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Xing MH, Shaari AL, Beute JE, Yun J, Chai RL. Thyroid Ethanol and Radiofrequency Ablation: A Call for Patient-Friendly Online Resources. ORL J Otorhinolaryngol Relat Spec 2024:1-7. [PMID: 38310864 DOI: 10.1159/000535657] [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: 06/09/2022] [Accepted: 12/04/2023] [Indexed: 02/06/2024]
Abstract
INTRODUCTION The multiple treatment options available to patients with thyroid nodules can generate uncertainty and confusion. Radiofrequency ablation (RFA) and ethanol ablation (EA) are two alternative modalities to manage thyroid nodules. As patients more frequently utilize online resources to guide their decision-making, the quality of such resources must be evaluated. The goal of this study was to assess the quality of online patient materials relating to RFA and EA compared to standard thyroidectomy. METHODS The terms "thyroidectomy," "thyroid radiofrequency ablation," and "thyroid ethanol ablation" were searched on Google. Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Patient Education Materials Assessment Tool (PEMAT) understandability and actionability were calculated for each website. Statistical analysis was conducted on SPSS Statistics. Google trends were used to determine search interest for each term (May 2016 - May 2021). RESULTS Of the 77 websites that met our inclusion criteria (30 thyroidectomy sites, 30 RFA sites, and 17 EA sites), the average FRE, FKGL, and SMOG scores of the RFA websites were significantly worse than those of the thyroidectomy websites (p < 0.05). The FKGL and SMOG scores of the EA websites were significantly worse than those of the thyroidectomy websites (p < 0.05). The average understandability and actionability scores for thyroidectomy websites were significantly higher than those of RFA and EA websites (p < 0.05). CONCLUSION Ablation websites have lower search interest, readability, validity, understandability, and actionability scores in comparison to traditional thyroidectomy websites. Our findings emphasize the need to consider readability and PEMAT scores when developing online educational resources for ablative alternatives to thyroidectomy to allow for greater patient accessibility.
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Affiliation(s)
- Monica H Xing
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Ariana L Shaari
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - John E Beute
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Jun Yun
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raymond L Chai
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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2
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Xing MH, Onajin O, Venkataraman G, Stein SL. A case of reactive granulomatous dermatitis associated with neonatal lupus erythematosus. J Cutan Pathol 2023; 50:793-797. [PMID: 37311658 DOI: 10.1111/cup.14479] [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: 01/09/2023] [Revised: 04/12/2023] [Accepted: 05/29/2023] [Indexed: 06/15/2023]
Abstract
Neonatal lupus erythematosus (NLE) is an uncommon disorder affecting approximately one out of 20 000 live births in the United States. Common manifestations of NLE include cutaneous eruptions and cardiac involvement. The typical rash of NLE most closely resembles the rash of subacute cutaneous lupus erythematosus both clinically and histopathologically. We present a case of reactive granulomatous dermatitis (RGD) associated with NLE in a 3-month-old male in whom the initial histopathology and immunohistochemistry were concerning for hematologic malignancy. RGD is a unifying term used to describe cutaneous granulomatous eruptions that occur in response to a variety of stimuli, including autoimmune connective tissue diseases. Our case demonstrates the range of histopathological findings that may be present in the setting of NLE.
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Affiliation(s)
- Monica H Xing
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Oluwakemi Onajin
- Section of Dermatology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Girish Venkataraman
- Department of Pathology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Sarah L Stein
- Section of Dermatology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
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Raheem OA, Xing MH, Cooper CA, Hyman MJ, Khera M, Modi PK. Reply by Authors. Urol Pract 2023; 10:326. [PMID: 37341370 DOI: 10.1097/upj.0000000000000402.02] [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] [Received: 12/27/2022] [Accepted: 03/07/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Omer A Raheem
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois
| | - Monica H Xing
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Caleb A Cooper
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois
| | - Max J Hyman
- The Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois
| | - Mohit Khera
- Department of Urology, Baylor College of Medicine, Houston, Texas
| | - Parth K Modi
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois
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Raheem OA, Xing MH, Cooper CA, Hyman MJ, Khera M, Modi PK. Increasing Role of the Advanced Practice Provider in Men's Health Clinics: An Analysis of Medicare and Commercial Claims in the United States. Urol Pract 2023:101097UPJ0000000000000402. [PMID: 37167418 DOI: 10.1097/upj.0000000000000402] [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] [Indexed: 05/13/2023]
Abstract
INTRODUCTION As urologic care delivery in the U.S. continues to evolve to meet patient needs, we aim to clarify the role of Advanced Practice Providers (APPs) for publicly and privately insured patients in the treatment of male urologic conditions commonly encountered in men's health clinics. METHODS Medicare and commercial insurance claims from the Physician/Supplier Procedure Summary and Merative MarketScan Commercial Database, were queried for procedures submitted by APPs between 2010 and 2021. Common urologic conditions were identified using Current Procedural Terminology codes and grouped into 4 categories: testicular hypofunction, erectile dysfunction (ED) and Peyronie's disease (PD), benign prostatic hyperplasia (BPH), and scrotal pain. The proportion of procedures submitted by APPs was calculated for each year and category. RESULTS From 2010 to 2021, the proportion of APP submitted service counts for each condition within the MarketScan group increased up to 5-fold, with BPH representing the greatest growth. The proportion of APP submitted service counts within the Medicare group increased up to 8-fold, with ED/PD representing the greatest fold change. The proportion of claims submitted by APPs treating all 4 conditions were higher in 2021 than 2010 in both publicly and privately insured groups. CONCLUSIONS The role of APPs in men's urologic health is increasing for both privately and publicly insured patient populations. APPs play a critical role in urologic care and can help to improve access to men's health.
