Tareck Ayad

Ergonomics in endoscopic sinus surgery: systematic review of the literature.

OBJECTIVE To conduct a systematic review of reports on the ergonomic posture of the surgeon during endoscopic sinus surgery. STUDY DESIGN Literature review. METHODS Systematic review of the French- and English-language literature using PubMed from January 1970 to March 2004. Articles were divided into four categories: visualization through an endoscope or a videoendoscope, monitor position, sitting or standing position, and arm support. RESULTS Endoscopic sinus surgery with direct vision through the endoscope is associated with faulty neck positioning and does not appear to bring any advantages in terms of surgical performance compared with vision via a video monitor. Low back pain and lower extremity complaints are commonly associated with the standing position. Spinal flexion seems more harmful than a straight posture. The preferred viewing angle for video monitors is a few degrees below the horizontal gaze line. An arm support can be beneficial because it is associated with minimization of neck, shoulder, and lumbar stress. CONCLUSION We recommend (1) visualization via a television monitor instead of direct vision through an endoscope, (2) positioning the screen in direct axis with the surgeons body and a few degrees below the horizontal line of gaze, (3) surgery in the seated position instead of the standing position, and (4) the use of an elbow support for the arm holding the endoscope.

Physiologic Features of Vocal Fatigue: Electromyographic Spectral-Compression in Laryngeal Muscles

Objectives: This study addresses the problem of defining observable attributes of “vocal fatigue” as a physiologic condition. The aim was to determine the applicability of electromyography (EMG) spectral compression in observing fatigue in laryngeal muscles arising from prolonged vocal effort.

Controversies in the management of retromolar trigone carcinoma.

Our objective is to discuss the current controversies that surround the management of retromolar trigone (RMT) cancer. We conducted this literature review to discuss trigone cancer. RTM and anterior pillar cancers should be studied separately. Preoperative clinical and radiographic assessments need to be further investigated to establish their reliability at predicting bone invasion. In the absence of suspicion of bone invasion, surgery and radiotherapy seem to give similar results, but recent reports indicate a greater benefit if they are used in combination. Some authors have advocated systematic segmental resection for all RMT cancers but marginal mandibulectomy is a reasonable option in selected cases. Standard treatment for RMT cancers with N0 necks is selective neck dissection or radiation therapy, depending on the modality of treatment of the primary. Allowing a better understanding of the evolution of RMT cancer and its response to different treatment modalities requires efforts to report different institutional experience with this rare tumor.

Predictive factors of survival and treatment tolerance in older patients treated with chemotherapy and radiotherapy for locally advanced head and neck cancer

PURPOSE To report outcomes and predictive factors of overall survival, hospitalization and treatment completion rates in elderly patients with locally advanced head and neck cancer treated with concurrent chemoradiotherapy (CRT). MATERIAL AND METHODS A retrospective analysis of patients aged 70years or older treated with concurrent CRT for locally advanced head and neck cancer was conducted. Univariate and multivariate analysis as well as competing risk survival analysis were used to determine predictors of mortality. Logistic regression was used to predict for hospitalization and treatment completion rates. RESULTS In total, 129 patients were included. Median follow-up was 27months (range: 1.7-125months). Completion rate of combined CRT was 84%. Actuarial OS and DSS at 4years were 56% and 75%. Hospitalization rate was 36%. On multivariate analysis, a Karnofsky performance status (KPS) ⩽80 was predictive of mortality. Using competing risks, KPS ⩽80 and weight loss >5% were predictive of cancer mortality whereas Charlson score ⩾3 was predictive of mortality due to other causes. On logistic regression, patients with abnormal renal function and lower body mass index were more likely to be hospitalized during their treatment course. Charlson score and chemotherapy regimen were predictive of treatment completion. CONCLUSION Concurrent CRT may be a feasible treatment option for healthier older patients at the cost of high hospitalization rates. Pre-treatment factors linked to physiological age such as KPS ⩽80, Charlson score ⩾3, abnormal renal function should be considered at the time of treatment decision.

North-American survey on HPV-DNA and p16 testing for head and neck squamous cell carcinoma.

