Jean Anderson Eloy

Juvenile nasopharyngeal angiofibroma: a systematic review and comparison of endoscopic, endoscopic-assisted, and open resection in 1047 cases.

This study is a review of the treatment outcomes of juvenile nasopharyngeal angiofibroma (JNA) specifically comparing endoscopic, endoscopic‐assisted, and open surgical approaches.

Sinonasal melanoma: survival and prognostic implications based on site of involvement

Sinonasal melanoma (SNM) is a rare malignancy that commonly presents at an advanced age and has a slight male predominance. Local recurrence has been implicated as a major reason for treatment failure, and there are poor reported 5‐year survival rates. We analyzed the impact of specific location within the sinonasal region on the survival of this rare malignancy.

Diffuse large B-cell lymphoma of the sinonasal tract: Analysis of survival in 852 cases

PURPOSEnDiffuse large B-cell lymphomas (DLBCLs) are rare tumors of the head and neck that often have non-specific presentations and significant morbidity and mortality. In this analysis we use a large cohort to compare the demographic and disease-specific parameters affecting survival and incidence of DLBCLs.nnnMETHODSnThe United States National Cancer Institutes Surveillance, Epidemiology, and End Results (SEER) registry was utilized to extract data regarding sinonasal diffuse large B-cell lymphoma between 1973 and 2009. A total of 852 cases of sinonasal DLBCLs were found. Presenting symptoms, demographics, disease specific survival, relative survival and survival by treatment modality were described for this rare tumor.nnnRESULTSnOverall disease specific survival (DSS) at 1-year was 84.7% and at 5 years was 68.0%. DSS was significantly lower for those not treated with radiation therapy, with 1- and 5-year survival rates of 77.3% and 62.5%, versus those treated with radiation therapy, with 1- and 5-year rates of 89.2% and 71.5% (p<0.05). Prognosis was significantly better for patients treated with radiation therapy (HR 0.6, p<0.05) while it was poorer for patients with involvement of multiple sinuses (HR 1.5, 1.8, p<0.05).nnnCONCLUSIONSnDLBCLs of the sinonasal tract are rare tumors of the head and neck. Survival is significantly improved for those treated with radiation therapy while the involvement of multiple sinuses is a negative prognostic indicator.

Laryngeal chondrosarcoma: a population-based analysis.

Laryngeal chondrosarcoma (LC) is a rare entity, reportedly comprising less than 1% of all laryngeal tumors. Consequently, the incidence and survival of patients with this slow‐growing tumor has been difficult to study. Our objective was to evaluate incidence, organized by patient demographics, as well as long‐term survival trends of this malignancy using a population‐based database.

Sinonasal Adenoid Cystic Carcinoma Systematic Review of Survival and Treatment Strategies

Objective This study reviews the published outcomes related to sinonasal adenoid cystic carcinoma (SNACC). Clinical presentation, radiographic diagnosis, pathology, treatment, and management outcomes of this uncommon disease are reported. Data Sources PubMed database. Methods A systematic review of studies for SNACC from 1960 to 2012 was conducted. A PubMed search for articles related to SNACC, along with bibliographies of those articles, was performed. Articles were examined for both individual patient data (IPD) and aggregate patient data (APD) that reported survivability. Demographics, disease site and spread, treatment strategies, follow-up, outcome, and survival were described for IPD, and a meta-analysis for survival rates was performed for APD. Results A total of 55 journal articles were included. Individual patient data were reported in 39 journal articles, comprising a total of 88 cases of SNACC. Sixteen articles, totaling 366 patients that reported aggregate 5-year survivorship pertaining to SNACC, were also included. Average follow-up in the IPD was 51.2 months (range, 1-198 months), and 5-year survivorship was 63.5%. In the studies reviewed, surgery followed by postoperative radiotherapy was the most common therapy used and resulted in the highest percentage of survivors. Aggregate patient data meta-analysis revealed a 5-year survival rate of 62.5%. Conclusion This study contains the largest pool of SNACC patients to date. The data suggest that SNACC has a poor overall prognosis. It also suggests that surgery with postoperative radiotherapy is the most commonly used and may possibly be the most effective therapy.

Do AAO-HNSF CORE Grants Predict Future NIH Funding Success?

Objective To determine (1) whether academic otolaryngologists who have received an American Academy of Otolaryngology— Head and Neck Surgery Foundation (AAO-HNSF) Centralized Otolaryngology Research Efforts (CORE) grant are more likely to procure future National Institutes of Health (NIH) funding; (2) whether CORE grants or NIH Career Development (K) awards have a stronger association with scholarly impact. Study Design and Setting Historical cohort. Methods Scholarly impact, as measured by the h-index, publication experience, and prior grant history, were determined for CORE-funded and non–CORE-funded academic otolaryngologists. All individuals were assessed for NIH funding history. Results Of 192 academic otolaryngologists with a CORE funding history, 39.6% had active or prior NIH awards versus 15.1% of 1002 non–CORE-funded faculty (P < .0001). Higher proportions of CORE-funded otolaryngologists have received K-series and R-series grants from the NIH (P-values < .05). K-grant recipients had higher h-indices than CORE recipients (12.6 vs 7.1, P < .01). Upon controlling for rank and experience, this difference remained significant among junior faculty. Conclusions A higher proportion of academic otolaryngologists with prior AAO-HNSF CORE funding have received NIH funding relative to their non–CORE-funded peers, suggesting that the CORE program may be successful in its stated goals of preparing individuals for the NIH peer review process, although further prospective study is needed to evaluate a “cause and effect” relationship. Individuals with current or prior NIH K-grants had greater research productivity than those with CORE funding history. Both cohorts had higher scholarly impact values than previously published figures among academic otolaryngologists, highlighting that both CORE grants and NIH K-grants awards are effective career development resources.