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Affiliation(s)
- Omer A Raheem
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois
| | - Monica H Xing
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Caleb A Cooper
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois
| | - Max J Hyman
- The Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois
| | - Mohit Khera
- Department of Urology, Baylor College of Medicine, Houston, Texas
| | - Parth K Modi
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois
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Hou SW, Xing MH, Gundeti MS. Pediatric robotic urologic procedures: Indications and outcomes. Indian J Urol 2023; 39:107-120. [PMID: 37304986 PMCID: PMC10249524 DOI: 10.4103/iju.iju_276_22] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/10/2022] [Accepted: 03/09/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Robotic-assisted laparoscopic surgery (RALS) has revolutionized minimally invasive surgery in pediatric urology. The robotic platform allows surgeons to maintain the benefits of laparoscopic surgery while having enhanced three-dimensional view, dexterity, range of motion, and control of high-resolution cameras. In this review, we summarize the indications and recent outcomes for various pediatric urologic RALS procedures to illustrate the current state of robotics in pediatric urology. Methods We systematically searched the PubMed and EMBASE databases. We extrapolated and summarized recent evidence on RALS in pediatric urology patients, with an emphasis on indications and outcomes, with regard to the following procedures and search terms: pyeloplasty, kidney stone surgery, partial nephrectomy, nephroureterectomy, ureteral reimplantation, appendico-vesicostomy, augmentation cystoplasty, bladder neck reconstruction, and Malone antegrade continence enema. Additional Medical Subject Headings terms used to augment the search included "Treatment Outcome" and "Robotic Surgical Procedures." Results Increasing usage of RALS has shown many benefits in perioperative and postoperative outcomes. In addition, there is growing evidence that robotic procedures in pediatric urology result in similar or better surgical outcomes when compared to the standard of care. Conclusions RALS has shown considerable effectiveness in pediatric urologic procedures and may achieve surgical outcomes comparable to the standard approaches of open or laparoscopic surgery. However, larger case series and prospective randomized controlled trials are still necessary to validate the reported outcomes, in addition to cost analyses and studies on the surgical learning curve. We believe that the continuous evolution of robotic platforms will allow for enhanced care and quality of life for pediatric urology patients.
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Affiliation(s)
- Sean W. Hou
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Monica H. Xing
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Mohan S. Gundeti
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
- Department of Surgery, Section of Urology, University of Chicago, Comer Children's Hospital, Chicago, IL, USA
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6
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Seo GT, Greenberg L, Xing MH, Su V, Dowling E, Mundi N, Matloob A, Khorsandi AS, Chai RL, Urken ML, Brandwein-Weber M. Extratumoral invasion: A unique phenomenon of aggressive recurrent oropharyngeal squamous cell carcinoma. Am J Otolaryngol 2023; 44:103756. [PMID: 36603379 DOI: 10.1016/j.amjoto.2022.103756] [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: 10/03/2022] [Accepted: 12/18/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Oropharyngeal squamous carcinomas cause significant morbidity and mortality. Poor prognosticators include lymphovascular and perineural invasion. Extratumoral phenotypes of these histologic findings confer worse prognoses. METHODS We report eight cases of recurrent oropharyngeal cancer with diffuse extratumoral lymphovascular invasion (ELVI) or extratumoral perineural invasion (EPNI) and review the existing literature. RESULTS On salvage resection for recurrence following primary radiation or chemoradiation, six patients manifested ELVI and two showed EPNI. These patterns conferred difficulty with complete surgical clearance; final pathologic analysis demonstrated positive margins for all eight patients. The six patients with ELVI were p16+ and the two with EPNI were p16-. Currently, two patients are deceased and six patients are alive at an average follow-up of 17.4 months. Of the six living patients, 2 have a new recurrence and are in hospice while 4 have no evidence of disease. CONCLUSIONS ELVI and EPNI have received little consideration in the literature as unique histopathologic features of oropharyngeal squamous carcinoma. We present the first series on these adverse extratumoral features in recurrent disease. We call attention to these unique histologic features in the setting of recurrent oropharyngeal cancer to encourage others to track the results of therapeutic intervention and to identify successful strategies for treatment.
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Affiliation(s)
- Gabriella T Seo
- Thyroid, Head and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5A, New York, NY 10003, USA
| | - Lily Greenberg
- Thyroid, Head and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5A, New York, NY 10003, USA
| | - Monica H Xing
- Thyroid, Head and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5A, New York, NY 10003, USA
| | - Vivian Su
- Thyroid, Head and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5A, New York, NY 10003, USA; Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY 10003, USA.
| | - Eric Dowling
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY 10003, USA
| | - Neil Mundi
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY 10003, USA
| | - Ammar Matloob
- Department of Pathology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY 10029, USA
| | - Azita S Khorsandi
- Department of Radiology, New York Eye and Ear Infirmary of Mount Sinai, 310 East 14th Street, New York, NY 10003, USA
| | - Raymond L Chai
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY 10003, USA
| | - Mark L Urken
- Thyroid, Head and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5A, New York, NY 10003, USA; Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY 10003, USA
| | - Margaret Brandwein-Weber
- Department of Pathology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY 10029, USA
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Seo GT, Urken ML, Wein LE, Saturno MP, Kapustin D, Xing MH, Yue LE, Dowling EM, Revenson TA, Roberts KJ, Tuttle RM. Psychological adjustment to initial treatment for low-risk thyroid cancer: Preliminary study. Head Neck 2023; 45:439-448. [PMID: 36495223 DOI: 10.1002/hed.27265] [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: 06/15/2022] [Revised: 10/17/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Low-risk papillary thyroid carcinoma (LR-PTC) can be managed by immediate surgery (IS) or active surveillance (AS). We compare the psychological impact of these treatments on patients with LR-PTC. METHODS Psychological data were collected over 1 year, with assessments at the time of treatment decision (T1), at 6 months (T2) and 12 months (T3) follow-up. Assessments included 13 validated psychological tools. RESULTS Of 27 enrolled patients, 20 chose AS and 7 chose IS. The average times to T2 and T3 were 5.7 and 11.3 months, respectively. For both groups, Impact of Events Scale scores significantly decreased (p = 0.001) at T2, and depressive/anxiety symptoms remained low. CONCLUSIONS This study demonstrates the feasibility of assessing psychological outcomes among patients treated for LR-PTC. Further studies are needed to evaluate the impact of AS versus IS on quality of life and changes that patients experience over longer time periods following their treatment decision.
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Affiliation(s)
- Gabriella T Seo
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Mark L Urken
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lauren E Wein
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Michael P Saturno
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Danielle Kapustin
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Monica H Xing
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Lauren E Yue
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Eric M Dowling
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tracey A Revenson
- Department of Psychology, Hunter College, City University of New York, New York, New York, USA
| | - Katherine J Roberts
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, New York, USA
| | - Robert Michael Tuttle
- Endocrinology Service-Division of Subspecialty Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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8
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Xing MH, Hou SW, Raheem OA. Aesthetic Penile Augmentation Procedures: A Comprehensive and Current Perspective. Curr Urol Rep 2022; 23:355-361. [PMID: 36350528 DOI: 10.1007/s11934-022-01123-8] [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] [Accepted: 09/18/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE OF REVIEW Some men experience small penis syndrome (SPS), a body dysmorphic disorder in which a patient believes their penis to be small even when it is clinically average. As cosmetic surgery becomes more widely accepted, management of SPS may present a challenge for urologists. We aim to provide an updated review of aesthetic penile augmentation procedures. RECENT FINDINGS Augmentation procedures range from invasive to noninvasive. Surgical solutions include grafts and flaps, suspensory ligament release, and suprapubic lipectomy. Minimally invasive solutions include injections of fillers (hyaluronic acid, polylactic acid, and polymethyl methacrylate). Noninvasive solutions include external devices such as vacuum pumps and traction devices. In the current climate, aesthetic penile augmentation is becoming a desirable option for many patients but remains clinically controversial. Our review summarizes recent and relevant studies and demonstrates the need for further research and consensus on penile augmentation procedures.
