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Ananthapadmanabhan S, Kudpaje A, Raju D, Smith M, Riffat F, Novakovic D, Stokan M, Palme CE. Trans-nasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) and its Utility in Otolaryngology, Head and Neck Surgery: A Literature Review. Indian J Otolaryngol Head Neck Surg 2024; 76:1921-1930. [PMID: 38566676 PMCID: PMC10982204 DOI: 10.1007/s12070-023-04445-2] [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] [Received: 11/01/2023] [Accepted: 12/13/2023] [Indexed: 04/04/2024] Open
Abstract
High-flow nasal oxygen (HFNO) therapy is extensively used in critical care units for spontaneously breathing patients. Trans-nasal humidified rapid insufflation ventilatory exchange (THRIVE) is a method of apnoeic oxygenation with continuous nasal delivery of warmed, humidified oxygen at high-flow rates up to 70L/min. THRIVE extends the apnoeic window before desaturation occurs so that tubeless anaesthesia is possible. The advent of THRIVE has had a monumental impact on anaesthetic practice, with a diverse range of clinical applications and it has been incorporated into difficult airway guidelines. THRIVE has many applications in otolaryngology and head and neck surgery. It is used as a pre-oxygenation tool during induction in both anticipated and unanticipated difficult airway scenarios and as a method of oxygenation for tubeless anaesthesia in elective laryngotracheal and hypopharyngeal surgeries and during emergence from anaesthesia. In this scoping review of the literature, we aim to provide an overview on the utility of THRIVE in otolaryngology, including the underlying physiologic principles, current indications and limitations, and its feasibility and safety in different surgical contexts and specific population groups.
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Affiliation(s)
| | - Akshay Kudpaje
- Department of Head and Neck Surgical Oncology, Cytecare Cancer Hospital, Bangalore, Karnataka India
| | - Dinesh Raju
- Department of Anaesthesia, Critical Care, and Pain, Cytecare Cancer Hospital, Bangalore, Karnataka India
| | - Mark Smith
- Department of Otolaryngology, Westmead Hospital, Westmead, NSW 2145 Australia
- Chris O’Brien Lifehouse, Camperdown, NSW Australia
| | - Faruque Riffat
- Department of Otolaryngology, Westmead Hospital, Westmead, NSW 2145 Australia
- Chris O’Brien Lifehouse, Camperdown, NSW Australia
| | - Daniel Novakovic
- Chris O’Brien Lifehouse, Camperdown, NSW Australia
- The Canterbury Hospital, Campsie, NSW Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW Australia
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Key S, Chia C, Hasan Z, Sundaresan P, Riffat F, Dwivedi RC. Molecular Factors in Carcinoma Ex Pleomorphic Adenoma: Systematic Review and Meta-Analysis. Laryngoscope 2024; 134:1042-1053. [PMID: 37610148 DOI: 10.1002/lary.30993] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/15/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE Carcinoma ex pleomorphic adenoma (CXPA) is a rare malignant salivary gland tumor. Although multiple reviews have been published on salivary gland malignancies, it has been a decade since the last dedicated systematic review pertaining to CXPA alone was published. This study examines molecular factors in CXPA diagnosis. DATA SOURCES MEDLINE, CINAHL, Embase, Scopus, Web of Science (BIOSIS), Cochrane CENTRAL, Health Collection (Informit), OpenDOAR, and GreyNet International. REVIEW METHODS Systematic review and meta-analysis from inception to October 31, 2022 for all English language studies pertaining to "carcinoma ex pleomorphic adenoma." Predicted incidence of each biomarker was calculated with meta-analysis. Comparison against pleomorphic adenoma (PA) and salivary duct carcinoma (SDC) when reported within the same study are performed. Risk of bias performed with JBI tool for prevalence studies. RESULTS Of 19151 unique studies undergoing abstract screening, 55 studies (n = 1322 patients) underwent data analysis. Biomarkers with >3 studies were p53, HER2, AR, EGFR, PLAG1, ERBB, ER, PR, HMGA2, p16, p63, a-SMA, RAS, PTEN, PDL1, BRAF, PIK3CA, and c-kit. Highest incidence was seen in AR, EGFR, p16, and p53. Significant differences were demonstrated compared with PA and SDC. There was high heterogeneity and overall high risk of bias within studies. CONCLUSION Molecular factors are an area of interest in the diagnosis of CXPA. Our study results support examining CXPA as a discrete cohort in future targeted therapy trials. Laryngoscope, 134:1042-1053, 2024.
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Affiliation(s)
- Seraphina Key
- Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Clemente Chia
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Zubair Hasan
- Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
- Department of Otolaryngology - Head and Neck Surgery, Westmead Hospital, New South Wales, Westmead, New South Wales, Australia
- Department of Otolaryngology - Head and Neck Surgery, John Hunter Hospital, Sydney, New South Wales, Australia
| | - Purnima Sundaresan
- Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Faruque Riffat
- Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
- Department of Otolaryngology - Head and Neck Surgery, Westmead Hospital, New South Wales, Westmead, New South Wales, Australia
- Macquarie University Hospital, Macquarie University, New South Wales, Australia
| | - Raghav C Dwivedi
- Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Department of Otolaryngology - Head and Neck Surgery, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
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Wong E, Smith M, Buchanan MA, Kudpaje A, Williamson A, Hedge PS, Hazan D, Idiare J, Smith MC, Sritharan N, Palme C, Riffat F. Correction: Smell-related quality of life changes after total laryngectomy: a multi-centre study. Eur Arch Otorhinolaryngol 2023; 280:4721. [PMID: 37584754 PMCID: PMC10477126 DOI: 10.1007/s00405-023-08161-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Affiliation(s)
- Eugene Wong
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, University of Sydney, Camperdown, NSW, 2006, Australia.
- Department of Surgery, School of Medicine and Health Sciences, University of Sydney, Camperdown, Australia.
| | - Murray Smith
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
| | | | - Akshay Kudpaje
- Department of Head and Neck Surgical Oncology, Cytecare Cancer Hospitals, Bangalore, India
| | - Andrew Williamson
- Department of ENT Surgery, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Prasanna Suresh Hedge
- Department of Head and Neck Surgical Oncology, Cytecare Cancer Hospitals, Bangalore, India
| | - Daniel Hazan
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Jordan Idiare
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Mark C Smith
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
- Department of Surgery, School of Medicine and Health Sciences, University of Sydney, Camperdown, Australia
- Chris O'Brien Lifehouse, Camperdown, NSW, 2006, Australia
- Department of Otolaryngology, Head and Neck Surgery, Macquarie University Hospital, Macquarie Park, Australia
| | - Niranjan Sritharan
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
- Department of Surgery, School of Medicine and Health Sciences, University of Sydney, Camperdown, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Carsten Palme
- Department of Surgery, School of Medicine and Health Sciences, University of Sydney, Camperdown, Australia
- Chris O'Brien Lifehouse, Camperdown, NSW, 2006, Australia
| | - Faruque Riffat
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
- Department of Surgery, School of Medicine and Health Sciences, University of Sydney, Camperdown, Australia
- Chris O'Brien Lifehouse, Camperdown, NSW, 2006, Australia
- Department of Otolaryngology, Head and Neck Surgery, Macquarie University Hospital, Macquarie Park, Australia
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Wong E, Smith M, Buchanan MA, Kudpaje A, Williamson A, Hedge PS, Hazan D, Idaire J, Smith MC, Sritharan N, Palme C, Riffat F. Smell-related quality of life changes after total laryngectomy: a multi-centre study. Eur Arch Otorhinolaryngol 2023; 280:3861-3866. [PMID: 37115324 PMCID: PMC10313529 DOI: 10.1007/s00405-023-07976-0] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE A total laryngectomy creates an alternate airway for gas exchange that bypasses the upper aerodigestive tract. The subsequent reduction in nasal airflow, and therefore, reduction in deposition of particles to the olfactory neuroepithelium leads to hyposmia or anosmia. The aim of this study was to assess the quality of life impairment conferred by anosmia following laryngectomy and identify any specific patient-related risk factors that are associated with poorer outcomes. METHODS Consecutive patients with a total laryngectomy presenting for review at three tertiary head and neck services (in Australia, the United Kingdom and India) over a 12-month period were recruited. Patient demographic and clinical data were collected, and each subject completed the validated assessment of self-reported olfactory functioning and olfaction-related quality of life questionnaire (ASOF). Dichotomous comparisons were performed using the student's unpaired t-test for continuous variables (SRP), a chi-squared test for categorical variables, and a Kendall's tau-b for ordinal variables (SOC) to assess for a correlation with poorer questionnaire scores. RESULTS A total of 66 laryngectomees (13.4% female; age 65.7 ± 8.6 years) were included in the study. The mean SRP score of the cohort was found to be 15.6 ± 7.4, while the mean ORQ score was noted to be 16.4 ± 8.1. No other specific risk factors associated with poorer quality of life were identified. CONCLUSION A significant quality of life detriment from hyposmia is conferred following laryngectomy. Further research to assess treatment options and the patient population that would best benefit from these interventions is required.
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Affiliation(s)
- Eugene Wong
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, University of Sydney, Camperdown, NSW, 2006, Australia.
