Megan L. Durr

Drug-Induced Sleep Endoscopy in Persistent Pediatric Sleep-Disordered Breathing After Adenotonsillectomy

OBJECTIVES To demonstrate the feasibility of drug-induced sleep endoscopy (DISE) in the pediatric population and to examine DISE results in children with persistent sleep-disordered breathing (SDB) after tonsillectomy and adenoidectomy (T&A). DESIGN Retrospective case series with medical chart review. SETTING Tertiary pediatric medical center. PATIENTS Thirteen pediatric subjects with persistent SDB after T&A are included in the study. INTERVENTION Drug-induced sleep endoscopy was per-formed on all patients with documentation of all sites of persistent airway obstruction. RESULTS Multilevel upper-airway obstruction was identified in the majority of patients, most commonly related to tongue base obstruction, adenoid regrowth, and/or inferior turbinate hypertrophy. There were no differences among the 4 subgroups. CONCLUSIONS Findings from DISE suggest that multiple factors contribute to airway obstruction in persistent SDB after T&A. Further research can address the extent to which directed surgical treatment can improve outcomes in these patients.

Airway hemangiomas in PHACE syndrome

To describe the clinical presentation and airway characteristics of infants with airway hemangiomas and concomitant PHACE syndrome and to determine the prevalence of airway hemangiomas in PHACE subjects at our institution.

Quantitative Methylation Profiles for Multiple Tumor Suppressor Gene Promoters in Salivary Gland Tumors

Background Methylation profiling of tumor suppressor gene (TSGs) promoters is quickly becoming a powerful diagnostic tool for the early detection, prognosis, and even prediction of clinical response to treatment. Few studies address this in salivary gland tumors (SGTs); hence the promoter methylation profile of various TSGs was quantitatively assessed in primary SGT tissue to determine if tumor-specific alterations could be detected. Methodology DNA isolated from 78 tumor and 17 normal parotid gland specimens was assayed for promoter methylation status of 19 TSGs by fluorescence-based, quantitative methylation-specific PCR (qMSP). The data were utilized in a binary fashion as well as quantitatively (using a methylation quotient) allowing for better profiling and interpretation of results. Principal Findings The average number of methylation events across the studied genes was highest in salivary duct carcinoma (SDC), with a methylation value of 9.6, compared to the normal 4.5 (p<0.0003). There was a variable frequency and individual methylation quotient detected, depending on the TSG and the tumor type. When comparing normal, benign, and malignant SGTs, there was a statistically significant trend for increasing methylation in APC, Mint 1, PGP9.5, RAR-β, and Timp3. Conclusions/Significance Screening promoter methylation profiles in SGTs showed considerable heterogeneity. The methylation status of certain markers was surprisingly high in even normal salivary tissue, confirming the need for such controls. Several TSGs were found to be associated with malignant SGTs, especially SDC. Further study is needed to evaluate the potential use of these associations in the detection, prognosis, and therapeutic outcome of these rare tumors.

Oral Tongue Squamous Cell Carcinoma in Never-Smokers Analysis of Clinicopathologic Characteristics and Survival

Objectives (1) To compare clinical characteristics, survival, and recurrence between never-smokers and ever-smokers with oral tongue squamous cell carcinoma (OTSCC). (2) To assess the relationship between clinicopathologic characteristics and survival/recurrence in OTSCC. Study Design Historical cohort study. Setting Academic university medical center. Subjects and Methods This is a study of 120 patients with OTSCC who were treated from January 1999 to February 2010. Clinicopathologic factors were compared between never-smokers and ever-smokers using t tests and χ2 tests. Cox regression analyses examined their association with survival and recurrence. Results Of 120 subjects, 66 (55%) were prior or current smokers. There were no significant differences in clinicopathologic factors between ever-smokers and never-smokers. After adjustment for clinicopathologic factors, multivariate Cox regression analysis demonstrated decreased overall survival for never-smokers, but this difference was not significant (hazard ratio [HR], 2.84; P = .056). Increased depth of tumor invasion (HR per millimter invasion, 1.09; P = .005), nodal metastasis (HR, 7.1; P = .025), and stage III or IV disease (HR, 9.45 and 7.31; P = .026 and .029, respectively) were associated with decreased overall survival. Perineural invasion (HR, 8.56; P = .005) and lymphovascular invasion (HR, 6.01; P = .011) were associated with disease recurrence. Conclusion Overall survival may be decreased in never-smokers with OTSCC. Greater depth of tumor invasion and more advanced stage disease are associated with decreased survival. Perineural invasion and lymphovascular invasion are associated with disease recurrence.

TP53 and CDKN2a mutations in never-smoker oral tongue squamous cell carcinoma.

To determine the incidence and clinical significance of TP53 and CDKN2a somatic mutations in never smokers with oral tongue squamous cell carcinoma (OTSCC).

