Stimulated Raman histology facilitates accurate diagnosis in neurosurgical patients: a one-to-one noninferiority study.

Objective: Stimulated Raman histology (SRH) offers efficient and accurate intraoperative neuropathological tissue analysis without procedural alteration to the diagnostic specimen. However, there are limited data demonstrating one-to-one tissue comparisons between SRH and traditional frozen sectioning. This study explores the non-inferiority of SRH as compared to frozen section on the same piece of tissue in neurosurgical patients.

Osteoradionecrosis of the sternoclavicular joint after laryngopharyngeal radiation.

Objectives: Adequate treatment of laryngopharyngeal malignancy often incorporates radiation therapy. Structures surrounding laryngopharynx exposed to traditional radiation doses are susceptible to posttreatment toxicity. Among poorly understood sequelae is the rare manifestation of sternoclavicular joint (SCJ) osteoradionecrosis (ORN).

Preoperative embolization in carotid body tumor surgery: is it required?

Objectives: We compared estimated blood loss (EBL) in patients who underwent surgical excision of carotid body tumors (CBTs) after preoperative superselective angiography with embolization (PSE) with that in patients who underwent excision of CBTs without PSE.

Methods: We performed a retrospective chart review of a consecutive case series in a single surgeon's practice within an academic tertiary care medical center. Twenty-five patients underwent surgical resection of a CBT from 1989 to 2009.

Endoscopic laser resection of laryngeal cancer: is it oncologically safe? Position statement from the American Broncho-Esophagological Association.

The purpose of this report is to summarize the salient points made during a panel discussion at the 88th Annual Meeting of the American Broncho-Esophagological Association about the efficacy and oncological safety of endoscopic laser treatment of laryngeal cancer. Guidelines for endoscopic laser management of early glottic and supraglottic cancer, including contraindications for this treatment modality, are presented. On the basis of all currently available data, the panel, which critically considered the question of oncological safety, is of the opinion that endoscopic laser resections are oncologically safe when applied judiciously and by a skilled oncological surgeon.

Meta-analysis of impaired vocal cord mobility as a prognostic factor in T2 glottic carcinoma.

Objectives: To pool and meta-analyze the reported outcomes in patients receiving radiotherapy for T2 glottic carcinoma with impaired vocal cord mobility.

Data Sources: A MEDLINE search and manual search were conducted to identify all studies published between January 1, 1950 and September 30, 2007, in English on the treatment of T2 glottic carcinoma. Search terms included laryngeal neoplasm, glottis, and glottic carcinoma.

Nodular fasciitis: a case series.

Background: Given its rarity, varied histological presentation and often pseudosarcomatous appearance, nodular fasciitis is frequently misdiagnosed on pre-operative, intra-operative and final analyses.

Methods: Four cases of nodular fasciitis are reviewed.

Results: Physical and radiological findings were consistent with a parapharyngeal tumour, probably neurogenic, a level four neck mass suspicious for lymphoma; a sternoclavicular mass in a patient with a history of breast cancer suspicious for metastasis; and a cheek mass consistent with an accessory parotid tumour.

Malignant solitary fibrous tumor of the nasal cavity.

Solitary fibrous tumors (SFTs) are unusual mesenchymal tumors that were first described as primary spindle-cell neoplasms of the pleura. These tumors have been described in many other locations, including the urogenital system, orbit, mediastinum, and upper respiratory tract. Twenty-two cases of an SFT of the paranasal sinuses and nasal cavity have been reported, but none described a malignant SFT extending through the anterior skull base.

Foot drop in head and neck cancer.

Objective: Common peroneal nerve (CPN) paresis or paralysis presents with weakness of the toe extensors as well as of the ankle dorsiflexors and evertors, causing foot drop and hypesthesia or paresthesia in the CPN distribution. Previous studies have shown associations with weight loss and leg crossing. Although CPN neuropathy has been described in cancer patients, it has not been described in head and neck cancer (HNC) patients specifically.

Determination of the function of the internal branch of the superior laryngeal nerve after thyroidectomy.

Background: Several unique complications of thyroidectomy exist because of its regional anatomy; they are well studied and reported. A majority of thyroidectomy patients report vague upper aerodigestive tract complaints. Despite this, no formal assessment of the integrity of the internal branch of the superior laryngeal nerve after thyroidectomy exists in the literature.

Extraorbital skull base idiopathic pseudotumor.

Objectives/hypothesis: The term idiopathic pseudotumor (IP) refers to a nonspecific, nonneoplastic inflammatory process without identifiable local or systemic causes, which is one of the most common causes of intraorbital space-occupying lesions. Occasionally, orbital pseudotumors may extend to other areas of the skull base. Rarely, pseudotumors may present as a skull base mass with no involvement of the orbit.