- Department of Surgery, School of Medicine and Health Sciences, University of Sydney, Camperdown, Australia.
| | - Murray Smith
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
| | | | - Akshay Kudpaje
- Department of Head and Neck Surgical Oncology, Cytecare Cancer Hospitals, Bangalore, India
| | - Andrew Williamson
- Department of ENT Surgery, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Prasanna Suresh Hedge
- Department of Head and Neck Surgical Oncology, Cytecare Cancer Hospitals, Bangalore, India
| | - Daniel Hazan
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Jordan Idaire
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Mark C Smith
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
- Department of Surgery, School of Medicine and Health Sciences, University of Sydney, Camperdown, Australia
- Chris O'Brien Lifehouse, Camperdown, NSW, 2006, Australia
- Department of Otolaryngology, Head and Neck Surgery, Macquarie University Hospital, Macquarie Park, Australia
| | - Niranjan Sritharan
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
- Department of Surgery, School of Medicine and Health Sciences, University of Sydney, Camperdown, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Carsten Palme
- Department of Surgery, School of Medicine and Health Sciences, University of Sydney, Camperdown, Australia
- Chris O'Brien Lifehouse, Camperdown, NSW, 2006, Australia
| | - Faruque Riffat
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
- Department of Surgery, School of Medicine and Health Sciences, University of Sydney, Camperdown, Australia
- Chris O'Brien Lifehouse, Camperdown, NSW, 2006, Australia
- Department of Otolaryngology, Head and Neck Surgery, Macquarie University Hospital, Macquarie Park, Australia
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Ahmadi N, Stone D, Stokan M, Coleman H, Heller G, Smith M, Riffat F, Kudpaje A, Veness M, Palme CE. Treatment of Early Glottic cancer with Transoral Laser Microsurgery: An Australian Experience. Indian J Otolaryngol Head Neck Surg 2023; 75:661-667. [PMID: 37274960 PMCID: PMC10235397 DOI: 10.1007/s12070-022-03392-8] [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] [Received: 05/05/2022] [Accepted: 12/07/2022] [Indexed: 12/30/2022] Open
Abstract
Introduction Early laryngeal carcinomas may be treated by transoral laser microsurgery (TLM) or external beam radiotherapy. We review our experience of surgical treatment of laryngeal pre-malignant and malignant lesions over the past 15 years in a high-volume head neck unit. Methods A review of a prospective patient database of patients with laryngeal SCC, who were treated with CO2 TLM between 2004 and 2019 was carried out. Results 83 patients with a mean age of 67.7 (SD: 10.6) years underwent primary curative TLM for T1a/b SCC. 5-year overall survival was 93.2% (95%CI 86.9-100%), disease free survival was 86.0% (95%CI 78.1-94.6%), locoregional control was 91.2% (95%CI: 85.1-97.7%) and larynx preservation rate of 95.1% at 5 years. Conclusion TLM is an excellent treatment modality for T1 early glottic SCC, with excellent locoregional control and disease-free survival. It is minimally invasive, outpatient-based, and cost-effective procedure preserving upper aerodigestive tract dysfunction for all activities of daily living.
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Affiliation(s)
- Navid Ahmadi
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, Sydney, NSW Australia
- Department of ENT, Westmead Hospital, Sydney, NSW Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW Australia
| | - Danielle Stone
- Crown Princess Cancer Care Centre, Westmead hospital, Sydney, NSW Australia
| | - Murray Stokan
- Department of Anaesthetics, Westmead Hospital, Sydney, NSW Australia
| | - Hedley Coleman
- Crown Princess Cancer Care Centre, Westmead hospital, Sydney, NSW Australia
- Douglass Hanly Moir Pathology, Sydney, NSW Australia
| | - Gillian Heller
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW Australia
| | - Mark Smith
- Department of ENT, Westmead Hospital, Sydney, NSW Australia
| | - Faruque Riffat
- Department of ENT, Westmead Hospital, Sydney, NSW Australia
| | - Akshay Kudpaje
- Crown Princess Cancer Care Centre, Westmead hospital, Sydney, NSW Australia
- Cytecare Cancer Hospitals, Bangalore, India
| | - Michael Veness
- Crown Princess Cancer Care Centre, Westmead hospital, Sydney, NSW Australia
- Sydney Medical School, University of Sydney, Sydney, NSW Australia
| | - Carsten E Palme
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, Sydney, NSW Australia
- Department of ENT, Westmead Hospital, Sydney, NSW Australia
- Sydney Medical School, University of Sydney, Sydney, NSW Australia
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Tjahjono R, Ahmadi N, Riffat F, Kudpaje A, Palme CE. Pathologically Negative Excision for Biopsy-Proven Early Glottic Carcinoma. Indian J Otolaryngol Head Neck Surg 2023; 75:278-281. [PMID: 37274959 PMCID: PMC10234992 DOI: 10.1007/s12070-022-03232-9] [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] [Received: 03/26/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
In certain instances, patients who underwent endoscopic laser excision (ELE) for biopsy-proven early glottic carcinoma do not show any evidence of carcinomatous cells on histopathologic analysis. Our study aims to determine the incidence of this phenomenon. A retrospective analysis of patients with biopsy-proven early glottic squamous cell carcinoma who underwent ELE was conducted. 121 patients with a mean age of 68.2 ± 10.7 were included in this study. Initial biopsy showed carcinoma in situ in 38 patients, (31.4%), T1a in 41 patients (33.9%), and T1b in 42 patients (34.7%). Following ELE, a pathologically negative excision was seen in 26 patients (21.5%). Disease recurrence occurred in 3 patients who had a pathologically negative excision (11.5%). Following repeat ELE, all patients remained disease free. A significant number of early glottic carcinoma present with small volume disease which may be eradicated with diagnostic biopsy alone.
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Affiliation(s)
- Richard Tjahjono
- Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Sydney, Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Navid Ahmadi
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse Joint Head of ENT – HNS, University of Sydney, 119-143 Missenden Rd, Camperdown, Sydney, NSW 2050 Australia
- Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Faruque Riffat
- Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Sydney, Australia
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse Joint Head of ENT – HNS, University of Sydney, 119-143 Missenden Rd, Camperdown, Sydney, NSW 2050 Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Akshay Kudpaje
- Department of Head and Neck Surgical Oncology, Cytecare Cancer Hospitals, Bengaluru, Karnataka India
| | - Carsten E. Palme
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse Joint Head of ENT – HNS, University of Sydney, 119-143 Missenden Rd, Camperdown, Sydney, NSW 2050 Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
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Tjahjono R, Phung D, Elliott MS, Riffat F, Palme CE. The Utility of Near-Infrared Autofluorescence for Parathyroid Gland Identification During Thyroid Surgery: A Single-Center Experience. Indian J Otolaryngol Head Neck Surg 2023; 75:121-125. [PMID: 37007878 PMCID: PMC10050657 DOI: 10.1007/s12070-022-03309-5] [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] [Received: 03/26/2022] [Accepted: 11/28/2022] [Indexed: 12/07/2022] Open
Abstract
Parathyroid gland injury during thyroid surgery is common and can lead to postoperative hypocalcemia. This study aims to determine the utility of near-infrared autofluorescence (NIRAF) technology for parathyroid gland identification in thyroid surgery. A prospective case series of patients who underwent thyroid surgery between March and June 2021 were examined. Following intra-operative visualisation, parathyroid glands and surrounding tissues were exposed to near-infrared light with a wavelength of approximately 800 nm using the Storz® Near-Infrared Range/Indocyanine Green (NIR/ICG) endoscopic system. Parathyroid glands were expected to show autofluorescence following exposure. Twenty patients who underwent thyroid surgery were included. Eighteen patients (90%) were female, with a median age of 50.0 (IQR 41.0 - 62.5). Surgeries performed include hemithyroidectomy (9 patients; 45.0%), total thyroidectomy (8 patients; 40.0%), completion thyroidectomy (2 patients; 10.0%) and right inferior parathyroidectomy (1 patient; 5.0%). Attempts were made to identify 56 parathyroid glands in this case series. There were 46/56 (82.1%) surgeon-identified parathyroid glands through direct visualisation. Using NIRAF technology, 39/46 (84.8%) were identified as parathyroid glands. There was no inadvertent resection of parathyroid glands or post-operative hypocalcaemia. NIRAF technology has the potential to be a useful tool in confirming the presence of parathyroid glands following direct visualisation intra-operatively.
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Affiliation(s)
- Richard Tjahjono
- Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Sydney, Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Daniel Phung
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, University of Sydney, 119-143 Missenden Rd, Camperdown, NSW 2050 Australia
| | - Michael S. Elliott
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, University of Sydney, 119-143 Missenden Rd, Camperdown, NSW 2050 Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Faruque Riffat
- Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Sydney, Australia
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, University of Sydney, 119-143 Missenden Rd, Camperdown, NSW 2050 Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Carsten E. Palme
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, University of Sydney, 119-143 Missenden Rd, Camperdown, NSW 2050 Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
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Ananthapadmanabhan S, Jabbour J, Lai S, Suruliraj A, Smith M, Riffat F, Devadas M, Liem H, Sritharan N. A Multidisciplinary Approach to Secondary Tracheoesophageal Puncture for Voice Prosthesis Insertion Using Flexible Esophagoscopy. J Voice 2022:S0892-1997(22)00076-5. [PMID: 35418350 DOI: 10.1016/j.jvoice.2022.03.009] [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] [Received: 01/10/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tracheoesophageal puncture (TEP) with voice prosthesis (VP) insertion is the gold standard of surgical voice restoration in postlaryngectomy patients. The conventional technique involves rigid esophagoscopes and trocar performed by ENT surgeons alone, with technical limitations encountered in patients with cervical abnormalities - in particular those with free or rotational flap reconstructions and postradiotherapy strictures. We report our technique using flexible endoscopy which we show to be feasible and without major safety events, as a possible consideration in the anticipated difficult TEP. METHODS Our study describes a multidisciplinary approach to secondary TEP involving a combined upper gastrointestinal (UGI) and (Ear, Nose, and Throat) ENT procedure, under the guidance of flexible esophagoscopy, with intraoperative involvement of the speech pathologist to guide VP insertion and placement. The procedure was performed with ease without major complications. RESULTS We identified nine postlaryngectomy and laryngopharyngectomy patients in our institution who underwent secondary TEP with VP insertion using flexible esophagoscopy and multidisciplinary intra-operative involvement. All patients had pharyngeal reconstruction, including radial forearm free flap (n = 4), pectoralis major rotational flap (n = 3), and anterolateral thigh flap (n = 2). Eight out of nine patients underwent adjuvant radiotherapy. The technique was successfully performed in all patients. There were three cases of early TEP displacement in two patients, of which one patient had a successful repeat procedure. We found the technique advantageous in terms of feasibility and practicality compared to the conventional approach, and without intraoperative difficulties encountered in achieving the desired field of views or navigating the challenging anatomy in a free flap and post-radiotherapy patients. This includes distorted cervical anatomy, the presence of bulky and hair-bearing flap skin, and stricture formation. Minor complications in our cohort included pharyngo-esophageal spasm, TEP displacement, granulation tissue, and peri-prosthetic leaks. CONCLUSION Our multidisciplinary approach to secondary TEP was performed with flexible esophagoscopy without major related complications. The technique is advantageous in the surgical approach to VP insertion in postlaryngectomy and laryngopharyngectomy patients who have had radiotherapy or pharyngeal reconstruction. It allows for safe anatomical insertion and thorough evaluation of the upper aerodigestive tract for comorbid benign or malignant esophageal pathology.