OBJECTIVES Human papillomavirus (HPV)-positive head and neck squamous cell carcinomas (HNSCC) have been shown to have a significantly better prognosis and response to current treatment modalities. Current guidelines recommend systematic HPV-DNA and/or p16 testing on HNSCCs, although treatment approach should not be directed by test results. The objectives of this study were to (1) assess whether HPV-DNA and/or p16 status are systematically evaluated across North American otolaryngologists-head and neck surgeons and (2) whether the status is used to direct treatment approach. MATERIALS AND METHODS A 15-question online survey was sent to three associations: the Association of Oto-rhino-laryngology-Head and Neck Surgery of Quebec, the Canadian Society of Otolaryngology-Head and Neck Surgery, and the American Head and Neck Society. RESULTS Sixty-seven percent of respondents systematically test for HPV-DNA and/or p16 on HNSCC sites, while 58.3% report using test results to direct treatment for oropharyngeal cancers. A lack of official guidelines was the primary reason (81.8%) physicians did not use test results to direct treatment. Academic centre physicians (83.3%) and physicians with ⩾50% oncologic practice (87.6%) were more likely to test for HPV-DNA and/or p16 in HNSCC compared to non-academic centre physicians (39.7%) and physicians with <50% oncologic practices (51.4%) (p<0.001). Cost of the tests (69.2%), lack of relevance (46.1%) and time constraints (30.8%) were the primary reasons HPV-DNA and/or p16 were not tested. CONCLUSION The majority of North American respondents in this survey systematically test for HPV-DNA and/or p16 in HNSCC sites, and most indicate that test results influence their treatment approach for oropharyngeal cancers.

Facial artery musculomucosal flap for reconstruction of skull base defects: A cadaveric study

Failure in skull base defects reconstruction following tumor resection can have serious consequences such as ascending meningitis and pneumocephaly. The nasoseptal flap showed a very low incidence of cerebrospinal fluid leak but is not always available. The superiorly pedicled facial artery musculomucosal (FAMM) flap has been successfully used for reconstruction of head and neck defects. Our objective is to show that the FAMM flap can be used as a new alternative in skull base reconstruction.

Predicting Depression and Quality of Life among Long-term Head and Neck Cancer Survivors

Objective The aim of this study is to identify clinical factors that are predictive of depression and quality of life (QOL) among long-term survivors of head and neck squamous cell carcinoma and to develop predictive scores using these factors. Study Design Cohort study Setting Tertiary referral center. Subjects and Methods A total of 209 posttreatment (median follow-up, 38.7 months) head and neck cancer patients were prospectively evaluated using the Hospital Anxiety Depression Scale (HADS), the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30, and the EORTC Quality of Life Questionnaire Head and Neck 35, and pretreatment patient-related, tumor-related, and treatment-related predictors were identified using chart review. Bivariate (χ2 and t test) and multivariate (linear regression) analyses were used to construct predictive models. Results Significant pretreatment predictors of depression were identified on multivariate analysis as smoking at diagnosis, >14 alcoholic drinks per week, T3 or T4 status, and >3 medications (P < .001). Two or more of these factors yielded an 82.3% sensitivity in detecting significant depressive symptoms (defined as a HADS cutoff score of 5). Significant predictors of fatigue, global health/QOL, social contact, speech, pain, swallowing, and xerostomia were also identified. Conclusion Pretreatment predictors of long-term depression and QOL have been defined using multivariate models, and an easily applicable predictive score of long-term depression is proposed. Potential eventual clinical applications include prophylactic intervention in at-risk patients.

Atypical presentation of Eagle syndrome with hypoglossal nerve palsy and Horner syndrome

Many nerve injuries have been associated with Eagle syndrome. The cranial nerves V, VII, IX, and X have been reported to be injured by the elongated styloid process in this syndrome.

Reconstruction of the prevertebral space with a submental flap: A novel application

UNLABELLED The submental island flap is an axial flap based on the submental branches of the facial artery. It is mostly used to recover oral and facial defects. In this report, a case is presented where it is used to reconstruct the prevertebral space during a spine surgery. Its purpose is to act as an interposition tissue between the pharyngeal suture line and the hardware to minimize the risk of wound dehiscence. LEVEL OF EVIDENCE V.

The facial artery musculomucosal flap: modification of the harvesting technique for a single-stage procedure.

INTRODUCTION The facial artery musculomucosal (FAMM) flap was first described in 1992 by Pribaz et al. This flap allows reconstruction of smallto medium-size oral cavity, oropharynx, and intranasal defects. Lateral and anterior floor-of-mouth (FOM) defects have been successfully reconstructed with the FAMM flap, maintaining the tongue mobility and ensuring adequate elocution and the oral phase of deglutition. The FAMM flap can also be used for reconstructions of other subsites of the oral cavity as well as the lip and vermillion reconstruction. However, a second-stage procedure is often needed to reduce the bulky mucosal paddle at the base of the flap, to increase the depth of the vestibule and to allow greater mobility of the mobile tongue. A second-stage procedure is required in approximately one third of the patients. We present herein a modification of the surgical approach of the FAMM flap to allow a one-stage procedure and the surgical outcomes in three cases.