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Mendelsohn AH, Elashoff DA, Abemayor E, St John MA. Surgery for papillary thyroid carcinoma: is lobectomy enough? ACTA ACUST UNITED AC 2010; 136:1055-61. [PMID: 21079156 DOI: 10.1001/archoto.2010.181] [Citation(s) in RCA: 198] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To further understanding of treatment of papillary thyroid carcinoma (PTC). DESIGN The Surveillance, Epidemiology, and End Results Program database was searched for patients who had undergone surgery for PTC. SETTING Areas covered by Surveillance, Epidemiology, and End Results population-based registries. PATIENTS Patients who had undergone PTC surgery between January 1, 1988, and December 31, 2001, were included in the study. MAIN OUTCOME MEASURES Disease-specific survival (DSS) and overall survival (OS). RESULTS Of the total 22,724 patients with PTC, 5964 patients underwent lobectomy. There were 2138 total and 471 disease-specific deaths. Controlling for tumor size, multivariate analysis revealed no survival difference between patients who had undergone total thyroidectomy and those who had undergone lobectomy. Increased tumor size, extrathyroidal extent, positive nodal status, and increased age displayed significantly worse DSS and OS (P < .001). Histologically, follicular PTC subtype did not affect DSS or OS. Patients who had received radioactive iodine had poorer DSS but improved OS. Patients undergoing external beam radiation therapy had poor DSS (hazard ratio, 4.48; 95% confidence interval, 3.30-6.06; P < .001) and OS (1.71; 1.42-2.07; P < .001). CONCLUSIONS The results of this study compel us to reinvestigate the current PTC surgical recommendations of total thyroidectomy based on tumor size because this may not affect survival across all populations. In addition, the current use of external beam radiation therapy for the treatment of PTC should be reexamined.
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Wu AW, Mowry SE, Vinuela F, Abemayor E, Wang MB. Bilateral vascular supply in juvenile nasopharyngeal angiofibromas. Laryngoscope 2010; 121:639-43. [DOI: 10.1002/lary.21337] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2010] [Indexed: 12/21/2022]
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Lau OD, Nabili V, Lai C, Kirsch CF, Tantiwongkosi B, Abemayor E. Pathology quiz case 1. Diagnosis: Sinonasal malignant Triton tumor (MTT) with intracranial extension. ACTA ACUST UNITED AC 2010; 136:929, 931. [PMID: 20855691 DOI: 10.1001/archoto.2010.137-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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79
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Mendelsohn AH, Lai CK, Shintaku IP, Elashoff DA, Dubinett SM, Abemayor E, St John MA. Histopathologic findings of HPV and p16 positive HNSCC. Laryngoscope 2010; 120:1788-94. [PMID: 20803740 DOI: 10.1002/lary.21044] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Human papilloma virus (HPV) and p16INKa (p16) positivity in head and neck squamous cell carcinomas (HNSCCs) is currently thought to be an encouraging prognostic indicator. However, the histopathologic changes responsible for this behavior are poorly understood. It is our objective to elucidate these histopathologic characteristics to help define the clinical utility of these markers. DESIGN Retrospective cohort study. METHODS 71 HNSCC tumors between July 1, 2008 and August 30, 2009 were examined for HPV, p16, and epidermal growth factor receptor (EGFR). Specified pathologic features were examined: perivascular invasion (PVI), perineural invasion (PNI), grade of squamous differentiation, basaloid classification. RESULTS HPV and p16 had no direct impact on perineural or perivascular invasion. However, HPV and p16 were strongly predictive of poorly differentiated tumors, as well as basaloid squamous cell carcinoma (SCCA) (P < .001). Additionally, upon multivariate analysis, HPV(+) and p16(+) tumors had an increased risk of nodal metastasis (HPV: odds ratio [OR] = 23.9 (2.2, 265.1) p = .01; p16: OR = 6.5 (1.4, 31.2) p = .02; PVI: OR = 6.0 (1.6, 22.8) p < .01). The area under the curve (AUC) of receiver operating characteristic (ROC) curves demonstrated improved predictive value for lymph node metastasis above standard H&E histopathologic features (76.7%) for both HPV (83.2%) and p16 (81.3%) individually. CONCLUSIONS HPV(+) and p16(+) are highly predictive for poorly differentiated tumors and basaloid SCCA. Additionally, HPV and p16 positivity demonstrate superior predictive value for lymph node metastasis above standard H&E histopathologic features. Although exact recommendations should be tempered by considerations of primary tumor subsite, T-stage, and depth of invasion, head and neck multidisciplinary teams should strongly consider aggressive lymph node treatment for any HPV(+) or p16(+) tumor.