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Affiliation(s)
| | - Joe Jabbour
- Department of Otolaryngology, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Stephanie Lai
- Department of Speech Pathology, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Anand Suruliraj
- Department of Otolaryngology, Nepean Hospital, Kingswood, New South Wales, Australia; Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Mark Smith
- Department of Otolaryngology, Nepean Hospital, Kingswood, New South Wales, Australia; Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Faruque Riffat
- Department of Otolaryngology, Nepean Hospital, Kingswood, New South Wales, Australia; Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Michael Devadas
- Department of Upper GI Surgery, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Han Liem
- Department of Upper GI Surgery, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Niranjan Sritharan
- Department of Otolaryngology, Nepean Hospital, Kingswood, New South Wales, Australia; Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia
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Ananthapadmanabhan S, Jabbour J, Tseros E, Sivapathasingam V, Smith M, Riffat F, Sritharan N. Operative technique in laryngeal paraganglioma: A case series and literature review. Laryngoscope Investig Otolaryngol 2022; 7:467-475. [PMID: 35434328 PMCID: PMC9008153 DOI: 10.1002/lio2.760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 01/11/2022] [Accepted: 01/31/2022] [Indexed: 11/06/2022] Open
Abstract
Background Methods Results Conclusions Level of Evidence Laryngeal paragangliomas are a rare subset of head and neck neoplasms, of neuroendocrine origin. We present a series of four cases of confirmed laryngeal paragangliomas and discuss our operative technique using coblation‐assisted excision via laryngofissure.
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Affiliation(s)
| | - Joe Jabbour
- Department of Otolaryngology Nepean Hospital Kingswood New South Wales Australia
| | - Evangelos Tseros
- Department of Otolaryngology Nepean Hospital Kingswood New South Wales Australia
| | | | - Mark Smith
- Department of Otolaryngology Nepean Hospital Kingswood New South Wales Australia
- Department of Otolaryngology Westmead Hospital Westmead New South Wales Australia
| | - Faruque Riffat
- Department of Otolaryngology Nepean Hospital Kingswood New South Wales Australia
- Department of Otolaryngology Westmead Hospital Westmead New South Wales Australia
| | - Niranjan Sritharan
- Department of Otolaryngology Nepean Hospital Kingswood New South Wales Australia
- Department of Otolaryngology Westmead Hospital Westmead New South Wales Australia
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Phung D, Fradet L, Riffat F, Novakovic D, Elliott MS, Nguyen K, Makeham J, Palme CE. Translaryngeal ultrasound in thyroid surgery: state of the art review. ANZ J Surg 2022; 92:385-389. [PMID: 35133056 DOI: 10.1111/ans.17530] [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] [Received: 09/10/2021] [Revised: 01/07/2022] [Accepted: 01/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Clinical voice assessment prior to thyroid and parathyroid surgery is essential, but the paradigm of indirect laryngoscopy (IDL), when indicated, has been challenged by the risk of aerosolised SARS-Cov-2 during endoscopy of the aerodigestive tract. Translaryngeal ultrasound (TLUS) to assess the vocal cords has been proposed as a safe, non-invasive and sensitive alternative. The aim of this review was to verify TLUS as a viable tool for perioperative laryngeal assessment. METHOD A literature review was performed using Medline, Embase, Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials and Scopus with the following search strategy: (vocal cord OR vocal fold OR glottic OR glottis OR vocal ligaments OR rima glottidis) AND (ultras* OR sonograph* OR echography OR echotomography). RESULTS Fifteen studies were included in this review. All studies compared TLUS to IDL in visualizing the vocal cords in adults. Ten studies compared pre-operative TLUS to IDL where 50.6-100% of vocal cords were successfully visualized. Nine studies compared post-operative TLUS to IDL and reported visualization between 39.6% and 100%. Pre- and post-operative negative predictive values ranged from 60% to 100%. CONCLUSION Whilst promising, successful visualization of the cords is limited by inter-user variability, older age and male gender. Thus, we see the role of TLUS as an alternative to IDL in the post-operative setting in the young patient following uncomplicated surgery with a normal voice on clinical examination, to confirm recurrent laryngeal nerve integrity while minimizing the risk of aerosolization.
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Affiliation(s)
- Daniel Phung
- Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Sydney, New South Wales, Australia
| | - Laurent Fradet
- Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Sydney, New South Wales, Australia.,Division of Otolaryngology, Department of Surgery, Faculty of Medicine, Université de Sherbrooke, CIUSSS de l'Estrie-CHUS, Sherbrooke, Quebec, Canada
| | - Faruque Riffat
- Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Sydney, New South Wales, Australia
| | - Daniel Novakovic
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Dr Liang Voice Program, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Otolaryngology, Head and Neck Surgery, Canterbury Hospital, Sydney, New South Wales, Australia
| | - Michael Sowden Elliott
- Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Kevin Nguyen
- Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Sydney, New South Wales, Australia
| | - John Makeham
- Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Carsten Erich Palme
- Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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11
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Fradet L, Charters E, Gao K, Froggatt C, Palme C, Riffat F, Nguyen K, Wu R, Milross C, Clark JR. Avoidance of primary site adjuvant radiotherapy following transoral robotic surgery: a cohort study. ANZ J Surg 2022; 92:511-517. [PMID: 35018703 DOI: 10.1111/ans.17463] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Post-operative radiotherapy (PORT) volumes and dose to target structures likely influence swallowing function and quality of life following transoral robotic surgery (TORS). The aim of this study is to analyse disease control and swallowing outcomes in patients undergoing TORS for oropharyngeal squamous cell carcinoma (OPSCC) to determine the impact of omitting the primary site from the PORT treatment volume. METHODS Prospectively collected data from patients that underwent TORS between March 2013 and April 2021 were reviewed. Patients were categorized into three groups: (1) no PORT, (2) PORT to the neck alone or (3) PORT to the primary site and neck. Survival curves were generated according to the Kaplan-Meier method and swallowing was assessed using the Functional Oral Intake Scale, Public Status Scale Head and Neck, MD Anderson Dysphagia Inventory and feeding tube/gastrostomy dependence. RESULTS A total of 121 patients underwent TORS, of which 103 met inclusion criteria with a median follow up of 2.6 years. No patients developed local recurrence. The 3-year regional control rates were 90%, 100% and 100% for groups 1, 2 and 3, respectively. Disease-specific survival was 97% over the study period. Patients that received PORT to both the primary site and the neck (group 3) had worse swallowing outcomes at 12 months. CONCLUSION Following TORS for OPSCC, avoiding PORT to the primary site, in appropriately selected patients, appears to be oncologically safe and is associated with superior swallowing outcomes.
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Affiliation(s)
- Laurent Fradet
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Division of Otolaryngology, Department of Surgery, Faculty of Medicine, Université de Sherbrooke, CIUSSS de l'Estrie - CHUS, Sherbrooke, Quebec, Canada
| | - Emma Charters
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Kan Gao
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Catriona Froggatt
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Carsten Palme
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Faruque Riffat
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Kevin Nguyen
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Raymond Wu
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Chris Milross
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
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12
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Tjahjono R, Nguyen K, Phung D, Riffat F, Palme CE. Methods of identification of parathyroid glands in thyroid surgery: A literature review. ANZ J Surg 2021; 91:1711-1716. [PMID: 34414647 DOI: 10.1111/ans.17117] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 06/10/2021] [Revised: 07/17/2021] [Accepted: 07/24/2021] [Indexed: 01/19/2023]
Abstract
Intra-operative identification and preservation of parathyroid glands is an important but challenging aspect of thyroid surgery. Failure to do so may lead to transient or permanent hypocalcaemia, where the latter represents a serious complication causing life-long morbidity. It would be beneficial, therefore, if a simple and reliable modality can be developed to assist in the identification of parathyroid glands intra-operatively. The aim of this literature review is to provide an overview of intra-operative modalities used to identify parathyroid glands with a particular focus on near-infrared autofluorescence (NIRAF). Twenty-seven studies were considered relevant in this literature review. Several modalities have been used to aid parathyroid gland identification, including Raman spectroscopy, indocyanine green angiography, and NIRAF. NIRAF technology allows parathyroid glands to spontaneously give off light (autofluorescence) when exposed to near-infrared light at a wavelength of 785 nm, creating a contrast between tissues to allow intra-operative differentiation. Studies utilising NIRAF technology were able to identify 76.3%-100% of parathyroid glands intra-operatively. Furthermore, two randomised controlled trials comparing NIRAF and white light showed that the use of NIRAF was able to significantly increase the mean number of parathyroid glands detected and reduce the incidence of post-operative hypocalcaemia. NIRAF is an emerging tool that has been shown to increase the number of intra-operative parathyroid gland identification and reduce the rate of post-operative hypocalcaemia in a safe and reproducible manner. Future trials are needed to evaluate the real-life impact of NIRAF technology in outcomes of patients following thyroid surgery.
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Affiliation(s)
- Richard Tjahjono
- Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Kevin Nguyen
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Daniel Phung
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Faruque Riffat
- Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Carsten E Palme
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
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13
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Ku D, Hui M, Cheung P, Chow O, Smith M, Riffat F, Sritharan N, Kamani D, Randolph G. Meta-analysis on continuous nerve monitoring in thyroidectomies. Head Neck 2021; 43:3966-3978. [PMID: 34342380 DOI: 10.1002/hed.26828] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/15/2021] [Accepted: 07/22/2021] [Indexed: 11/05/2022] Open
Abstract
In the last decade, the introduction of continuous intraoperative recurrent laryngeal nerve (RLN) monitoring (C-IONM) has enabled the operator to verify the functional integrity of the vagus nerve-recurrent laryngeal nerve (VN-RLN) axis in real-time. We aim to present the current evidence on C-IONM utility for thyroid surgery by conducting the first meta-analysis on this technique. A systematic review of literature was conducted by two independent reviewers via Ovid in the Medline, EMBASE, and Cochrane reviews databases. The search was limited to human subject research in peer-reviewed articles of all languages published between Jan 1946 and April 2020. Medical subject headings (MeSH) terms utilized were thyroid surgery, thyroidectomies, recurrent laryngeal nerve, vagal nerve, monitor, and stimulation. Thirty-eight papers were identified from Ovid, another six papers were identified by hand-search. A random effect meta-analysis was performed with assessment of heterogeneity using the I2 value. A total of 23 papers that investigated the use of continuous vagal nerve monitoring during thyroid surgery were identified. The proportion of nerves at risk (NAR) with temporary RLN paralysis postoperation was 2.26% (95% CI: 1.6-2.9, I2 = 37). The proportion of NAR with permanent RLN palsy postoperation was 0.05% (95% CI: 0.08-0.2, I2 = 0). In this meta-analysis, there is one case of temporary vagal nerve paralysis secondary to VN electrode dislodgement, and a case of hemodynamic instability manifested in bradycardia and hypotension in the initial phase of surgery shortly after calibration. C-IONM is a safe and effective means by which RLN paralyses in thyroid surgery can be reduced.
