Amy Anne D. Lassig

Cochlear implant failures and revision.

Objective: To review cases involving implant failure and revision surgery in a large cochlear implant program. Study Design: Retrospective case series. Setting: Cochlear implant program in an academic medical center. Patients: Adults and children who underwent revision cochlear implantation (n = 58). Intervention: Diagnosis and explantation of failed cochlear implants, with subsequent reimplantation. Assessment of implant function and speech perception. Main Outcome Measures: Device type, time from implantation to revision, cause of failure, performance with original implant versus revision, number of electrodes placed, and surgical challenges related to reimplantation. Results: Forty-five patients initially implanted at this program and 13 patients implanted elsewhere underwent revision surgery. The institutional device failure rate was 3.7% and the overall revision rate was 5.1%. Reasons for implant revision included documented internal device failure (46%), scalp flap complications (17%), optimization of electrode placement (13%), unexplained deterioration of performance (12%), technology upgrade (10%), and intratemporal pathology (3%). Revision surgery typically involved only minor anatomic challenges, but five patients required circumodiolar drillout procedures to improve electrode position. Electrode insertion was equal or deeper in 53 of 58 cases. Speech perception ability decreased in only three patients. Conclusions: Management of implant failures and performance of revision surgery are becoming increasingly important in cochlear implant programs. Outcomes are generally excellent. Revision implantation is a safe and appropriate procedure that should be pursued in a timely fashion when patients experience cochlear implant failure.

The Effect of Treating Institution on Outcomes in Head and Neck Cancer

Objective Factors leading patients with head and neck cancer (HNCA) to seek radiation or chemoradiation in an academic center versus the community are incompletely understood, as are the effects of site of treatment on treatment completion and survival. Study Design Historical cohort study. Setting Tertiary academic center, community practices. Methods A historical cohort study was completed of patients with mucosal HNCA identified by International Classification of Disease, Ninth Revision (ICD-9) codes receiving consultation at the authors’ institution from 2003 to 2008. Patients who received primary and adjuvant radiation at an academic center or in the community were included. The authors compared treatment completion rates and performed univariate and multivariate analyses of treatment outcomes. Results Of 388 patients, 210 completed treatment at an academic center and 145 at a community center (33 excluded, location unknown). Patients with HNCA undergoing radiation at an academic site had more advanced disease (P = .024) and were more likely to receive concurrent chemotherapy. Academic hospitals had a higher percentage of noncurrent smokers, higher median income, and higher percentage of oropharyngeal tumors. There was no significant difference in the rate of planned treatment completion between community and academic centers (93.7% vs 94.7%, P > .81) or rate of treatment breaks (22.4% vs 28.4%, P > .28). On Kaplan-Meier analysis, the 5-year survival rate was 53.2% (95% confidence interval [CI], 45.3%-61.1%) for academic centers and 32.8% (95% CI, 22.0%-43.6%) for community hospitals (P < .001). Conclusion In this cohort, although treatment completion and treatment breaks were similar between academic and community centers, survival rates were higher in patients treated in an academic setting.

Squamous cell carcinoma involving the temporal bone: Lateral temporal bone resection as primary intervention

Objective To provide an up-to-date review of treatment and outcomes of patients with squamous cell carcinoma (SCCA) involving the temporal bone. Design Retrospective cohort study of all patients treated at our institution for SCCA of the temporal bone between 1995 and 2007 with follow-up until 2011. Factors evaluated were demographics, presenting findings, follow-up time, previous treatment, workup, stage, surgical intervention, adjuvant therapy, histopathologic findings, recurrence, and survival. Setting Tertiary care academic medical center. Patients Thirty patients with SCCA of the temporal bone, originating from the external auditory canal and adjacent sites. Intervention Surgical resection ± adjuvant therapy. Lateral temporal bone resection was the primary and most aggressive procedure performed. Main Outcome Measures Disease-free survival. Results The overall disease free survival for this series when considering both external auditory canal and adjacent site SCCAs was 70%. When evaluated by tumor stage, disease-free survival was as follows: T1 tumors = 100%, T2 tumors = 100%, T3 tumors = 67%, and T4 tumors = 56%. Aggressive tumors of this series originating at periauricular sites behaved in a similar manner to primary canal tumors. Need for surgical resection of CN VII was associated with diminished survival on multivariate analysis. Conclusion Lateral temporal bone resection provides comparable disease free survival rates to more radical surgical therapy. Such resection is appropriate for many SCCAs of the external auditory canal and adjacent sites, as these tumors are similar in disease progression and prognosis. CN VII involvement portends a poor outcome.

