Abib Agbetoba

International collaborative validation of intraneural invasion as a prognostic marker in adenoid cystic carcinoma of the head and neck.

The purpose of this study was to characterize the incidence, pattern of spread, and prognostic correlation of nerve invasion in patients with adenoid cystic carcinoma (ACC).

Adenoid Cystic Carcinoma of the Nasal Cavity and Paranasal Sinuses: A Meta-Analysis

Objectives To identify independent predictors of outcome in patients with adenoid cystic carcinoma (ACC) of the paranasal sinuses and skull base. Design Meta-analysis of the literature and data from the International ACC Study Group. Setting University-affiliated medical center. Participants The study group consisted of 520 patients, 99 of them from the international cohort. The median follow-up period was 60 months (range, 32 to 100 months). Main Outcome Measures Overall survival (OS) and disease-specific survival (DSS). Results The 5-year OS and DSS of the entire cohort were 62% and 67%, respectively. The local recurrence rate was 36.6%, and the regional recurrence rate was 7%. Distant metastasis, most commonly present in the lung, was recorded in 106 patients (29.1%). In the international cohort, positive margins and ACC of the sphenoid or ethmoidal sinuses were significant predictors of outcome (p < 0.001). Perineural invasion and adjuvant treatment (radiotherapy or chemoradiation) were not associated with prognosis. Conclusion Tumor margin status and tumor site are associated with prognosis in ACC of the paranasal sinuses, whereas perineural invasion is not. Adjuvant treatment apparently has no impact on outcome.

Analysis of failure in patients with adenoid cystic carcinoma of the head and neck. An international collaborative study

Adenoid cystic carcinoma (ACC) is a locally aggressive tumor with a high prevalence of distant metastases. The purpose of this study was to identify independent predictors of outcome and to characterize the patterns of failure.

Incidence of cervical lymph node metastasis and its association with outcomes in patients with adenoid cystic carcinoma. An international collaborative study

The patterns of regional metastasis in adenoid cystic carcinoma (ACC) of the head and neck and its association with outcome is not established.

Revision Sinus Surgery

Revision sinus surgery for inflammatory disease has been revolutionized by endoscopic sinus surgery. Clinical trials have shown statistically significant positive outcome data for patient symptoms and quality of life, as well as improvements in objective findings on postoperative nasal endoscopy and computed tomography imaging for patients undergoing revision sinus surgery. The keys to successful revision surgery are adjunctive medical management, aggressive postoperative debridement, mucosal preservation, and removal of osteitic bone. Both the physician and patient should also understand the underlying disease process and comorbid factors so that anticipated postoperative outcomes can be met with realistic expectations.

The impact of nasal airflow on sinus mucosa: A radiographic review

BACKGROUND Chronic rhinosinusitis (CRS) is a disease of widespread prevalence and high morbidity. Many suggest that the introduction of toxins and allergens via nasal airflow plays a significant role in the development of CRS. In patients who have undergone total laryngectomy, nasal airflow is disrupted, providing an opportunity to examine the role of nasal airflow in sinonasal pathology. METHODS All patients who received a total laryngectomy between 2002 and 2012 with preoperative and postoperative computed tomography (CT) scans were retrospectively reviewed. The Lund-Mackay (LM) score for each sinus was recorded for both scans. The assessment of differences in pre-operative and post-operative LM scores was analyzed utilizing paired t-tests. RESULTS 56 patients underwent total laryngectomy and had both preoperative and postoperative CT scans. There were no significant differences in the LM scores between pre-operative and post-operative scans within each sinus (frontal sinus, p = 1.0; anterior ethmoid sinus, p = 0.77; posterior ethmoid sinus, p = 0.45; maxillary sinus, p = 0.90; sphenoid sinus, p = 0.63; ostiomeatal complex, p = 0.78) or in the total LM scores (p = 0.97). Furthermore, patients with pre-operative sinonasal mucosal thickening (total LM score > 0) showed no significant change in their total LM score post-operatively (p = 0.13). CONCLUSION In total laryngectomy patients, studies demonstrate that a disruption in nasal airflow is correlated to altered sinonasal physiology and decreased subjective symptoms. However, our study shows that the disruption of nasal airflow results in no significant change in radiographic evidence of sinonasal mucosal thickening.

Oral Cavity and Oropharyngeal Squamous Cell Carcinoma

Erythroplakia>leukoplakia are premalignant conditions which require monitoring/biopsy. Bone invasion (mandible or maxilla) portends poor prognosis and represents T4 disease (see TNM staging below). Cervical metastasis is the most influential prognostic factor and confers a 50 % decrease in survival. Tumors >5 mm thickness have higher (20 %>) risk of cervical metastasis. Cervical metastasis (neck mass) is a common presenting sign of oropharyngeal malignancy. HPV viral induced oropharyngeal SCCA has dramatically improved prognosis when compared with HPV− cancers and has shifted treatment paradigms and research protocols.

Use of HRCT-MRI Fusion Imaging in the Detection of Cerebrospinal Fluid Leaks:

Objective: 1) Determine the accuracy of high resolution computed tomography and magnetic resonance fused imaging in detecting skull base cerebrospinal fluid leaks. 2) Develop a comprehensive algorithm for the diagnostic workup of anterior skull base cerebrospinal fluid leaks. Method: We retrospectively reviewed 16 cases of patients who underwent HRCT-MRI fusion studies with intraoperative fluorescein localization for the evaluation and repair of CSF leaks during a 3-year period between 2008 and 2011 at the Mount Sinai Medical Center. Results: Sixteen HRCT-MRI fusion studies were evaluated from 16 different patients suspected of having CSF leaks. Eleven out of the 16 subjects had a confirmed diagnosis of CSF leak on intraoperative nasal endoscopy. HRCT-MRI fusion imaging accurately identified the CSF leak and its location in each of the 11 subjects yielding a sensitivity of 100%. Three of the 16 patients were found to have no signs of active leak or skull base defect on intraoperative nasal endoscopy, 2 of which correlated with negative findings on fusion imaging. Conclusion: HRCT-MRI fusion is an excellent imaging modality that not only provides accurate identification and localization of CSF leaks but also acts as a great adjunct for intraoperative localization and repair. HRCT-MRI fusion should be incorporated into the diagnostic algorithm for management of CSF leaks.