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Affiliation(s)
- Dominic Ku
- Department of Otolaryngology - Head & Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Michelle Hui
- Department of Otolaryngology - Head & Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Phylannie Cheung
- Department of Otolaryngology - Head & Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Oliver Chow
- Department of Otolaryngology - Head & Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Mark Smith
- Department of Otolaryngology - Head & Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Department of Otolaryngology - Head & Neck Surgery, Nepean Hospital, Sydney, New South Wales, Australia
| | - Faruque Riffat
- Department of Otolaryngology - Head & Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Department of Otolaryngology - Head & Neck Surgery, Nepean Hospital, Sydney, New South Wales, Australia
| | - Niranjan Sritharan
- Department of Otolaryngology - Head & Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Department of Otolaryngology - Head & Neck Surgery, Nepean Hospital, Sydney, New South Wales, Australia
| | - Dipti Kamani
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Gregory Randolph
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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14
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Chia C, Key S, Hasan Z, Virk S, Riffat F. Systematic review and meta-analysis of cervical metastases in oral maxillary squamous cell carcinoma. Cancer Rep (Hoboken) 2021; 4:e1410. [PMID: 33963809 PMCID: PMC8714539 DOI: 10.1002/cnr2.1410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/05/2021] [Accepted: 03/25/2021] [Indexed: 12/30/2022] Open
Abstract
Background Management of the node‐negative neck in oral maxillary squamous cell carcinoma (SCC), encompassing the hard palate and upper alveolar subsites of the oral cavity, is controversial, with no clear international consensus or recommendation regarding elective neck dissection in the absence of cervical metastases. Aim To assess the occult metastatic rate in patients with clinically node negative oral maxillary SCC; both as an overall metastatic rate, and a comparison of patients managed with an elective neck dissection at index surgery, compared to excision of the primary with clinical observation of the neck. Methods and results A systematic review was performed by two independent investigators for studies relating to oral maxillary SCC and analysed according to PRISMA criteria. Data were extracted from Pubmed, Ovid MEDLINE, EMBASE, and SCOPUS via relevant MeSH terms. Grey literature was searched through Google Scholar and OpenGrey. Five hundred and fifty‐three articles were identified on the initial search, 483 unique articles underwent screening against eligibility criteria, and 29 studies were identified for final data extraction. Incidence of occult metastases in patients with clinically node negative oral maxillary SCC was identified either on primary elective neck dissection or on routine follow up. Meta‐analyses were performed. Of 553 relevant articles identified on initial search, 29 were included for analysis. The pooled overall rate of occult metastases in patients initially presenting with clinically node‐negative disease was 22.2%. There is a statistically significant effect of END on decreasing regional recurrence demonstrated in this study (RR 0.36, 95% CI 0.24, 0.59). Conclusion The results of this systematic review and meta‐analysis suggest elective neck dissection for patients presenting with hard palate or upper alveolar SCC, even in a clinically node negative neck.
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Affiliation(s)
| | | | - Zubair Hasan
- Monash Health, Clayton, Victoria, Australia.,Westmead Hospital, Westmead, New South Wales, Australia.,University of Sydney, Camperdown, New South Wales, Australia
| | - Sohaib Virk
- University of New South Wales, Randwick, New South Wales, Australia
| | - Faruque Riffat
- University of Sydney, Camperdown, New South Wales, Australia.,Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.,Macquarie University Hospital, Macquarie University, Macquarie Park, New South Wales, Australia
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15
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Tjahjono R, Phung D, Gurney H, Gupta R, Riffat F, Palme CE. Thyroid gland metastasis from renal cell carcinoma: a case series and literature review. ANZ J Surg 2020; 91:708-715. [PMID: 33319504 DOI: 10.1111/ans.16482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/16/2020] [Accepted: 11/24/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Renal cell carcinoma (RCC) is the most common malignancy that metastasises to the thyroid. This study aims to better understand the clinical characteristics of patients with thyroid metastasis from RCC. METHODS A retrospective case series of patients with thyroid metastasis from RCC between 2008 and 2020 from two tertiary centres were examined. MEDLINE and PubMed database searches were performed to retrieve the relevant literature. RESULTS Fifteen patients (eight males) were identified, with a median age of 57.0 (interquartile range (IQR) 51.0-63.0) at time of RCC diagnosis. Median time to thyroid metastasis was 92.0 months (IQR 40.0-156.0), with 12 (80.0%) patients undergoing thyroidectomy within 2 months of diagnosis. No patients developed post-operative complications or local thyroid recurrence. The two most common non-thyroid metastatic sites in this case series are lungs and bone (five patients, respectively; 33.3%) and pancreas (four patients; 26.7%). Ten (66.6%) patients underwent systemic chemotherapy, and five (33.4%) patients underwent radiotherapy for other sites of metastasis. Median survival following thyroid metastasis was 54.0 months (IQR 15.0-100.0). The literature review was conducted through MEDLINE and PubMed database searches, and 30 papers were considered relevant to this review. Results from our study are comparable to those reported in the literature. CONCLUSION Thyroid metastases can occur long after nephrectomy and portends a better prognosis. To prevent development of central neck disease, thyroidectomy should be considered.
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Affiliation(s)
- Richard Tjahjono
- Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Daniel Phung
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Howard Gurney
- The Crown Princess Mary Cancer Centre, Western Sydney Local Health District, Sydney, New South Wales, Australia.,Faculty of Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Ruta Gupta
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Faruque Riffat
- Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,The Crown Princess Mary Cancer Centre, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Carsten E Palme
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
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16
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Ahmadzada S, Vasan K, Sritharan N, Singh N, Smith M, Hull I, Riffat F. Utility of narrowband imaging in the diagnosis of laryngeal leukoplakia: Systematic review and m
eta‐analysis. Head Neck 2020; 42:3427-3437. [DOI: 10.1002/hed.26428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/23/2020] [Accepted: 07/28/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Sejad Ahmadzada
- Department of Otolaryngology – Head and Neck Surgery Westmead Hospital Westmead New South Wales Australia
- The University of Sydney Sydney Australia
| | | | - Niranjan Sritharan
- Department of Otolaryngology – Head and Neck Surgery Westmead Hospital Westmead New South Wales Australia
- Department of Otolaryngology – Head and Neck Surgery Nepean Hospital Nepean New South Wales Australia
| | - Narinder Singh
- Department of Otolaryngology – Head and Neck Surgery Westmead Hospital Westmead New South Wales Australia
- The University of Sydney Sydney Australia
| | - Mark Smith
- Department of Otolaryngology – Head and Neck Surgery Westmead Hospital Westmead New South Wales Australia
- Department of Otolaryngology – Head and Neck Surgery Nepean Hospital Nepean New South Wales Australia
| | - Isabelle Hull
- Swinburne University of Technology Melbourne Victoria Australia
| | - Faruque Riffat
- Department of Otolaryngology – Head and Neck Surgery Westmead Hospital Westmead New South Wales Australia
- The University of Sydney Sydney Australia
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17
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Ahmadzada S, Tseros E, Sritharan N, Singh N, Smith M, Palme CE, Riffat F. The value of narrowband imaging using the Ni classification in the diagnosis of laryngeal cancer. Laryngoscope Investig Otolaryngol 2020; 5:665-671. [PMID: 32864436 PMCID: PMC7444790 DOI: 10.1002/lio2.414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/15/2020] [Accepted: 05/26/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Narrowband imaging (NBI) is a special endoscopic optical enhancement setting allowing better visualization of mucosal microvasculature compared to white light endoscopy. This study evaluates the validity of NBI using the Ni classification in the detection and differentiation of severe dysplasia (SD) and glottic squamous cell carcinoma (SCC). METHODS Patients with suspicious vocal cord lesions underwent conventional white light endoscopy followed by clinically indicated biopsy. At the same time, NBI images were obtained and graded independently. Lesions were graded from I to V according to the Ni classification and compared to histopathological findings. RESULTS Fifty-two patients were included in this study (40 SCC and 12 SD). The sensitivity and specificity of NBI in diagnosing laryngeal cancer was 95.0% (CI, 83.9%-99.4%) and 83.3% (CI, 51.6%-97.9%), respectively. The negative likelihood ratio was 0.06. Higher Ni grades correlated very strongly with more advanced disease. CONCLUSIONS NBI using the Ni classification is a sensitive diagnostic tool for the detection and differentiation of early neoplastic and preneoplastic glottic lesions. As higher Ni classification correlates strongly with advanced disease, it serves as a useful adjunct to white light endoscopy in the diagnosis of laryngeal cancer.Level of Evidence: Level IV.
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Affiliation(s)
- Sejad Ahmadzada
- Department of Otolaryngology, Head and Neck SurgeryWestmead HospitalWestmeadNew South WalesAustralia
- The University of SydneySydneyAustralia
| | - Evan Tseros
- Department of Otolaryngology, Head and Neck SurgeryWestmead HospitalWestmeadNew South WalesAustralia
| | - Niranjan Sritharan
- Department of Otolaryngology, Head and Neck SurgeryWestmead HospitalWestmeadNew South WalesAustralia
- The University of SydneySydneyAustralia
| | - Narinder Singh
- Department of Otolaryngology, Head and Neck SurgeryWestmead HospitalWestmeadNew South WalesAustralia
- The University of SydneySydneyAustralia
| | - Mark Smith
- Department of Otolaryngology, Head and Neck SurgeryWestmead HospitalWestmeadNew South WalesAustralia
- The University of SydneySydneyAustralia
| | - Carsten E. Palme
- Department of Otolaryngology, Head and Neck SurgeryWestmead HospitalWestmeadNew South WalesAustralia
- The University of SydneySydneyAustralia
| | - Faruque Riffat
- Department of Otolaryngology, Head and Neck SurgeryWestmead HospitalWestmeadNew South WalesAustralia
- The University of SydneySydneyAustralia
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18
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Kumarasinghe D, Wong E, Duvnjak M, Sritharan N, Smith MC, Palme C, Riffat F. Risk factors associated with microbial colonisation and infection of tracheostomy tubes. Am J Otolaryngol 2020; 41:102495. [PMID: 32334923 DOI: 10.1016/j.amjoto.2020.102495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND A long-term tracheostomy tube has the potential to cause significant morbidity and mortality in both hospitalised patients and those in the community. This study aims to assess the rates of microbial colonisation and infection of tracheostomy tubes. MATERIALS AND METHODS Consecutive patients were enrolled from both inpatient and outpatient settings during their routine tracheostomy changes. During changes, culture swabs were taken from the cuff/outer-cannula and inner-cannula. Analysis were performed to compare culture results with risk factors. RESULTS 65 patients were enrolled in the study. Inpatients (65.9% vs 38.1%, χ2 4.48, p = 0.03), increasing acuity of care (from outpatient; ward; HDU; and ICU in increasing acuity) (τb = 0.289, p = 0.012), cuffed tracheostomy tubes, (66.7% vs 39.1%; χ2 4.59, p = 0.032); diabetics (64.6% vs 35.3%; χ2 4.39, p = 0.036); and males were associated with increased colonisation (72.4% vs 44.4%; χ2 5.12, p = 0.024). CONCLUSION Factors associated with an increase in colonisation and infection of tracheostomy tubes were location, and in males, diabetics and in cuffed tubes.
