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Cravens MG, Nielsen TJ, Faucett EA, Erman AB. An unusual presentation of papillary thyroid carcinoma in a pediatric patient: A case report. Ear Nose Throat J 2018; 97:E7-E10. [PMID: 30540894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Cystic neck masses in the pediatric population are common but rarely concerning for malignancy. Given this typically benign nature, they are frequently managed conservatively. Here we present an unusual case of a waxing and waning cystic neck mass in a pediatric patient. After surgical removal, the mass was found to be metastatic papillary thyroid cancer. This is a unique presentation in the pediatric age group that has not yet been described. Based on this case, we suggest an expanded differential in any workup for a cystic neck mass to include papillary thyroid carcinoma, regardless of the patient's age.
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Affiliation(s)
- Matthew G Cravens
- University of Arizona College of Medicine - Tucson, 1501 N. Campbell Ave., PO Box 245017, Tucson, AZ 85724, USA.
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Faucett EA, Barry JY, McCrary HC, Saleh AA, Erman AB, Ishman SL. Otolaryngology Resident Education and the Accreditation Council for Graduate Medical Education Core Competencies. JAMA Otolaryngol Head Neck Surg 2018. [DOI: 10.1001/jamaoto.2017.3163] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Erynne A. Faucett
- Department of Otolaryngology−Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jonnae Y. Barry
- Department of Otolaryngology, University of Arizona College of Medicine, Tucson
| | - Hilary C. McCrary
- Department of Otolaryngology, University of Utah School of Medicine, Salt Lake City
| | | | - Audrey B. Erman
- Department of Otolaryngology, University of Utah School of Medicine, Salt Lake City
| | - Stacey L. Ishman
- Division of Pediatric Otolaryngology−Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Otolaryngology−Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio
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Faucett EA, McCrary HC, Barry JY, Saleh AA, Erman AB, Ishman SL. High-Quality Feedback Regarding Professionalism and Communication Skills in Otolaryngology Resident Education. Otolaryngol Head Neck Surg 2017; 158:36-42. [DOI: 10.1177/0194599817737758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The Accreditation Council for Graduate Medical Education (ACGME) requires competency-based education for residents and recommends 5 basic features of high-quality feedback. Our aim was to examine the incorporation of feedback in articles regarding professionalism and interpersonal/communication skills for otolaryngology residency training curriculum. Data Sources PubMed, Embase, ERIC, Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov . Methods We used studies identified during a systematic review of all indexed years through October 4, 2016. Results Eighteen studies were included in this review. Professionalism was discussed in 16, of which 15 (94%) examined aspects of feedback. Interpersonal/communication skills were the focus of 16 articles, of which 14 16 (88%) discussed aspects of feedback. Our assessment demonstrated that timeliness was addressed in 8 (44%) articles, specificity in 4 (22%), learner reaction and reflection in 4 (22%), action plans in 3 (20%), and balancing reinforcing/corrective feedback in 2 (13%). Two articles did not address feedback, and 6 did not address aspects of high-quality feedback. The ACGME-recommended feedback systems of ADAPT (ask, discuss, ask, plan together) and R2C2 (relationship, reactions, content, and coach) were not reported in any of the studies. Conclusion Feedback is an essential component of graduate medical education and is required by the ACGME milestones assessment system. However, the core feedback components recommended by the ACGME are rarely included in the otolaryngology resident education literature.
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Affiliation(s)
- Erynne A. Faucett
- Department of Otolaryngology and Head and Neck Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | | | - Jonnae Y. Barry
- Department of Otolaryngology and Head and Neck Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Ahlam A. Saleh
- Health Sciences Library, University of Arizona, Tucson, Arizona, USA
| | - Audrey B. Erman
- Department of Otolaryngology and Head and Neck Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Stacey L. Ishman
- Division of Pediatric Otolaryngology Head and Neck Surgery & Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati College of Medicine Cincinnati, Ohio, USA
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Abstract
Introduction Advanced Kadish stage esthesioneuroblastoma requires more extensive resections and aggressive adjuvant therapy to obtain adequate disease-free control, which can lead to higher complication rates. We describe the case of a patient with Kadish D esthesioneuroblastoma who underwent multiple surgeries for infectious, neurologic, and wound complications, highlighting potential preventative and salvage techniques. Case Presentation A 61-year-old man who presented with a large left-sided esthesioneuroblastoma, extending into the orbit, frontal lobe, and parapharyngeal nodes. He underwent margin-free endoscopic-assisted craniofacial resection with adjuvant craniofacial and cervical radiotherapy and concomitant chemotherapy. He then returned with breakdown of his skull base reconstruction and subsequent frontal infections and ultimately received 10 surgical procedures with surgeries for infection-related issues including craniectomy and abscess evacuation. He also had surgeries for skull base reconstruction and CSF leak, repaired with vascularized and free autologous grafts and flaps, synthetic tissues, and CSF diversion. Discussion Extensive, high Kadish stage tumors necessitate radical surgical resection, radiation, and chemotherapy, which can lead to complications. Ultimately, there are several options available to surgeons, and although precautions should be taken whenever possible, risk of wound breakdown, leak, or infection should not preclude radical surgical resection and aggressive adjuvant therapies in the treatment of esthesioneuroblastoma.
