Jose C. Dutra

Role of Intrathyroidal Calcifications Detected on Ultrasound as a Marker of Malignancy

Objectives: Clinically palpable thyroid nodules are present in between 4% and 7% of the population, with only a small percentage of those harboring malignancy. Thus, it is important to find a cost‐effective way to determine which nodules are more likely to be malignant. The purpose of this study was to evaluate the use of intrathyroidal calcifications detected on ultrasound as a risk factor for malignancy.

Esthesioneuroblastoma: The Northwestern University experience

Objective To review our experience with esthesioneuroblastoma, a rare malignancy of the head and neck.

Ultrasound-guided fine needle aspiration biopsy of thyroid nodules performed in the office.

Introduction: The majority of thyroid fine needle aspiration biopsies (FNAB) today are performed in the office freehand by palpation. Not infrequently, patients are sent to radiology for an ultrasound‐guided FNAB (USG‐FNB). Real‐time ultrasound (US) allows for continuous visualization of the needle during insertion and sampling. Historically, USG‐FNAB has been a procedure performed by a radiologist in a designated radiology suite. In more recent years, with the development of smaller more portable US machines, there has been a push for clinicians other than radiologists to perform the procedure.

Preoperative radiation therapy and its effects on outcomes in microsurgical head and neck reconstruction

OBJECTIVE : Preoperative radiation therapy is considered a significant factor in head and neck reconstruction. STUDY AND DESIGN AND SETTING : In our consecutive series of 114 patients, 44 patients had prior head and neck irradiation. The 2 groups were compared on the basis of age, ischemic time, and flap size and were found not to be statistically different. The average ischemic time for the irradiated group was 94.1 minutes, and the average was 102.8 minutes for the nonirradiated group. The average flap size for the irradiated group was 69.5 cm 2 , and was 72.0 cm 2 , for the nonirradiated group. RESULTS : Using a single-factor analysis of variance, the 2 groups did not differ statistically. The overall major flap complication rate for both irradiated and nonirradiated groups was approximately 10%. CONCLUSION : Microvascular reconstruction was accomplished in both irradiated and nonirradiated head and neck patients, with a 99% total flap survival rate and a 10% major flap complication rate.

Head and Neck

The introduction of aspiration cytology has revolutionized the workup of many human tumors. In the head and neck, it has streamlined the evaluation of the thyroid and salivary glands tumors, cervical lymphadenopathy, orbital lesions, and other head and neck masses. The technique has evolved and is frequently the first step in the initial in-office evaluation of head and neck tumors. Fine needle aspiration biopsy is safe, accurate, practical, and very cost-effective. Despite its wide acceptance, many aspects relating to the utility and interpretation of cytologic specimens remain controversial. The purpose of this chapter is to familiarize the oncologist with the role of cytology and fine needle biopsy in head and neck neoplasms and their use in clinical practice.

CT characteristics of thyroglossal duct cysts in adults

Abstract Objectives: The thyroid gland originates as a diverticulum off the foramen cecum that then descends along a duct to its adult position in the neck. Failure of resorption of this duct forms the basis for the development of (thyroglossal duct cysts) TDC. We reviewed the most common CT findings of TDC in adults, specifically looking at its relation to the hyoid bone, the strap muscles, position in neck, complexity, and size. Methods: Retrospective study of 26 patients. All patients had a preoperative CT scan and tissue diagnosis consistent with TDC. Results: Of the 26 TDC, 17 (65.4%) were located at the hyoid bone with inferior extension, 4 (15.4%)were infrahyoid only, 2 (7.7%) were at the hyoid bone with superior extension, 2 extended from floor of mouth to thyroid cartilage and 1 was only suprahyoid; 23 (88.5%) were completely imbedded in the strap muscles, 2 had no involvement of the strap muscles, and 1 was external to the strap muscles. Ten (38.5%) were midline, 10 were midline with left extension, 5 (19.2%)were right and midline. 15 (57.7%) were unilocular, 11 (42.3%) were multilocular. 8 (30.7%) contained either enhancement, septations, or punctate lesions. The average cephalad-caudal extension was 2.59 cm (1–6 cm). Conclusion: TDC are not just simple cysts, but instead have a varied appearance, size, and location in the adult neck. CT offers the advantage of superior spatial delineation and precision to help further characterize these lesions.

Synchronous ipsilateral cerebellopontine angle glossopharyngeal schwannoma and parotid adenoid cystic carcinoma.

A 49-year-old woman presented to our clinic with a several-month history of right aural fullness, facial pain, headache, and a parotid mass. She had no symptoms of dysphagia, weight loss, hoarseness, or other otologic complaints. She denied changes in vision, gait, or coordination. Past medical history was significant for an ectopic pregnancy, adenotonsillectomy, and depression. Family history was noncontributory. Medications included Zoloft and Pepcid. Physical examination was remarkable for an ill-defined, tender, 2 × 2-cm right parotid mass without palpable cervical adenopathy. A right serous effusion was present. All cranial nerves were intact with no gross cerebellar findings. Preoperative brain magnetic resonance imaging (MRI) revealed a 2.4-cm enhancing lesion of the right cerebellopontine angle with fourth ventricle compression compatible with a vestibular schwannoma (Fig 1). Computed tomography scanning and MRI of the neck and skull base revealed a 2 × 3-cm right parotid mass with extension to the mastoid, middle ear, and marrow of the occipital condyle. The patient underwent a fine needle biopsy of the parotid mass and results were consistent with adenoid cystic carcinoma (Fig 2). In addition, a nonenhancing lytic lesion of the anterior midline vertebral body of C6 was noted. This lesion was suspicious for metastatic disease. To relieve fourth ventricle compression, the cerebellopontine mass was removed through a posterior fossa craniotomy. Intraoperatively, the lesion was consistent with a glossopharyngeal schwannoma. On the first postoperative day, the patient had a grade 4/6 right facial paresis, a right tongue deviation, and an intact gag reflex. The patient had dysphagia with mild aspiration. Three weeks later, the patient underwent a right radical parotidectomy, modified lateral neck dissection (levels II and III), subtotal temporal bone resection, partial occipital condylectomy, and a C6 corpectomy. A microvascular rectus muscle free flap was used to reconstruct the surgical defect. Postoperatively the patient had deficits of cranial nerves VII, IX, and X. Postoperative radiation therapy is planned.