Demographics and survival trends of sinonasal adenocarcinoma from 1973 to 2009.

The purpose of this work was to study the demographics and survival of patients diagnosed with sinonasal adenocarcinoma (SNAC) within the time period of 1973 to 2009 using the Surveillance, Epidemiology, and End Result (SEER) database.

Impact of Diabetes Mellitus on Head and Neck Cancer Patients Undergoing Surgery.

Objective The impact of diabetes mellitus (DM) on surgical outcomes and cost of care for patients undergoing surgery for head and neck cancer (HNCA) is not well established. We used the Nationwide Inpatient Sample to analyze the postoperative impact of DM on HNCA patients. Study Design Population-based inpatient registry analysis. Setting Academic medical center. Subjects and Methods Discharge data from the Nationwide Inpatient Sample were analyzed for patients undergoing HNCA surgery from 2002 to 2010. Patient demographics, comorbidities, length of stay, hospital charges, and postoperative complications were compared between HNCA patients with and without DM. Results Of 31,075 patients, 4029 patients (13.0%) had a DM diagnosis. DM patients were older (65.7 ± 10.8 vs 61.1 ± 14.1 years old; P < .001), had more preexisting comorbidities, had longer hospitalizations, and incurred greater hospital charges. Compared with the non-DM cohort, DM patients experienced significantly higher rates of postoperative infections (2.6% vs 2.1%, P = .025), cardiac events (9.0% vs 4.3%, P < .001), pulmonary edema/failure (6.6% vs 5.7%, P = .023), acute renal failure (3.3% vs 1.5%, P < .001), and urinary tract infections (2.8 % vs 2.1%, P = .005). No differences in surgical wound healing rates were observed (0.1 vs 0.1, P = .794). On multivariate logistic regression corrected for age and race, DM patients had greater odds of postoperative infections (1.382, P = .007), cardiac events (1.893, P < .001), and acute renal failure (2.023, P < .001). Conclusions DM is associated with greater length of stay and hospital charges among HNCA patients. DM patients have significantly greater rates of postoperative complications, including postoperative infections, cardiac events, and acute renal failure.

Modified subtotal-Lothrop procedure for extended frontal sinus and anterior skull-base access: a case series

The endoscopic modified Lothrop procedure (EMLP) is well established for resistant frontal sinus disease and anterior skull base (ASB) exposure. However, this technique may be unnecessarily aggressive by removing avoidable sinonasal structures in select cases. Previously, in a cadaveric study, we proposed a modification of the EMLP, termed the modified subtotal‐Lothrop procedure (MSLP), to access the ASB and to address complex frontal sinus disease, for which access to the bilateral frontal sinus posterior table is required. This study provides a step‐by‐step description of this technique, and presents our experience in 5 patients who underwent this approach.

Endoscopic graduated multiangle, multicorridor resection of juvenile nasopharyngeal angiofibroma: an individualized, tailored, multicorridor skull base approach

OBJECT Juvenile nasopharyngeal angiofibromas (JNAs) are formidable tumors because of their hypervascularity and difficult location in the skull base. Traditional transfacial procedures do not always afford optimal visualization and illumination, resulting in significant morbidity and poor cosmesis. The advent of endoscopic procedures has allowed for resection of JNAs with greater surgical freedom and decreased incidence of facial deformity and scarring. METHODS This report describes a graduated multiangle, multicorridor, endoscopic approach to JNAs that is illustrated in 4 patients, each with a different tumor location and extent. Four different surgical corridors in varying combinations were used to resect JNAs, based on tumor size and location, including an ipsilateral endonasal approach (uninostril); a contralateral, transseptal approach (binostril); a sublabial, transmaxillary Caldwell-Luc approach; and an orbitozygomatic, extradural, transcavernous, infratemporal fossa approach (transcranial). One patient underwent resection via an ipsilateral endonasal uninostril approach (Corridor 1) only. One patient underwent a binostril approach that included an additional contralateral transseptal approach (Corridors 1 and 2). One patient underwent a binostril approach with an additional sublabial Caldwell-Luc approach for lateral extension in the infratemporal fossa (Corridors 1-3). One patient underwent a combined transcranial and endoscopic endonasal/sublabial Caldwell-Luc approach (Corridors 1-4) for an extensive JNA involving both the lateral infratemporal fossa and cavernous sinus. RESULTS A graduated multiangle, multicorridor approach was used in a stepwise fashion to allow for maximal surgical exposure and maneuverability for resection of JNAs. Gross-total resection was achieved in all 4 patients. One patient had a postoperative CSF leak that was successfully repaired endoscopically. One patient had a delayed local recurrence that was successfully resected endoscopically. There were no vascular complications. CONCLUSIONS An individualized, multiangle, multicorridor approach allows for safe and effective surgical customization of access for resection of JNAs depending on the size and exact location of the tumor. Combining the endoscopic endonasal approach with a transcranial approach via an orbitozygomatic, extradural, transcavernous approach may be considered in giant extensive JNAs that have intracranial extension and intimate involvement of the cavernous sinus.