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Abemayor E. Foresight and courage: Levi Cooper Lane, MD, a model head and neck surgeon. Laryngoscope 2010; 113:1834-8. [PMID: 14520115 DOI: 10.1097/00005537-200310000-00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To detail the life and achievements of Levi Cooper Lane, MD, author of the first American textbook on surgery of the head and neck. METHODS Literature search and analysis. RESULTS/CONCLUSIONS While some of Lane's observations have been diluted by the passage of time, the lessons imparted by his life and work merit continued study by contemporary head and neck surgeons.
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Dohadwala M, Wang G, Heinrich E, Luo J, Lau O, Shih H, Munaim Q, Lee G, Hong L, Lai C, Abemayor E, Fishbein MC, Elashoff DA, Dubinett SM, St John MA. The role of ZEB1 in the inflammation-induced promotion of EMT in HNSCC. Otolaryngol Head Neck Surg 2010; 142:753-9. [PMID: 20416468 DOI: 10.1016/j.otohns.2010.01.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 12/20/2009] [Accepted: 01/28/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine the role of ZEB1 in the inflammation-induced promotion of the epithelial-mesenchymal transition (EMT) in head and neck squamous cell carcinoma (HNSCC). STUDY DESIGN A molecular biology study. Real-time quantitative reverse-transcriptase polymerase chain reaction (RT-PCR), Western blot analysis, and immunohistochemical staining of human HNSCC tissue sections were used to determine how inflammation affects the transcriptional repressor, ZEB1. SETTING An academic hospital laboratory. SUBJECTS AND METHODS Relative ZEB1 RNA levels were determined by RT-PCR, and protein expression was evaluated in situ by immunohistochemical staining of human HNSCC tissue sections. RESULTS IL-1beta-treated HNSCC cell lines demonstrated a significant decrease in E-cadherin mRNA and an increase in the mRNA expression of the transcriptional repressor ZEB1. IL-1beta exposure led to enhanced ZEB1 binding at the chromatin level, as determined by chromatin immunoprecipitation assays (ChIP). An inverse relationship between ZEB1 and E-cadherin was demonstrated in situ by immunohistochemical staining of human HNSCC tissue sections. CONCLUSIONS Our recent investigations indicate that inflammatory mediators are potent regulators of EMT in HNSCC. This is the first report indicating the role of ZEB1 in the inflammation-induced promotion of EMT in HNSCC. This newly defined pathway for transcriptional regulation of E-cadherin in HNSCC has important implications for targeted chemoprevention and therapy.