Postobstructive pulmonary edema after laryngospasm in the otolaryngology patient.

Context: Post-obstructive pulmonary edema (PPE) is an uncommon complication which develops immediately after the onset of acute airway obstruction such as laryngospasm or epiglottitis (type I) or after the relief of chronic upper airway obstruction such as adenotonsillar hypertrophy (type II).

Objective: To describe the development of type I PPE following laryngospasm in pediatric and adult patients undergoing otolaryngologic surgical procedures other than those for treatment of obstructive sleep apnea.

Design: Retrospective case series of 13 otolaryngology patients from 1996 to 2003.

Management of inverted papillomas of the nose and paranasal sinuses.

Purpose: Inverted papillomas (IPs), although histologically benign, are aggressive lesions that may recur after an excision. The objective of this study was to compare the surgical treatment options for IPs with an emphasis on the experience of our institution with midfacial degloving (MFD) and medial maxillectomy.

Materials And Methods: A retrospective review of the charts of patients with IP treated by MFD and medial maxillectomy was performed.

Carcinoma of the oropharynx: factors affecting outcome.

Objectives/hypothesis: To assess the value of both patient- and tumor-related factors of oropharyngeal squamous cell carcinoma in predicting patient outcome, with respect to the three primary subsites of the disease. It was hypothesized that the subsite has a significant impact on outcome.

Study Design: Historical cohort study.

Combined endoscopic transmaxillary-transnasal approach to the pterygoid region, lateral sphenoid sinus, and retrobulbar orbit.

Objectives: The sublabial transmaxillary approach to the pterygoid region was a popular one during the Caldwell-Luc, pre-endoscopic era. It was the procedure of choice for management of lesions of the pterygopalatine space, for internal maxillary artery ligation, and for vidian neurectomy. With the introduction of endoscopic instrumentation and techniques, the Caldwell-Luc procedure is rarely performed today.

Age as a prognostic factor for complications of major head and neck surgery.

Objective: To determine if age alone is a prognostic indicator of surgical outcomes for major head and neck procedures.

Design: Retrospective cohort study over a 4-year period.

Setting: Academic referral center, institutional practice, hospitalized care.

Endoscopic transnasal transsphenoidal pituitary surgery--comparison with the traditional sublabial transseptal approach.

The technique of endoscopic transnasal, nontransseptal, transsphenoidal pituitary surgery is gaining increasing popularity. Many pituitary surgical teams consider it the procedure of choice. It provides a rapid and safe approach to the sella turcica.

Endoscopic Craniofacial Approach for Intracranial Polyposis: The "Blue-Sky Technique".

Massive sinonasal polyposis associated with skull base dehiscence and intracranial extension is a difficult disease to treat. Conventional transnasal or transfacial techniques can result in dural injury, cerebrospinal fluid (CSF) leak and infection. We describe our experience with a combined neurosurgical-endoscopic technique that protects the meninges.

Management of the lacrimal system during maxillectomy.

Background: Oncologic resection of the maxilla requires management of the nasolacrimal sac/duct system (NLS). A variety of techniques may be used: simple transection, transection with transcanalicular stenting, drilling of the entire nasolacrimal bony canal to the inferior meatus with mobilization of an intact NLS, marsupialization of the NLS with or without stenting, and simple transection with routine delayed dacryocystorhinostomy (DCR) for symptomatic epiphora. Rates of prolonged epiphora range from 13 to 63%.

Endoscopic management of anterior skull base tumors.

Anterior craniofacial resection has become a standard procedure for management of lesions of the anterior skull base. During the last 2 decades, modifications of the classic anterior craniofacial resection have been reported. With the introduction of endoscopic sinus techniques and instrumentation, surgeons have begun to use endoscopic approaches for management of anterior skull base lesions.

Tracheal resection with end-to-end anastomosis for benign tracheal stenosis.

To review our experience with tracheal resection with end-to-end anastomosis for tracheal stenosis, we performed a retrospective review at a tertiary-care academic medical center. Twenty-eight patients underwent circumferential tracheal resection with end-to-end anastomosis by 2 attending otolaryngologists from 1989 to 2002. Patients were excluded if they were under 12 years of age or if the surgical indication was tracheal or thyroid neoplasm.

Recurrence rates after endoscopic sinus surgery for massive sinus polyposis.

Background And Objectives: Most studies on outcome after endoscopic sinus surgery (ESS) include patients with varying degrees of disease severity. Recurrence rates cited by those studies may not apply to the subset of patients with severe polyposis. Our aim is to provide reference information for recurrence rates and need for revision surgery in patients with severe disease.