The effect of smoking on perioperative complications in head and neck oncologic surgery

Cigarette smoking is the most important risk factor for head and neck cancer. Conventional wisdom suggests that smoking causes increased postoperative wound healing and systemic complications in this patient population, but it is unclear if the clinical literature supports this.

Elevated levels of 1-hydroxypyrene and N′-nitrosonornicotine in smokers with head and neck cancer: A matched control study

Head and neck squamous cell carcinoma (HNSCC) is associated with tobacco use. Still, most smokers do not develop HNSCC. The mechanisms of varying susceptibility to HNSCC are poorly studied to date. Tobacco metabolite research provides insight regarding the innate metabolism and excretion of carcinogens.

Magnetic resonance imaging of oropharyngeal cancer.

Magnetic resonance imaging (MRI) is a powerful tool for cross-sectional analysis of head and neck anatomy and pathology. This is especially true with regard to oropharyngeal neoplasms, where soft tissue spread, nodal disease, perineural extension, and osseous involvement may significantly alter therapy and prognosis. In this article, we will provide a background on oropharyngeal cancers and MRI techniques and strategies, describing potential advantages of MRI with regard to particular anatomic subsites of the oropharynx. Future imaging trends in perfusion and diffusion MRI of such cancers are also discussed.

The effect of young age on outcomes in head and neck cancer

Many head and neck surgeons believe that young patients with head and neck cancer (HNCA) have poorer outcomes than older patients, whereas the evidence in the literature is mixed. We sought to review our HNCA population to evaluate for survival differences between young and older patients.

Tobacco exposure and wound healing in head and neck surgical wounds

Smoking impairs wound healing, yet the underlying pathophysiological mechanisms are unclear. We evaluated tobacco‐altered healing in head and neck surgery by studying the association between biomarkers and tobacco exposure, as well as cutaneous perfusion by smoking status.

Effects of Topical Copper Tripeptide Complex on Wound Healing in an Irradiated Rat Model

Objectives To evaluate clinical and immunohistopathological effects of topical glycyl-histidyl-lysine-copper (GHK-Cu) on in vivo irradiated rat wounds. Design Animal model. Setting Academic institution. Subjects and Methods After dorsal irradiation and a 28-day recovery period, 2 × 8 cm cranially based dorsal flaps were created in Sprague-Dawley rats. Twice daily GHK-Cu gel (test) or aquaphilic ointment (control) was applied for 10 days. Animals were euthanized, digital images of flaps were taken, and harvested tissues were immunohistochemically stained for a vascular endothelium marker, caveolin-1, and vascular endothelial growth factor (VEGF). Digital image analysis was used for outcome measures. Unpaired t-tests were used for statistical analyses; significance of P < .01 accounted for multiple comparisons. Results By digital analysis of clinical images, 13 test and 10 control animals showed mean ischemic areas of 5.0 cm2 (SD = 0.9) for tests and 3.8 cm2 (SD = 1.1; P = .011) for controls. Whole slide digitized images allowed quantification of caveolin-1-stained blood vessels and VEGF expression in fibroblasts at the interface of healing flaps. Caveolin-1 analyses showed a mean of 209.0 vessels (SD = 111.1) and a mean vessel luminal area of 525.7 um2 (SD = 191.0) in tests and 207.4 vessels (SD = 109.4; P = .973) and 422.8 um2 (SD = 109.7; P = .118) in controls. VEGF quantified as the percentage of pixels exceeding a colorimetric threshold, with higher fractions of positive pixels indicating more intense staining, showed a mean intensity score of 0.34 (SD = 0.19) in tests and 0.54 (SD = 0.41; P = .169) in controls. Conclusions Irradiated dorsal rat flaps treated with topical GHK-Cu gel demonstrated no difference in flap ischemia, blood vessel number or area, or VEGF expression compared to controls.

Acute airway compromise from a hemorrhagic posterior cervical-mediastinal mass: Rare presentation of a parathyroid adenoma.

Massive hemorrhage secondary to rupture of a parathyroid adenoma is exceedingly rare. We present the case of a hemorrhagic parathyroid adenoma resulting in airway compromise treated with surgical decompression.