Douglas J. Van Daele

ASSOCIATION BETWEEN SEVERITY OF DYSPHAGIA AND SURVIVAL IN PATIENTS WITH HEAD AND NECK CANCER

This study examined risk factors for dysphagia, a common and serious condition in patients with head and neck cancer, and the association between severity of dysphagia and survival.

Outcomes after the use of gastrostomy tubes in patients whose head and neck cancer was managed with radiation therapy

The purpose of this study was to examine the effect of continued oral intake and duration of gastrostomy tube placement on posttreatment nutritional outcomes in patients being irradiated for head and neck cancer.

Evaluation of open approach and injection laryngoplasty in revision thyroplasty procedures.

INTRODUCTION: Vocal outcomes after medialization laryngoplasty are variable and may change over time. A revision procedure via open approach or an injection laryngoplasty may be necessary to improve vocal outcomes. METHODS: A retrospective chart review was performed. RESULTS: Twenty-nine subjects were identified and stratified into group 1A (n = 9) if the allograft was repositioned/replaced, group 1B (n = 4) if the allograft was removed, and group 2 (n = 16) if an injection laryngoplasty was performed. Statistically significant differences were found between all data prerevision to postrevision (P ≤ 0.05) for group 1A and group 2 when multiple paired-sample t tests were calculated for patient-reported voice severity ratings and voice impact ratings as well as clinician-reported voice ratings of grade, roughness, and breathiness. Results of group 2 were often temporary, with 10 of 16 (62.5%) subjects receiving multiple injections. CONCLUSION: Both open revision laryngoplasty and injection laryngoplasty are successful at providing improved vocal outcomes. Results are often temporary after injection laryngoplasty and often require multiple procedures.

A Biomechanical Study of Hyoid Bone and Laryngeal Movements During Swallowing Comparing the Blom Low Profile Voice Inner Cannula and Passy-Muir One Way Tracheotomy Tube Speaking Valves

The aim of this prospective, consecutive, cohort study was to investigate the biomechanical effects, if any, of the Blom low profile voice inner cannula and Passy-Muir one-way tracheotomy tube speaking valves on movement of the hyoid bone and larynx during swallowing. Ten adult patients (8 male, 2 female) with an age range of 61–89xa0years (mean 71xa0years) participated. Criteria for inclusion were ≥18xa0years of age, English speaking, and ability to tolerate both changing to a Blom tracheotomy tube and placement of a one-way tracheotomy tube speaking valve with a fully deflated tracheotomy tube cuff. Digitized videofluoroscopic swallow studies were performed at 30xa0frames/s and with each patient seated upright in the lateral plane. A total of 18 swallows (three each with 5xa0cc bolus volumes of single contrast barium and pureexa0+xa0bariumxa0×xa03 conditions) were analyzed for each participant. Variables evaluated included larynx-to-hyoid bone excursion (mm), maximum hyoid bone displacement (mm), and aspiration status under three randomized conditions: 1. Tracheotomy tube open with no inner cannula; 2. Tracheotomy tube with Blom valve; and 3. Tracheotomy tube with Passy-Muir valve. Blinded reliability testing with a Pearson product moment correlation was performed on 20xa0% of the data. Intra- and inter-rater reliability for combined measurements of larynx-to-hyoid bone excursion and maximum hyoid bone displacement was rxa0=xa00.98. Intra- and inter-rater reliability for aspiration status was 100xa0%. No significant differences (pxa0>xa00.05) were found for larynx-to-hyoid bone excursion and maximum hyoid bone displacement during swallowing based upon an open tracheotomy tube, Blom valve, or Passy-Muir valve. Aspiration status was identical for all three randomized conditions. The presence of a one-way tracheotomy tube speaking valve did not significantly alter two important components of normal pharyngeal swallow biomechanics, i.e., hyoid bone and laryngeal movements. Aspiration status was similarly unaffected by valve use. Clinicians should be aware that the data do not support placement of a one-way tracheotomy tube speaking valve to reduce prandial aspiration.

