Raul M. Cruz

Relation of lymph‐node metastasis to histopathologic appearance in oral cavity and oropharyngeal carcinoma: A case series and literature review

A number of histopathologic parameters in squamous cell carcinoma of the oral cavity and oropharynx have been identified as having a statistically significant correlation with regional lymph‐node metastasis. These parameters have been inconsistent and not readily reproducible.

Prospective, randomized, controlled clinical trial of a novel matrix hemostatic sealant in patients with acute anterior epistaxis.

Objectives: Floseal, a novel hemostatic sealant composed of collagen‐derived particles and topical bovine‐derived thrombin, is applied as a high‐viscosity gel for hemostasis. This study is a prospective, randomized, controlled clinical trial of Floseal compared with nasal packing in patients with acute anterior epistaxis.

Thyroglossal duct carcinoma: a large case series.

Thyroglossal duct cysts (TDCs) are common congenital abnormalities of thyroid development. Carcinoma occurs rarely in patients with TDCs. In a large case series drawn from medical records at a health maintenance organization from 1971 through 1995, 14 cases of carcinoma in a TDC were found. This represents the largest known reported case series to date. Demographics, diagnosis, and treatment methods are reviewed. We recommend the Sistrunk operation and evaluation of the thyroid gland and neck for potential abnormality that would necessitate thyroidectomy and lymph node dissection. Long-term follow-up incorporating clinical examination is mandatory.

Prospective, Randomized, Controlled Clinical Trial of a Novel Matrix Hemostatic Sealant in Children Undergoing Adenoidectomy

PROBLEM ADDRESSED: Floseal is a novel matrix hemostatic sealant composed of collagen-derived particles and topical bovine-derived thrombin. It is applied as a high-viscosity gel for hemostasis and has been clinically proven to control bleeding. This study is a prospective, randomized, controlled clinical trial of Floseal sealant compared to traditional suction cautery hemostasis in children undergoing adenoidectomy. METHODS AND MEASURES: Seventy patients (mean age 7.0 yrs, 45.7% male) with obstructive sleep apnea underwent traditional cold steel adenoidectomy with an adenoid curette and were then randomized to receive the hemostatic sealant (Floseal) or cautery to obtain hemostasis. Patients were crossed over to the other hemostatic technique if hemostasis was not achieved after more than 100 mL of blood loss or 15 minutes elapsed time. Objective data collected included time to hemostasis and blood loss during hemostasis. Visual analog scales (VAS) were used to record subjective data by the operating surgeon including bleeding following adenoid pack removal (0 = none, 3 = brisk) and ease of operation (1 = extremely easy, 6 = extremely difficult). Parents recorded diet on a journal and were contacted by phone at postoperative day 7 and questioned with regard to return to regular diet and use of narcotics. RESULTS: Compared to patients in the cautery group (n = 35), Floseal patients (n = 35) had significantly shorter times to hemostasis (0.6 ± 1.3 minutes vs 9.5 ± 5.4 minutes (mean ± SD), P < 0.001), less blood loss (2.5 ± 9.2 mL vs 29.4 ± 27.1 mL, P < 0.001), less subjective bleeding (0.0 ± 0.6 vs 2.0 ± 0.7, (median 4-point VAS ± SD), P < 0.001), and subjectively easier operations (2.6 ± 1.0 vs 5.2 ± 1.0 (mean 6-point VAS ± SD), P < 0.001). Furthermore, Floseal patients returned to regular diet earlier (2.7 ± 0.7 vs 4.1 ± 0.5 days (mean ± SD), P < 0.001) and had less use of narcotics at 7 days postoperatively (40% vs 69%, P < 0.05). Lastly, three patients in the cautery group were crossed over to the Floseal group, but no Floseal subjects were crossed over to the cautery group. The retail cost of Floseal is

Ventricular dysphonia: a profile of 40 cases.

85. Operating room costs are estimated at

Comparison of ThinPrep versus conventional smear cytopreparatory techniques for fine-needle aspiration specimens of head and neck masses.

12/minute. Reducing the operative length by 8.9 minutes on average produces a cost savings of

Bilateral glossopharyngeal nerve paralysis after tonsillectomy: Case report and anatomic study

106.80 per operation. There were no complications in either experimental group including postoperative hemorrhage, hospitalization, blood transfusion, or aspiration. CONCLUSIONS: Floseal matrix hemostatic sealant is a safe, efficacious, easy, and cost-effective technique for obtaining hemostasis in children undergoing adenoidectomy. Limitations of the study include the fact that it is nonblinded, which does allow for some bias in the subjective data recorded. However, utilizing 4 different operating surgeons, 3 of whom were not affiliated with the study, minimized this. CLINICAL SIGNIFICANCE OF STUDY: This study demonstrates the safety and efficacy of a novel hemostatic sealant in children undergoing adenoidectomy. Floseal matrix hemostatic sealant can be used as a first-line hemostatic agent, and it is a good tool in the armamentarium of otolaryngologists who encounter significant bleeding following adenoidectomy.

Asymptomatic Near-Total Airway Obstruction by a Cylindrical Tracheal Foreign Body

Ventricular dysphonia is a poorly understood disorder involving ventricular fold participation during phonation. A population of ventricular dysphonia patients was evaluated using phonatory function studies such as laryngovideostroboscopy, advanced acoustic analysis, and electroglottography to identify shared epidemiologic characteristics and to discuss possible neuromuscular mechanisms and causes. Forty patients with ventricular dysphonia were studied and epidemiologic, acoustic, and histologic data were analyzed. In almost all cases, the authors found abnormalities affecting the glottis caused by a related medical condition. The abnormalities included true vocal cord (TVC) aperiodicity in 100% of the patients, TVC asymmetry in 65%, a laryngeal mass or foreign body (usually Teflon®) in 35%, TVC erythema or edema in 32.5%, and TVC bowing in 22.5%. Ventricular dysphonia seems to be primarily a compensatory mechanism for glottic dysfunction. Therapy is based on identifying and correcting the underlying abnormalities. Laryngovideostroboscopy is a particularly important tool in examining chronic dysphonia.

Infiltration of epinephrine in tonsillectomy: a randomized, prospective, double-blind study.

OBJECTIVES: Diagnostic accuracy of the ThinPrep process (Cytyc, Boxborough, MA) was compared with that of conventional (smear) cytopreparation for fine-needle aspiration (FNA) of head and neck masses. METHODS: In a prospective, randomized, single-blinded study, 209 patients served as their own controls and underwent 236 FNAs using ThinPrep and conventional (smear) cytopreparatory techniques. RESULTS: ThinPrep produced less air-drying artifact and less mechanical distortion than the conventional method. The conventional technique was diagnostic in 63% of samples; the ThinPrep technique was diagnostic in 55% of samples. When all results were combined, pathologists subjectively preferred the conventional technique but accepted use of ThinPrep as the only cytopreparatory technique for most head and neck masses. CONCLUSIONS: For adequately experienced cytopathologists, ThinPrep is acceptable for FNA of salivary masses, neck cysts, metastatic lymph nodes, and thyroid lesions. Conventional smear technique should be used for FNA of nonmetastatic lymphoid lesions. Use of ThinPrep can complement use of the conventional (smear) cytopreparatory technique when aspirate is nondiagnostic or bloody, when the patient has a blood-borne infectious disease, when the clinician is inexperienced, or when aspirate has entered the syringe.

Relation between age and head and neck cancer recurrence after surgery: A multivariate analysis☆☆☆★

Objective: To present a case report and to propose an anatomic explanation for a rare complication of tonsillectomy, severe dysphagia caused by bilateral paralysis of the glossopharyngeal nerve.