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Affiliation(s)
- Monica H Xing
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
| | - Sean W Hou
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Omer A Raheem
- Department of Surgery, Section of Urology, University of Chicago, Chicago, IL, USA
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Beute JE, Seo GT, Saturno M, Xing MH, Mundi N, Dowling EM, Matloob A, Chen H, Khorsandi AS, Steinberger J, Urken ML. Central compartment neoplasms masquerading as thyroid tumors: Presentation of two unusual cases and review of the literature. Otolaryngology Case Reports 2022. [DOI: 10.1016/j.xocr.2022.100471] [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: 11/30/2022] Open
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10
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Urken ML, O’Malley Q, Sandler M, Xing MH, Ansari E, Mundi N, Buchbinder D, Alon E, Okay D. Staged Head and Neck Reconstruction: Heresy or a Reasoned Approach in a Select Group of Patients? Craniomaxillofac Trauma Reconstr 2022; 15:253-263. [PMID: 36081675 PMCID: PMC9446279 DOI: 10.1177/19433875211031361] [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] [Indexed: 09/03/2023] Open
Abstract
Study Design case series. Objective The restoration of defects in a single procedure with microvascular free flap reconstruction has become a mainstay of head and neck surgery. Yet in patients with complex defects and pre-existing comorbid medical conditions, a staged-reconstructive approach can enhance the safety of the procedure and improve the patient's outcome. Methods We present 3 representative case examples of a larger series of patients who underwent reconstruction of major defects and discuss the usefulness of a staged-reconstructive approach in the management of complex patients. Results All 3 patients, with an existing composite defect in the setting of prior radiation therapy, underwent successful staged-reconstructive surgery using a variety of free tissue and regional flap transfers. Conclusions A staged approach facilitates the reconstruction of complex composite defects, increases vessel availability, and mitigates the risk of flap failure. Although this approach commits the patient to multiple procedures and a more prolonged plan of care, it is preferable to 1 operation in specific complex situations with adverse, high-risk clinical features.
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Affiliation(s)
- Mark. L. Urken
- THANC (Thyroid, Head and Neck Cancer)
Foundation, New York, NY, USA
- Department of Otolaryngology-Head and Neck
Surgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New
York, NY, USA
| | - Quinn O’Malley
- THANC (Thyroid, Head and Neck Cancer)
Foundation, New York, NY, USA
| | - Mykayla Sandler
- THANC (Thyroid, Head and Neck Cancer)
Foundation, New York, NY, USA
| | - Monica H. Xing
- THANC (Thyroid, Head and Neck Cancer)
Foundation, New York, NY, USA
| | - Edward Ansari
- Department of Otolaryngology-Head and Neck
Surgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New
York, NY, USA
| | - Neil Mundi
- Department of Otolaryngology-Head and Neck
Surgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New
York, NY, USA
| | - Daniel Buchbinder
- Department of Otolaryngology-Head and Neck
Surgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New
York, NY, USA
| | - Eran Alon
- Department of Otolaryngology Head and Neck
Surgery, The Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Devin Okay
- Department of Otolaryngology-Head and Neck
Surgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New
York, NY, USA
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Wein LE, O'Malley QF, Xing MH, Sims JR, Mundi N, Dowling EM, Buchbinder D, Urken ML. Novel technique to prevent or correct open-mouth deformity after bilateral mandibular resection: Use of tensor fascia lata slings. Head Neck 2022; 44:1995-2000. [PMID: 35638703 DOI: 10.1002/hed.27105] [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: 11/24/2021] [Revised: 04/19/2022] [Accepted: 05/11/2022] [Indexed: 11/07/2022] Open
Abstract
Open-mouth deformity after mandibular resection presents a challenge for surgeons and patients, contributing to significant functional and cosmetic morbidity. We present an innovative surgical technique to prevent or correct open-mouth deformity. Tensor fascia lata slings were utilized in combination with maxillomandibular fixation to surgically correct or prevent open-mouth deformity in four patients who had previously undergone mandibulectomy or at the time of a contralateral mandibulectomy following prior hemimandibulectomy and reconstruction. Two patients achieved favorable outcomes, including oral competence and improved resting jaw position, while open-mouth deformity could not be corrected for one patient. Another patient remains in the early postoperative period following a secondary procedure to correct open-mouth deformity. Open-mouth deformity is a functional/aesthetic problem that has not been addressed in the literature. Use of tensor fascia lata slings to suspend the mandible is a novel approach to the surgical management of open-mouth deformity.
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Affiliation(s)
- Lauren E Wein
- THANC (Thyroid, Head, and Neck Cancer) Foundation, New York, New York, USA
| | - Quinn F O'Malley
- THANC (Thyroid, Head, and Neck Cancer) Foundation, New York, New York, USA
| | - Monica H Xing
- THANC (Thyroid, Head, and Neck Cancer) Foundation, New York, New York, USA
| | - John R Sims
- THANC (Thyroid, Head, and Neck Cancer) Foundation, New York, New York, USA.,Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Neil Mundi
- THANC (Thyroid, Head, and Neck Cancer) Foundation, New York, New York, USA.,Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric M Dowling
- THANC (Thyroid, Head, and Neck Cancer) Foundation, New York, New York, USA.,Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Buchbinder
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mark L Urken
- THANC (Thyroid, Head, and Neck Cancer) Foundation, New York, New York, USA.,Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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12
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Shaari AL, Spaulding SL, Xing MH, Yue LE, Machado RA, Moubayed SP, Mundi N, Chai RL, Urken ML. The anatomical basis for preserving the blood supply to the parathyroids during thyroid surgery, and a review of current technologic advances. Am J Otolaryngol 2022; 43:103161. [PMID: 34375794 DOI: 10.1016/j.amjoto.2021.103161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/01/2021] [Accepted: 07/17/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Devascularization of the parathyroid glands is generally accepted as the most common mechanism for iatrogenic hypocalcemia, a frequently seen complication of both total and completion thyroidectomy procedures. Much has been written about iatrogenic hypoparathyroidism, but few papers have precisely delineated the arterial supply of the parathyroid glands and the common anatomical variations that may impact parathyroid preservation during thyroid surgery. METHODS We offer an illustrated review and discussion of the only two anatomic studies published in the medical literature focusing on parathyroid vasculature. In addition, we examine current techniques of parathyroid identification, preservation, and classification. FINDINGS A surgical technique that preserves the parathyroid arteries is vital to preserving the viability of the parathyroid gland(s) during thyroid surgery. In 1907, Halsted and Evans described a technique of ligating the distal branches of the thyroid arteries beyond the origin of the parathyroid arteries, a technique termed ultra-ligation. In 1982, Flament et al.. reported three distinct anatomical variations of the parathyroid arteries which place the parathyroid blood supply at risk for devascularization during thyroid surgery. Our review also highlights novel techniques that aid surgeons in identification and assessment of the parathyroid glands. CONCLUSIONS Recognition of the variations of parathyroid anatomy and their potential to lead to devascularization aids thyroid surgeons in their pursuit of parathyroid preservation. An awareness of the variety of novel parathyroid identification and preservation techniques can assist surgeons to achieve this goal.
