Mindy Rabinowitz

Learning Progression in the Use of Sialendoscopy for Sialolithiasis Effect on Gland Preservation

Objective Evaluate how learning progression affects outcomes for the use of sialendoscopy for sialolithiasis. Study Design Case series with chart review. Setting Academic tertiary care center. Subjects and Methods A retrospective chart review was conducted on 81 patients presenting with sialolithiasis between 2008 and 2012 who underwent surgical intervention on 85 salivary glands. Outcomes compared between the first 43 and subsequent 42 consecutive glands included successful removal, surgical method, and need for further intervention. Results For the first 43 patients (group A), mean age was 47.3 years (range, 15-77), and 44.2% were male. For the second 38 patients (group B), mean age was 49.9 (range, 23-76), and 50% were male. Mean stone size was similar in both groups; 8.3 versus 7.6 mm, respectively. In cases of stone visualization and removal, complete removal without gland excision was accomplished in 78.4% of cases in group A versus 94.3% in group B (P = .04). Endoscopic removal occurred in 24.3% of patients in group A, versus 45.8% in group B. A combined approach was used in 54.1% of patients in group A versus 48.6% in group B. In group A, 18.9% underwent gland removal as part of initial intervention versus 0% in group B (P = .007). Overall gland preservation was 81.4% in group A versus 97.6% in group B (P = .015). Conclusion This study documents the effect of learning curve on sialendoscopy for the management of sialolithiasis. With experience, the success of sialendoscopy increases with a significant decrease in the number of gland excisions.

Castleman disease in the pediatric neck: a literature review.

Objective To investigate the common features of cervical pediatric Castleman disease. Data Sources Literature review of pediatric patients with cervical Castleman disease. Review Methods Online medical journal databases were searched for patients aged 18 years or younger. Eighteen published studies were found, comprising 29 patients. Conclusions An asymptomatic or slowly enlarging neck mass was the most common presentation. No sex differences were noted. Magnetic resonance imaging demonstrates a homogeneous, isointense to slightly hyperintense T1-weighted signal and high signal intensity on T2-weighted imaging. Lymphoma was the most common differential diagnosis. All patients were treated with complete surgical excision and diagnosed as hyaline-vascular type on histology, except for 1 patient for whom histologic type was not reported. No reports of multicentric disease, plasma cell, or mixed histology were found. No recurrences were reported. Implications for Practice In this article, we provide the largest known literature review of pediatric patients with cervical Castleman disease. Although Castleman disease is rare, it should be considered on the differential for a pediatric neck mass, particularly when presenting with an asymptomatic posterior neck mass and equivocal workup. Fortunately, our study suggests that if diagnosed as Castleman disease, the most likely diagnosis is hyaline-vascular type, for which the long-term prognosis is good. Surgical excision is both diagnostic and therapeutic.

A Homozygous SLITRK6 nonsense mutation is associated with progressive auditory neuropathy in humans

SLITRK family proteins control neurite outgrowth and regulate synaptic development. In mice, Slitrk6 plays a role in the survival and innervation of sensory neurons in the inner ear, vestibular apparatus, and retina, and also influences axial eye length. We provide the first detailed description of the auditory phenotype in humans with recessive SLITRK6 deficiency.

Septal transposition: a novel technique for preservation of the nasal septum during endoscopic endonasal resection of olfactory groove meningiomas.

Endonasal resection of olfactory groove meningiomas allows for several advantages over transcranial routes, including a direct approach to the bilateral anterior cranial base and dura mater, early tumor devascularization, and avoidance of brain retraction. Although considered minimally invasive, the endoscopic approach to the cribriform plate typically requires resection of the superior nasal septum, resulting in a large superior septal perforation. The septal transposition technique improves preservation of sinonasal anatomy through the elimination of a septal perforation while allowing for wide exposure to the midline anterior cranial base and harvest of a nasal septal flap. Herein, the authors describe a 39-year-old female who presented with a progressively enlarging olfactory groove meningioma. An endoscopic endonasal resection with a septal transposition technique was performed. On follow-up, the nasal cavity had completely normal anatomy with preservation of the turbinates and nasal septum. The authors conclude that septal transposition is a useful technique that allows wide exposure of the anterior cranial base with maximal preservation of normal nasal anatomy and avoidance of a large septal perforation.

Endoscopic Ultrasonic Dacryocystorhinostomy for Recurrent Dacryocystitis Following Rhinoplasty

UNLABELLED The lacrimal sac is the structure most vulnerable to injury when performing rhinoplastic osteotomies. When performed in a low lateral position or along the frontal process of the frontal-maxillary suture, osteotomies can potentially tear the medial canthal tendon and injure the underlying lacrimal sac, possibly resulting in dacryocystitis. In this case report, the authors discuss a case of dacryocystitis following primary rhinoplasty; this injury was repaired with endoscopic dacryocystorhinostomy (DCR) using a Sonopet ultrasonic bone aspirator (Stryker, Kalamazoo, Michigan) at a single institution. This method achieved nasolacrimal duct patency, and the patient continued to be symptom-free at an 18-month follow-up. This is the first reported case of recurrent dacryocystitis following rhinoplasty as treated by endoscopic DCR. LEVEL OF EVIDENCE 5.