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Affiliation(s)
- Sheri K Palejwala
- Division of Neurosurgery, Department of Surgery, University of Arizona, Tucson, Arizona, United States
| | - Saurabh Sharma
- Department of Otolaryngology, University of Arizona, Tucson, Arizona, United States
| | - Christopher H Le
- Department of Otolaryngology, University of Arizona, Tucson, Arizona, United States
| | - Eugene Chang
- Department of Otolaryngology, University of Arizona, Tucson, Arizona, United States
| | - Audrey B Erman
- Department of Otolaryngology, University of Arizona, Tucson, Arizona, United States
| | - G Michael Lemole
- Division of Neurosurgery, Department of Surgery, University of Arizona, Tucson, Arizona, United States
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McCrary HC, Faucett EA, Erman AB. Immunoglobulin G4-related sclerosing disease Mimicking sjogren's syndrome: A case report. Laryngoscope 2016; 126:2242-5. [PMID: 27296721 DOI: 10.1002/lary.26112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2016] [Indexed: 11/09/2022]
Abstract
Immunoglobulin G4-related sclerosing disease (IgG4-RSD) is a fibroinflammatory condition that has the potential to affect nearly every organ system. Classic histological findings include storiform fibrosis and lymphoplasmacytic infiltrates of immunoglobulin G4 (IgG4)-positive plasma cells. The clinical features of IgG4-RSD may be an under-recognized disease process that can mimic other autoimmune disorders, including Sjogren's syndrome. We describe a rare case of IgG4-RSD involving the salivary glands, initially misdiagnosed as Sjogren's syndrome. Clinical features of IgG4-RSD can mimic those of other autoimmune disorders affecting the head and neck. Therefore, otolaryngologists should have IgG4-RSD on their differential when evaluating patients with diffuse salivary gland swelling. Laryngoscope, 126:2242-2245, 2016.
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Affiliation(s)
- Hilary C McCrary
- University of Arizona College of Medicine, Tucson, Arizona, U.S.A..
| | - Erynne A Faucett
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson, Arizona, U.S.A
| | - Audrey B Erman
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson, Arizona, U.S.A
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Abstract
Methamphetamines are the second most commonly used illicit drug worldwide and cost the United States health-care system ∼$23.4 billion annually. Use of this drug affects multiple organ systems and causes a variety of clinical manifestations. Although there are commonly known sequelae of methamphetamine abuse such as "meth mouth," there is limited evidence regarding maxillary sinus manifestations. The following cases highlight the initial evaluation and management of two methamphetamine abusers with loculated purulent collections within the maxillary sinus as a result of methamphetamine abuse. Our aim was to delineate the otolaryngologic symptoms associated with the patients' methamphetamine abuse. Computed tomography and magnetic resonance imaging studies revealed loculated purulent collections within the maxillary sinus of probable odontogenic origin in both patients. Methamphetamine abuse leading to rampant caries and poor oral hygiene may predispose individuals for craniofacial infections and fluid collections. These cases illustrate the development of maxillary sinusitis and maxilla mucoceles that have been associated with methamphetamine use.
