Richard W. Borrowdale

Osteonecrosis of the mandible or maxilla associated with the use of new generation bisphosphonates.

Objective: The use of bisphosphonates is well established for the treatment of patients with metastatic bone disease, osteoporosis, and Pagets disease. Osteonecrosis of the mandible or maxilla associated with the use of bisphosphonates is a newly described entity never before discussed in the otolaryngology literature. In this paper, we review a series of patients diagnosed with osteonecrosis, all treated with new generation bisphosphonates. Our objective is to inform and educate others, particularly otolaryngologists/head and neck surgeons, about this drug induced entity, a condition that should be recognized early to avoid potential devastating consequences.

Management of advanced cervical metastasis using intraoperative radiotherapy.

Seventy‐five patients who had advanced cervical metastasis with possible invasion of the deep muscles or carotid artery were approached with aggressive resection and intraoperative radiotherapy (IORT). All metastatic nodes were greater than 3 cm, 65% were fixed on clinical examination, and 35% involved the carotid artery. Forty‐six (61%) of the patients had previously received irradiation. Fifteen of the patients required extended neck dissections with carotid resections and grafting. After the resection an average single dose of 2000 cGy of electron beam IORT was delivered.

Utility of Preoperative Radionuclide Scanning for Primary Hyperparathyroidism

This study retrospectively reviews 60 cases of primary hyperparathyroidism, 21 of whom underwent technetium 99 sestamibi scanning and 10 of whom underwent thallium 201/technetium 99 pertechnetate scanning preoperatively. The sestamibi and thallium scans demonstrated an 89.5% and a 62.5% sensitivity rate for adenoma, respectively. Neither scan demonstrated hyperplastic glands well. Although the scans localized adenomatous glands to the correct side well, the ability to localize them more discretely was 68.4% and 62.5%, respectively. In cases of solitary adenoma the effect of an accurate preoperative scan on operative time for bilateral exploration was not significant, whereas the experience of the attending surgeon was significant. Also, the cost of the scans at our institution was greater than the cost of the time saved in performing even unilateral neck exploration. Thus preoperative radionuclide scanning is not cost‐effective for the initial exploration of patients with primary hyperparathyroidism and is insufficiently sensitive to make routine unilateral neck exploration for adenoma consistently effective.

Preauricular infratemporal fossa approach for advanced malignant parotid tumors

The aims of this study were to demonstrate the surgical technique involved in the preauricular infratemporal fossa (ITF) approach, outline the clinical indications for use of this technique, and present the results in using this approach in 159 patients with malignant parotid tumors. At the conclusion of this article, the reader should be able to understand the utility of the preauricular infratemporal fossa approach in the management of patients with advanced malignant parotid tumors.

Postlaryngectomy dysphagia masking as velopharyngeal insufficiency: a simple solution for an anterior neopharyngeal diverticulum.

Postlaryngectomy dysphagia is a common occurrence and can be a source of emotional distress that results in a decrease in quality of life among a patient population that is already exposed to considerable morbidity. One etiologic source that is less commonly reported as a source for postlaryngectomy dysphagia, and perhaps overlooked, is an anterior neopharyngeal diverticulum. Herein, we describe a postlaryngectomy dysphagia caused by a neopharyngeal diverticulum masking as velopharyngeal insufficiency of liquids. The liquid dysphagia was immediately relieved via transoral endoscopic approach using the Harmonic scalpel to resect and simultaneously coagulate the posterior wall.

Late Complication of Thoracic Endovascular Stent–Grafting

Thoracic endovascular aortic repair (TEVAR) has become increasingly popular for the treatment of descending thoracic aortic aneurysms. Despite their proven efficacy and safety, several complications can occur with TEVAR. We report a case of a 76-year-old woman with a late-term complication after TEVAR related to recurrent thyroid cancer and carotid-subclavian revascularization.

Spinal epidural abscess following glossectomy and neck dissection: A case report

Highlights • Lumbar spinal epidural abscess is uncommon following head and neck surgery.• Isolating Klebsiella pneumoniae as the etiologic pathogen is even more rare.• Early diagnosis is paramount with magnetic resonance imaging being the study of choice.• The preferred treatment strategy consists of surgical decompression and drainage combined with intravenous antibiotics.

Subglottic Basal Cell Adenocarcinoma

Objectives: To discuss the presentation and management of a rare neoplasm in a previously unreported laryngeal subsite. Methods: Case report and literature review. Results: An 89-year-old woman presented with a subglottic mass, biopsy of which was consistent with basal cell adenocarcinoma. She was successfully treated with surgical intervention and remains disease free 29 months postoperatively. Conclusions: Basal cell adenocarcinoma is a rare salivary gland tumor, the laryngeal variant of which is even scarcer. Herein we describe the presentation and successful surgical management of the first reported case of subglottic basal cell adenocarcinoma. We additionally provide a histologic review followed by approaches to treatment.

Combination Trimodality Therapy Using Vismodegib for Basal Cell Carcinoma of the Face

Background. For large basal cell carcinomas (BCCs) of the head and neck, definitive surgery often requires extensive resection and reconstruction that may result in prolonged recovery and limited cosmesis. Vismodegib, a small-molecule inhibitor of the hedgehog pathway, is approved for advanced and metastatic BCCs. We present a case of advanced BCC treated with combination of vismodegib, radiotherapy, and local excision resulting in excellent response and cosmesis. Case Presentation. A 64-year-old gentleman presented with a 5-year history of a 7 cm enlarging right cheek mass, with extensive vascularization, central ulceration, and skin, soft tissue, and buccal mucosa involvement. Biopsy revealed BCC, nodular type. Up-front surgical option involved a large resection and reconstruction. After multidisciplinary discussion, we recommended and he opted for combined modality of vismodegib, radiotherapy, and local excision. The patient tolerated vismodegib well and his right cheek lesion decreased significantly in size. He was then treated with radiotherapy followed by local excision that revealed only focal residual BCC. Currently, he is without evidence of disease and has excellent cosmesis. Conclusions. We report a case of locally advanced BCC treated with trimodality therapy with vismodegib, radiotherapy, and local excision, resulting in excellent outcome and facial cosmesis, without requiring extensive resection or reconstructive surgery.

Photo Quiz: A 55-Year-Old Male with Hoarseness of Voice and Laryngeal Mass

A 55-year-old male presented to the ear, nose, and throat (ENT) clinic with hoarseness that had lasted several weeks. His past medical history was significant for polycythemia vera and hypertension. He had a history of smoking 40 or more packs of cigarettes a year. On laryngeal examination, he was