Manish D. Shah

Esthesioneuroblastoma: The Princess Margaret Hospital experience

Esthesioneuroblastoma is rare. The aim of the study was to review our experience and to evaluate the staging system and treatment that best correlates with the patient outcome.

Quality of life in patients undergoing thyroid surgery.

OBJECTIVE The extent of thyroidectomy in the management of low-risk, well-differentiated thyroid carcinoma (WDTC) has been debated extensively. Our objective was to determine if hemithyroidectomy has a less detrimental effect on quality of life (QOL) than total thyroidectomy. DESIGN Prospective, nonblinded, nonrandomized, cohort study. SETTING Tertiary care academic otolaryngology-head and neck surgery practice. METHODS Using both disease-specific and global QOL instruments, patients treated with either hemi- or total thyroidectomy were prospectively followed. QOL was assessed preoperatively and for 12 months postoperatively. MAIN OUTCOME MEASURES Scores on the two QOL instruments throughout a 12-month postoperative period. RESULTS Patients with cancer experienced a greater drop in QOL during the first 6 months following surgery when compared with patients with benign disease (p < .03). Additionally, patients treated with total thyroidectomy did not have a significantly different QOL than patients treated with hemithyroidectomy (p > .2). CONCLUSION These results suggest that QOL is not significantly impacted by the extent of surgery and that QOL should not be a factor in the decision-making process for the treatment of low-risk WDTC.

Efficacy and Safety of Central Compartment Neck Dissection for Recurrent Thyroid Carcinoma

OBJECTIVE To explore the safety and efficacy of central compartment neck dissection (CCND) in the treatment of well-differentiated thyroid carcinoma (WDTC) recurrences in the central compartment of the neck. DESIGN Retrospective medical chart review. SETTING Tertiary-care academic hospital. PATIENTS Eighty-two consecutively treated patients with recurrent WDTC, with a median follow-up of 28 months. MAIN OUTCOME MEASURES Postoperative complications, disease control posttreatment, and normalization of serum thyroglobulin (Tg) level. RESULTS Eighty-two patients underwent 86 central compartment procedures. Only CCND was performed in 36 patients (42%), while a lateral neck dissection was also required in the remainder. Postoperative hypoparathyroidism was temporary in 17 patients (20%) and permanent in 6 patients (7%). Postoperative intact serum parathyroid hormone level was greater than 15.0 pg/mL (to convert to nanograms per liter, multiply by 1.0) in 81% of patients, accurately predicting eucalcemia postoperatively. Unilateral recurrent laryngeal nerve injury was transient in 3 patients (2% of nerves at risk) and permanent in 3 patients (2%). Seventeen patients (21%) experienced subsequent recurrences after their CCND-2 patients (2%) had recurrence in the central neck, 8 (9%) in the lateral neck, 2 (2%) in the central and lateral neck, and 7 (8%) at distant sites. Twenty-seven patients underwent a CCND alone and were deemed appropriate for efficacy analysis. The Tg level was normalized in 15 patients (56%) in the group overall. Normalization occurred in 10 of the 20 patients (50%) who received sodium iodide I 131 ablation and in 5 of the 7 patients (71%) who did not. CONCLUSION Central compartment neck dissection is a safe and efficacious procedure for the management of central neck recurrences in WDTC.

Blood transfusion prediction in patients undergoing major head and neck surgery with free-flap reconstruction.

OBJECTIVE to develop a clinically useful perioperative blood transfusion prediction model for patients undergoing a major head and neck surgical procedure requiring free-flap reconstruction. DESIGN retrospective observational study. SETTING tertiary care university-affiliated teaching hospital (University Health Network, Toronto, Ontario, Canada). PATIENTS all patients with a head and neck malignant neoplasm undergoing major head and neck surgery requiring free-flap reconstruction. MAIN OUTCOME MEASURE perioperative single-unit red blood cell transfusion. RESULTS all the preoperative variables were tested for an association with perioperative blood transfusion using univariable and multivariable analyses. After multivariable regression analysis, the following preoperative variables were found to be significantly associated with perioperative transfusion: sex, body mass index, T stage, preoperative hemoglobin level, and type of free-flap reconstruction used (ie, osseous vs nonosseous). The regression model was used to develop a transfusion risk score. Receiver operating characteristic curve analysis confirmed adequate discrimination of risk using the transfusion risk score. CONCLUSIONS we have developed a reliable model for predicting perioperative blood transfusion requirements in patients undergoing major head and neck surgery requiring free-flap reconstruction. This model can be used for accurate preoperative risk stratification.