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Suh JD, Blackwell KE, Sercarz JA, Cohen M, Liu JH, Tang CG, Abemayor E, Nabili V. Disease relapse after segmental resection and free flap reconstruction for mandibular osteoradionecrosis. Otolaryngol Head Neck Surg 2010; 142:586-91. [DOI: 10.1016/j.otohns.2009.12.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 11/14/2009] [Accepted: 12/03/2009] [Indexed: 10/19/2022]
Abstract
Objective: The objective of this study was to assess the outcomes, complications, and incidence of disease recurrence of mandibular osteoradionecrosis (ORN) after resection and microvascular free flap reconstruction. Study Design: Case series with chart review. Setting: Academic medical center. Subjects And Methods: Retrospective patient data review of 40 patients with mandibular ORN who were treated by segmental mandibulectomy and microvascular reconstruction between 1995 and 2009. All patients received radiation therapy for previous head and neck cancer, and 12 of 40 patients received concurrent chemotherapy. All patients failed to respond to conservative management. There were 26 males and 14 females, with a median age of 62 years. Median follow-up was 17.4 months. Results: There were no free flap failures. The incidence of wound-related complications was 55 percent. Median time to complication was 10.6 months. Ten (25%) patients developed symptoms of residual or recurrent ORN, with 70 percent of the recurrences arising in unresected condyles that were adjacent to the segmental mandibulectomy. Statistical analysis revealed that current smokers were at reduced risk to develop residual or recurrent ORN. Conclusion: This present study confirms that microvascular free flaps are reliable for treatment of advanced mandibular ORN. Nevertheless, there remains a 55 percent incidence of wound-healing complications. The lack of objective clinical criteria to judge the appropriate amount of mandible resection in patients with ORN remains an unresolved issue that resulted in the development of recurrent ORN in 25 percent of patients. Further investigations are needed to better understand the pathophysiology of ORN to prevent postoperative wound complications and disease recurrence.
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Mendelsohn AH, Bhuta S, Calcaterra TC, Shih HB, Abemayor E, St John MA. Parapharyngeal space pleomorphic adenoma: a 30-year review. Laryngoscope 2009; 119:2170-4. [PMID: 19824044 DOI: 10.1002/lary.20496] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the treatment results of pleomorphic adenoma (PA) of the parapharyngeal space at a single institution during a 30-year period. STUDY DESIGN A retrospective review. METHODS This study was performed by examining the records and reviewing the pathology of 44 patients with PA of the parapharyngeal space treated at a single medical center from January 1975 to November 2005. RESULTS Of the 44 patients with PA, 35 patients underwent 38 excisions. Eleven men and 27 women were treated surgically. Follow-up varied from 24 months to 180 months. There were three recurrences in two patients. Recurrence rates at 5 and 10 years were equal at 7.9%. Gender, age, tumor volume, surgical approach, pathologic surgical margin status, and prior resections were evaluated for significant prognostic factors. Advanced age proved a poor prognostic indicator (P < .05). History of prior resection (P < .01) was significant for recurrence. Positive surgical margins (P = .69) proved a negative association. CONCLUSIONS We report low recurrence rates in this patient population with two important prognostic indicators. History of prior resection is significant to predict recurrence. Interestingly, positive surgical margins are actually shown not to effect risk of recurrence. Local recurrence of the tumor is associated with further recurrence and less favorable prognosis.
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St John MA, Dohadwala M, Luo J, Wang G, Lee G, Shih H, Heinrich E, Krysan K, Walser T, Hazra S, Zhu L, Lai C, Abemayor E, Fishbein M, Elashoff DA, Sharma S, Dubinett SM. Proinflammatory mediators upregulate snail in head and neck squamous cell carcinoma. Clin Cancer Res 2009; 15:6018-27. [PMID: 19789323 DOI: 10.1158/1078-0432.ccr-09-0011] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Inflammatory cytokines have been implicated in the progression of head and neck squamous cell carcinoma (HNSCC). Herein we investigate the mechanisms by which interleukin-1beta (IL-1beta) might contribute to Epithelial-Mesenchymal Transition (EMT) in HNSCC. EXPERIMENTAL DESIGN We evaluated the effect of IL-1beta on the molecular events of EMT in surgical specimens and HNSCC cell lines. We examined the correlation with tumor histologic features, and a SCID xenograft model was used to assess the effects of Snail overexpression. RESULTS Cyclooxygenase-2 (COX-2)-dependent pathways contribute to the modulation of E-cadherin expression in HNSCC. An inverse relationship between COX-2 and E-cadherin was shown in situ by double immunohistochemical staining of human HNSCC tissue sections. Treatment of HNSCC cells with IL-1beta caused the downregulation of E-cadherin expression and upregulation of COX-2 expression. This effect was blocked in the presence of COX-2 small hairpin RNA. IL-1beta-treated HNSCC cell lines showed a significant decrease in E-cadherin mRNA and an increase in the mRNA expression of the transcriptional repressor Snail. IL-1beta exposure led to enhanced Snail binding at the chromatin level. Small hairpin RNA-mediated knockdown of Snail interrupted the capacity of IL-1beta to downregulate E-cadherin. In a SCID xenograft model, HNSCC Snail-overexpressing cells showed significantly increased primary and metastatic tumor burdens. CONCLUSIONS IL-1beta modulates Snail and thereby regulates COX-2-dependent E-cadherin expression in HNSCC. This is the first report indicating the role of Snail in the inflammation-induced promotion of EMT in HNSCC. This newly defined pathway for transcriptional regulation of E-cadherin in HNSCC has important implications for targeted chemoprevention and therapy.
