Utility of intraoperative frozen sections of thyroid tissue in the age of molecular testing.

Objectives: Our study aims to examine the correlation between preoperative ultrasound-guided fine-needle aspiration and intraoperative frozen section and examine the clinical benefit of frozen section in the context of the latest national guidelines on the management of differentiated thyroid cancer.

Study Design: A retrospective review of thyroid frozen section from 2012 to2017 at one institution.

Setting: Tertiary care centre.

An extended toboggan technique for resection of substernal thyroid goiters.

We describe our technique for the safe resection of substernal thyroid goiters. Early mobilization of the thyroid gland from tracheal attachments anteriorly and laterally facilitates extraction of the goiter from the mediastinum. Retrograde dissection through the ligament of Berry on the ipsilateral side can also facilitate identification of the recurrent laryngeal nerve and delivery of the substernal portion of the gland.

Outcomes in head and neck reconstruction by surgical site and donor site.

Objectives/hypothesis: Define surgical outcomes of specific donor sites for free tissue transfer in head and neck reconstruction.

Study Design: Retrospective cohort review at an academic tertiary care center.

Methods: A review was made of free tissue transfer procedures performed at a university-based tertiary care facility from October 2004 to April 2011.

Primary versus delayed tracheoesophageal puncture for laryngopharyngectomy with free flap reconstruction.

Objectives: To determine whether postoperative complication rates and speech outcomes differ between patients undergoing primary versus secondary tracheoesophageal puncture following total laryngectomy with free flap reconstruction.

Study Design: Retrospective clinical study in a tertiary academic center.

Methods: Between November 2004 and June 2010, 137 patients underwent total laryngectomy or laryngopharyngectomy with pharyngeal free flap reconstruction for malignant disease.

Minimally invasive parathyroidectomy: use of intraoperative parathyroid hormone assays after 2 preoperative localization studies.

Objectives: To review minimally invasive parathyroidectomy (MIP) in patients undergoing initial surgical management of primary hyperparathyroidism (HPT) with preoperative, localizing sestamibi scanning (MIBI), and concordant ultrasonography (US) to determine if intraoperative parathyroid hormone (iPTH) is necessary in these cases. Minimally invasive parathyroidectomy has become an acceptable therapeutic option in treating primary HPT. Preoperative MIBI scanning, high-resolution US with color Doppler flow, and iPTH monitoring have refined this technique.

Zygomatic-maxillary buttress reconstruction of midface defects with the osteocutaneous radial forearm free flap.

Background: The purpose of this study was to evaluate morbidity, functional, and aesthetic outcomes in midface zygomatic-maxillary buttress reconstruction using the osteocutaneous radial forearm free flap (OCRFFF).

Methods: A retrospective review of 24 consecutive patients that underwent midface reconstruction using the OCRFFF was performed. All patients had variable extension of maxillectomy defects that requires restoration of the zygomatic-maxillary buttress.

Fluorescent detection of rat parathyroid glands via 5-aminolevulinic acid.

Objective: Anatomic identification of parathyroid glands during surgery is challenging and time consuming. We sought to determine whether 5-aminolevulinic acid (5-ALA) could produce parathyroid gland fluorescence to improve their detection in a preclinical model.

Methods: Thirty-two rats were administered 0 to 700 mg/kg of 5-ALA by intraperitoneal injection prior to neck exploration under the illumination of a blue light (380-440 nm).

Durable improvements in efficiency, safety, and satisfaction in the operating room.

Background: Enhanced productivity and efficiency in the operating room must be balanced with patient safety and staff satisfaction. In December 2004, transition to an expanded replacement hospital resulted in mandatory overtime, unpredictable work hours, and poor morale among operating room (OR) staff. A staff-retention crisis resulted, which threatened the viability of the OR and the institution.

Locoregionally advanced head and neck cancer treated with primary radiotherapy: a comparison of the addition of cetuximab or chemotherapy and the impact of protocol treatment.

Purpose: The addition of platinum-based chemotherapy (ChRT) or cetuximab (ExRT) to concurrent radiotherapy (RT) has resulted in improved survival in Phase III studies for locoregionally advanced head and neck cancer (LAHNC). However the optimal treatment regimen has not been defined. A retrospective study was performed to compare outcomes in patients who were treated definitively with ExRT or ChRT.

The role of ultrasonography in parathyroid surgery.

Objective: To assess the role of high-resolution ultrasonography in the preoperative evaluation of patients with hyperparathyroidism.

Design: Retrospective cohort.

Setting: Tertiary care university hospital.

Role of microvascular density in nonlocalizing parathyroid sestamibi scans.

Objectives: Sestamibi scans for localization of abnormal parathyroid glands in patients with hyperparathyroidism are widely used at many institutions. Minimally invasive parathyroid surgery demands accurate preoperative localization imaging; however, nonlocalizing sestamibi scans occur in 15% of patients with primary hyperparathyroidism. It remains unknown why some sestamibi scans fail to localize.

Free tissue transfer to manage salvage laryngectomy defects after organ preservation failure.

Objective: Salvage laryngectomy to treat organ preservation failures results in significantly higher local wound complications. Even in the absence of extralaryngeal disease, primary closure of laryngeal defects can result in protracted wound care problems. We hypothesize that even when sufficient mucosa is present to close the defect primarily, introduction of vascularized tissue to close the defect may improve outcomes.

Expandable tracheal stenting for benign disease: worth the complications?

