Abie H. Mendelsohn

Surgery for Papillary Thyroid Carcinoma: Is Lobectomy Enough?

OBJECTIVE To further understanding of treatment of papillary thyroid carcinoma (PTC). DESIGN The Surveillance, Epidemiology, and End Results Program database was searched for patients who had undergone surgery for PTC. SETTING Areas covered by Surveillance, Epidemiology, and End Results population-based registries. PATIENTS Patients who had undergone PTC surgery between January 1, 1988, and December 31, 2001, were included in the study. MAIN OUTCOME MEASURES Disease-specific survival (DSS) and overall survival (OS). RESULTS Of the total 22,724 patients with PTC, 5964 patients underwent lobectomy. There were 2138 total and 471 disease-specific deaths. Controlling for tumor size, multivariate analysis revealed no survival difference between patients who had undergone total thyroidectomy and those who had undergone lobectomy. Increased tumor size, extrathyroidal extent, positive nodal status, and increased age displayed significantly worse DSS and OS (P < .001). Histologically, follicular PTC subtype did not affect DSS or OS. Patients who had received radioactive iodine had poorer DSS but improved OS. Patients undergoing external beam radiation therapy had poor DSS (hazard ratio, 4.48; 95% confidence interval, 3.30-6.06; P < .001) and OS (1.71; 1.42-2.07; P < .001). CONCLUSIONS The results of this study compel us to reinvestigate the current PTC surgical recommendations of total thyroidectomy based on tumor size because this may not affect survival across all populations. In addition, the current use of external beam radiation therapy for the treatment of PTC should be reexamined.

Histopathologic findings of HPV and p16 positive HNSCC

Human papilloma virus (HPV) and p16INKa (p16) positivity in head and neck squamous cell carcinomas (HNSCCs) is currently thought to be an encouraging prognostic indicator. However, the histopathologic changes responsible for this behavior are poorly understood. It is our objective to elucidate these histopathologic characteristics to help define the clinical utility of these markers.

Outcomes following transoral robotic surgery: Supraglottic laryngectomy.

To describe a single center outcomes following transoral robotic surgery for supraglottic laryngectomy (TORS–SL).

Heterogeneity in the clinical presentation of Eagle's syndrome.

OBJECTIVE: Eagles syndrome (ES) or symptomatic elongated styloid process is an uncommon but important cause of chronic head and neck pain. This study reports our experience in the diagnosis and treatment of a series of patients with ES. STUDY DESIGN: Patient histories, radiographic tests, and operative reports of 3 patients over a 3-month period were prospectively collected. SETTING: Tertiary referral otolaryngology service. RESULTS: All patients had resolution of symptoms relating to their elongated styloid processes after surgical resection. CONCLUSION: Although sometimes clouded by coexisting symptoms, ES can be easily diagnosed based on good history taking and physical examination. If diagnosed appropriately, surgical treatment can be administered promptly. SIGNIFICANCE: Patients with ES commonly have a long history of chronic pain treated by multiple physicians. Appropriate diagnosis can lead to prompt treatment of this condition. EBM rating: C-4

Transoral robotic surgery total laryngectomy

has been reported with feasibility trials andpromising initial data. The combination of the two proce-dures, supraglottic and hypopharyngeal TORS resection,can be adapted to perform a TORS total laryngectomy(TORS-TL). In the past, TORS-TL has been met with skep-tical criticism as to its ultimate clinical benefit. Conversely,the authors suggest that the minimally invasive TORSapproach offers significant benefits toward improvingpatient recuperation and the avoidance of substantial post-operative morbidity. However, such benefits can only bedemonstrated following repeated clinical experience. It isthe purpose of this report to describe the surgical protocolutilized by the authors to encourage further application andstudy of this promising surgical advancement.

Long-term follow-up results of selective laryngeal adductor denervation-reinnervation surgery for adductor spasmodic dysphonia.