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Ahmed S, Sidell D, Blackwell KE, Sercarz JA, Abemayor E, Nabili V. The Use of Ultrasonic Shears for the Harvest of Perforator Free Flaps. ACTA ACUST UNITED AC 2009; 11:343-6. [DOI: 10.1001/archfacial.2009.64] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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86
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Sung AP, Bhuta S, Blackwell K, Suh J, Abemayor E. SP220 – Kimura's disease of the head and neck: Diagnosis and approach to management. Otolaryngol Head Neck Surg 2009. [DOI: 10.1016/j.otohns.2009.06.500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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87
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Cohen M, Nabili V, Nishimura I, Hokugo A, Beumer III J, Abemayor E, Juillard G. SP129 – A novel rat model of osteoradionecrosis of the mandible. Otolaryngol Head Neck Surg 2009. [DOI: 10.1016/j.otohns.2009.06.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sidell D, Nabili V, Lai C, Cheung G, Kirsch C, Abemayor E. Pediatric squamous cell carcinoma: Case report and literature review. Laryngoscope 2009; 119:1538-41. [PMID: 19522006 DOI: 10.1002/lary.20531] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Describe a rare pediatric malignancy. Discuss the clinical, diagnostic, and therapeutic differences between squamous cell carcinoma (SCC) of the adult and pediatric population. STUDY DESIGN Case report including a detailed radiological and histopathologic analysis and review of the literature. METHODS A case report is described from a tertiary care university hospital. Histopathologic assessment and radiological details are reviewed. A literature review of the background, incidence, disease course, and treatment options are presented. RESULTS This case report presents a 6-year-old male with a 2-month history of an enlarging oral lesion. The patient denied dysphagia, pain, weight loss, bleeding, or loosening of the teeth. Biopsy demonstrated invasive, well-differentiated, exophytic squamous cell carcinoma with perineural and angiolymphatic invasion. Computed tomography and magnetic resonance imaging demonstrated a 2.7 x 3.0 cm poorly marginated infiltrative mass involving the gingival aspect of the superior alveolar ridge and the adjacent bony marrow, primarily to the right of midline. Multiple small subcentimeter lymph nodes were also identified in the bilateral level II to V posterior cervical triangles bilaterally. CONCLUSIONS Pediatric SCC of the oral cavity is indeed a rare entity; however, its presence in the pediatric population should not be ignored. This case report describes the occurrence of SCC in the oral cavity of a 6-year-old male patient, the youngest case ever reported, and is a reminder that a multidisciplinary approach tailored to pediatric individuals is essential to obtain clear diagnoses and appropriate treatment plans.