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Affiliation(s)
- Ariana L Shaari
- Thyroid, Head, and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY 10003, USA.
| | - Sarah L Spaulding
- Thyroid, Head, and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY 10003, USA
| | - Monica H Xing
- Thyroid, Head, and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY 10003, USA
| | - Lauren E Yue
- Thyroid, Head, and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY 10003, USA
| | - Rosalie A Machado
- Thyroid, Head, and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY 10003, USA
| | - Sami P Moubayed
- Thyroid, Head, and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY 10003, USA; Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY 10003, USA
| | - Neil Mundi
- Thyroid, Head, and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY 10003, USA; Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY 10003, USA
| | - Raymond L Chai
- Thyroid, Head, and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY 10003, USA; Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY 10003, USA
| | - Mark L Urken
- Thyroid, Head, and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY 10003, USA; Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY 10003, USA
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13
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Caulley L, Eskander A, Yang W, Auh E, Cairncross L, Cho NL, Golbon B, Iyer S, Liu JC, Lee PJ, Lindeman B, Meltzer C, Molin N, Moore A, Noel J, Nozolino H, Pasternak J, Price B, Ramsay T, Rolighed L, Sajisevi M, Sharma A, Sinclair C, Sorensen M, Tae K, Tang AL, Tsao G, Williams M, Wrenn S, Xing MH, Zafereo M, Stack BC, Randolph G, Davies L. Trends in Diagnosis of Noninvasive Follicular Thyroid Neoplasm With Papillarylike Nuclear Features and Total Thyroidectomies for Patients With Papillary Thyroid Neoplasms. JAMA Otolaryngol Head Neck Surg 2021; 148:99-106. [PMID: 34817546 DOI: 10.1001/jamaoto.2021.3277] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Increasing detection of early-stage papillary thyroid neoplasms without improvements in mortality has prompted development of strategies to prevent or mitigate overtreatment. Objective To determine adoption rates of 2 recent strategies developed to limit overtreatment of low-risk thyroid cancers: (1) a new classification, noninvasive follicular thyroid neoplasm with papillarylike nuclear features (NIFTP), and (2) hemithyroidectomy for selected papillary thyroid carcinomas (PTCs) up to 4 cm in size. Design, Setting, and Participants This is a cross-sectional analysis of 3368 pathology records of 2 cohorts of patients from 18 hospitals in 6 countries during 2 time periods (2015 and 2019). Participating hospitals were included from the US (n = 12), Canada (n = 2), Denmark (n = 1), South Korea (n = 1), South Africa (n = 1), and India (n = 1). The records of the first 100 patients per institution for each year who underwent thyroid-directed surgery (hemithyroidectomy, total thyroidectomy, or completion thyroidectomy) were reviewed. Main Outcomes and Measures Frequency of diagnosis of NIFTP, PTCs, and thyroidectomies during the study period. Results Of the 790 papillary thyroid neoplasms captured in the 2019 cohort, 38 (4.8%) were diagnosed as NIFTP. Diagnosis of NIFTP was observed in the US, South Africa, and India. There was minimal difference in the total proportion of PTCs in the 2015 cohort compared with the 2019 cohort (778 [47.1%] vs 752 [44.5%]; difference, 2.6% [95% CI, -16.9% to 22.1%]). The proportion of PTCs eligible for hemithyroidectomy but treated with total thyroidectomy in the 2 cohorts demonstrated a decreasing trend from 2015 to 2019 (341 of 453 [75.3%] vs 253 of 434 [58.3%]; difference, 17.0% [95% CI, -1.2% to 35.2%]). Conclusions and Relevance Results of this cohort study showed that the 2 mitigation strategies for preventing overtreatment of early-stage thyroid cancer have had mixed success. The diagnosis of NIFTP has only been applied to a small proportion of thyroid neoplasms compared with expected rates. However, more patients eligible for hemithyroidectomy received it in 2019 compared with 2015, showing some success with this deescalation strategy.
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Affiliation(s)
- Lisa Caulley
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Weining Yang
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Edel Auh
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Lydia Cairncross
- Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bahar Golbon
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Subramania Iyer
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, India
| | - Jeffrey C Liu
- Division of Head and Neck Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania.,Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Paul J Lee
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Brenessa Lindeman
- Department of General Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham
| | | | - Nicole Molin
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Alessandra Moore
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julia Noel
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California
| | - Halie Nozolino
- Department of General Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham
| | - Jesse Pasternak
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Brendon Price
- Division of Anatomical Pathology, Department of Pathology, Faculty of Health Sciences, University of Cape Town/National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lars Rolighed
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Mirabelle Sajisevi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Larner College of Medicine, University of Vermont Medical Center, Burlington
| | - Arun Sharma
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield
| | - Catherine Sinclair
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York
| | - Meredith Sorensen
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Alice L Tang
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Gabriel Tsao
- The Permanente Medical Group, Santa Rosa, California
| | - Michelle Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Sean Wrenn
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Monica H Xing
- The Thyroid, Head, and Neck Cancer Foundation, New York, New York
| | - Mark Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brendan C Stack
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York
| | - Greg Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Louise Davies
- VA Outcomes Group, White River Junction, Vermont.,Section of Otolaryngology-Head and Neck Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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14
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Seo GT, Xing MH, Mundi N, Matloob A, Khorsandi AS, Urken ML. Adenoid Cystic Carcinoma of the Gingiva: A Case Report and Literature Review. Ann Otol Rhinol Laryngol 2021; 131:1151-1157. [PMID: 34706573 DOI: 10.1177/00034894211055591] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Adenoid cystic carcinoma (ACC) is a commonly encountered salivary gland malignancy. However, it rarely occurs in the gingiva, an area generally thought to be devoid of minor salivary glands. We present a case occurring in this unusual site and review other reported cases. METHODS A 56 year-old male presented with a right-sided mandibular toothache for 1 year and underwent dental extraction. Due to persistent pain, follow up examination revealed a large gingival lesion. A biopsy was positive for adenoid cystic carcinoma. RESULTS The patient underwent a complete right segmental mandibulectomy and was reconstructed with a fibular osteocutaneous free flap. Three months postoperatively, during the planning for adjuvant radiation therapy, the patient developed pain in the left mandible. Imaging revealed extensive involvement of the left native mandible. Deep bone biopsies in several areas of the left mandible revealed ACC. He then underwent a complete left hemi-mandibulectomy and reconstruction with a fibular osteocutaneous free flap. Tensor fascia lata suspension slings were placed due to concern for an open mouth deformity attributable to disruption of bilateral masticator slings. He will undergo adjuvant radiation therapy. Our review of the literature revealed 50 cases of gingival ACC published since 1972. Disease recurrence and distant metastases were noted in several patients, occurring at the latest after 30 years follow-up. CONCLUSIONS Given its indolent behavior, high proclivity for late recurrence and metastasis, and overall infrequency, ACC represents a pathology that requires early diagnosis and comprehensive long-term surveillance. While ACC is well described in oral cavity sites with high densities of minor salivary glands, it is not commonly seen in the gingiva. As such, gingival ACC may display a unique biological and/or clinical character. We offer the first literature review of this rare entity.