Topical Therapies for Refractory Chronic Rhinosinusitis

Topical therapy has become an important tool in the otolaryngologists armamentarium for refractory chronic rhinosinusitis (CRS). Daily high-volume sinonasal saline irrigation and standard metered-dose topical nasal steroid therapy are supported by the most evidence. Nonstandard topical sinonasal steroid therapies are a potential option for refractory CRS. Current evidence recommends against the use of topical antifungal therapy and topical antibiotic therapy delivered using spray and nebulized techniques in routine cases of CRS. Stents are a new modality with preliminary data showing they are an option when traditional treatment has failed. Further research with long-term effects and outcomes studies for refractory CRS are needed.

Paranasal sinus lymphoma: Retrospective review with focus on clinical features, histopathology, prognosis, and relationship to systemic lymphoma

Paranasal sinus lymphoma is a rare clinical entity.

Head and Neck Manifestations of Eosinophilic Granulomatosis with Polyangiitis: A Systematic Review.

Objective To conduct the first and only systematic review of the existing literature on head and neck manifestations of eosinophilic granulomatosis with polyangiitis to guide clinical decision making for the otolaryngologist. Data Sources PubMed, Cochrane Library, Scopus, and LILACS. Review Methods A systematic review of the aforementioned sources was conducted per the PRISMA guidelines. Results From an initial 574 studies, 28 trials and reports were included, accounting for a total of 1175 patients with eosinophilic granulomatosis with polyangiitis. Among clinical and cohort studies, 48.0% to 96.0% of all included patients presented with head and neck manifestations. In a distinct group of patients detailed in case reports describing patients presenting with head and neck manifestations, patients on average fulfilled 4.6 diagnostic criteria per the American College of Rheumatology. Furthermore, 95.8% of reported cases were responsive to steroids, and 60% required additional therapy. Conclusion Otolaryngologists are in a unique position for the early diagnosis and prevention of late complications of eosinophilic granulomatosis with polyangiitis. The American College of Rheumatology criteria should be relied on in the diagnostic workup. Close surveillance of these patients in a multidisciplinary fashion and with baseline complete blood counts, chest radiographs, and autoimmune laboratory tests is often necessary. Such patients with head and neck manifestations of the disease are nearly always responsive to steroids and often require additional immunosuppressive therapy or surgical intervention in cases of cranial neuropathies, temporal bone involvement, and refractory symptoms.

Contrast-Enhanced Ultrasound-Guided Sentinel Lymph Node Biopsy of the Ocular Conjunctiva

Sentinel lymph node biopsy (SLNB) has been utilized for cutaneous melanoma and other malignancies arising from the eye and ocular adnexa. Currently, SLNB requires blue dyes and/or radiopharmaceuticals; both of which have significant shortcomings. This study sought to evaluate the feasibility of SLNB with the use of real‐time, contrast‐enhanced ultrasound (CEUS) as an alternative technique for tumors arising in the conjunctiva.

Biphenotypic Sinonasal Sarcoma—Case Report and Review of Clinicopathological Features and Diagnostic Modalities

Background Biphenotypic sinonasal sarcoma is a recently described malignancy showing dual differentiation with both myogenic and neural elements. Due to its histologic similarities to other sinonasal malignancies, it is a diagnostic challenge. Objective The main purpose of this article is to report a case of biphenotypic sinonasal sarcoma and to consolidate data and provide a comprehensive review regarding pathological differences between biphenotypic sarcoma and other sinonasal malignancies and diagnostic modalities used for biphenotypic sarcoma. Material and Methods A systematic review of all cases of biphenotypic sinonasal sarcoma was performed using electronic databases (PubMed and Medline). Data collected included age, gender, symptoms, sub‐site of origin, immunophenotyping, metastasis, recurrence, treatment, duration of follow‐up, and survival outcomes. Results Ninety‐five cases of biphenotypic sarcoma were found with mean age at diagnosis of 52.36 years (range, 24‐87 years). Female to male ratio was 2.27:1. Extra‐sinonasal extension was present in 28%. Immunophenotyping revealed that S‐100 and SMA (smooth muscle actin) were consistently positive, while SOX‐10 was consistently negative. PAX3‐MAML3 fusion [t (2; 4) (q35; q31.1)] was the most common genetic rearrangement. Surgical excision with or without adjuvant radiotherapy was the most frequent treatment modality used. Recurrence was observed in 32% of cases with follow‐up. None of the cases reported metastasis. Three patients had died at the time of publication that included one case with intracranial extension. Conclusion Biphenotypic sarcoma is distinct sinonasal malignancy with unique clinicopathological features. Testing involving a battery of myogenic and neural immunomarkers is essential for diagnostic confirmation and is a clinically useful endeavor when clinical suspicion is high.