Farhad Ardeshirpour

Concomitant Radiotherapy and Chemotherapy for High-Risk Nonmelanoma Skin Carcinomas of the Head and Neck

Background. To report on the use and feasibility of a multimodality approach using concomitant radiotherapy and chemotherapy in patients with high-risk nonmelanoma skin carcinoma (NMSC) of the head and neck. Methods. Records of patients with NMSC of the head and neck who received concomitant CRT at the University of North Carolina between 2001 and 2007 were reviewed. Results. Fifteen identified patients had at least one of the following high-risk factors: T4 disease (93%), unresectability (60%), regional nodal involvement (40%), and/or recurrence (47%). Ten patients were treated in the definitive setting and five in the postoperative setting. Platinum based chemotherapy was given in 14 (93%) patients. Ten of fifteen (67%) patients completed all planned chemotherapy treatments, and thirteen patients (87%) completed at least 80% of planned chemotherapy. Mild radiation dermatitis occurred in all patients and reached grade 3 in 13% of patients. No patients experienced grade 4 or 5 toxicity. With a median followup of 31 months in surviving patients, the 2-year actuarial locoregional control and relapse-free survival were 79% and 49%, respectively. Conclusions. Definitive or postoperative chemoradiotherapy for patients with locally advanced or regionally metastasized NMSC of the head and neck appears feasible with acceptable toxicities and favorable locoregional control.

Surgery for pediatric invasive fungal sinonasal disease

To evaluate the management and outcomes of children with invasive fungal sinonasal disease treated with radical surgery.

Complication from hearing aid mold material: A case report and review of legal matters ☆,☆☆

Ear mold impression middle ear foreign bodies are a rare complication of hearing aid fitting. Only a small number of cases have been reported; however, the actual incidence is unknown and likely much higher than expected. We present the case of a 77-year-old man with a history of preexisting tympanic membrane perforations who presented with an ear mold impression middle ear foreign body that required surgical removal. We explore the state and federal laws that guide the interaction between patients, hearing aid sellers and otolaryngologists. We highlight steps that can be taken to reduce the incidence of this complication.

Improving Posttraumatic Facial Scars

Posttraumatic soft-tissue injuries of the face are often the most lasting sequelae of facial trauma. The disfigurement of posttraumatic scarring lies in both their physical deformity and psychosocial ramifications. This review outlines a variety of techniques to improve facial scars and limit their lasting effects.

Computed tomography scan does not correlate with patient experience of nasal obstruction

Third‐party payors have begun to demand imaging studies to document septal deviation prior to authorizing septoplasties. This study aims to determine whether septal deviation findings on computed tomography (CT) correlate with symptoms of nasal obstruction as determined by the Nasal Obstruction Symptom Evaluation (NOSE) scale.

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.

Use of Translucent Template in the Reconstruction of Nasal Defects: A Novel Technique

Reconstruction of complex nasal defects is a rewarding and challenging endeavor. Paramedian forehead flap may be used for medium or large nasal defects, while melolabial flap or other local flap may be used for smaller defects. Flap design and templating of the defect are critical and highly nuanced components of nasal reconstruction. Various methods of nasal defect template design have been described including use of Steri-Strips, suture pack foil, sterile surgical glove paper, and aquaplast. However, the use of these materials has limitations. As these materials are not translucent, it can be difficult to accurately trace the nasal subunits or defects onto these materials, resulting in a template that may not be accurate in size or shape. Further, as some materials are inflexible there are limitations in fashioning a template of a defect having complex topographic dimensional variations. We describe a simple technique of using a transparent surgical drape (3M 1010 SteriDrape, 3M Inc.) as a template for surgical planning of a paramedian forehead flap, melolabial flap, or other interpolated flap.

