Anthony Bared

Surgical outcomes and safety of transnasal endoscopic resection for anterior skull tumors.

Objective To report the surgical outcomes and safety of transnasal endoscopic resection (TER) for anterior skull base (ASB) tumors. Study Design and Setting A retrospective chart review to identify patients undergoing TER for ASB tumors at a tertiary care medical center between September 1997 and June 2006. Results Nineteen patients underwent TER for ASB tumors without open craniotomy. There were 17 malignant and two benign lesions. Olfactory neuroblastoma was the most common pathology, occurring in 53 percent of patients. One patient recurred locally, resulting in an overall local control rate of 94.7 percent for all neoplasms and 94.1 percent for malignant disease. It should be noted that the tumor control rate may be premature given the small sample size and limited follow-up. Overall, there were 16 complications, but only two of these, an orbital hematoma and a frontal lobe abscess, were considered major complications directly attributable to surgery. Conclusions TER for ASB tumors appears to be safe in properly selected patients. In light of the small sample size and limited follow-up, the major complication rate directly attributable to surgery was 11 percent, and the overall local control rate was 95 percent. A larger multi-institutional series with longer follow-up is warranted.

Sentinel node biopsy for squamous cell carcinoma of the head and neck

The clinical utility of sentinel node biopsy for melanoma has led multiple investigators to apply this approach to other cutaneous malignancies as well as to early cancers of the upper aerodigestive tract. Data are most extensive for oral cancer. A multi‐institutional pathologic validation trial for selected oral cancers provided negative predictive values of 96%. Subsequent trials should document clinical follow‐up. This technique may ultimately play a wider role in the management of mucosal cancers. J. Surg. Oncol. 2008;97:683–690.

Antioxidant enzymes, presbycusis, and ethnic variability.

OBJECTIVE: A proposed mechanism for presbycusis is a significant increase in oxidative stress in the cochlea. The enzymes glutathione S-transferase (GST) and N-acetyltransferase (NAT) are two classes of antioxidant enzymes active in the cochlea. In this work, we sought to investigate the association of different polymorphisms of GSTM1, GSTT1, and NAT2 and presbycusis and analyze whether ethnicity has an effect in the genotype-phenotype associations. STUDY DESIGN: Case-control study of 134 DNA samples. SETTING: University-based tertiary care center. SUBJECTS AND METHODS: Clinical, audiometric, and DNA testing of 55 adults with presbycusis and 79 control patients with normal hearing. RESULTS: The GSTM1 null genotype was present in 77 percent of white Hispanics and 51 percent of white non-Hispanics (Fishers exact test, 2-tail, P = 0.0262). The GSTT1 null genotype was present in 34 percent of control patients and in 60 percent of white presbycusis subjects (P = 0.0067, odds ratio [OR] = 2.843, 95% confidence interval [95% CI] = 1.379–5.860). The GSTM1 null genotype was more frequent in presbycusis subjects, i.e., 48 percent of control patients and 69 percent of white subjects carried this deletion (P = 0.0198, OR = 2.43, 95% CI = 1.163–5.067). The NAT2∗6A mutant genotype was more frequent among subjects with presbycusis (60%) than in control patients (34%; P = 0.0086, OR = 2.88, 95% CI = 1.355–6.141). CONCLUSION: We showed an increased risk of presbycusis among white subjects carrying the GSTM1 and the GSTT1 null genotype and the NAT∗6A mutant allele. Subjects with the GSTT1 null genotypes are almost three times more likely to develop presbycusis than those with the wild type. The GSTM1 null genotype was more prevalent in white Hispanics than in white non-Hispanics, but the GSTT1 and NAT2 polymorphisms were equally represented in the two groups.

MANAGEMENT OF THE NECK IN MERKEL CELL CARCINOMA OF THE HEAD AND NECK: UNIVERSITY OF MIAMI EXPERIENCE

We reviewed management of the cervical lymph nodes in patients with Merkel cell carcinoma (MCC) of the head and neck.

Malleus handle: determinant of success in ossiculoplasty

OBJECTIVE The purpose of this study is to identify prognostic factors affecting outcome in ossicular chain reconstruction (OCR). STUDY DESIGN AND SETTING This study is a retrospective case series of electronic database at an academic institution. MATERIALS AND METHODS We reviewed 209 cases of chronic supportive otitis media performed from January 2000 through December 2007 and collected demographic, clinical, audiologic, and outcome information. Univariate analyses of group differences in terms of postoperative air-bone gap (ABG) changes were evaluated by analysis of variance. Multiple regression analyses were used to examine the relationship between postoperative ABG and the independent variables. RESULTS There were 105 cases of OCR the met the inclusion criteria (44 primary and 61 revision tympanoplasties), with an average follow-up of 19 months. The diagnoses were chronic suppurative otitis media without cholesteatoma in 36 cases and cholesteatoma in 69 cases. The mean preoperative ABG was 34 +/- 15 dB, and the mean postoperative ABG was 20 +/- 14 dB (P < 0.001). Of the independent variables analyzed, the type of procedure (ie, OCR performed during second-look tympanoplasty vs canal wall up vs canal wall down), preoperative ABG, and status of malleus handle were predictive of the success of OCR. CONCLUSIONS Favorable prognostic factors in OCR include smaller preoperative ABG and the presence of an intact malleus handle.

