Samer Al-Khudari

Gastrostomy Tube Use after Transoral Robotic Surgery for Oropharyngeal Cancer

Objective. To evaluate factors that influence gastrostomy tube (g-tube) use after transoral robotic surgery (TORS) for oropharyngeal (OP) cancer. Study Design/Methods. Retrospective review of TORS patients with OP cancer. G-tube presence was recorded before and after surgery at followup. Kaplan-Meier and Cox hazards model evaluated effects of early (T1 and T2) and advanced (T3, T4) disease, adjuvant therapy, and free flap reconstruction on g-tube use. Results. Sixteen patients had tonsillar cancer and 13 tongue base cancer. Of 22 patients who underwent TORS as primary therapy, 17 had T1 T2 stage and five T3 T4 stage. Seven underwent salvage therapy (four T1 T2 and three T3 T4). Nine underwent robotic-assisted inset free flap reconstruction. Seventeen received adjuvant therapy. Four groups were compared: primary early disease (PED) T1 and T2 tumors, primary early disease with adjunctive therapy (PEDAT), primary advanced disease (PAD) T3 and T4 tumors, and salvage therapy. Within the first year of treatment, 0% PED, 44% PEDAT, 40% PAD, and 57% salvage patients required a g-tube. Fourteen patients had a temporary nasoenteric tube (48.3%) postoperatively, and 10 required a g-tube (34.5%) within the first year. Four of 22 (18.2%) with TORS as primary treatment were g-tube dependent at one year and had received adjuvant therapy. Conclusion. PED can be managed without a g-tube after TORS. Similar feeding tube rates were found for PEDAT and PAD patients. Salvage patients have a high rate of g-tube need after TORS.

Head and neck cancer in transplant recipients

The development of malignancy in organ transplant patients is a well‐known complication of long‐term immunosuppressive therapy. We sought to characterize our institutions 20‐year experience with head and neck cancer after solid organ transplantation.

Osteocutaneous radial forearm reconstruction of large partial cricotracheal defects.

Single‐stage procedures for reconstruction of large cricotracheal defects have been limited in success and malignant immature teratomas in the larynx of an adult have never been reported.

Roller coaster-induced barotrauma

We present the case of a 24‐year‐old male who presented to the otolaryngology clinic for otalgia and aural fullness after riding a roller coaster. We present his clinical course and outcome and briefly discuss the mechanism of injury and otologic barotrauma. Roller coasters have been reported as the cause of many different types of injuries, but this is the first reported case of otologic barotrauma. As the engineering for roller coasters continues to advance in terms of increasing speed, otolaryngologists need to be aware of a new etiology of otologic barotrauma. Laryngoscope, 2011

A Pediatric Case of Gorham Disease with Extensive Maxillofacial Involvement

Objectives: To present a rare pediatric case of Gorham disease with craniofacial involvement. Study design: Case report and literature review. Methods: Literature review of craniofacial Gorham disease in pediatrics and discussion of a representative case within our health system. Results: A nine year old male presented after mandibular dental trauma. Massive maxillofacial osteolysis ensued. Photographs and radiologic images demonstrate the dysmorphic facial features of this case of Gorham disease. Conclusion: To the best of our knowledge, our case represents the fourth case in the literature to document Gorham disease in a male pediatric patient with mandibular involvement.

Delayed Failure after Endoscopic Staple Repair of an Anterior Spine Surgery Related Pharyngeal Diverticulum

We present a rare complication of endoscopic staple repair of a pharyngeal diverticulum related to prior anterior cervical spine surgery. A 70-year-old male developed a symptomatic pharyngeal diverticulum 2 years after an anterior cervical fusion that was repaired via endoscopic stapler-assisted diverticulectomy. He initially had improvement of his symptoms after the stapler-assisted approach. Three years later, the patient presented with dysphagia and was found to have erosion of the cervical hardware into the pharyngeal lumen at the site of the prior repair. We present the first reported case of late hardware erosion into a pharyngeal diverticulum after endoscopic stapler repair.

Case Report: Mediastinal Hematoma Secondary to Hypertension, Presenting as a Retropharyngeal Space Abscess

The majority of retropharyngeal hematomas described in the literature have been associated with anticoagulation therapy, tumors, aneurysm, infection or cervical spine injury. We present a case of a 55-year-old African American female with acute chest pain, sore throat, and dysphagia. Her past medical history was significant for uncontrolled hypertension and cervical spine arthritis. Physical exam was significant for posterior pharyngeal edema and her labs indicated mild leukocytosis. Contrast-enhanced CT scan of the neck demonstrated an extensive retropharyngeal fluid collection with mediastinal extension, concerning for an abscess. A trans-oral and trans-cervical incision and drainage of the presumed abscess revealed clotted blood and venous ooze. Penrose drains were placed in the retropharyngeal space to allow for spontaneous drainage over the next two days. The patient was kept intubated for 8 days to ensure a secure airway while venous ooze was allowed to self-tamponade. Antihypertensive medications were utilized to control her labile blood pressures. To our knowledge this is the first case report of uncontrolled chronic hypertension as the etiology of a spontaneous mediastinal venous hematoma with presentation as a retropharyngeal space fluid collection. When evaluating retropharyngeal space occupying lesion with mediastinal extension, consideration should be given to mediastinal venous plexus bleeding. Treatment involves securing the airway, drainage, and control of blood pressure.