Babak Larian

The role of hyperplasia in multiple parathyroid adenomas.

Parathyroid adenoma is the most common cause of primary hyperparathyroidism (pHPT). Adenomas usually involve only a single gland, and the remaining glands are normal or suppressed. Multiple parathyroid adenomas have been reported to occur in as high as 11% of patients with pHPT. The significant incidence of multiple adenomas with histologic similarities to hyperplasia has raised the possibility that adenoma is a continuation of the hyperplasia state. To test this theory, we used molecular genetics to compare clonality and proliferative activity of parathyroid adenoma with its corresponding normal glandular tissue. Furthermore, we devised a scheme to definitively distinguish between the different parathyroid states on a molecular level, because histologic distinction is unreliable.

Magnetic Resonance Imaging–Guided Fine‐Needle Aspiration Biopsies of Retropharyngeal Lesions

Objective The retropharyngeal space is a deep neck space susceptible to a host of disease processes. Surgical access to this space is technically difficult and associated with potential morbidity. An image‐guided fine‐needle aspiration (FNA) biopsy, if proven accurate and safe, would be of great benefit as an alternative diagnostic approach to this space. This study reports on the use of magnetic resonance imaging (MRI)–guided FNA for diagnostic evaluation of retropharyngeal lesions. Technical details of needle systems, approach to this space, and reliability of this method are described.

Parotidectomy for Benign Parotid Tumors

Parotidectomy for benign tumors is undergoing constant evolution. The potential for recurrence and malignant transformation of pleomorphic adenomas creates complexities that have forced head and neck surgeons to undertake more comprehensive parotid surgery with facial nerve dissection. This approach carries inherent morbidities, including facial nerve injury, Frey syndrome, and facial asymmetry, that have to be addressed. Extracapsular dissection is compared with conventional superficial parotidectomy; surgical histologic findings are discussed as well as outcome data. More novel approaches are discussed as well. This article provides a systematic approach to benign parotid tumor surgery.

Facial Nerve and Parotid Gland Anatomy.

This article provides an overview of important anatomic and functional anatomy associated with the parotid gland and facial nerve for the practicing otolaryngologist, head and neck surgeon, facial plastic surgeon, and plastic surgeon. The discussion includes the important anatomic relationships and physiology related to the parotid gland and salivary production. A comprehensive description of the path of facial nerve, its branches, and important anatomic landmarks also are provided.

Locoregional Parotid Reconstruction.

Parotidectomy for benign and malignant tumors often results in conspicuous contour abnormalities and soft tissue defects. Immediate reconstruction leads to improved patient satisfaction and local or regional flaps can be used for reconstruction in most cases. This article provides a systematic approach to parotid reconstruction.

Photobiomodulation therapy: management of mucosal necrosis of the oropharynx in previously treated head and neck cancer patients

Necrosis of the oral mucosa following head and neck cancer radiation therapy presents considerable clinical management challenges. We report three cases of symptomatic persisting oral ulcerations where the addition of photobiomodulation therapy resulted in a rapid resolution of the oral lesions and in patient symptoms. These cases suggest that photobiomodulation may represent an adjunct to care of these difficult to manage complications in oncology.

29 Eyelid Laceration and an Unusual Foreign Body

In a series of 541 patients who were evaluated for laserassisted uvulopalatoplasty (LAUP) for snoring, 170 patients have completed LAUP treatment. Among the 170 patients, 65 had obstructive sleep apnea syndrome based on preoperative polysomnography. Thirty-three patients (51%) has postoperative polysomnograms available for comparison. Surgical success with postoperative respiratory disturbance index (RDI) was achieved in 16 (48%) patients. Unfortunately, seven (21%) had postoperative RDI that was worse than preoperative RDI. The focus of this report is to determine if there are preoperative factors that could predict who will fail LAUP treatment of obstructive sleep apuea syndrome. Polysomnographic data, as well as history and physical examination, will be reviewed.