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Park NJ, Zhou H, Elashoff D, Henson BS, Kastratovic DA, Abemayor E, Wong DT. Salivary microRNA: discovery, characterization, and clinical utility for oral cancer detection. Clin Cancer Res 2009; 15:5473-7. [PMID: 19706812 DOI: 10.1158/1078-0432.ccr-09-0736] [Citation(s) in RCA: 598] [Impact Index Per Article: 39.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE We have previously shown that a transcriptome is found in saliva and subpanels of these mRNAs can be used as oral cancer biomarkers. In this study, we measured the presence of microRNAs (miRNA) in saliva and determined their potential as an additional set of oral cancer biomarkers. EXPERIMENTAL DESIGN A total of 314 miRNAs were measured using reverse transcriptase-preamplification-quantitative PCR in 12 healthy controls. Degradation pattern of endogenous and exogenous saliva miRNAs were measured at room temperature over time. Selected miRNAs were validated in saliva of 50 oral squamous cell carcinoma patients and 50 healthy matched control subjects. RESULTS We detected approximately 50 miRNAs in both the whole and supernatant saliva. Endogenous saliva miRNA degraded much slower compared with exogenous miRNA. Two miRNAs, miR-125a and miR-200a, were present in significantly lower levels (P < 0.05) in the saliva of oral squamous cell carcinoma patients than in control subjects. CONCLUSIONS Both whole and supernatant saliva of healthy controls contained dozens of miRNAs, and similar to saliva mRNAs, these miRNAs are stable. Saliva miRNAs can be used for oral cancer detection.
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Abemayor E. United we stand, divided we fall. ARCHIVES OF OTOLARYNGOLOGY--HEAD & NECK SURGERY 2009; 135:432-433. [PMID: 19451460 DOI: 10.1001/archoto.2009.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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91
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Suh JD, Kim BP, Abemayor E, Sercarz JA, Nabili V, Liu JH, Juillard GJ, Blackwell KE. Reirradiation after salvage surgery and microvascular free flap reconstruction for recurrent head and neck carcinoma. Otolaryngol Head Neck Surg 2009; 139:781-6. [PMID: 19041503 DOI: 10.1016/j.otohns.2008.09.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2008] [Revised: 08/04/2008] [Accepted: 09/02/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the outcome and complications of reirradiation of recurrent head and neck cancer after salvage surgery and microvascular reconstruction. STUDY DESIGN Retrospective. SUBJECTS AND METHODS Twelve patients underwent salvage surgery with microvascular reconstruction for recurrent or second primary head and neck cancer in a previously irradiated field. Median prior radiation therapy dose was 63.0 Gy. Patients then underwent postoperative reirradiation, and received a median total cumulative radiation dose of 115.0 Gy. RESULTS Three (25%) patients experienced acute complications (<3 months) during reirradiation. Four (33%) patients developed grade 3 or 4 late reirradiation complications (>3 months). There were no incidences of free flap failure, brain necrosis, spinal cord injury, or carotid rupture. The incidence of soft tissue necrosis and osteoradionecrosis was 8%. Six (50%) patients are alive without evidence of recurrent disease a median of 40 months after reirradiation. CONCLUSION Microvascular free flaps allow for maximal resection and reliable reconstruction of previously irradiated cancers before high dose reirradiation and may reduce the incidence of severe late complications and treatment related mortality.