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19
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Kumarasinghe D, Wong EH, Duvnjak M, Smith MC, Palme CE, Riffat F. Colonization rates of tracheostomy tubes associated with the frequency of tube changes. ANZ J Surg 2020; 90:2310-2314. [PMID: 32419324 DOI: 10.1111/ans.15970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/15/2020] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Tracheostomy-tube change protocols are implemented primarily due to concern regarding infections. Currently changes vary from within 4 weeks post-insertion to 3 monthly thereafter. However, currently no evidence-based guidelines exist to justify these protocols. This study aims to assess the colonization of tracheostomy-tubes associated with the frequency of changes. METHODS A prospective cohort study over 18-months of adult tracheostomy patients at a single institution (inpatient/outpatients). Patients were grouped based on whether tubes were changed at ≤4 weeks or >4 weeks and microbiology swabs sent for microscopy, culture and sensitivities. RESULTS A total of 65 patients were enrolled. No statistically significant difference in colonization in patients undergoing tube changes more than every 4 weeks to those less than every 4 weeks was found (56.2% versus 57.1%, χ2 = 0.004, P = 0.95). CONCLUSION The timing of tracheostomy-tube changes may not affect colonization and infection rates. Routine changes for the purpose of reducing infection risk may not be needed unless clinically indicated.
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Affiliation(s)
- Dulitha Kumarasinghe
- Department of Otolaryngology-Head and Neck Surgery, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Eugene H Wong
- Department of Otolaryngology-Head and Neck Surgery, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Marin Duvnjak
- Department of Otolaryngology-Head and Neck Surgery, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Mark C Smith
- Department of Otolaryngology-Head and Neck Surgery, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia.,Department of Otolaryngology-Head and Neck Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Carsten E Palme
- Department of Otolaryngology-Head and Neck Surgery, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia.,Department of Otolaryngology-Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Faruque Riffat
- Department of Otolaryngology-Head and Neck Surgery, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia.,Department of Otolaryngology-Head and Neck Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
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Wong E, Ho J, Smith M, Sritharan N, Riffat F, Smith MC. Use of Purastat, a novel haemostatic matrix based on self-assembling peptides in the prevention of nasopharyngeal adhesion formation. Int J Surg Case Rep 2020; 70:227-229. [PMID: 32422584 PMCID: PMC7231812 DOI: 10.1016/j.ijscr.2020.04.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/01/2020] [Accepted: 04/18/2020] [Indexed: 11/29/2022] Open
Abstract
Purastat is a novel haemostatic agent used effectively in nasal procedures in the prevention of epistaxis and adhesions. This study describes the use of PuraStat following division of nasopharyngeal stenosis to reduce the risk of restenosis. On last follow-up the patient experienced excellent resolution of symptoms with no evidence of readhesion. The authors propose that PuraStat may be used in other surgical interventions to prevent mucosal adhesion formation.
Introduction Purastat is a novel haemostatic agent that has recently been used effectively in nasal procedures, specifically in functional endoscopic endonasal surgery in the prevention of post-operative epistaxis while minimising adhesion formation. This study presents a case of successful application of Purastat following division of a nasopharyngeal/palatal stenosis following radiotherapy. Presentation of case A 49-year-old male developed severe nasopharyngeal stenosis following concurrent chemoradiotherapy with curative intent a HPV positive base of tongue squamous cell carcinoma. Following treatment, while the patient experienced excellent metabolic response, he began to progressive nasal obstruction which he reported to be significantly affecting his quality of life. Following multidisciplinary team discussion, division of the stenosis was considered appropriate. Under general anaesthesia, the patient was positioned lying supine with the neck extended. A Boyle-Davis gag with lip and teeth protection was placed and a Y-suction catheter inserted to lift the palate from the posterior pharyngeal wall. Coblation using a PDW wand was used to divide the area of fibrosis bilaterally toward the superior tonsillar pillar until palatopharyngeus musculature was visible. Injection of 4 mg of Dexamethasone with a hypodermic needle was then performed followed by application of 4 ml of topical Purastat onto the raw surfaces after haemostasis was confirmed. The patient was discharged the same day on simple analgesia and instructions to avoid exertion for two weeks. He attended follow-up in the outpatient department two months later and reported persisting resolution of his nasal obstructive symptoms. No evidence of recurrence or residual adhesion tissue was noted.
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Affiliation(s)
- Eugene Wong
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Westmead, NSW, Australia.
| | - Joyce Ho
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Westmead, NSW, Australia; Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - Murray Smith
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Westmead, NSW, Australia; Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - Niranjan Sritharan
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Westmead, NSW, Australia; Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - Faruque Riffat
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Westmead, NSW, Australia; Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - Mark C Smith
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Westmead, NSW, Australia; Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
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Ansari UH, Wong E, Smith M, Singh N, Palme CE, Smith MC, Riffat F. Validity of narrow band imaging in the detection of oral and oropharyngeal malignant lesions: A systematic review and meta‐analysis. Head Neck 2019; 41:2430-2440. [DOI: 10.1002/hed.25724] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/10/2019] [Accepted: 02/18/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
- Umair H. Ansari
- Department of Maxillofacial SurgeryWestmead Public Hospital Sydney New South Wales Australia
| | - Eugene Wong
- Department of OtolaryngologyWestmead Public Hospital Sydney New South Wales Australia
| | - Murray Smith
- Department of OtolaryngologyWestmead Public Hospital Sydney New South Wales Australia
| | - Narinder Singh
- Department of OtolaryngologyWestmead Public Hospital Sydney New South Wales Australia
| | - Carsten E. Palme
- Department of OtolaryngologyWestmead Public Hospital Sydney New South Wales Australia
| | - Mark C. Smith
- Department of OtolaryngologyWestmead Public Hospital Sydney New South Wales Australia
| | - Faruque Riffat
- Department of OtolaryngologyWestmead Public Hospital Sydney New South Wales Australia
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Wong E, Smith M, Stone DB, Palme CE, Smith MC, Riffat F. Arytenoid vertical height discrepancy in predicting outcomes after unilateral vocal cord medialization. Laryngoscope 2019; 130:418-422. [PMID: 30843620 DOI: 10.1002/lary.27900] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 11/28/2018] [Revised: 01/09/2019] [Accepted: 02/12/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Unilateral vocal fold paralysis is a structural abnormality that often occurs secondary to dysfunction of the recurrent laryngeal nerve and typically presents as a breathy voice. Medialization laryngoplasty is a constellation of procedures that improves apposition of the vocal cords. Many patients, however, fail to experience sufficient improvement in vocal quality postoperatively despite apparent glottic closure on stroboscopy. This suggests that asymmetry in other cord characteristics may also have acoustic consequences. Our hypothesis is that arytenoid height symmetry may play a significant role in vocal quality. To our knowledge there are no human observational studies examining this topic. We therefore aimed to correlate asymmetry in arytenoid height and patient-reported satisfaction in voice quality after thyroplasty. STUDY DESIGN Retrospective cohort analysis. METHODS A retrospective review of prospectively collected data on consecutive patients who underwent medialization thyroplasty at a tertiary Sydney, Australia hospital was performed. Data collected included age, sex, onset of symptoms, as well as well as preoperative and 3-month postoperative maximum phonation time and Voice Handicap Index (VHI). Preoperative computed tomography scans were assessed for discrepancy of arytenoid vertical height discrepancy. RESULTS Twenty-three patients (56.5% female) with mean age of 52.4 ± 14.9 years were included. Most patients underwent injection thyroplasty (78.3%, n = 5), whereas the remaining underwent an open approach. A statistically significant inverse correlation was found between increasing height discrepancy and VHI improvement (r = -0.6, P = .003.) Revision surgery was associated with increased height discrepancy. CONCLUSIONS Findings of this study may affect future recommendations to address height discrepancy in surgery to treat unilateral vocal cord paralysis. LEVEL OF EVIDENCE 3 Laryngoscope, 130:418-422, 2020.
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Affiliation(s)
- Eugene Wong
- Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - Murray Smith
- Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Danielle B Stone
- Department of Speech Pathology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Carsten E Palme
- Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - Mark C Smith
- Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - Faruque Riffat
- Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
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Wong EH, Smith M, Fish B, Jani P, Palme CE, Smith MC, Riffat F. Thyroidectomy in octogenarians is not associated with poorer postoperative outcomes. Head Neck 2019; 41:2500-2506. [DOI: 10.1002/hed.25712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 12/20/2018] [Accepted: 02/05/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Eugene H. Wong
- Department of Otolaryngology; Westmead Hospital; Westmead New South Wales Australia
- Sydney Medical School; University of Sydney; Camperdown New South Wales Australia
| | - Murray Smith
- Department of Otolaryngology; Westmead Hospital; Westmead New South Wales Australia
| | - Brian Fish
- Department of Otolaryngology; Addenbrooke's Hospital; Cambridge United Kingdom
| | - Piyush Jani
- Department of Otolaryngology; Addenbrooke's Hospital; Cambridge United Kingdom
| | - Carsten E. Palme
- Department of Otolaryngology; Westmead Hospital; Westmead New South Wales Australia
- Sydney Medical School; University of Sydney; Camperdown New South Wales Australia
| | - Mark C. Smith
- Department of Otolaryngology; Westmead Hospital; Westmead New South Wales Australia
- Sydney Medical School; University of Sydney; Camperdown New South Wales Australia
| | - Faruque Riffat
- Department of Otolaryngology; Westmead Hospital; Westmead New South Wales Australia
- Sydney Medical School; University of Sydney; Camperdown New South Wales Australia
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Vu J, Coleman HG, Palme CE, Riffat F, Schifter M, Zoellner H. Diagnostic utility of microsurgical carbon dioxide laser excision of oral potentially malignant lesions vs incisional biopsy: a retrospective histopathological review. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:516-525. [PMID: 30948343 DOI: 10.1016/j.oooo.2018.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/07/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Complete excision of oral potentially malignant lesions (OPMLs) could result in improved and earlier detection of more severe grades of oral epithelial dysplasia and/or frank malignancy. Transoral microsurgical carbon dioxide laser techniques allow for resection of OPMLs, even those that are extensive. The advantages are improved diagnostic yield, improved viability of the specimen for pathologic evaluation, reduced postoperative morbidity, and easier postoperative clinical surveillance. STUDY DESIGN Retrospective review of the histopathology slide material and attendant clinical notes of 31 sequential patients with OPMLs demonstrated the following histopathologic diagnoses on conventional incisional biopsy (CIB): verrucous hyperplasia (2 patients); mild dysplasia (11 patients), moderate dysplasia (3 patients) or severe dysplasia (15 patients); and subsequently, these patients went on to have laser excision biopsy (LEB) of their OPMLs. RESULTS Histologic diagnosis was upgraded after LEB in 14 (45%) patients (P < .001), with unexpected findings of cancer in 9 cases (29%) and more severe dysplasia in 5 cases (16%). CONCLUSIONS Use of LEB to supplement CIB appears superior in the detection of severe dysplasia and frank malignancy in OPMLs compared with use of CIB alone. Prospective trials are indicated to determine if the superior diagnostic utility of LEB improves patient outcomes with regard to earlier detection of oral squamous cell and/or verrucous carcinoma.