Objectives: To characterize the limitations of self-expandable stents in the management of benign tracheal stenosis, we performed a retrospective review at a tertiary care medical center.

Methods: Patients who underwent tracheal stenting were assessed for the cause and severity of tracheal stenosis, comorbidities, stent-related complications, and follow-up airway procedures.

Results: Sixteen adults (12 women, 4 men; mean age, 47 years) had a total of 26 stents placed for benign disease.

Use of negative pressure dressings in head and neck reconstruction.

Background: Head and neck microvascular surgery commonly requires management of complex wounds of the upper aerodigestive tract and donor sites. Negative pressure dressings have been reported to promote healing in compromised wounds.

Methods: Between February 2001 and June 2004, data were collected in a retrospective manner on 23 patients who underwent treatment with negative pressure dressings at two tertiary care institutions.

Preemptive vessel dilator cricothyrotomy aids in the management of upper airway obstruction.

Purpose: Our objective was to demonstrate that preemptive vessel dilator cricothyrotomy may be useful when managing the patient with airway obstruction.

Methods: An Institutional Review Board approved retrospective study was undertaken in 88 patients for whom this technique was selected. The anesthesiologists and surgeons identified as authors were directly involved in the care of these patients.

Extracellular matrix metalloprotease inducer-expressing head and neck squamous cell carcinoma cells promote fibroblast-mediated type I collagen degradation in vitro.

Until recently, tumor progression has been considered a multistep process defined by tumor cell mutations and the importance of the surrounding stroma poorly understood. It is now recognized that matrix-degrading enzymes that promote tumor cell invasion are elaborated by both tumor cells and fibroblasts in vivo. To determine the relative role of tumor cell-derived proteases compared with fibroblast-derived proteases, coculture experiments were done with each cell type using an in vitro model of type I collagen degradation.

Simplifying head and neck microvascular reconstruction.

Background: Free-tissue transfer has become the preferred method of head and neck reconstruction but is a technique that is considered to use excessive hospital resources.

Methods: This study is a retrospective review of 125 consecutive free flaps in 117 patients over a 16-month period at a tertiary care university hospital.

Results: Defects of the oral cavity/oropharynx (60%), midface (9%), hypopharynx (15%), or cervical and facial skin (16%) were reconstructed from three donor sites: forearm (70%), rectus (11%), and fibula (19%).

Expression of proteolytic enzymes in head and neck cancer-associated fibroblasts.

Objective: To elucidate tumor-stromal interactions during tumor invasion by assessing the expression of proteolytic enzymes by carcinoma-associated fibroblasts (CAFs) in vivo using complementary DNA (cDNA) array analysis.

Methods: Tumor-associated stroma was isolated from tumor and adjacent mucosal specimens of the same patient by laser capture microdissection, and the messenger RNA (mRNA) was assessed by cDNA microarray specific for proteolytic enzymes and their inhibitors. Protein overexpression was then analyzed by immunoblotting of primary fibroblast isolates derived from skin, mucosa, and tumor specimens.

Expression of extracellular matrix metalloprotease inducer in laryngeal squamous cell carcinoma.

Objectives/hypothesis: Head and neck cancer tumor cell invasion is responsible for both local destruction and distant metastasis. Invasion is largely mediated by matrix metalloproteases that are thought to be induced by tumor cell derived extracellular matrix metalloprotease inducer (EMMPRIN) in surrounding fibroblasts. We hypothesize that EMMPRIN is overexpressed in laryngeal cancer.

Three-dose vs extended-course clindamycin prophylaxis for free-flap reconstruction of the head and neck.

Background: Twenty-four hours of perioperative antibiotics provides effective prophylaxis for most head and neck cancer resections. Many reconstructive surgeons have been hesitant to apply this standard to free-flap reconstruction of the head and neck. This prospective clinical trial compared short-course and long-course clindamycin prophylaxis for wound infection in patients with head and neck cancer undergoing free-flap reconstruction.

Use of the endoscopic microdebrider in the management of airway obstruction from laryngotracheal carcinoma.

Endoscopic debridement of obstructing laryngotracheal carcinoma with the microdebrider is an alternative to CO2 laser excision or emergency tracheotomy. This is a retrospective study of 27 patients with advanced laryngotracheal carcinoma treated with the microdebrider for airway obstruction from 1998 to 2002. In 26 patients, the carcinoma was debrided successfully and tracheotomy was safely avoided.

Outcome of salvage total laryngectomy following organ preservation therapy: the Radiation Therapy Oncology Group trial 91-11.

Objective: To evaluate the incidence of morbidity, mortality, and disease control for patients requiring salvage total laryngectomy (TL) following organ preservation therapy.

Design: Patients entered into a 3-arm randomized prospective multi-institutional trial for laryngeal preservation who required TL following initial treatment.

Setting: The Radiation Therapy Oncology Group 91-11 trial for laryngeal preservation.

Phase 1 trial of combined chemotherapy and reirradiation for recurrent unresectable head and neck cancer.

Background: The management of recurrent unresectable head and neck cancer remains a challenging problem. Based on the circadian rhythm concept, we sought to determine the maximum tolerated dose (MTD) of infusional 5-flourouracil (5-FU), hydroxyurea (HU), and reirradiation (RT).

Method: Bolus 5-FU was escalated from 300 mg/m(2)/d to a 10-hour infusion beginning at midnight, increased at 150 mg/m(2)/d increments.