Ian Witterick

Clinical course of thyroid carcinoma after neck dissection.

Objectives/Hypothesis The objective was to compare the rate and site of recurrences in patients with well‐differentiated thyroid carcinoma who underwent a central compartment dissection, a posterolateral neck dissection, or a combination of both procedures.

Supraomohyoid neck dissection. Is it diagnostic or therapeutic

The supraomohyoid neck dissection (SOHND) is often performed in patients with cancer of the oral cavity, where there is no clinical or radiologic evidence of regional metastases. When on pathologic examination positive neck nodes are found, however, some consider it a curative operation, whereas others regard it as a staging procedure only.

Predictive Value of Serum Thyroglobulin After Surgery for Thyroid Carcinoma

Objective To determine the relationship between stimulated serum thyroglobulin levels (taken 3 months after total thyroidectomy) and tumor stage and recurrence in patients with well‐differentiated thyroid carcinoma.

Intranasal corticosteroid use is associated with lower rates of bacterial recovery in chronic rhinosinusitis

Objective To determine whether use of a topical intranasal corticosteroid (INCS) preoperatively had an effect on the bacterial recovery rate and flora recovered at endoscopic sinus surgery (ESS). Study Design and Setting A prospective, multicenter, observational study from academic-based rhinology practices. Consecutive, unselected patients undergoing ESS had protected sinus cultures done at the time of ESS. Results 157 patients were assessed. Overall growth rate was 45.5%. INCS users had a positive culture rate of 35.4% vs 61.7% in nonusers (P = 0.0001). This effect was most pronounced in the subgroup undergoing revision surgeries (bacterial recovery rate INCS: 40.0%, no INCS: 82.6%, P = 0.001) and most marked for S. aureus (INCS: 12.5%, no INCS: 40.0%, P = 0.04) and CNS (INCS: 12.5%, no INCS: 30.4%, P = 0.05). While the rate of nasal polyposis was higher in both revision and the INCS-treated groups, rate of bacterial recovery was not influenced by a diagnosis of nasal polyposis. Conclusion INCS use preoperatively is associated with a lesser rate of bacterial recovery at the time of ESS, especially in individuals with previous ESS. Significance The results suggest a possible role of INCS in the management of post-ESS disease.

Epinephrine/Lidocaine Injection Vs. Saline During Endoscopic Sinus Surgery

Objectives: To assess the safety and effectiveness of an epinephrine/lidocaine mixture administered by injection versus epinephrine administered topically and to learn its pharmacokinetics following administration to the nasal mucosa.

Cause of Death in Patients With Well-Differentiated Thyroid Carcinoma†

Objectives The aim of this study is to examine in detail patients dying of well‐differentiated thyroid carcinoma.

Comparison of endoscopic endonasal and bifrontal craniotomy approaches for olfactory groove meningiomas: A matched pair analysis of outcomes and frontal lobe changes on MRI.

We compare the outcomes and postoperative MRI changes of endoscopic endonasal (EEA) and bifrontal craniotomy (BFC) approaches for olfactory groove meningiomas (OGM). All patients who underwent either BFC or EEA for OGM were eligible. Matched pairs were created by matching tumor volumes of an EEA patient with a BFC patient, and matching the timing of the postoperative scans. The tumor dimensions, peritumoral edema, resectability issues, and frontal lobe changes were recorded based on preoperative and postoperative MRI. Postoperative fluid-attenuated inversion recovery (FLAIR) hyperintensity and residual cystic cavity (porencephalic cave) volume were compared using univariable and multivariable analyses. From a total of 70 patients (46 EEA, 24 BFC), 10 matched pairs (20 patients) were created. Three patients (30%) in the EEA group and two (20%) in the BFC had postoperative cerebrospinal fluid leaks (p=0.61). Gross total resections were achieved in seven (70%) of the EEA group and nine (90%) of the BFC group (p=0.26), and one patient from each group developed a recurrence. On postoperative MRI, there was no significant difference in FLAIR signal volumes between EEA and BFC approaches (6.9 versus 13.3 cm(3); p=0.17) or in porencephalic cave volumes (1.7 versus 5.0 cm(3); p=0.11) in univariable analysis. However, in a multivariable analysis, EEA was associated with less postoperative FLAIR change (p=0.02) after adjusting for the volume of preoperative edema. This study provides preliminary evidence that EEA is associated with quantifiable improvements in postoperative frontal lobe imaging.