Mucoepidermoid carcinoma of the external auditory canal (EAC)

We present the third case of mucoepidermoid carcinoma of the external auditory canal (EAC) in the English literature, and discuss the management of this lesion. The patient underwent a wide local resection, superficial parotidectomy, and selective neck dissection. Although intraoperative frozen section margins were negative, permanent histopathologica examination demonstrated tumor in the medial margin, and the tumor was upgraded to a high-grade mucoepidermoid carcinoma. The patient returned to the operating room for a wider local resection, and EAC reconstruction with a temporoparietal pedicled flap and split thickness skin graft. All margins were negative on final histopathologic examination. Radiotherapy was deferred in the event of a recurrence. The patient is currently disease-free 29 months after the final excision. Most authors advocate an aggressive surgical approach, which includes a form of a temporal bone resection, for the treatment of EAC carcinoma. Although this may be warranted in cases of squamous cell carcinoma, mucoepidermoid carcinoma of the EAC may be amenable to a conservative step-by-step approach for local control with less postoperative morbidity. Given the difficulty in detecting mucoepidermoid carcinoma in surgical margins by frozen section analysis, patients should be informed of the possibility of further surgery (re-resection) when a conservative approach is used.

Audioprofiles and antioxidant enzyme genotypes in presbycusis

Audiometric patterns have been shown to indirectly provide information regarding the pathophysiology of presbycusis and be useful in the phenotyping of hereditary deafness.

Single-stage total endoscopic resection of a plexiform neurofibroma of the maxillary sinus in a child with type 1 neurofibromatosis

Plexiform neurofibromas are peripheral nerve sheath tumors associated with neurofibromatosis type 1. The maxillary sinus is an extremely rare location of the plexiform neurofibroma and only two adult cases have been previously reported. We report the first case of plexiform neurofibroma of the maxillary sinus occurring in a child with neurofibromatosis type 1. This unusual location presents a management challenge considering the infiltrative nature and the potential malignant degeneration of this type of tumor. MRI is highly valuable to diagnose and plan the surgical approach of the plexiform neurofibroma of the maxillary sinus. Due to the location of the tumor and the patients age, conservative surgery is highly recommended. We performed an endoscopic total en-bloc resection of the tumor with no recurrence after nine months of follow-up.

Anti-Oxidant Enzymes and Age-Related Hearing Loss

METHODS: Experimental study conducted from October to December of 2008. Ten male adult guinea pigs were placed in groups according to the daily intraperitoneal administration of different substances for 14 days. Group 1 received aminoguanidine and gentamicin. Group 2 received gentamicin and saline. Group 3 received aminoguanidine and saline. They were submitted to hearing evaluations for the presence of Preyer reflex and otoacoustic emissions previous to and after the treatment and electrocochleography at the end. The labyrinthine liquids were also collected for dosage of nitric oxide by chemiluminescence. RESULTS: The Preyer reflex remained until the end of this experiment in groups 1 and 3, and disappeared in group 2. Otoacoustic emissions also remained present in groups 1 and 3, and became absent after the 14th day in Group 2. The electrocochleography showed a threshold of 20dB for the guinea pigs in groups 1 and 3. A guinea pig in group 2 had a threshold of 30 dB and another of 80 dB. The concentration of nitric oxide in group 1 was close to group 3. The levels of nitric oxide in group 2 were higher than those of others. CONCLUSIONS: The results suggest that aminoguanidine may have a protective effect against gentamicin ototoxicity.

Malleus Handle: Determinant of Success in Ossiculoplasty:

Objective Identify prognostic factors affecting outcome in ossicular chain reconstruction (OCR). Methods Retrospective case series of electronic database at an academic institution. We reviewed 209 cases of OCR performed from January 2000 through September 2007, and systematically collected demographic, clinical, audiologic, and outcome information. Univariate analyses of group differences in terms of postoperative air-bone gap (ABG) changes were evaluated by ANOVA. Multiple regression analyses were used to examine the relationship between postoperative air-bone gap (dependent variable) and the independent variables. Results There were 107 cases of OCR which met inclusion criteria (45 primary and 62 revision tympanoplasties) with an average follow-up of 19 months. There were 36 cases of chronic suppurative otitis media without cholesteatoma and 71 cases with cholesteatoma. The mean preoperative ABG was 32 ± 15 dB and the mean postoperative ABG was 23 ± 14 dB (P < 0.001). Of the independent variables analyzed, the type of procedure (i.e., tympanoplasty vs. canal-wall up vs. canal-wall down) and status of malleus handle were predictive of the success of OCR. Conclusions Favorable prognostic factors in OCR include smaller preoperative ABG and the presence of an intact malleus handle. Our findings support the practice of performing OCR at the time of the second-look procedure.