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Affiliation(s)
- Jacinta Vu
- Faculty of Dentistry, The University of Sydney, Sydney, New South Wales, Australia; Department of Oral Medicine Oral Pathology and Special Care Dentistry, Level 3, Westmead Centre for Oral Health, Westmead Hospital, Westmead, New South Wales, Australia; Perth Oral Medicine & Dental Sleep Centre, Perth, Western Australia, Australia; UWA Dental School, University of Western Australia, Perth, Western Australia, Australia
| | - Hedley G Coleman
- Faculty of Dentistry, The University of Sydney, Sydney, New South Wales, Australia; Department of Tissue Pathology and Diagnostic Oncology, Level 3, Institute for Clinical Pathology and Medical Research (ICPMR), Pathology West, Westmead Hospital, Westmead, New South Wales, Australia
| | - Carsten E Palme
- Faculty of Dentistry, The University of Sydney, Sydney, New South Wales, Australia; Department of Otolaryngology/Head and Neck Surgery, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Faruque Riffat
- Department of Otolaryngology/Head and Neck Surgery, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Mark Schifter
- Faculty of Dentistry, The University of Sydney, Sydney, New South Wales, Australia; Department of Oral Medicine Oral Pathology and Special Care Dentistry, Level 3, Westmead Centre for Oral Health, Westmead Hospital, Westmead, New South Wales, Australia; Department of Otolaryngology/Head and Neck Surgery, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia.
| | - Hans Zoellner
- Faculty of Dentistry, The University of Sydney, Sydney, New South Wales, Australia; Department of Oral Medicine Oral Pathology and Special Care Dentistry, Level 3, Westmead Centre for Oral Health, Westmead Hospital, Westmead, New South Wales, Australia
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Singh N, Wong E, Huang J, Riffat F. Trans-Frontal Five-Fluorouracil (TraFFF): a novel technique for the application of adjuvant topical chemotherapeutic agents in sinonasal adenocarcinoma. BMJ Case Rep 2018; 2018:bcr-2018-226234. [PMID: 30361452 DOI: 10.1136/bcr-2018-226234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sinonasal adenocarcinoma has traditionally been treated with surgery (craniofacial or endoscopic) and adjuvant radiotherapy. Two large series have demonstrated favourable 5-year survival using surgery with adjuvant topical chemotherapy applied repeatedly over several weeks. The authors describe a novel, transnasal application of topical 5-fluorouracil. However, complete coverage of the frontal region of the anterior skull base can be difficult to achieve with a purely transnasal approach in an outpatient setting. We present a novel adjunct method of delivering chemotherapeutic agents into this key area used in a 37-year-old man with T2N0M0 ethmoid adenocarcinoma. The procedure was well tolerated in an outpatient setting and remains disease free at 3 years postoperatively. We suggest that frontal trephination is a useful adjunct to aid accurate placement of adjuvant topical chemotherapeutic agents in the treatment of sinonasal adenocarcinoma.
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Affiliation(s)
- Narinder Singh
- Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Eugene Wong
- Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Johnson Huang
- Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Faruque Riffat
- Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, NSW, Australia
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Abstract
OBJECTIVE To review the available literature as it pertains to the buccal space with a specific focus on the pathologies encountered within this space. Clinical presentation, investigations, and surgical approaches to the region are also reviewed. METHODS A systematic review of the available literature was performed on buccal space tumours from 1980 to 2017. Data was extracted on clinical presentation, investigations and surgical approaches to the buccal space. The pathologies encountered in the buccal space were reviewed and presented. RESULTS Forty-nine unique articles were reviewed, with a total 217 patients. The age of the patients ranged from 0 to 83 with a mean age of 45.8. A total of 51 pathologies were reported. The majority of these were vascular and salivary gland pathologies. The majority of salivary gland neoplasms were malignant. However a wide variety of benign and malignant soft tissue tumours were also reported to occur in this region. CONCLUSIONS The buccal space is a small and complex region with a variety of pathologies occurring within it. This review clarifies the differential diagnosis of a mass which presents in this area and the pathologies which occur within it.
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Affiliation(s)
- Zubair Hasan
- Department of Otolaryngology-Head & Neck Surgery, Westmead Hospital, Westmead, Australia.
| | - Darius Tan
- Department of Surgery, Monash Health, Clayton, Australia
| | - Malcolm Buchanan
- Department of Otolaryngology-Head & Neck Surgery, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Carsten Palme
- Department of Otolaryngology-Head & Neck Surgery, Westmead Hospital, Westmead, Australia
| | - Faruque Riffat
- Department of Otolaryngology-Head & Neck Surgery, Westmead Hospital, Westmead, Australia
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Gunaratne DA, Tseros EA, Hasan Z, Kudpaje AS, Suruliraj A, Smith MC, Riffat F, Palme CE. Cervical necrotizing fasciitis: Systematic review and analysis of 1235 reported cases from the literature. Head Neck 2018; 40:2094-2102. [PMID: 29934952 DOI: 10.1002/hed.25184] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [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: 07/27/2017] [Revised: 01/14/2018] [Accepted: 02/20/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cervical necrotizing fasciitis is a progressive soft tissue infection with significant morbidity and mortality. METHODS A case review of cervical necrotizing fasciitis managed at our institution (2007-2017) and a systematic review of PubMed, MEDLINE, and EMBASE databases using the algorithm "(cervical OR neck) AND necrotizing fasciitis." RESULTS There were 1235 cases from 207 articles which were included in our clinical review. Mean age for cervical necrotizing fasciitis was 49.1 years (64.23% men). Etiology was odontogenic (47.04%), pharyngolaryngeal (28.34%), or tonsillar/peritonsillar (6.07%). There were 2 ± 0.98 organisms identified per patient; streptococci (61.22%), staphylococci (18.09%), and prevotella (10.87%). There were 2.5 ± 3.22 surgical debridements undertaken. Descending necrotizing mediastinitis occurred in 31.56% of patients. Mean length of stay in the hospital was 29.28 days and overall mortality was 13.36%. CONCLUSION Physicians and surgeons must be vigilant of the diagnosis of cervical necrotizing fasciitis as early clinical findings may be subtle and prompt identification to facilitate aggressive intervention is required to preclude catastrophic local and systemic morbidity and mortality.
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Affiliation(s)
- Dakshika A Gunaratne
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Evan A Tseros
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Zubair Hasan
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Akshay S Kudpaje
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Anand Suruliraj
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Mark C Smith
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia.,Macquarie University Hospital, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - Faruque Riffat
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia.,Macquarie University Hospital, Sydney, Australia.,Chris O'Brien Lifehouse, Sydney, Australia
| | - Carsten E Palme
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia.,Crown Princess Mary Cancer Centre, Westmead Hospital, Australia.,Macquarie University Hospital, Sydney, Australia.,The University of Sydney, Sydney, Australia.,Chris O'Brien Lifehouse, Sydney, Australia
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Lau J, Loizou P, Palme C, Riffat F. The suspended endoscopy technique (SET) for intra-operative assessment in awake type I thyroplasty—how I do it. ACTA ACUST UNITED AC 2018. [DOI: 10.21037/ajo.2018.05.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Tseros E, Riffat F, Palme CE, Coleman HG, Singh NP. Neville Wran's voice: how the Premier's Teflon-coated vocal cords came unstuck. Med J Aust 2017; 207:468-470. [PMID: 29227762 DOI: 10.5694/mja17.00198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/07/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | - Hedley G Coleman
- Institute for Clinical Pathology and Medical Research, Westmead Hospital, Sydney, NSW
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Howard J, Masterson L, Dwivedi RC, Riffat F, Benson R, Jefferies S, Jani P, Tysome JR, Nutting C. Minimally invasive surgery versus radiotherapy/chemoradiotherapy for small-volume primary oropharyngeal carcinoma. Cochrane Database Syst Rev 2016; 12:CD010963. [PMID: 27943254 PMCID: PMC6463943 DOI: 10.1002/14651858.cd010963.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND More than 400,000 cases of oropharyngeal squamous cell carcinoma (OPSCC) are diagnosed each year worldwide and the incidence is rising, partly as a result of human papillomavirus. Human papillomavirus-associated OPSCC affects younger patients and often presents at a higher stage; however, it is associated with a better prognosis.Until recently, first-line management of OPSCC involved chemoradiotherapy, as research had demonstrated comparable survival outcomes when compared with open surgery, with significantly decreased morbidity. However, interventions have now evolved with computerised planning and intensity-modulated radiotherapy, and the advent of endoscopic head and neck surgery, which provide the potential for decreased treatment-associated morbidity.The oropharynx plays an essential role in swallowing, speech and protecting the airway as it is situated at the bifurcation of the respiratory and digestive tracts. Treatment modality recommendations are based on survival outcomes. Given the younger patient demographic, establishing the safety of modalities that potentially have better functional outcome is becoming increasingly important. OBJECTIVES To assess the efficacy of endoscopic head and neck surgery (transoral robotic surgery or transoral laser microsurgery) for small-volume, primary (T1-2, N0-2) oropharyngeal squamous cell carcinoma (OPSCC) in comparison to radiotherapy/chemoradiotherapy. SEARCH METHODS The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2016, Issue 10); PubMed; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 8 November 2016. SELECTION CRITERIA Randomised controlled trials in patients with carcinoma in the oropharynx subsite (as defined by the World Health Organization classification C09, C10). Cancers included were primary squamous cell carcinomas arising from the oropharyngeal mucosa. The tumours were classified as T1-T2 with or without nodal disease and with no evidence of distant metastatic spread. The intervention was transoral, minimally invasive surgery with or without adjuvant radiotherapy or adjuvant chemoradiotherapy. The comparator was primary radiotherapy with or without induction or concurrent chemotherapy for the tumour. The treatments received and compared were of curative intent and patients had not undergone prior intervention, other than diagnostic biopsy. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. Our primary outcomes were overall survival (disease-related mortality was to be studied where possible), locoregional control, disease-free survival and progression-free survival or time to recurrence. All outcomes were to be measured at two, three and five years after diagnosis. Our secondary outcomes included quality of life, harms associated with treatment, patient satisfaction and xerostomia score. MAIN RESULTS No completed studies met the inclusion criteria for the review. Two ongoing trials fulfilled the selection criteria, however neither are complete.'Early-stage squamous cell carcinoma of the oropharynx: radiotherapy versus trans-oral robotic surgery (ORATOR)' is a phase II randomised controlled trial comparing primary radiation therapy with primary transoral robotic surgery for small-volume primary (T1-2, N0-2) OPSCC. It is currently in progress with an estimated completion date of June 2021.'European Organisation for Research and Treatment of Cancer 1420 (EORTC 1420-HNCG-ROG)' is a phase III, randomised study assessing the "best of" radiotherapy compared to transoral robotic surgery/transoral laser microsurgery in patients with T1-T2, N0 squamous cell carcinoma of the oropharynx and base of tongue. It was due to start accrual mid-2016. AUTHORS' CONCLUSIONS The role of endoscopic head and neck surgery in the management of OPSCC is clearly expanding as evidenced by its more overt incorporation into the current National Comprehensive Cancer Network guidelines. Data are mounting regarding its outcomes both in terms of survival and lower morbidity. As confidence increases, it is being used in the management of more advanced OPSCC.Based on this review, there is currently no high-quality evidence from randomised controlled trials regarding clinical outcomes for patients with oropharyngeal cancer receiving endoscopic head and neck surgery compared with primary chemoradiotherapy.