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Affiliation(s)
- Gabriella T Seo
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, NY, USA
| | - Monica H Xing
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, NY, USA
| | - Neil Mundi
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ammar Matloob
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Azita S Khorsandi
- Department of Radiology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Mark L Urken
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, NY, USA.,Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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15
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Spaulding SL, Ansari E, Xing MH, Sandler ML, O'Malley QF, Ho R, Spitzer H, Levy J, Ganz C, Khorsandi AS, Mundi N, Urken ML. Diagnosis and management of pharyngoesophageal stenosis: A comprehensive approach to prophylactic, endoscopic, and reconstructive treatment options. Am J Otolaryngol 2021; 42:103003. [PMID: 33894689 DOI: 10.1016/j.amjoto.2021.103003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/15/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pharyngoesophageal stenosis (PES) is a serious complication that substantially impacts functional outcomes and quality of life (QOL) for up to a third of head and neck cancer patients who undergo radiotherapy. Dysphagia is often multifactorial in nature and is a devastating complication of treatment that impacts patients' QOL, general health and overall wellbeing. The authors detail the clinical presentation, risk factors, imaging characteristics, preventive measures, and multimodality treatment options for PES. METHODS The authors present a comprehensive management algorithm for PES, including treatment by dilation, stenting, spray cryotherapy and dilation, and reconstructive treatment options utilizing different pedicled and free flaps. RESULTS The authors advocate for a thorough assessment of the extent and degree of pharyngoesophageal involvement of PES to determine the optimal management strategy. CONCLUSIONS The development of post treatment dysphagia requires appropriate imaging and biopsy, when indicated, to rule out the presence of persistent/recurrent cancer. Multidisciplinary management by a team of physicians well-versed in the range of diagnostic and therapeutic interventions available for PES is critical to its successful management.
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Affiliation(s)
- Sarah L Spaulding
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Edward Ansari
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10003, United States of America
| | - Monica H Xing
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America.
| | - Mykayla L Sandler
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Quinn F O'Malley
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Rebecca Ho
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Hannah Spitzer
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Juliana Levy
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Cindy Ganz
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Azita S Khorsandi
- Department of Radiology, New York Eye and Ear Infirmary, New York, NY 10003, United States of America
| | - Neil Mundi
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10003, United States of America
| | - Mark L Urken
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10003, United States of America
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16
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Xing MH, Shaari AL, Beute JE, Mundi N, Matloob A, Khorsandi AS, Wisdom G, Urken ML. Rare case of anaplastic plasmacytoma in the sinonasal tract. Head Neck 2021; 43:E46-E50. [PMID: 34272912 DOI: 10.1002/hed.26818] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/10/2021] [Accepted: 07/09/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Extramedullary plasmacytomas are tumors that develop from plasma cells and rarely express anaplastic features. To our knowledge, there have only been three reported cases of anaplastic plasmacytomas of the sinonasal tract in the English literature. We detail the fourth case. METHODS A 70-year-old male was seen with a 4-month history of nasal congestion, bloody mucous, and left sided nasal obstruction. On positron emission tomography/computed tomography, the lesion was FDG-avid with an SUVmax of 25.1. A biopsy of the lesion and subsequent immunohistochemical staining confirmed the diagnosis of an anaplastic plasmacytoma. RESULTS The patient is undergoing a 5-week course of curative-intent radiation therapy. CONCLUSION Extramedullary plasmacytomas with anaplastic features are very rare. We highlight the value of thorough histopathological review and detailed immunostains to arrive at a diagnosis of anaplastic extramedullary plasmacytoma.
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Affiliation(s)
- Monica H Xing
- The Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Ariana L Shaari
- The Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - John E Beute
- The Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Neil Mundi
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ammar Matloob
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Azita S Khorsandi
- Department of Radiology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Gregory Wisdom
- Department of Otolaryngology, Caremount Medical Katonah Office, Katonah, New York, USA
| | - Mark L Urken
- The Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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17
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Xing MH, Liu X, Shaari A, Urken ML, Chen H. Fine needle aspiration cytology of metastatic myxoid liposarcoma to the thyroid. Diagn Cytopathol 2021; 49:899-901. [PMID: 33979041 DOI: 10.1002/dc.24773] [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] [Received: 01/15/2021] [Revised: 04/02/2021] [Accepted: 05/03/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Monica H Xing
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Xulei Liu
- Fine Needle Aspiration Biopsy Clinic, Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Downtown Union Square Medical Center, New York, New York, USA
| | - Ariana Shaari
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Mark L Urken
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Downtown Union Square Medical Center, New York, New York, USA
| | - Hua Chen
- Fine Needle Aspiration Biopsy Clinic, Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Downtown Union Square Medical Center, New York, New York, USA
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18
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Silberzweig AM, Xing MH, Mundi N, Matloob A, Urken ML. First reported PET positive, FDG avid free flap pedicle ossification and review of the literature. Clin Imaging 2021; 79:30-35. [PMID: 33866112 DOI: 10.1016/j.clinimag.2021.03.034] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 03/19/2021] [Accepted: 03/29/2021] [Indexed: 11/18/2022]
Abstract
The fibular free flap (FFF) is commonly used for head and neck bony reconstruction. Ossification of the vascular pedicle has been reported but is an uncommon complication of this procedure. Ossification of the pedicle with FDG avidity has not been identified in the literature. Here we present a case of FDG avid free flap ossification seen on PET/CT imaging in a patient who developed trismus after fibular free flap reconstruction of a maxillary defect for a primary squamous cell carcinoma of the palate. The FDG avidity of the free flap ossification and trismus were both concerning for recurrent squamous cell carcinoma.