Thyroid Cancer Outcomes in Filipino Patients

OBJECTIVE To compare the outcomes of patients having thyroid cancer among Filipinos vs non-Filipinos. DESIGN Retrospective medical record review. SETTING High-volume tertiary referral center in Toronto, Ontario, Canada. PATIENTS A total of 499 patients with thyroid cancer (36 Filipino and 463 non-Filipino) treated at Mount Sinai Hospital from January 1, 1984, to August 31, 2003, with a minimum 5-year follow-up period and a minimum 1.0-cm tumor size. Patients were identified from a thyroid cancer database. Data on patient, tumor, and treatment factors were collected along with outcomes. MAIN OUTCOME MEASURES The presence of thyroid cancer recurrence, the rate of death from disease, and the time to recurrence. RESULTS The 2 groups were similar for sex, age, history of head and neck radiation exposure, family history of thyroid cancer, follow-up time, tumor size, tumor pathologic findings, presence of tumor multifocality, stage of primary disease, type of thyroid surgery, use of postoperative radioactive iodine therapy, and use of external beam radiation therapy. Filipino patients experienced a thyroid cancer recurrence rate of 25% compared with 9.5% for non-Filipino patients (odds ratio, 3.20; 95% confidence interval, 1.23-7.49; P = .004). On multivariate analysis, the increased risk of thyroid cancer recurrence persisted for Filipino patients (odds ratio, 6.99; 95% confidence interval, 2.31-21.07; P < .001). No significant differences were noted between Filipino patients and non-Filipino patients regarding the rate of death from disease (5.6% vs 1.9%) and the time to recurrence (52.6 vs 53.1 months). CONCLUSIONS Filipino patients have a significantly higher risk of thyroid cancer recurrence compared with non-Filipino patients. However, no significant difference was noted in the time to recurrence or the rate of death from disease. These findings justify a more aggressive initial management and follow-up regimen for Filipino patients with thyroid cancer.

Risk factors for well-differentiated thyroid carcinoma in patients with thyroid nodular disease

Objectives Evaluate current accepted risk factors for well-differentiated thyroid carcinoma, and develop a predictive model to determine ones risk of malignancy given a thyroid nodule. Study Design Retrospective analysis of 600 patients. Subjects and Methods Patients with benign thyroid nodular disease and with well-differentiated thyroid cancer were randomly selected. Patient, clinical, and investigational data were compared by means of univariate and multivariate regression analyses. Results Age, regional lymphadenopathy, ipsilateral vocal cord palsy, solid and/or calcified nodules, and an aspiration biopsy being malignant or suspicious predicted for cancer (P < 0.05). Regional lymphadenopathy and vocal cord palsy are perfect predictors of malignancy. Multivariate analysis indicated age, solid and/or calcified nodules, and all fine-needle aspiration biopsy results to be significant in assessing risk (P < 0.05). Conclusion Taking individual risk factors in isolation is not always reliable. Using a predictive model, one can anticipate a patients risk of malignancy when the diagnosis is unclear.

Office-Based Laryngeal Procedures

Awake office-based laryngeal procedures offer numerous advantages to the patient and surgeon. These procedures are well-tolerated, safe, and can be used to treat a wide variety of laryngeal pathology. This article discusses office-based laser procedures and laryngeal biopsies. Indications, procedural techniques, postprocedural care, and potential complications are reviewed in detail.

Computed tomography has low yield in the evaluation of idiopathic unilateral true vocal fold paresis

To determine the clinical yield of neck and chest computed tomography in the initial assessment of patients with idiopathic unilateral true vocal fold paresis.

Assessment of phonomicrosurgical training in otolaryngology residencies: A resident survey

The primary objective of this study is to assess the adequacy of clinical and laboratory‐based phonomicrosurgical training in otolaryngology residency programs using a self‐report survey. The study aims to establish whether there is a need and desire for focused surgical training in phonomicrosurgery.

Methicillin-resistant and methicillin-sensitive Staphylococcus aureus laryngitis†‡

Despite the fact that a wide variety of head and neck methicillin‐resistant Staphylococcus aureus (MRSA) infections have been described, only four cases of MRSA laryngitis are reported in the literature. Our clinical experience suggests that this diagnosis is more common and can be more subtle that previously reported. The objective of this study was to identify and describe the clinical presentation, diagnosis, treatment, and outcomes of MRSA and methicillin‐sensitive S aureus (MSSA) laryngitis, highlighting the in‐office workup of these patients.