An objective analysis of the impact of lateral rhinotomy and medial maxillectomy on nasal airway function.

Objective: The lateral rhinotomy and medial maxillectomy procedure, while known to interrupt nasal valve supports, has not previously been reported to adversely affect nasal airway function. The purpose of this study was to utilize state‐of‐the‐art techniques to objectively analyze the impact of this procedure on nasal airway function. Design: The study design was retrospective and subject controlled. Methods: The study population was derived from an academic, tertiary‐referral, otolaryngology—head and neck surgery department with an estimated catchment population of 4 million people. Subjects included 21 consecutive, long‐term postoperative patients who had undergone lateral rhinotomy and medial maxillectomy for inverted papilloma. Objective measures included vestibular cephalometric measurements, airflow rhinomanometry, and acoustic rhinometry. Results: Statistically significant results reveal that although lateral rhinotomy and medial maxillectomy are associated with alar collapse, both overall nasal airflow and valve areas are increased. Conclusion: Lateral rhinotomy and medial maxillectomy does not adversely affect nasal airway function. This appears to be the result of concomitant resection of the functionally dominant inferior turbinate. This suggests that lateral rhinotomy performed in conjunction with operations not requiring inferior turbinectomy, such as anterior craniofacial resection, may adversely affect nasal airway function. Key Words: Lateral rhinotomy, medial maxillectomy, nasal airway function, airflow, rhinomanometry, acoustic rhinometry.

Preliminary cross-sectional reliability and validity of the Skull Base Inventory (SBI) quality of life questionnaire

BackgroundThe Skull Base Inventory (SBI) was developed to assess the quality of life of patients undergoing endoscopic or open approaches for anterior and central skull base pathologies. In this study, we sought to establish the discriminative and evaluative properties for this instrument.MethodsThe SBI was administered in a cross-sectional fashion to patients who previously had skull base surgery after treatment and then again 2xa0weeks after completing the instrument. Internal consistency, test-retest reliability, and construct validity were determined. Four constructs were evaluated with the following a priori hypotheses: lower scores will be seen in patients with 1.malignant versus benign histology, 2.a history of radiation versus none, and those with 3.recurrences versus no recurrence, and 4.items deemed relevant versus irrelevant by respondents.ResultsFifty-two patients completed the questionnaire; 32 had endoscopic and 20 open surgeries. Internal consistency was good (>0.7 and <0.95) for all domains except one. Test-retest reliability was good (>0.70) for 38 of 41 items. Four constructs were evaluated and three were consistent with a priori hypotheses (pu2009<u20090.05). The instrument failed to confirm the hypothesis that malignant tumours are associated with poorer scores than benign.ConclusionsThe SBI demonstrated preliminary reliability and validity for discriminative use.

Summary of proceedings of the second World Congress on Thyroid Cancer.

The second World Congress on Thyroid Cancer was held from July 10 to July 14, 2013, in Toronto, Canada. Its purpose was to provide a platform for the multidisciplinary discussion on research, education, and patient management of thyroid malignancy. Herein, we summarize the latest major trends and controversies within the field of thyroid oncology as discussed in the Congress including the use of ultrasound, standardization of cytology, role of molecular testing, treatment options for small recurrence including ablation and observation, management of recurrent laryngeal nerve injury, importance of identification of the external branch of the superior laryngeal nerve, role of minimally invasive thyroid surgery, trends in radioactive iodine treatment, advancements in targeted agents, and the importance of personalizing treatment to individual patients.