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Affiliation(s)
- Alex M Silberzweig
- Thyroid, Head and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY 10003, USA.
| | - Monica H Xing
- Thyroid, Head and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY 10003, USA
| | - Neil Mundi
- Thyroid, Head and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY 10003, USA; Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY 10003, USA
| | - Ammar Matloob
- Department of Pathology, Icahn School of Medicine at Mount Sinai, 1000 10th Ave, New York, NY 10019, USA
| | - Mark L Urken
- Thyroid, Head and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY 10003, USA; Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY 10003, USA
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19
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Xing MH, Chai RL. The Patient Perspective: Evaluating the Accessibility of Transoral Robotic Surgery Online Resources. Ann Otol Rhinol Laryngol 2021; 131:27-38. [PMID: 33843290 DOI: 10.1177/00034894211007248] [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] [Indexed: 11/17/2022]
Abstract
PURPOSE The varied treatment options available to patients with HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) can cause significant patient confusion. In particular, transoral robotic surgery (TORS) has become widely used for treatment of HPV-positive OPSCC. As patients commonly refer to the internet for additional information, we aim to evaluate the quality of online patient educational materials for TORS in comparison to other otolaryngology surgical procedures. METHODS The terms "transoral robotic surgery," "glossectomy," "thyroidectomy," and "neck dissection" were searched on Google. Flesch reading ease, Flesh-Kincaid Grade Level, MD review rates, and PEMAT understandability and actionability were assessed for each search term. Google trends was used to determine search interest for each term between May 2015 and May 2020. RESULTS Of the 30 TORS websites that met inclusion criteria, the average FRE and FKGL scores were 40.74 and 11.60 (that of an average high school senior). The FRE and FKGL scores for TORS were all statistically significantly lower than those of all comparator search terms (P < .05). Only 1 out of 30 TORS sites were MD reviewed, representing the lowest MD review rate across all search terms. Understandability and actionability scores for TORS were also the lowest across all search terms at 77.71% and 2.66%, respectively. TORS had the lowest search interest. CONCLUSIONS In comparison to other common otolaryngology procedures, TORS websites are the least patient friendly. As TORS becomes a more widely used procedure, it is critical that TORS websites become higher quality resources that patients can reliably reference.
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Affiliation(s)
- Monica H Xing
- Thyroid, Head and Neck Cancer Foundation, New York, NY, USA
| | - Raymond L Chai
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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20
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Sandler ML, Griffin M, Xing MH, Ansari E, Khorsandi AS, Urken ML. Postoperative Imaging Appearance of Iliac Crest Free Flaps Used for Palatomaxillary Reconstructions. AJNR Am J Neuroradiol 2021; 42:753-758. [PMID: 33632734 PMCID: PMC8040998 DOI: 10.3174/ajnr.a7005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/24/2020] [Indexed: 11/07/2022]
Abstract
The osteomyocutaneous iliac crest free flap is a reconstructive option for segmental mandibular or complex palatomaxillary defects. Familiarity with the radiographic appearance of free flaps such as the iliac crest is necessary for the postoperative evaluation of patients after mandibular, maxillary, or palatal reconstructions because it allows radiologists to properly monitor and interpret the appearance of the flap over time. This study presents a retrospective review of 5 patients who underwent palatomaxillary reconstruction with an iliac crest free flap at our institution. The imaging appearances of the 5 patients were analyzed to determine the key radiographic characteristics of a healthy and successful iliac crest free flap. Radiographic fluency with the imaging appearance of the iliac crest free flap, as well as the new anatomy of the region in the postoperative period, will allow for better interpretation of the flap appearance on imaging and will prevent false identification of tumor recurrence.
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Affiliation(s)
- M L Sandler
- From the Thyroid, Head & Neck Cancer (THANC) Foundation (M.L.S., M.G., M.H.X., M.L.U.), New York, New York
| | - M Griffin
- From the Thyroid, Head & Neck Cancer (THANC) Foundation (M.L.S., M.G., M.H.X., M.L.U.), New York, New York
| | - M H Xing
- From the Thyroid, Head & Neck Cancer (THANC) Foundation (M.L.S., M.G., M.H.X., M.L.U.), New York, New York
| | - E Ansari
- Department of Otolaryngology-Head and Neck Surgery (E.A., M.L.U.), Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New York, New York, New York
| | - A S Khorsandi
- Department of Radiology (A.S.K.), NY Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - M L Urken
- From the Thyroid, Head & Neck Cancer (THANC) Foundation (M.L.S., M.G., M.H.X., M.L.U.), New York, New York
- Department of Otolaryngology-Head and Neck Surgery (E.A., M.L.U.), Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New York, New York, New York
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21
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Sandler ML, Ho R, Xing MH, Gidumal S, Spitzer H, Levy JC, Chai RL. Primary Hyperparathyroidism During Pregnancy Treated With Parathyroidectomy: A Systematic Review. Laryngoscope 2021; 131:1915-1921. [PMID: 33751589 DOI: 10.1002/lary.29489] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES/HYPOTHESIS The primary objective of this study was to assess the safety of parathyroidectomy during pregnancy as treatment for hyperparathyroidism (HPTH) in comparison to nonsurgical management plans. Secondary outcomes involved analyzing the safety of surgery in the third trimester and the benefit of operating on asymptomatic pregnant patients. STUDY DESIGN Systematic review. METHODS PRISMA-guided systematic review of all cases of primary hyperparathyroidism during pregnancy published in peer-reviewed English journals on PubMed/MEDLINE, EMBASE, and SCOPUS from 1980 to 2020. RESULTS A total of 75 manuscripts were included in this review describing 382 cases of gestational hyperparathyroidism. The median maternal age was 31 years. Overall, 108 cases (28.3%) underwent parathyroidectomy during pregnancy while 274 cases (71.7%) were treated nonsurgically. The majority of surgeries took place during the second trimester (67.6%). Complications and/or deaths were less likely to occur after surgery in the second trimester (4.48%) as compared to surgery in the third trimester (21.1%). Nine surgically treated cases resulted in infant complications and/or death; however, none of these nine cases had any surgical complications. Despite these complications, the overall infant complication rate for patients who underwent surgical treatment remained lower than that of patients treated with conservative therapy (9.1% vs. 38.9%). CONCLUSIONS This review suggests that for all pregnant patients with diagnosed HPTH, parathyroidectomy should be considered regardless of symptomatology. Our data suggest that parathyroidectomy is associated with fewer risks than more conservative treatments and results in better fetal outcomes. Surgery during the third trimester is feasible and surgery should be considered in both symptomatic and asymptomatic patients. Laryngoscope, 131:1915-1921, 2021.