Comparison of Neurovascular Characteristics of Facial Skin in Patients After Primary and Revision Rhytidectomies

Importance Wound healing influences both the cosmetic and functional outcomes of facial surgery. Study of cutaneous innervation may afford insight into patients’ preoperative wound healing potential and aid in their selection of appropriate surgical procedures. Objective To present the quantitative and qualitative differences of epidermal nerve fibers (ENFs), neurotransmitters, vasculature, and mast cells in facial skin among patients after primary and revision rhytidectomies. Design, Setting, and Participants This pilot study collected cutaneous specimens from 8 female patients aged 42 to 66 years who underwent primary rhytidectomy (n = 5) and revision rhytidectomy (n = 3) at Centennial Lakes Surgery Center, Edina, Minnesota, from July 2010 to March 2014. Tissue was processed for confocal/epifluorescence microscopy and indirect immunofluorescent localization of several neural and tissue antigens as well as basement membrane and mast cell markers. Intervention Primary rhytidectomy vs revision rhytidectomy with selection of a small area of redundant, otherwise disposed of tissue anterior to the tragus for ENF study. Main Outcomes and Measures Demographic characteristics included smoking status; 10-point rating scales for facial sensation, pain, and paresthesias; and confocal/epifluorescence microscopy to quantify ENFs, neurotransmitters, vasculature, and mast cells. Results Patients in the primary rhytidectomy group had a mean (SD) of 54.4 (31.6) ENFs/mm (range, 14.2-99.2 ENFs/mm), and those in the revision rhytidectomy group had a mean (SD) of 18.6 (5.8) ENFs/mm (range, 13.8-25.0 ENFs/mm). A patient in the primary rhytidectomy group was a 25-pack-year smoker and had 14.2 ENFs/mm, the lowest in both groups. In addition to these structural neural changes, functional neural changes in revision rhytidectomy samples included qualitative changes in normal neural antigen prevalence (substance P, calcitonin gene-related peptide, and vasoactive intestinal peptide). Capillary loops appeared less robust and were less common in dermal papilla among samples from both the primary and revision groups, and mast cells were more degranulated. No differences were found in subjective, self-reported postoperative facial sensation. Conclusions and Relevance Previous skin elevation was associated with decreased epidermal nerve fiber density and qualitative changes in dermal nerves, capillaries, and mast cells in a clinical sample of patients undergoing rhytidectomy. Future research is needed to determine whether histological findings predict wound healing and to better understand the effects of surgery on regenerative capacity of epidermal nerve fibers. Level of Evidence NA.

Effects of Copper Tripeptide on Healing Irradiated Tissues

Objective: To evaluate clinical and immunohistochemical effects of topical copper tripeptide (GHK-Cu) on wound healing in an in vivo irradiated rat model. Method: After dorsal radiation to a human-equivalent-dose of 66.67 gray and a recovery period, 2x8-cm cranially based dorsal flaps were created. Twice daily GHK-Cu (test) or Eucerin (control) was applied for 10 days. Animals were euthanized, digital images of flaps were taken, and harvested tissues were stained for vascular endothelial growth factor (VEGF). Results: Thirteen test and 10 control animals were included. Photographs were converted to binary to calculate total pixels within the necrotic region and area of ischemia. The mean ischemic areas were 5.0 cm2 (standard deviation 0.9) for tests and 3.8 cm2 (1.1) for controls, which were significantly different (P = .01). Digitized slides allowed for calculation of the percent of pixels reaching specific brown calorimetric thresholds and for an intensity staining score with higher scores indicating more intense staining. The VEGF mean intensity scores were 0.34 (0.19) for tests and 0.54 (0.41) for controls, which were not significantly different. Unpaired t tests were utilized for statistical analyses. Conclusion: In this study, irradiated soft tissue flaps treated with topical GHK-Cu demonstrated a greater amount of flap ischemia and no difference in VEGF production compared to controls. These findings contrast prior studies suggesting a favorable growth factor environment and an improvement in wound healing with GHK-Cu treatment.

Ear Mold Impression Foreign Body

He elected to undergo surgical resection. The mold was found to fill the middle ear space and surrounded the ossicles (Figure 2). After the mold was removed, the stapes footplate was found to be dislocated with a perilymphatic leak. A fascial graft was used to cover the footplate and the leak resolved. The patient’s symptoms improved. Post-operatively the audiogram showed that hearing was preserved with the rightsided pure tone average (PTA) measuring 53 dB which improved to 73 dB at 6 months. Speech discrimination score initially decreased to 60% which eventually increased to 76%. To present the case of a patient whose right ear hearing aid canal mold impression was complicated by having mold material enter his middle ear.