Selective laryngeal adductor denervation‐reinnervation surgery for the treatment of adductor spasmodic dysphonia was reported in 1999 in 21 patients with encouraging results. Here, we report long‐term results of this procedure. Surgical outcome was evaluated using patient surveys and perceptual voice assessment. Measured outcomes included Voice Handicap Index (VHI)‐10 scores, patient questionnaire, and perceptual evaluation for voice breaks and breathiness. Patient survey was obtained from 83 patients, and perceptual voice evaluation was performed in voice samples from 46 patients. Average follow‐up interval was 49 months. Mean VHI‐10 scores improved from a mean of 35.6 to 12.7. Eighty‐three percent showed significantly improved VHI‐10 scores, representing improved physical, social, and emotional well‐being. There was a high degree of patient satisfaction, with 91% agreeing that their voice is more fluent after the surgery. Perceptual evaluation of postoperative voice samples revealed voice breaks in 26% (15% mild, 4% moderate, 7% severe) and breathiness in 30% (11% mild, 13% moderate, 6% severe). A majority of patients had stable, long‐lasting resolution of spasmodic voice breaks.

Parapharyngeal space pleomorphic adenoma: A 30-year review†

To evaluate the treatment results of pleomorphic adenoma (PA) of the parapharyngeal space at a single institution during a 30‐year period.

Phonation threshold pressure and onset frequency in a two-layer physical model of the vocal folds

The influence of vocal fold geometry and stiffness on phonation onset was experimentally investigated using a body-cover physical model of the vocal folds. Results showed that a lower phonation threshold pressure and phonation onset frequency can be achieved by reducing body-layer or cover-layer stiffness, reducing medial surface thickness, or increasing cover-layer depth. Increasing body-layer stiffness also restricted vocal fold motion to the cover layer and reduced prephonatory glottal opening. Excitation of anterior-posterior modes was also observed, particularly for large values of the body-cover stiffness ratio. The results of this study were also discussed in relation to previous theoretical and experimental studies.

Transoral robotic surgery for laryngeal cancer.

Purpose of reviewTransoral robotic surgery (TORS) has seen substantial surge since its introduction in around 2007. Although initially described for cancer of the oropharynx, advances in robotic instrumentation and endoscopy have allowed for application of TORS toward laryngeal cancer. This review discusses the recent published experience of TORS for laryngeal cancer. Recent findingsTORS supraglottic laryngectomy continues to be the most frequent application of robotic surgery for laryngeal cancer. A number of case series have described the positive experience with TORS supraglottic laryngectomy with both oncologic and functional outcomes rivaling alternative therapy options. TORS total laryngectomy also continues to be applied in selective cases for laryngeal cancer. The objectives of TORS total laryngectomy is to reduce the size of the resultant pharyngotomy and to limit the lateral exposure of the cervical vessels. Although limited in numbers, TORS total laryngectomy appears to be a technique of increasing application. TORS approach for primary glottic cancer has also been described in limited case series. Although the majority of patients demonstrated positive outcomes following TORS glottic cordectomy, this technique may still require additional advancement of robotic technology before widespread application is seen. SummaryA TORS approach for laryngeal cancer is increasing in application and utility. The major surgical procedures described to date include supraglottic laryngectomy, total laryngectomy, and glottic cordectomy with promising results.

Hyaluronic acid for the treatment of vocal fold scars.

Purpose of reviewIn vocal fold scars the lamina propria layer is lost or deficient. Lamina propria replacement therapy remains a clinical challenge because this layer has a highly specialized three-dimensional organization of extracellular matrix molecules and unique viscoelastic properties. Use of a polymer such as hyaluronic acid appears most promising for replacement therapy because it has the optimal viscoelasticity and also plays a role in the maturation and maintenance of vocal fold lamina propria. Recent findingsA variety of cross-linked hyaluronic acid formulations and growth factor therapies targeted to increase hyaluronic acid production have been used in the treatment of both acute and established vocal fold scars. Therapeutic strategies have focused on prevention of scar at the time of initial injury, and rejuvenation of lamina propria layer in established scars. Both strategies show improved histologic, viscoelastic, acoustic, and aerodynamic measures. SummaryCross-linked hyaluronic acid formulations appear useful in the treatment of vocal fold scarring. Their use at the time of acute injury especially appears to lessen the degree of long-term scar formation and appears promising. While animal studies have demonstrated the safety profile of many hyaluronic acid formulations, further improvement in these materials and well designed and controlled human trials are needed to further establish the safety and efficacy of these materials and therapeutic approaches.