Steven C. Marks

Evaluation of prognostic factors in endoscopic sinus surgery.

A retrospective analysis of 115 consecutive patients who underwent endoscopic sinus surgery for chronic sinusitis was conducted to evaluate the effect on outcome of variables including previous sinus surgery, allergy, asthma, and computed tomography stage of disease. Outcome was assessed in each patient by a survey in which the patient rated the benefit of surgery in terms of percent improvement in different symptoms compared with symptoms before surgery. Outcome was also assessed by the need for revision surgery and the presence of endoscopic criteria for failure. The results indicate that allergy and previous sinus surgery are associated with lower individual symptom scores, but no variable was associated with overall symptomatic failure. Previous sinus surgery was strongly associated with the need for subsequent revision surgery. The computed tomography stage was strongly associated with endoscopic evidence of failure. In conclusion, both history of previous sinus surgery and computed tomography stage of disease are correlated to poor outcomes after endoscopic sinus surgery.

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.

Functional Outcomes After Supracricoid Laryngectomy

Objectives Local control and 5‐year survival rates are similar for patients undergoing total laryngectomy and supracricoid laryngectomy for the treatment of advanced‐stage laryngeal carcinoma. However, comprehensive studies of functional outcomes after supracricoid laryngectomy are lacking.

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.

Outcome of frontal sinus obliteration

Objectives: To evaluate the indications, technique, and results after long‐term follow‐up of osteoplastic frontal sinusectomy with fat obliteration.

Middle turbinate graft for repair of cerebral spinal fluid leaks.

Endoscopic management of CSF leaks has been reported as highly successful by several authors. Various techniques are used for site preparation, graft selection, and graft stabilization. In this report the middle turbinate as a donor site for repair is described. Guidelines for harvest, preparation, and application are presented. The middle turbinate graft can be used as a free mucosal graft for linear cracks or small defects, as a composite bone/mucosal graft for moderate sized defects, or as a donor site for separate bone and mucosal grafts for large defects or encephaloceles when intracranial bone placement is desirable. Experience with 18 patients is presented with 100% initial graft take, and 17/18 (94%) with long term success. The middle turbinate is an excellent source of donor material for repair of almost any endoscopically repairable CSF leak.

Effects of zinc and nutritional status on clinical outcomes in head and neck cancer

The head and neck cancer patient often presents with both protein malnutrition and trace element deficiencies. Zinc has been found to be deficient in many head and neck cancer patients. In this study, pretreatment zinc status and nutritional status (measured by the Prognostic Nutritional Index [PNI]) were correlated with clinical outcomes in 47 patients. The patients were followed-up for a median of 52 mo from the time of enrollment. Our results showed that the tumor size and overall stage correlated significantly to zinc status whereas no such correlation was seen with PNI, alcohol intake, or smoking in our subjects. The results also showed that impaired zinc status was associated with an increased number of treatment morbidities, unplanned hospitalizations, and treatment delays (P < 0.05). Nutritional status was not associated with any studied outcome variable. The disease-free interval was highest for the group which had both zinc-sufficient and nutrition-sufficient status. Although our data do not prove conclusively, they do suggest that impaired zinc status at presentation may contribute to treatment morbidity, and that for an optimal mean disease-free interval, a sufficient zinc and nutritional status is required.

Bacteriology of sinusitis in human immunodeficiency virus‐positive patients: Implications for management

The bacteriology of sinusitis in human immunodeficiency virus (HIV)‐infected patients has been only sporadically reported. In this study, we report the results of cultures taken from 12 HIV patients with refractory chronic sinusitis who underwent surgery.

Learning curve in endoscopic sinus surgery

The existence of a long learning curve for endo-scopic sinus surgery has been proposed as a reason for rigorous and extensive training to prepare physicians to perform this surgery. In this article, the author—who participated in this type of training program—examines his experience over a 5-year period to assess the effect of rigorous training on the learning curve for endoscopic sinus surgery. Beginning with the first day of practice after training, 5 years with 393 cases were evaluated for complications and the need for revision surgery. The results were analyzed in 100-case groups. The results show no difference in major and serious complications or revision surgery rates. However, a statistically significant difference in the minor-complication rate, specifically frontal-sinus stenosis, was found from the first half to the second half of the experience. These findings show that, with rigorous training of the physician, the learning curve can largely be completed during residency training, allowing the new practitioner to perform endoscopic sinus surgery safely and with good results.

Acute Sinusitis in the Rabbit Model: Histologic Analysis

Objectives: Characterize the histology of the rhinogenic model of sinusitis and compare this with existing models of sinusitis.