A novel sinonasal endoscopy scoring system: the discharge, inflammation, and polyps/edema (DIP) score.

There is an increasing need for a validated grading system to assess sinusitis severity as observed on endoscopic examination. Existing endoscopy scales have limitations in complexity, validation, and/or applicability. We present a novel and straightforward endoscopic scoring system measuring discharge, inflammation, and polyps/edema (DIP). The aim of this study is to determine correlation of the DIP score with existing sinus endoscopy scoring systems, and to determine interrater and test‐retest reliability.

Severe Hypocalcemia Complicating Thyroid Surgery After Roux-en-Y Gastric Bypass Procedure

Patients who undergo malabsorptive bariatric surgery have a high incidence of mild hypocalcemia and seem to be at increased risk for developing severe symptomatic hypocalcemia after thyroid surgery. We describe 2 patients who underwent prior Roux-en-Y gastric bypass procedures who later had thyroid surgery that was complicated by severe hypocalcemia in the postoperative period. We also emphasize the importance of screening patients for thyroid disease and of completing any necessary thyroid procedures before bariatric surgery to avoid this serious complication. The prevalence of obesity (body mass index calculated as weight in kilograms divided by height in meters squared [BMI], 30) in the United States has increased drastically during the last several decades. Thirty-two percent of adults were considered obese in 2004 compared with 15% in 1980. 1 Therefore, record numbers of patients with morbid obesity are undergoing bariatric surgery. 2 Roux-en-Y gastric bypass surgery and biliopancreatic diversion are 2 common and effective malabsorptive bariatric operations that bypass a portion of the small intestine and stomach. Both have been shown to result in sustained weightloss,withadecreaseincomorbidities. 3-5 During these procedures, the preferential sites for calcium absorption, the duodenumandtheproximaljejunum,are bypassed, placing the patients at increased risk for hypocalcemia. 5

Endoscopic partial medial maxillectomy with mucosal flap for maxillary sinus mucoceles

PURPOSE To describe a technique of endoscopic medial maxillectomy with mucosal flap for postoperative maxillary sinus mucoceles and to present a case series of subjects who underwent this procedure. MATERIALS AND METHODS This case series includes four subjects with postoperative maxillary sinus mucoceles who underwent resection via endoscopic partial medial maxillectomy with a mucosal flap. We will discuss the clinical presentation, imaging characteristics, operative details, and outcomes. RESULTS Four subjects are included in this study. The average age at the time of medial maxillectomy was 52 years (range 35-65 years). Three subjects (75%) were female. One subject (25%) had bilateral postoperative maxillary sinus mucoceles. Two subjects (50%) had unilateral right sided mucoceles, and the remaining subject had a unilateral left sided mucocele. All subjects had a history of multiple sinus procedures for chronic sinusitis including Caldwell-Luc procedures ipsilateral to the postoperative mucocele. All subjects underwent endoscopic medial maxillectomy without complication and were symptom free at the last follow up appointment, average 24 months (range 3-71 months) after medial maxillectomy. CONCLUSIONS For postoperative maxillary sinus mucoceles in locations that are difficult to access via the middle meatus antrostomy, we recommend endoscopic medial maxillectomy with mucosal flap. Our preliminary experience with four subjects demonstrates complete resolution of symptoms after this procedure.

Oral cavity squamous cell carcinoma in never smokers: Analysis of clinicopathologic characteristics and survival

PURPOSE To examine the relationship between tobacco smoking history and the clinicopathologic and survival characteristics of patients with oral cavity squamous cell carcinoma (OCSCC). MATERIALS AND METHODS This is a retrospective review of 531 patients treated for OCSCC from January 1998 to December 2009 at a tertiary care medical center. RESULTS Thirty-two percent of OCSCC patients were never smokers. There were significant differences in tumor location between ever smokers and never smokers (p<0.001), with never smokers more likely to have oral tongue tumors. Smokers were significantly (p<0.001) more likely than never smokers to present with locally advanced (T3 or T4) disease (57.8% vs. 35.4%). Never smokers demonstrated improved overall survival (78.8 months in never smokers vs. 44.7 months in ever smokers, p=.03). However, there were no survival differences when the two groups were compared separately for locally early (T1/T2) or advanced (T3/T4) disease. For T1/T2 tumors, mean survival was 88.2 months for never smokers and 78.5 months for smokers (p=.10). For T3/T4 tumors, median survival was 29.1 months for never smokers and 23.8 months for smokers (p=.09). CONCLUSIONS Primary tumor location and T-status in OCSCC differed between never smokers and smokers. Compared to smokers, never smokers had fewer locally advanced tumors and better overall survival.

Comparison of imaging modalities in pediatric thyroglossal duct cysts

To determine and compare the accuracy of different imaging modalities including ultrasound (US), magnetic resonance imaging (MRI), and computed tomography (CT) in the diagnosis of thyroglossal duct cysts (TGDC) in children.