Robert H. Mathog

Integration of human papillomavirus type 11 in recurrent respiratory papilloma-associated cancer.

Objectives/Hypothesis: The main objective was to demonstrate that human papillomavirus (HPV) type 11 is an aggressive virus that plays a significant role in the development of laryngeal cancer in patients with a history of recurrent respiratory papillomatosis (RRP). We have done so by preliminary investigation into the molecular mechanism underlying the malignant transformation of RRP to invasive squamous cell carcinoma.

Orbital Measurement in Black and White Populations

Objective: Obtain measurements of globe projection, intercanthal distance (ICD), interpupillary distance (IPD), palpebral fissure width (PFW), and palpebral fissure height (PFH) in a population of presumably normal white and black adults to determine if any significant differences exist between these groups. Study Design: Prospective direct measurement of cohorts regarding orbital and globe measurements in a tertiary medical center. Methods: Measurements of globe projection, ICD, IPD, PFW, and PFH were taken in 61 black adults and directly compared with measures taken from 65 white adults in an outpatient setting. Mean values and ranges were calculated and compared between races and sexes using an unpaired t test. Results: A significant difference was found between races for globe projection, with black males demonstrating a mean projection of 18.23 ± 2.26 mm as compared with 17 ± 2.65 mm for white males (P > .025). Black females demonstrated a mean projection of 17.27 ± 1.44 mm as compared with 15.98 ± 2.22 mm for white females (P > .01). Similar differences were seen for measures of IPD and PFW, with greater mean values for black as compared with white adults. No racial differences existed for ICD or PFH. Conclusions: These findings suggest that racial differences exist for certain measures of globe and orbital position, i.e., projection, IPD, and PFW. Racial background should be considered when evaluating orbital anatomy.

Aspiration in patients with head and neck cancer and tracheostomy

Tracheopulmonary aspiration is a common occurrence in patients with dysphagia associated with head and neck cancer. We performed quantitative scintigraphic analysis of tracheopulmonary aspiration in 125 patients with head and neck cancer; 58 of these patients had a tracheostomy. Tracheopulmonary aspiration occurred in 58% of patients with a tracheostomy and in 23% of patients without a tracheostomy. In six of seven patients with a tracheostomy, tracheopulmonary aspiration significantly increased when the obturator was removed and, in these patients, occlusion of the tracheostomy tube during feedings eliminated or reduced the complication. Our studies suggest that aspiration can be monitored accurately and conveniently by scintigraphy, and that this technique is useful in the evaluation and management of dysphagia in debilitated patients.

Craniocervical Necrotizing Fasciitis: An 11-Year Experience

OBJECTIVE: We review our experience and present our approach to treating craniocervical necrotizing fasciitis (CCNF). STUDY DESIGN: All cases of CCNF treated at Wayne State University/Detroit Receiving Hospital from January 1989 to April 2000 were reviewed. Patients were analyzed for source and extent of infection, microbiology, co-morbidities, antimicrobial therapy, hospital days, surgical interventions, complications, and outcomes. RESULTS: A review of 250 charts identified 10 cases that met the study criteria. Five cases (50%) had spread of infection into the thorax, with only 1 (10%) fatality. An average of 24 hospital days (7 to 45), 14 ICU days (6 to 21), and 3 surgical procedures (1 to 6) per patient was required. CONCLUSION: Aggressive wound care, broad-spectrum antibiotics, and multiple surgical interventions resulted in a 90% (9/10) overall survival and 80% (4/5) survival for those with thoracic extension. SIGNIFICANCE: This is the largest single institution report of CCNF with thoracic extension identified to date.

