James J. Jaber

Cervical spine causes for referred otalgia

Objective Present experience in diagnosis and treatment for referred otalgia secondary to cervical spine degenerative disease (CSDD). Study Design A retrospective study of 123 patients with ear pain. Subjects and Methods All patients had a normal otologic examination and diagnosed with unspecified otalgia. The causes for referred otalgia were categorized into Group I: otalgia from non–cervical spine disease (n = 72), and Group II: cervical spine disease–referred otalgia (n = 51). Pain relief following cervical spine physical therapy (CSPT) was assessed. RESULTS: The most common cause for referred otalgia in Group I was Temporomandibular joint (TMJ) dysfunction (46%); most common cervical spine finding in Group II was CSDD (88%). CSPT in those documented patients all reported subjective pain relief. Conclusion As the population in America ages, CSDD in the elderly will begin to emerge as a major etiologic source for referred otalgia. With a targeted medical history and physical examination one can use directed studies to diagnose CSDD-referred otalgia, and this pain can be alleviated with CSPT.

Multi-institutional investigation of the prognostic value of lymph nodel yield in advanced-stage oral cavity squamous cell carcinoma

Although existing literature provides surgical recommendations for treating occult disease (cN0) in early‐stage oral cavity squamous cell carcinoma (SCC), a focus on late‐stage oral cavity SCC is less pervasive.

Etiologic causes of late osteocutaneous free flap failures in oral cavity cancer reconstruction

To evaluate perioperative complications in a homogeneous cohort undergoing microvascular osteocutaneous free flap (OCFF) reconstruction following segmental mandibulectomy for advanced oral cancer and to identify the causes of late OCFF failures.

Osseointegrated Implant Applications in Cosmetic and Functional Skull Base Rehabilitation

This study discusses the indications, outcomes, and complications in patients that underwent osseointegrated implantation for skull base rehabilitation. We conducted a retrospective review of eight patients with skull base defects who had undergone implantation of a facial prosthetic retention device ± bone-anchored hearing aid at a tertiary academic referral center. Descriptive analysis of applications, techniques, outcomes, and complications were reviewed. The majority of patients were males (n = 6) with previously diagnosed skull base malignancy (n = 5) with an average age of 46 (range, 14 to 77). All patients received an implanted facial prosthetic device either for an aural (n = 7) or orbital (n = 1) prosthesis. There were only two complications that included infection (n = 1) and implant extrusion (n = 1). Osseointegrated implantation of abutments for anchoring prosthetic devices in patients for skull base rehabilitation provides an excellent cosmetic option with minimal complications.

Evolving treatment strategies in thin cutaneous head and neck melanoma: 1 institution's experience

Although existing melanoma literature provides recommendations for thinner lesions (≤1 mm) within a heterogeneous population, a focus on the head and neck group is less pervasive.

Inner Ear Effects of Canal Wall Down Mastoidectomy

Objective. To evaluate the inner ear effects of canal wall down (CWD) mastoidectomy without ossiculoplasty in the treatment of chronic otitis media (COM) with regard to sensorineural hearing loss (SNHL) and reported tinnitus and dizziness-related disability. Setting. Tertiary care academic medical center. Subjects and Methods. Prospective study of 86 patients treated by CWD mastoidectomy without ossiculoplasty for COM with or without cholesteatoma. Standard patient workup included preoperative audiogram and completion of 2 surveys: Dizziness Handicap Inventory (DHI) and Tinnitus Handicap Inventory (THI). Patients underwent repeat audiogram, DHI, and THI surveys at 4 to 6 months postoperatively. Preoperative and postoperative data were analyzed. Results. No significant SNHL occurred after CWD mastoidectomy. Thirteen patients (13/34 [38%]) had DHI improvement greater than 18 points, indicating a significant improvement in dizziness-related disability. Three patients developed new-onset postoperative dizziness complaints. Twenty patients (20/43 [46.5%]) had THI improvement greater than 7 points, indicating a significant improvement in tinnitus-related disability. Five patients developed new-onset postoperative tinnitus complaints. The odds ratio for improving DHI and THI scores after surgery was 6.6 (1.8 to 25.0) and 4.2 (95% confidence interval, 1.45% to 12.2%), respectively. Conclusion. In this study, CWD mastoidectomy without ossiculoplasty in the treatment of COM did not cause significant SNHL. In addition, using the DHI and THI measures, patient-perceived disability from dizziness and tinnitus, respectively, was shown to decrease after mastoid surgery.

Postlaryngectomy dysphagia masking as velopharyngeal insufficiency: a simple solution for an anterior neopharyngeal diverticulum.

Postlaryngectomy dysphagia is a common occurrence and can be a source of emotional distress that results in a decrease in quality of life among a patient population that is already exposed to considerable morbidity. One etiologic source that is less commonly reported as a source for postlaryngectomy dysphagia, and perhaps overlooked, is an anterior neopharyngeal diverticulum. Herein, we describe a postlaryngectomy dysphagia caused by a neopharyngeal diverticulum masking as velopharyngeal insufficiency of liquids. The liquid dysphagia was immediately relieved via transoral endoscopic approach using the Harmonic scalpel to resect and simultaneously coagulate the posterior wall.