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Affiliation(s)
- Erynne A Faucett
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
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Herr MW, Gray ST, Erman AB, Curry WT, Deschler DG, Lin DT. Orbital preservation in patients with esthesioneuroblastoma. J Neurol Surg B Skull Base 2013; 74:142-5. [PMID: 24436904 DOI: 10.1055/s-0033-1338259] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022] Open
Abstract
Objectives Surgical resection in addition to adjuvant radiation with or without chemotherapy is the mainstay of treatment for esthesioneuroblastoma (ENB). However, management of patients with orbital involvement remains controversial. Historically, orbital exenteration has been advocated when there is evidence of periorbital invasion. Recently, the indications for orbital exenteration have become more selective and orbital preservation has been advocated. We report our experience with anterior craniofacial resection and orbital preservation in patients with ENB. Design Retrospective review of all patients diagnosed with esthesioneuroblastoma who underwent traditional open anterior craniofacial resection at the Massachusetts General Hospital/Massachusetts Eye and Ear Infirmary Cranial Base Center from 1997 to 2008. Results Sixteen patients were identified with a mean follow-up of 76 months. All patients underwent anterior craniofacial resection via an open approach and adjuvant proton beam radiation. Six of the 16 patients had evidence of either periorbital or lacrimal sac involvement at the time of surgery. All of these patients underwent periorbital resection to negative histologic margins with preservation of the orbit. Conclusion In our study, patients with ENB and periorbital invasion-who were treated with anterior craniofacial resection and periorbital resection with orbital preservation-had no evidence of decreased survival. In all patients, negative histologic margins of the periorbital resection were achieved.
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Affiliation(s)
- Marc W Herr
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts, USA
| | - Stacey T Gray
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts, USA
| | - Audrey B Erman
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona Cancer Center, Tucson, Arizona, USA
| | - William T Curry
- Department of Neurosurgery, Pappas Center for Neuro-oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel G Deschler
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts, USA
| | - Derrick T Lin
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts, USA
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Erman AB, Collar RM, Griffith KA, Lowe L, Sabel MS, Bichakjian CK, Wong SL, McLean SA, Rees RS, Johnson TM, Bradford CR. Sentinel lymph node biopsy is accurate and prognostic in head and neck melanoma. Cancer 2011; 118:1040-7. [PMID: 21773971 DOI: 10.1002/cncr.26288] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 04/25/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) has emerged as a widely used staging procedure for cutaneous melanoma. However, debate remains around the accuracy and prognostic implications of SLNB for cutaneous melanoma arising in the head and neck, as previous reports have demonstrated inferior results to those in nonhead and neck regions. Through the largest single-institution series of head and neck melanoma patients, the authors set out to demonstrate that SLNB accuracy and prognostic value in the head and neck region are comparable to other sites. METHODS A prospectively collected database was queried for cutaneous head and neck melanoma patients who underwent SLNB at the University of Michigan between 1997 and 2007. Primary endpoints included SLNB result, time to recurrence, site of recurrence, and date and cause of death. Multivariate models were constructed for analyses. RESULTS Three hundred fifty-three patients were identified. A sentinel lymph node was identified in 352 of 353 patients (99.7%). Sixty-nine of the 353 (19.6%) patients had a positive SLNB. Seventeen of 68 patients (25%) undergoing completion lymphadenectomy after a positive SLNB result had at least 1 additional positive nonsentinel lymph node. Patients with local control and a negative SLNB failed regionally in 4.2% of cases. Multivariate analysis revealed positive SLNB status to be the most prognostic clinicopathologic predictor of poor outcome; hazard ratio was 4.23 for SLNB status and recurrence-free survival (P < .0001) and 3.33 for overall survival (P < .0001). CONCLUSIONS SLNB is accurate and its results are of prognostic importance for head and neck melanoma patients.
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Affiliation(s)
- Audrey B Erman
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan 48109-5312, USA
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Abstract
AbstractImprovements in voice rehabilitation over the past century have paralleled the surgical success of laryngectomy. The establishment of the tracheoesophageal puncture marked a turning point in the development of successful and dependable voice rehabilitation. Surgical options include both primary and secondary placement of a tracheoesophageal puncture. Though complications, such as pharyngoesophageal spasm or prosthesis leakage may occur, patients should expect functional voice restoration after laryngectomy.
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Abstract
The glossopharyngeal and vagus nerves mediate the complex interplay between the many functions of the upper aerodigestive tract. Defects may occur anywhere from the brainstem to the peripheral nerve and can result in significant impairment in speech, swallowing, and breathing. Multiple etiologies can produce symptoms. In this review, the authors broadly examine the normal functions, clinical examination, and various pathologies of cranial nerves IX and X.
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Affiliation(s)
- Audrey B Erman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
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