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Lee KJ, Abemayor E, Sayre J, Bhuta S, Kirsch CF. Perineural Spread of Cutaneous Head and Neck Malignancies: Imaging Manifestations and Therapeutic Management. Laryngoscope 2009. [DOI: 10.1002/lary.20423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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93
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Sidell DR, Nabili V, Bhuta SM, Kirsch C, Armin B, Abemayor E. Pediatric Intraoral Squamous Cell Carcinoma: A Case Report and Literature Review. Laryngoscope 2009. [DOI: 10.1002/lary.20475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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94
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Cohen M, Nabili V, Federman N, Birns JW, Nelson SD, Abemayor E. Giant Cell Fibroblastoma of the Epiglottis. Laryngoscope 2009. [DOI: 10.1002/lary.20409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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95
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Armin BB, Bhuta SM, Kirsch C, Penn R, Nabili V, Abemayor E. Intraparotid Kikuchi-Fujimoto Disease with Persistence of Disease: A Case Report. Laryngoscope 2009. [DOI: 10.1002/lary.20450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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96
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Lau OD, Bhuta S, Kirsch CM, Penn R, Nabili V, Abemayor E. Sinonasal Malignant Triton Tumor: A Case Report. Laryngoscope 2009. [DOI: 10.1002/lary.20420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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97
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Knott PD, Suh JD, Nabili V, Sercarz JA, Head C, Abemayor E, Blackwell KE. Evaluation of Hardware-Related Complications in Vascularized Bone Grafts With Locking Mandibular Reconstruction Plate Fixation. ACTA ACUST UNITED AC 2007; 133:1302-6. [DOI: 10.1001/archotol.133.12.1302] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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98
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Said M, Heffelfinger R, Sercarz JA, Abemayor E, Head C, Blackwell KE. Bilobed fibula flap for reconstruction of through-and-through oromandibular defects. Head Neck 2007; 29:829-34. [PMID: 17315169 DOI: 10.1002/hed.20612] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The role of fibula free flaps for reconstruction of through-and-through oromandibular defects is examined. METHODS Thirty-four patients underwent reconstruction of through-and-through oromandibular defects using fibula free flaps that contain large, bilobed skin paddles for simultaneous reconstruction of intraoral mucosa and external skin. We examined the incidence of wound healing complications, the need for revision reconstructive surgery, and factors affecting the incidence of complications. RESULTS Wound healing complications occurred in 50% of patients. There was a relatively high incidence of partial flap necrosis (26%) and revision surgery (41%). The area of the flap skin paddle was significantly associated with the risk of partial flap necrosis and the need for revision surgery. CONCLUSIONS Many through-and-through oromandibular defects can be successfully reconstructed using a fibula free flap that contains a large, bilobed skin paddle. However, wound healing complications are increased when the flap skin paddle area exceeds 300 cm2.
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Holtel MR, Terris DJ, Lee KJ, Kirsch CFE, Lufkin RB, Bhuta S, Abemayor E. 09:40: Identifying Perineural Invasion on Radiographic Images. Otolaryngol Head Neck Surg 2007. [DOI: 10.1016/j.otohns.2007.06.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kim AJ, Suh JD, Sercarz JA, Abemayor E, Head C, Funk G, Blackwell KE. Salvage surgery with free flap reconstruction: factors affecting outcome after treatment of recurrent head and neck squamous carcinoma. Laryngoscope 2007; 117:1019-23. [PMID: 17545864 DOI: 10.1097/mlg.0b013e3180536705] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine factors predicting the outcome after salvage surgery with microvascular flap reconstruction for recurrent squamous cell cancer (SCC) of the head and neck. STUDY DESIGN This is a retrospective analysis of patients treated at an academic medical center. METHODS One hundred six patients underwent salvage surgery and microvascular flap reconstruction after prior unsuccessful cancer treatment using surgery, radiation, or chemotherapy. All patients had a follow-up interval after salvage surgery of at least 24 months unless cancer rerecurrence occurred within 24 months after salvage surgery. Factors including age, sex, comorbidity level, tobacco use, alcohol use, disease-free interval since prior therapy, prior radiation, prior chemotherapy, prior surgery, recurrent tumor T class, recurrent tumor N class, recurrent cancer stage, and tumor location were examined to determine their association with cancer rerecurrence after salvage surgery. Successful treatment was defined as patients who remained free from cancer rerecurrence for a minimum 2 year period after salvage surgery. RESULTS Advanced recurrent T class (P = .02) was significantly associated with cancer recurrence. Recurrent cancer stage and patient smoking status approached statistical significance (P = .06). CONCLUSION Patients with recurrent T1 and T2 class are the best candidates for salvage surgery and microvascular flap reconstruction for treatment of recurrent SCC of the head and neck. Patients with T3 and T4 class recurrent cancers and patients who continue to smoke after initial diagnosis and treatment of head and neck SCC are poor candidates to undergo salvage surgery.
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