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Affiliation(s)
- James Howard
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | - Liam Masterson
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | - Raghav C Dwivedi
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | | | - Richard Benson
- Addenbrooke's HospitalOncology CentreBox 193CambridgeUKCB2 2QQ
| | - Sarah Jefferies
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Piyush Jani
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | - James R Tysome
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Chris Nutting
- Royal Marsden HospitalHead and Neck UnitFulham RoadLondonUKSW3 6JJ
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O'Neil LM, Palme CE, Riffat F, Mahant N. Botulinum Toxin for the Management of Sjögren Syndrome–Associated Recurrent Parotitis. J Oral Maxillofac Surg 2016; 74:2428-2430. [DOI: 10.1016/j.joms.2016.06.169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/06/2016] [Accepted: 06/06/2016] [Indexed: 01/20/2023]
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Affiliation(s)
- Joel Hardman
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Lee M, Buchanan MA, Riffat F, Palme CE. Complications after CO2 laser surgery for early glottic cancer: An institutional experience. Head Neck 2015; 38 Suppl 1:E987-90. [PMID: 26040665 DOI: 10.1002/hed.24142] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 01/13/2015] [Revised: 04/17/2015] [Accepted: 05/31/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Transoral laser microsurgery (TLM) of the glottis is increasingly utilized in the current management of early glottic cancer, its advantages being administrative ease, potential to be repeated, ability to keep radiotherapy and open laryngeal surgery available as salvage options, and low complication rates. METHODS A retrospective chart review of prospectively gathered data on all patients over a 10-year period who had undergone TLM for Tis or early (T1-2) glottic squamous cell carcinomas (SCCs) was analyzed to examine the complications experienced. RESULTS Of 132 patients undergoing TLM, complications were: edema requiring tracheostomy (n = 1), surgical emphysema (n = 1), pharyngeal bruising (n = 1), endotracheal tube cuff perforation (n = 1), anterior glottic web (n = 14), vocal cord granuloma (n = 14), laryngocele (n = 1), and none of airway fire or intraoperative or postoperative hemorrhage. CONCLUSION Our results suggest that for early glottic cancers, and in skilled hands, with appropriate anesthetic and theater staff support, TLM is a safe and repeatable procedure. © 2015 Wiley Periodicals, Inc. Head Neck 38: E987-E990, 2016.
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Affiliation(s)
- Migie Lee
- Department of Otolaryngology/Head and Neck Surgery, Westmead Hospital, Westmead, Sydney, Australia
| | - Malcolm A Buchanan
- Department of Otolaryngology/Head and Neck Surgery, Westmead Hospital, Westmead, Sydney, Australia
| | - Faruque Riffat
- Department of Otolaryngology/Head and Neck Surgery, Westmead Hospital, Westmead, Sydney, Australia
| | - Carsten E Palme
- Department of Otolaryngology/Head and Neck Surgery, Westmead Hospital, Westmead, Sydney, Australia
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Buchanan MA, Coleman HG, Daley J, Digges J, Sandler M, Riffat F, Palme CE. Relationship between CO2 laser-induced artifact and glottic cancer surgical margins at variable power doses. Head Neck 2015; 38 Suppl 1:E712-6. [PMID: 25899602 DOI: 10.1002/hed.24076] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 04/13/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The carbon dioxide laser can induce thermal cytologic artifacts at the margin of early glottic squamous cell carcinoma histologic specimens, which makes assessment of the margin difficult. This study assesses and correlates the depth of laser-induced thermal artifact with laser power rating. METHODS The surgical margins of 30 patients with early glottic squamous cell carcinomas who underwent laser resection were reanalyzed retrospectively. RESULTS Thermal damage consisted of collagen denaturation within the vocal cord lamina propria and vocalis muscle, and epithelial structural changes. There was a decrease in depth of tissue artifact with increased power rating (p > .05). The average depth of thermal damage was 380.83 ± 178.79 μm. CONCLUSION The laser causes less thermal damage at higher power, presumably because of the increased speed of cutting and reduced contact time with surrounding cells. Knowledge of the depth of thermal artifact is important surgically when ensuring the cancer is excised with sufficient oncologic margin. © 2015 Wiley Periodicals, Inc. Head Neck 38: E712-E716, 2016.
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Affiliation(s)
- Malcolm A Buchanan
- Department of Otolaryngology/Head and Neck Surgery, Westmead Hospital, University of Sydney, Westmead, New South Wales, Australia
| | - Hedley G Coleman
- Department of Tissue Pathology and Diagnostic Oncology, Institute for Clinical Pathology and Medical Research, Pathology West, Westmead Hospital, University of Sydney, Sydney, Australia.,Faculty of Dentistry, University of Sydney, Westmead, New South Wales, Australia
| | - James Daley
- Faculty of Dentistry, University of Sydney, Westmead, New South Wales, Australia
| | - James Digges
- Faculty of Dentistry, University of Sydney, Westmead, New South Wales, Australia
| | - Mark Sandler
- Faculty of Dentistry, University of Sydney, Westmead, New South Wales, Australia
| | - Faruque Riffat
- Department of Otolaryngology/Head and Neck Surgery, Westmead Hospital, University of Sydney, Westmead, New South Wales, Australia
| | - Carsten E Palme
- Department of Otolaryngology/Head and Neck Surgery, Westmead Hospital, University of Sydney, Westmead, New South Wales, Australia
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Dwivedi R, Jani P, Masterson L, Riffat F, Marker A, Woodruff S, Hardy A. Inverted papilloma of lacrimal sac invading into the orbit: Case report and review of literature. J Cancer Res Ther 2015; 11:238-40. [DOI: 10.4103/0973-1482.155111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Smith ME, Riffat F, Berman LH, Jani P. Intraoperative ultrasound to facilitate removal of a submucosal foreign body. J Clin Ultrasound 2014; 42:565-568. [PMID: 25145586 DOI: 10.1002/jcu.22226] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 06/03/2023]
Abstract
A 61-year-old man with a history of fish bone ingestion and poorly localized symptoms was seen. His clinical examination was unremarkable, but CT demonstrated a foreign body deeply embedded within his tongue. Intraoperative ultrasound (US) guidance facilitated identification of a bone, allowing a needle to be placed as a guide to dissection. Repeat US scanning through the incision permitted precisely targeted surgery. CT and US are the most effective imaging techniques for localizing fish bones. Intraoperative US can be used to accurately locate a submucosal fish bone in mobile tissue such as the tongue, and focused, image-guided dissection can reduce surgical tissue trauma.
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Affiliation(s)
- Matthew E Smith
- Department of ENT Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, United Kingdom, CB2 0QQ
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Riffat F, Dwivedi RC, Palme C, Fish B, Jani P. A systematic review of 1143 parapharyngeal space tumors reported over 20years. Oral Oncol 2014; 50:421-30. [DOI: 10.1016/j.oraloncology.2014.02.007] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 02/09/2014] [Accepted: 02/11/2014] [Indexed: 11/29/2022]
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Wong BLK, Dwivedi RC, Masterson L, Riffat F, Marker A, Jani P. Kaposiform hemangioendothelioma of paranasal sinus. Laryngoscope 2014; 124:2103-6. [PMID: 24619771 DOI: 10.1002/lary.24669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 03/07/2014] [Indexed: 11/10/2022]
Abstract
Kapossiform hemangioendothelioma (KHE) of the paranasal sins (PNS) is a rare cause of recurrent epistaxis. To date, only two cases of PNS KHE have been reported in the literature, both occurring in the pediatric population. The case presented here appears to be the first case of PNS KHE occurring in an adult. A 46-year-old white female presented with progressively worsening unilateral recurrent epistaxis. Diagnostic histopathology confirmed it to be KHE. After a detailed workup, the tumor was completely excised en bloc (medial maxillectomy; anterior and posterior ethmoidectomy) via a lateral-rhinotomy approach. Complete excision of the tumor with clear margins offers the best results.