Endoscopic transnasal resection of ameloblastoma with intracranial extension

Ameloblastoma is a rare odontogenic tumor with characteristics of epithelial tissue that produces enamel for the developing tooth. This lesion is generally considered benign, but has malignant forms that invade locally and metastasize. We present a 60-year-old man with maxillary ameloblastoma that after multiple recurrences developed intracranial extension with dural involvement of the middle cranial fossa and was treated by endoscopic transnasal resection followed by radiation therapy. Our technique and intraoperative findings are described with a review of the literature on intracranial ameloblastoma. This patient represents a unique account of endoscopic transnasal resection being utilized in the treatment of intracranial extension of ameloblastoma and demonstrates potential for application in similar cases.

Multifactorial dysphagia: Diffuse idiopathic skeletal hyperostosis and eosinophilic esophagitis†

Swallowing is a complex, multistage event with oral, pharyngeal, and esophageal phases. A thorough clinical examination for swallowing complaints begins to differentiate whether the problem is due to anatomic, mechanical, or neurologic etiologies. Based on the clinical suspicion, additional tests may be beneficial, including fluoroscopic and direct imaging methods, and electrophysiologic measurements. A multidisciplinary approach may also be advantageous, as in this case of dysphagia from diffuse idiopathic skeletal hyperostosis and eosinophilic esophagitis, which incorporated care from otolaryngology, speech pathology, orthopedic surgery, and gastroenterology. Laryngoscope, 2010

Insular thyroid carcinoma in a patient with Cowden syndrome

Cowden syndrome is an autosomal dominant disorder characterized by benign and malignant hamartomatous lesions that can develop from all three germ cell derivatives. This disorder predisposes patients to develop malignant tumors of the breast, endometrium, and thyroid. We present a patient with clinically relevant manifestations of Cowden syndrome, with genetic verification, impacting by way of airway compromise due to hamartomas, urinary tract abnormalities, and insular thyroid cancer. This case illustrates the value of recognizing Cowden syndrome at an earlier stage when the patient could have received appropriate management to decrease the morbidity of untreated hamartomatous growths, and an elective thyroidectomy would have been a viable option to manage his malignancy. Through this case report, we provide further insight into management of this disorder. Laryngoscope, 2010

Tracheoesophageal puncture with immediate prosthesis placement

INTRODUCTION Tracheoesophageal puncture (TEP), with use of a TEP prosthesis, as described by Singer and Blom, is an outstanding option for voice restoration after total laryngectomy. TEP can be performed at the time of laryngectomy (primary TEP) or after an interval of time (secondary TEP). Multiple modifications of the classic technique have been developed for secondary TEP including use of potassium titanyl phosphate lasers, percutaneous gastrostomy sets, and flexible endoscopes. Most commonly, the puncture is created, and a temporary catheter is placed, which is replaced with a speech prosthesis after edema resolves. This two-step process creates a delay, during which patients cannot begin voice rehabilitation and must tolerate the inconvenience of an indwelling catheter. Patients may experience leakage at the puncture site around the catheter, which does not have flanges to create a seal, and may have troublesome obstruction and crusting at the tracheostomy. For these reasons, there has been increasing interest in techniques in which the prosthesis is immediately placed in a single-stage procedure. We describe a technique by which the prosthesis is placed immediately using instruments from a percutaneous tracheotomy kit to avoid these problems.

In reference to Cost-effective dental protection during rigid endoscopy.

Attention to the risk of dental injury during suspension laryngoscopy has spawned a series of technical advances to diminish that risk. The article by Domanski et al. describes a useful technique that we plan to incorporate in the selective management of dentate patients requiring urgent intervention with suspension laryngoscopy. However, for those patients with adequate time to prepare, we advocate that either dentists or patients themselves make a dental protector. When possible, preoperative assessment with identification of risk factors associated with dental injury coupled with the patients’ personal preferences should guide the selection of dental protection. Inexpensive (

Quantitative contributions of the muscles of the tongue, floor-of-mouth, jaw, and velum to tongue-to-palate pressure generation.

2 to