Thyroseq V3 Molecular Profiling for Tailoring the Surgical Management of Hürthle Cell Neoplasms.

Hürthle cell predominant thyroid nodules often confound the diagnostic utility of fine needle aspiration biopsy (FNAB) with cytology often interpreted as a Hürthle cell lesion with an indeterminate risk of malignancy, Bethesda category (BC) III or IV. Molecular diagnostics for Hürthle cell predominant nodules has also been disappointing in further defining the risk of malignancy. We present a case of a slowly enlarging nodule within a goiter initially reported as benign on FNAB, BC II but on subsequent FNAB suspicious for a Hürthle cell neoplasm, BC IV.

A simplified approach to minimally invasive parathyroidectomy.

Objectives/hypothesis: To assess the feasibility of a simplified approach for the use of a rapid intraoperative parathyroid hormone (IOPTH) assay based on a single 10-minute post-excision level using the workup parathyroid hormone level (wPTH) as the baseline in minimally invasive parathyroidectomy (MIP) and to compare the predictive value of this criterion with other recommended criteria.

Study Design: Case series with chart review.

Methods: A single surgeon's prospectively maintained parathyroidectomy database at an academic center was reviewed over a 2-year period from June 2009 through June 2011.

GlideScope-assisted nerve integrity monitoring tube placement for intra-operative recurrent laryngeal nerve monitoring.

Objective: The proper positioning of the Nerve Integrity Monitoring® endotracheal tube during recurrent laryngeal nerve monitoring is of paramount importance. This article describes our experience with the GlideScope® and explains how it can facilitate the accurate placement of the Nerve Integrity Monitoring endotracheal tube.

Methods: Endotracheal intubation with the Nerve Integrity Monitoring endotracheal tube was performed in 250 patients undergoing thyroidectomies using the GlideScope video laryngoscope.

Parathyroid gland preservation and selective autotransplantation utilizing topical lidocaine in total thyroidectomy.

Objectives/hypothesis: To review a new technique during total thyroidectomy that facilitates parathyroid gland preservation and selective autotransplantation utilizing topical 2% plain lidocaine as a spasmolytic/vasodilator agent.

Study Design: Retrospective case series review at a university hospital.

Methods: The study population comprised 100 consecutive patients (84 women and 16 men; mean age, 52 years) undergoing total thyroidectomy from January 2007 to December 2008.

Rapid intraoperative localization of parathyroid glands utilizing methylene blue infusion.

Objective: To review a single surgeon's experience utilizing an intraoperative methylene blue infusion (IMBI) to identify parathyroid glands during neck exploration for primary hyperparathyroidism.

Study Design And Setting: Retrospective review of 35 patients who underwent bilateral neck exploration utilizing an IMBI at a dose of 7.5 mg/kg following the induction of general anesthesia.

Tracheal autograft prefabrication using microfibrillar collagen and bone morphogenetic protein.

Objective: To investigate the feasibility of prefabricating a tracheal autograft capable of microvascular free tissue transfer using microfibrillar collagen (Avitene) as a carrier for bone morphogenetic protein (BMP).

Methods And Design: Using heterotopic bone induction and soft tissue molding, an attempt was made to prefabricate a homologous tracheal autograft in a rodent free flap model. In 12 male Sprague-Dawley rats, linear troughs were dissected along the length of the gracillis muscle, filled with BMP-saturated microfibrillar collagen, molded around a silicone tracheal stent, and left pedicled on the femoral vessels.

Sarcoidosis of the sinonasal tract: a new staging system.

Sarcoidosis is a chronic multisystem granulomatous disease that has a predilection for pulmonary and upper respiratory tract involvement. Because the initial signs and symptoms of sarcoidosis may be identical to those of other forms of chronic sinonasal inflammatory disease, these patients will often first seek treatment from an otolaryngologist. We present a series of 28 patients whose primary symptoms was involvement of a sinonasal tract.

Prefabricated microvascular autograft in tracheal reconstruction.

Tracheal reconstruction continues to be a challenge in head and neck surgery. Numerous techniques, including the use of alloplasts, composite grafts, and staged laryngotracheal troughs, have met with limited success because of implant exposure, infection, persistent granulation tissue, and eventual restenosis. With recently introduced techniques for soft-tissue molding, bone induction with bone morphogenetic protein, and microvascular free tissue transfer, a rodent model was developed to create a well-vascularized tracheal autograft.

Lateral arm free flap in head and neck reconstruction.

The lateral arm fasciocutaneous free flap is a versatile donor site of sensate soft tissue for reconstruction and augmentation of the head and neck. The lateral arm flap can be quickly harvested without interference to the head and neck team and with minimal morbidity to the patient. For these reasons, this flap has become our soft-tissue flap of choice.

Mandibular reconstruction using vascularized bone grafts.

Total oromandibular reconstruction following cancer extirpation remains a significant challenge to the head and neck surgeon. Reconstructive goals must address occlusion, salivary continence, mastication, deglutition, and articulation. In this article, various methods of mandibular reconstruction, with special attention to the most recent advances in vascularized bone and free tissue transfer techniques, are reviewed.

Controlled laryngoplasty for vocal cord medialization: a technique using tissue expansion.

Laryngeal framework surgery has become an increasingly popular alternative to Teflon injection for vocal rehabilitation. Vocal cord medialization requires custom tailoring of the implant's size and shape to optimize individual vocal quality, whether it be via the interposition of Silastic implants between the thyroid ala and the inner thyroid perichondrium or through a cartilage window. A new technique is described for vocal cord medialization using an implanted miniature tissue expander.

Delayed airway obstruction and neck abscess following manual strangulation injury.

Few reports describing manual strangulation injury to the neck are found in the otolaryngologic literature. Since most victims sustain immediate fatal asphyxiation, brain anoxia, or cardiac arrest, they are usually examined by a forensic pathologist. When strangulation attempts are nonfatal, neck injuries can lead to delayed airway obstruction.

Osteocartilaginous necrosis of the sinonasal tract following cocaine abuse.

As cocaine abuse has become increasingly widespread, there has been a concomitant rise in associated medical complications. Nasal inhalation ("snorting") causes profound effects on the upper respiratory tract in addition to the well known nasal septal perforation. Septal necrosis can be accompanied by bleeding, granulation tissue, ulceration, and sinusitis.

Nasal septal perforations and nasal obstruction.

Nasal septal perforations cause a wide range of symptoms that vary from mild discomfort and nasal obstruction to life-threatening epistaxis. The differential diagnosis, pathophysiology, and treatment of this disorder are reviewed.

Laryngotracheal injury following cricothyroidotomy.

Airway complications following elective cricothyroidotomy were reviewed in 48 adult cardiothoracic surgery patients. A 52% incidence of airway complications was found and manifested by failed or delayed decannulation, extensive subglottic granulation tissue, stenosis, vocal cord paralysis, and aspiration pneumonia. The most common cause for decannulation difficulty was subglottic stenosis (50%).

Squamous cell carcinoma of the thyroid: a diagnostic dilemma.

Four cases of primary squamous cell carcinoma of the thyroid gland are reported. Thorough evaluation confirmed these lesions to be of primary thyroid origin rather than from metastasis or direct invasion from contiguous structures. These cases illustrate the aggressive nature of the disease and the propensity for local and distant metastases.