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Affiliation(s)
- Billy L K Wong
- Department of Otolaryngology, Head and Neck Surgery, Addenbrookes Hospital, Cambridge, United Kingdom
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Wang AY, Wang JT, Levin B, Alam M, Palme CE, Riffat F. Parapharyngeal pleomorphic adenoma as a cause of severe obstructive sleep apnoea. ANZ J Surg 2013; 84:883-4. [DOI: 10.1111/ans.12330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Allen Y. Wang
- Department of Otolaryngology; Westmead Hospital; University of Sydney; Sydney New South Wales Australia
| | - Jeffrey T. Wang
- Department of Otolaryngology; Westmead Hospital; University of Sydney; Sydney New South Wales Australia
| | - Brett Levin
- Department of Otolaryngology; Westmead Hospital; University of Sydney; Sydney New South Wales Australia
| | - Mostayn Alam
- Department of Otolaryngology; Westmead Hospital; University of Sydney; Sydney New South Wales Australia
| | - Carsten E. Palme
- Department of Otolaryngology; Westmead Hospital; University of Sydney; Sydney New South Wales Australia
| | - Faruque Riffat
- Department of Otolaryngology; Westmead Hospital; University of Sydney; Sydney New South Wales Australia
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Riffat F, Forer M, Wignall A, Veivers D, Patel N. Intracranial and internal jugular vein thrombosis secondary to ENT infections: a report of 3 cases. Ear Nose Throat J 2013; 92:E25. [PMID: 24170472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
We report 3 cases of rare, life-threatening intracranial and internal jugular vein (IJV) thrombosis that were caused by common ENT infections. These infections included otitis media in a 6-year-old girl, tonsillitis in a 21-year-old woman, and odontogenic sepsis in a 56-year-old woman. All 3 patients were treated with culture-directed systemic antibiotics; 2 of them also required surgical drainage (the child and the older adult). The 2 adults also received therapeutic anticoagulation, which was continued until venous recanalization was documented; the duration of combined antibiotic and anticoagulation treatment was 6 weeks. All 3 patients made uneventful recoveries. Significant morbidities associated with intracranial and IJV thrombosis were avoided as a result of prompt diagnosis and judicious treatment.
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Affiliation(s)
- Faruque Riffat
- Department of Surgery, Westmead Hospital, PO Box 533, Wentworthville 2145, NSW, Australia.
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Riffat F, Del Pero MM, Fish B, Jani P. Radiologically predicting when a sternotomy may be required in the management of retrosternal goiters. Ann Otol Rhinol Laryngol 2013; 122:15-9. [PMID: 23472311 DOI: 10.1177/000348941312200104] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Surgery remains the most effective treatment for retrosternal goiters. These commonly present as asymptomatic lesions in elderly patients, but may also cause airway and esophageal compression and, less commonly, may also be malignant. Although the majority of these goiters are amenable to transcervical thyroidectomy, in a minority of patients sternotomy is required. The ability to predict the need for sternotomy before operation would allow for safer surgery and operative counseling, as well as improved logistical efficiency if coordination with thoracic surgeons is required. In this report, we assess the radiologic factors that might be predictive of the need for sternotomy. METHODS We performed a retrospective review of 97 retrosternal goiters for which thyroidectomy was performed within the otolaryngology department at Addenbrooke's Hospital, Cambridge, between 2001 and 2011. There were a total of 80 cervical excisions and 17 cases in which sternotomy was required. A detailed computed tomographic analysis of these 17 cases was undertaken to assess the predictive factors for the requirement of sternotomy. The factors assessed included posterior mediastinal extension, presence of an ectopic nodule, extension below the carina, extension below the aortic arch, a "conical shape" of the goiter, and tracheal compression. These were compared to the same factors in the control group of 80 patients, and Fisher's exact test was used to determine statistical significance. RESULTS The significant predictive factors for sternotomy, were posterior mediastinal extension, extension below the carina, and a "conical" goiter in which the thoracic inlet becomes a ring of constriction (all p < 0.05). CONCLUSIONS Our results suggest that it is possible to predict on the basis of computed tomographic imaging the need for sternotomy in retrosternal goiters.
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Affiliation(s)
- Faruque Riffat
- Department of Otolaryngology-Head and Neck Surgery, Addenbrooke's Hospital, Cambridge, England
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Riffat F, Mahrous AK, Buchanan MA, Fish BM, Jani P. Safety of extracapsular dissection in benign superficial parotid lesions. J Maxillofac Oral Surg 2012; 11:407-10. [PMID: 24293931 PMCID: PMC3485475 DOI: 10.1007/s12663-012-0349-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [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: 11/28/2011] [Accepted: 02/07/2012] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The current practice for removal of clinically benign superficial parotid lesions is an appropriate superficial parotidectomy with a cuff of normal parotid tissue for complete pathological clearance. This technique requires the identification of the facial nerve at the main trunk and dissection of the segment of the facial nerve deep to the lesion. The reported major complications of this procedure include temporary or permanent facial nerve weakness, Frey's syndrome and salivary leaks. In order to avoid these complications, a local extracapsular dissection technique can be utilised in the management of small inferiorly located benign lesions of the parotid gland. METHODS A retrospective case note review was performed for all parotidectomies between 2004 and 2009 in Addenbrooke's Hospital, Cambridge by the senior authors. RESULTS A total of 172 cases were identified out which 46 underwent an extracapsular dissection. The average size of these lesions was 1.9 cm (0.9-2.4 cm) with all universally located inferior or posterior to the angle of the mandible. The pathologies were 14 pleomorphic adenomas, 24 Warthin's tumours, 6 lymphangiomas and 2 simple cysts. There were no post-operative facial nerve weaknesses, Frey's syndrome or salivary leaks within the extracapsular dissection group. The median follow-up of these patients were 4.6 years (2-6 years) with 6 patients lost to follow-up. No recurrences have been noted in the cohort at follow-up.
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Affiliation(s)
- F Riffat
- Department of Otolaryngology and Head and Neck Surgery, Addenbrooke's Hospital, Cambridge, UK
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Al-lami A, Riffat F, Alamgir F, Dwivedi R, Berman L, Fish B, Jani P. Utility of an intraoperative ultrasound in lateral approach mini-parathyroidectomy with discordant pre-operative imaging. Eur Arch Otorhinolaryngol 2012. [DOI: 10.1007/s00405-012-2284-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Buchanan MA, Riffat F, Mahrous AK, Fish BM, Jani P. Endoscopic or external approach revision surgery for pharyngeal pouch following primary endoscopic stapling: which is the favoured approach? Eur Arch Otorhinolaryngol 2012; 270:1707-10. [PMID: 23015198 DOI: 10.1007/s00405-012-2186-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 09/07/2012] [Indexed: 12/11/2022]
Abstract
This study aimed to assess outcomes of revision endoscopic stapling and external excision of pharyngeal pouch. A 5-year prospective study was performed on all patients requiring revision pouch surgery following primary endoscopic stapling. Data were collected retrospectively. Eighteen patients underwent revision pouch surgery. In seven patients, pouch size was down-graded from 3 to 2, and these were stapled endoscopically. Two leaks resulted. Eleven patients with grade 1 or 3 pouches underwent external excision of pouch, with no post-operative complications. As per results external excision of pouch is safe for grade 1 and 3 pouches. It avoids risking redundant mucosa and recurrence of symptoms which can complicate stapling and enables a myotomy to be performed to reduce cricopharyngeal hypertonicity. The highest predictable success is with grade 2 pouches, whose size is amenable to adequate endoscopic stapling. However, the "staple over staple" effect of revision stapling leads to unpredictable fibrosis, which can contribute to risk of perforation.
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Affiliation(s)
- Malcolm A Buchanan
- Department of Otorhinolaryngology and Head & Neck Surgery, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.
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Jefferson N, Riffat F, McGuinness J, Johnstone C. The laryngeal mask airway and otorhinolaryngology head and neck surgery. Laryngoscope 2011; 121:1620-6. [DOI: 10.1002/lary.21768] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
OBJECTIVES Adult supraglottitis is a potentially life-threatening airway infection. We reviewed the management and outcome of supraglottitis in 169 adults admitted to Liverpool Hospital between 1999 and 2009. METHODS A retrospective review was conducted of all admissions with supraglottitis in patients at least 18 years of age. The diagnosis was confirmed by fiberoptic nasolaryngoscopy or direct laryngoscopy under general anesthesia. The main outcome measure was the need for intubation or tracheotomy. Univariate analysis was performed to determine factors that led to a worse outcome. RESULTS There were 80 men and 89 women in the cohort, with a median age of 51 years. Of these, 140 patients were admitted to the intensive care unit for a mean duration of 2 days. The common symptoms and signs at presentation were odynophagia and dysphagia (94%), dysphonia (65%), and stridor (33%). Endotracheal intubation was performed in 16 patients, and an awake tracheotomy was required in 4 patients. Dexamethasone acetate was used in 103 patients. Thirty-five patients had diabetes mellitus as a comorbidity. The presence of diabetes was predictive of the need for intubation or tracheotomy (p < 0.05), and the use of steroids was predictive of an intensive care unit stay of 24 hours or less (p < 0.05). CONCLUSIONS Fiberoptic laryngoscopy is the gold standard for diagnosis of supraglottitis, and close airway monitoring is crucial. Conservative management of the airway is a viable option, but the presence of diabetes makes airway intervention more likely. The use of steroids aids in symptom alleviation and hastens resolution of airway swelling, with no negative sequelae.
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Affiliation(s)
- Faruque Riffat
- Department of Otolaryngology-Head and Neck Surgery, Liverpool Hospital, Sydney, Australia
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Coleman H, Riffat F, Palme C. Cystic variant of calcifying epithelial odontogenic tumour. Pathology 2011. [DOI: 10.1016/s0031-3025(16)33110-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Riffat F. Acute Epiglottitis in Adults. Otolaryngol Head Neck Surg 2010. [DOI: 10.1016/j.otohns.2010.06.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Riffat F. Management of Pediatric Caustic Ingestion. Otolaryngol Head Neck Surg 2010. [DOI: 10.1016/j.otohns.2010.06.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Riffat F, Walker P. Prevalence of tonsillar Actinomyces in children undergoing tonsillectomy for sleep disordered breathing compared with recurrent tonsillitis. Int J Pediatr Otorhinolaryngol 2009; 73:1111-3. [PMID: 19447506 DOI: 10.1016/j.ijporl.2009.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 04/20/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the prevalence of tonsillar actinomycosis in pediatric tonsillectomies performed for sleep disordered breathing (SDB) compared with recurrent infective tonsillitis. METHODS All tonsillectomy specimens performed in a pediatric otolaryngology practice over a 10-year period were sent to the same pathology laboratory for histological analysis for the prevalence of Actinomyces. A database of 1213 children was generated and analyzed to determine any significant differences in Actinomyces carriage between children with a primary diagnosis of sleep disordered breathing, compared with recurrent tonsillitis. Statistical analysis was performed using a 2 way contingency table, and significance analyzed via chi-squared and Fisher's exact test. RESULTS Four hundred and sixty five children aged less than 16 underwent tonsillectomy for recurrent tonsillitis and 748 for SDB. Actinomyces were identified in 68 of the group with recurrent tonsillitis (14.6%) and in 153 of the group with SDB (20.5%). This difference was statistically significant with p=0.009 on two-tail Fisher's exact test. CONCLUSION There was a statistically significant higher rate of Actinomyces colonization in children undergoing tonsillectomies for SDB compared to recurrent tonsillitis.
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