing the ability to suture the dura mater in a deep, dark corridor. Because visualization was excellent, tremor-free closure was possible. Conclusions The authors' findings suggest that transoral robotic surgery, with the da Vinci robot system, holds great potential for decompression of the CCJ as well as resection of both extra- and intradural tumors of this region. Further instrument development is necessary and continued investigation is warranted.
    Type of Medium: Online Resource
    ISSN: 1547-5654
    RVK:
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2010
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  • 10
    In: The Laryngoscope, Wiley, Vol. 131, No. 8 ( 2021-08), p. 1790-1797
    Abstract: Primary orbital melanoma (POM) is a rare disease with limited data on survival and best treatment practices. Here we utilize the National Cancer Database (NCDB) to determine the overall survival (OS) and covariates that influence mortality. Study Design : Retrospective cohort study. Methods All patients diagnosed with POM from 2004 to 2016 were identified in the NCDB. Patient and oncologic data were analyzed using the Kaplan–Meier method and multivariate models for the primary outcome of OS. Results A total of 129 patients were identified. Median OS was 36.9 months (95% confidence interval [CI] 24.1–78.7 months) with mean 5‐year survival of 42.0% (CI 33.2%–53.2%). Treatments received included surgery alone (43.4%), radiation alone (23.3%), and surgery followed by radiation (20.2%). The multivariate model demonstrated an increased risk of death associated with age over 80 years (hazard ratio [HR] 3.41, CI 1.31–8.86, P  = .012), a Charlson‐Deyo comorbidity score of 2 or greater (HR 5.30, CI 1.87–15.03, P  = .002), and no treatment (HR 2.28, CI 1.03–5.06, P  = .042). For every 1 cm increase in tumor size, there was an increased risk of death (HR 1.06, CI 1.00–1.13, P  = .039). When compared to surgery alone, no other treatment modality had an effect on OS. Conclusions This study leveraged multiyear data from the NCDB to provide prognostic and demographic information on the largest known cohort of POM cases. Increased age, increased comorbidities, not receiving treatment, and larger tumor size were associated with increased mortality. There was no clear survival advantage for specific treatments. Level of Evidence 4 Laryngoscope , 131:1790–1797, 2021
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2026089-1
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