Robust Differences in p16-Dependent Oropharyngeal Squamous Cell Carcinoma Distant Metastasis Implications for Targeted Therapy

Objective Historically, head and neck squamous cell carcinoma (HNSCC) has been earmarked a lymphatic malignancy. Recently, this has been called into question. Our study aims to (1) illustrate the robust differences in distant metastases between p16+ and p16– oropharyngeal squamous cell carcinoma (OPSCC) and (2) provide support that p16+ OPSCC has a predilection toward vasculature invasion and hematogenous spread. Study Design Multi-institutional, case series with chart review. Setting Four academic institutions. Subjects and Methods Within a group of 1113 patients with primary OPSCC who received treatment between 1979 and 2013, those who developed distant metastasis (DM) were divided into 2 cohorts based on p16 status. Intergroup and intragroup univariate analysis was performed as well as descriptive analysis of end-organ sites. Results Of the 1058 patients included, 89 developed DM. Thirty were p16– and 59 were p16+. Of the p16– patients with DM, only 10% had disseminated disease (distant metastases at ≥2 sites) compared with 74% of p16+ patients. Distant disease in p16+ patients included brain, abdomen, and a distinct pattern of pulmonary metastases. Conclusion Our large, multi-institutional study supports published reports that p16+ OPSCC metastasizes with a unique phenotype that is hematogenous and widely disseminated with atypical end-organ sites. Our data suggest that p16+ OPSCC has a predilection toward active vasculature invasion as evidenced by the results and illustrative radiologic and pathohistologic examples. These findings may have implications for future targeted therapy when treating p16+ OPSCC.

Robust Differences in Distant Metastases for p16 ± OPSCC: Implications for Future Targeted Therapy

Objectives: Historically, head and neck squamous cell carcinoma (HNSCC) has been considered a lymphatic malignancy with regional disease. Recently, this has been called into question. Our study aims to (1) illustrate the robust differences between p16+ and p16- oropharyngeal squamous cell carcinoma (OPSCC), and (2) provide circumstantial evidence that p16+ OPSCC has a predilection toward active vasculature invasion and hematogenous spread. Methods: A multi-institutional, retrospective study of 1060 patients with OPSCC undergoing definitive treatment between 1979 and 2012. Patients were divided into 2 cohorts: p16+ and p16- OPSCC. Differences in distant metastases (DM) between the 2 cohorts were assessed for risk factors, rate and temporal differences, phenotypic behavior, and post-DM progression-free and disease-specific survival. Results: Of the 1060 patients, 105 patients had DM. Thirty-four were p16- and 71 were p16+. Full statistical analysis has yet to be completed, but preliminary findings conclude that of the p16- patients with DM, only 6% had disseminated disease (distant metastases at >1 site) as compared with 70% of p16+ patients with DM. Distant disease in p16+ patients included brain and unique bilateral lung findings. Conclusions: Our large, multi-institutional study supports the previously reported claim that patients with p16+ OPSCC have a unique phenotypic disseminated behavior. This calls into question the belief that HNSCC is a lymphatic malignancy. Our data suggest that p16+ disease has a predilection toward active vasculature invasion evidenced by atypical end-organ DM and dissemination profile. This study’s findings coupled with data in the literature may have implications for future p16+ OPSCC targeted therapy.

Cervical Lymph Node P16 Status in Diagnosis of the Unknown Primary

Objectives: (1) Evaluate the role of p16 status of cervical lymph node (LN) metastases in localizing carcinoma of unknown primary (CUP). (2) Compare the sensitivity, specificity, and accuracy of positron emission tomography PET scan for locating the primary site in the setting of p16 positive and p16 negative LN metastases. Methods: Retrospective review of 30 patients that were identified from archived tumor board lists from 2010 to 2013. All patients presented to a tertiary care center with squamous cell carcinoma metastases to cervical LN of unknown source despite initial clinical evaluation and computed tomography scan. Fine needle biopsy or excisional biopsy specimens were tested for the p16 biomarker. The accuracy of the PET scan was assessed by comparing the fludeoxyglucose-avid predicted site against a standard panendoscopy with directed biopsies. Results: A primary was identified in 61% of cases presenting as CUP. All p16+ LN metastases were from an oropharyngeal primary or remained unknown. All primaries located outside the upper aerodigestive tract were p16–. The sensitivity and specificity of PET in patients with p16+ LN metastases were worse than in p16- metastases (71%, 33% vs 100%, 100%). Conclusions: LN p16 status can help localize CUP. In our series, the sensitivity and specificity of PET scan were much worse in p16+ LN metastases. PET scan may be of limited utility for localizing CUP with p16+ LN metastasis.