Nutritional and Zinc Status of Head and Neck Cancer Patients: An Interpretive Review

In this review, we provide evidence based on our studies, for zinc deficiency and cell mediated immune disorders, and the effects of protein and zinc status on clinical morbidities in patients with head and neck cancer. We investigated subjects with newly diagnosed squamous cell carcinoma of the oral cavity, oropharynx, larynx, and hypopharynx. Patients with metastatic disease and with severe co-morbidity were excluded. Nutritional assessment included dietary history, body composition, and prognostic nutritional index (PNI) determination. Zinc status was determined by zinc assay in plasma, lymphocytes, and granulocytes. Pretreatment zinc status and nutritional status were correlated with clinical outcomes in 47 patients. Assessment of immune functions included production of TH1 and TH2 cytokines, T cell subpopulations and cutaneous delayed hypersensitivity reaction to common antigens. At baseline approximately 50% of our subjects were zinc-deficient based on cellular zinc criteria and had decreased production of TH1 cytokines but not TH2 cytokines, decreased NK cell lytic activity and decreased proportion of CD4+ CD45RA+ cells in the peripheral blood. The tumor size and overall stage of the disease correlated with baseline zinc status but not with PNI, alcohol intake, or smoking. Zinc deficiency was associated with increased unplanned hospitalizations. The disease-free interval was highest for the group which had both zinc sufficient and nutrition sufficient status. Zinc deficiency and cell mediated immune dysfunctions were frequently present in patients with head and neck cancer when seen initially. Zinc deficiency resulted in an imbalance of TH1 and TH2 functions. Zinc deficiency was associated with increased tumor size, overall stage of the cancer and increased unplanned hospitalizations. These observations have broad implications in the management of patients with head and neck cancer.

Mucoceles of the maxillary sinus

The maxillary sinus is an uncommon site for mucoceles within the paranasal sinuses. In this study nine patients with maxillary sinus mucoceles are presented. Six of these patients were treated by open approaches, and three were treated by endoscopic drainage alone. For uncomplicated maxillary sinus mucoceles, endoscopic drainage appears to be a reasonable approach, whereas for more complicated cases extending outside the sinus, open approaches may be required.

Detection and quantification of laryngotracheopulmonary aspiration with scintigraphy

Aspiration is analyzed by a new scintigraphic technique and standard videofluoroscopy in 78 patients with head and neck pathology and neurologic disorders. When both methods are compared to clinical aspiration and a positive x‐ray film of pneumonia, they appear to complement each other and provide a very accurate evaluation. Scintigraphy is a more sensitive method for detecting aspiration below the vocal cords and also provides for flow dynamics and a method of quantifying the amount of aspirated material. Videofluoroscopy shows more clearly the mechanism of the swallowing disorder and how the bolus enters the tracheobronchial tree. Studies in patients following head and neck surgery demonstrate a high incidence of dysphagia, aspiration, and pneumonia.

Hearing Function and Chronic Renal Failure

In order to evaluate the degree and type of hearing loss in patients with chronic renal failure, 61 patients undergoing chronic hemodialysis were examined. Hearing threshold levels, adjusted for age and sex, demonstrated a significant high frequency deficit, which in some patients was noted early in the course of hemodialysis. Fluctuations in hearing were noted over single dialysis events but were transient and apparently independent of corresponding changes in Na, K, Ca, BUN, creatinine, glucose, mean blood pressure, and weight. Preliminary attempts to evaluate hyperlipidemia as a possible cause of hearing loss did not reveal any hearing deficit or gain as related to triglyceride or cholesterol levels. The data suggested other possible causes of observed auditory loss.

Transoral robotic surgery for treatment of obstructive sleep apnea‐hypopnea syndrome

To evaluate the efficacy of base of tongue (BOT) resection via transoral robotic surgery (TORS) in the treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS).

Human papillomavirus (HPV) transcripts in malignant inverted papilloma are from integrated HPV DNA

Objectives: The objectives of the study were to detect human papillomavirus (HPV) sequences in nasal inverted papilloma (IP) lesions and to determine whether HPV is involved in the progression of IP to sinonasal squamous cell carcinoma (SCC).