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Affiliation(s)
- Mykayla L Sandler
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Rebecca Ho
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Monica H Xing
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Sunder Gidumal
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hannah Spitzer
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Juliana C Levy
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Raymond L Chai
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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22
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Xing MH, Mundi N, Govindan A, Khorsandi A, Urken ML. Unusual location of a second branchial cleft cyst presenting in the suprasternal notch. Head Neck 2021; 43:E27-E29. [PMID: 33533131 DOI: 10.1002/hed.26629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/28/2020] [Revised: 12/26/2020] [Accepted: 01/21/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Second branchial cleft cysts (SBCCs) are congenital benign tumors that comprise up to 90% of all branchial cleft anomalies. SBCCs typically present in the lateral neck along the anterior border of the upper third of the sternocleidomastoid muscle. We describe a case of a SBCC presenting in an unusual location in the lower neck close to midline. METHODS An 18-year-old male presented with a 2-year history of a neck mass in the suprasternal notch. Imaging findings were reviewed with a head and neck radiologist who felt that the findings were highly suggestive of a fourth branchial cleft cyst. RESULTS The patient underwent surgical excision of the mass. Final pathologic evaluation confirmed the diagnosis of a second branchial cleft cyst. CONCLUSIONS Though extremely uncommon, second branchial cleft cysts can extend to the suprasternal notch and should not be excluded from the differential diagnoses of lower neck masses.
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Affiliation(s)
- Monica H Xing
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Neil Mundi
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New York, New York, USA
| | - Aparna Govindan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New York, New York, USA
| | - Azita Khorsandi
- Department of Radiology, New York Eye and Ear Infirmary, Mount Sinai Health System, New York, New York, USA
| | - Mark L Urken
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New York, New York, USA
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23
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Sandler ML, Xing MH, Levy JC, Chai RL, Khorsandi AS, Gonzalez-Velazquez C, Urken ML. Metastatic thyroid carcinoma to the parapharyngeal and retropharyngeal spaces: Systematic review with seven newly reported cases describing an uncommon presentation of a common disease. Head Neck 2020; 43:1331-1344. [PMID: 33295689 DOI: 10.1002/hed.26572] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 05/08/2020] [Revised: 11/09/2020] [Accepted: 11/20/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Metastatic thyroid carcinoma to retropharyngeal and parapharyngeal (RP/PP) lymph nodes is rare. Literature suggests previous lateral neck dissection (LND) may alter patterns of lymphatic drainage in the neck, predisposing to these less common sites of spread. METHODS PRISMA-guided systematic search for all published cases detailing RP/PP metastases of well-differentiated thyroid carcinoma from 1970 to 2019. RESULTS Seventy articles were identified and 44 were included, along with seven cases treated at our institution, totaling 239 cases. Cases represented both retropharyngeal (60.7%) and parapharyngeal (39.3%) metastases identified in the initial (27.6%) and recurrent (72.4%) setting. CONCLUSION RP/PP metastases generally present in the recurrent setting. RP/PP metastases often represent high-risk disease, and surgical treatment is recommended.
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Affiliation(s)
- Mykayla L Sandler
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Monica H Xing
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Juliana C Levy
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Raymond L Chai
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Azita S Khorsandi
- Department of Radiology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Camilo Gonzalez-Velazquez
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA.,Division of Endocrinology, Internal Medicine Department, Dr. Jose E. González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Mark L Urken
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
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24
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Xing MH, Mundi N, Govindan A, Khorsandi A, Brandwein-Weber M, Matloob A, Liaw B, Urken ML. Rare case of metastatic liposarcoma to the thyroid gland and a review of the literature of metastatic sarcomas to the thyroid. Head Neck 2020; 43:E20-E26. [PMID: 33220159 DOI: 10.1002/hed.26552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/06/2020] [Accepted: 11/10/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Liposarcomas are the second most common type of soft tissue sarcomas. Typically, myxoid liposarcomas have a metastatic rate of 10%, usually involving the retroperitoneal space, abdomen, and spine. Metastasis to the thyroid is extremely rare. DESIGN/METHOD A 62-year-old male with a history of metastatic myxoid liposarcoma in his right thigh presented to our clinic for evaluation of a thyroid nodule incidentally identified on a CT scan. A subsequent FNA biopsy was suggestive of a metastatic liposarcoma. RESULTS The patient underwent a left thyroid lobectomy and final pathology confirmed a grade II/III metastatic myxoid liposarcoma that measured 3.3 cm. The patient tolerated the procedure well. CONCLUSIONS Our case highlights the role of a patient's medical history when evaluating thyroid nodules to optimize accurate diagnosis, as liposarcomas do not typically metastasize to the thyroid. We also provide an updated review of the literature on all cases of metastatic sarcomas to the thyroid.
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Affiliation(s)
- Monica H Xing
- The Thyroid, Head and Neck Cancer (THANC) Foundation, New York, NY, USA
| | - Neil Mundi
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New York, NY, USA
| | - Aparna Govindan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New York, NY, USA
| | - Azita Khorsandi
- Department of Radiology, New York Eye and Ear Infirmary, New York, NY, USA
| | | | - Ammar Matloob
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Bobby Liaw
- Department of Hematology-Oncology, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New York, NY, USA
| | - Mark L Urken
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New York, NY, USA
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25
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Sandler ML, Sims JR, Xing MH, Khorsand AS, Brandwein-Weber M, Lee NY, Urken ML. Atypical metastasis of nasopharyngeal cancer: noncontiguous spread to the ipsilateral ear. Clin Imaging 2020; 72:70-74. [PMID: 33217673 DOI: 10.1016/j.clinimag.2020.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/19/2020] [Revised: 10/13/2020] [Accepted: 11/11/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Nasopharyngeal carcinoma (NPC) is a rare form of squamous cell carcinoma. Primary NPC is generally treated with radiation and chemotherapy, though recurrence and distant metastases are common. Reports of noncontiguous metastasis to the middle ear and external ear canal (EAC) are rare. MATERIALS AND METHODS Case presentation of a female patient previously treated for NPC, who developed an EAC metastasis. A literature review of all reported cases of metastatic NPC in the middle ear and EAC is also included. RESULTS A patient presenting with noncontiguous metastasis of NPC to the EAC was treated with surgical resection followed by chemotherapy and radiation. The patient successfully completed treatment and is currently alive but with suspected distant metastatic disease at 11 months following treatment. CONCLUSIONS NPC metastasis to the EAC is extremely rare. Treatment options are varied, and prognosis is generally poor. The case presented here shows better outcomes than many previous reports.
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Affiliation(s)
- Mykayla L Sandler
- THANC (Thyroid, Head and Neck Cancer) Foundation, 10 Union Square East, Suite 5B, New York, NY 10003, USA
| | - John R Sims
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai West, 1000 10th Avenue, New York, NY 10003, USA
| | - Monica H Xing
- THANC (Thyroid, Head and Neck Cancer) Foundation, 10 Union Square East, Suite 5B, New York, NY 10003, USA.
| | - Azita S Khorsand
- Department of Radiology, New York Eye & Ear Infirmary of Mount Sinai, 310 East 14th Street, New York, NY 10003, USA
| | - Margaret Brandwein-Weber
- Department of Pathology, Icahn School of Medicine at Mount Sinai, Mount Sinai West, 1000 10th Avenue, New York, NY 10019, USA
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, NY, NY 10017, USA
| | - Mark L Urken
- THANC (Thyroid, Head and Neck Cancer) Foundation, 10 Union Square East, Suite 5B, New York, NY 10003, USA; Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai West, 1000 10th Avenue, New York, NY 10003, USA
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26
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Xing MH, Sandler ML, Urken ML. Reply to "Function preservation for resection of vagal schwannoma of the head and neck: Are we talking about the same technique?". Head Neck 2020; 42:3471. [PMID: 32881114 DOI: 10.1002/hed.26450] [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] [Received: 07/20/2020] [Accepted: 08/18/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Monica H Xing
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, NY, USA
| | | | - Mark L Urken
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel Hospital, New York, NY, USA
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27
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Xing MH, Ansari E, O'Malley QF, Khorsandi A, Khan MN, Urken ML. Radiation necrosis of the pharyngeal soft tissue: Unique clinical entity reconstructed with a previously unreported composite brachioradialis and flexor digitorum superficialis radial forearm flap. Head Neck 2020; 42:E23-E29. [PMID: 32783228 DOI: 10.1002/hed.26405] [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: 04/28/2020] [Revised: 06/13/2020] [Accepted: 07/14/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The radial forearm free flap (RFFF) is a versatile flap commonly used in head and neck reconstructive surgery. We describe the use of a composite RFFF that includes muscle for reconstruction of a hostile wound of the posterior pharyngeal wall. METHODS A 54-year-old male with a history of recurrent right palatine tonsil HPV+ squamous cell carcinoma developed severe soft tissue necrosis of the posterior pharyngeal wall secondary to reirradiation. The defect was reconstructed with a composite RFFF that included the brachioradialis (BR) muscle and the flexor digitorum superficialis (FDS) muscle. RESULTS Restoration of this complex defect was successfully accomplished with minimal donor site functional deficits and satisfactory functional outcomes including decannulation and resumption of oral intake. CONCLUSION This composite RFFF can be effectively used to reconstruct a hostile wound of the posterior pharyngeal wall. Incorporation of muscle in the reconstruction of complex wounds with soft tissue necrosis is beneficial.
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Affiliation(s)
- Monica H Xing
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, USA
| | - Edward Ansari
- Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Beth Israel, New York, New York, USA
| | - Quinn F O'Malley
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, USA
| | - Azita Khorsandi
- Department of Radiology, New York Eye & Ear Infirmary of Mount Sinai, New York, USA
| | - Mohemmed Nazir Khan
- Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Beth Israel, New York, New York, USA
| | - Mark L Urken
- Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Beth Israel, New York, New York, USA
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28
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Xing MH, van den Akker T, Gonzalez-Velazquez C, Urken ML, Chen H. Images in cytology: Fine needle aspiration cytology of BRAF V600E positive anaplastic thyroid carcinoma. Diagn Cytopathol 2020; 49:150-152. [PMID: 32681762 DOI: 10.1002/dc.24545] [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] [Received: 04/30/2020] [Revised: 06/01/2020] [Accepted: 06/22/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Monica H Xing
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Tayler van den Akker
- Fine Needle Aspiration Biopsy Clinic, Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New York, New York, USA
| | - Camilo Gonzalez-Velazquez
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA.,Division of Endocrinology, Internal Medicine Department, Dr. Jose E. González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Mark L Urken
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New York, New York, USA
| | - Hua Chen
- Fine Needle Aspiration Biopsy Clinic, Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New York, New York, USA
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29
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Gonzalez-Velazquez C, Xing MH, Urken ML. Harder than just hitting a bulls-eye: treatment for hypothyroidism in children might have more than just one target. Endocrine 2020; 69:230. [PMID: 32162183 DOI: 10.1007/s12020-020-02254-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Camilo Gonzalez-Velazquez
- Thyroid, Head and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
| | - Monica H Xing
- Thyroid, Head and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY, 10003, USA.
| | - Mark L Urken
- Thyroid, Head and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
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30
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Xing MH, Ansari E, Levy JC, Samankan S, Khorsandi A, Urken ML. Incongruent radiographic indication of calvarial metastatic diploic space invasion with absent histologic findings in a patient with basal cell carcinoma of the scalp. Head Neck 2020; 42:E1-E5. [PMID: 32011047 DOI: 10.1002/hed.26097] [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: 11/11/2019] [Accepted: 01/15/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Radiographic imaging is often used to determine basal cell carcinoma (BCC) extension and invasion and to define a surgical plan. However, imaging modalities may overestimate tumor invasion and lead to unnecessarily aggressive treatment. METHODS A 77-year-old woman was seen with a growing BCC of the scalp with MRI imaging indicative of calvarial diploic space invasion. The patient underwent Mohs surgery followed by a parietal craniectomy. RESULTS Contrary to the MRI findings, histological evaluation of the cortical parietal calvarium and the diploic space did not demonstrate BCC. CONCLUSIONS Surgeons should be wary of diploic space changes in the absence of cortical erosion demonstrated in MRI as it may not explicitly indicate tumor invasion. Biopsy of the diploe is necessary in such cases to determine the surgical course and to avoid morbidity associated with calvarium removal.
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Affiliation(s)
- Monica H Xing
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York
| | - Edward Ansari
- Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Beth Israel, New York, New York
| | - Juliana C Levy
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York
| | - Shabnam Samankan
- Department of Pathology, Icahn School of Medicine and Mount Sinai, New York, New York
| | - Azita Khorsandi
- Department of Radiology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - Mark L Urken
- Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Beth Israel, New York, New York
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