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Obermeyer IP, Nguyen CH, Yoo F, Garg R, Kuan EC. Anatomic Relationship Between the Head of the Middle Turbinate and First Olfactory Filum: A Radiographic Assessment. Ann Otol Rhinol Laryngol 2024; 133:418-423. [PMID: 38240258 DOI: 10.1177/00034894241227034] [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] [Indexed: 02/27/2024]
Abstract
BACKGROUND The endoscopic modified Lothrop procedure (EMLP) has become a frequently utilized procedure in rhinologic surgery. One of the most serious complications of the procedure is cerebrospinal fluid leak, which may occur due to lack of recognition of the anterior skull base in the region of the first olfactory filum (FOF), or direct injury to the FOF itself. OBJECTIVES To evaluate the position of the head of the middle turbinate (MT) relative to the FOF, which is an important landmark in the EMLP. METHODS A series of previously obtained patient computed tomography scans of the sinus were reviewed. A reproducible process was implemented to obtain the measurements. First, the FOF was identified on an axial series. Using a localization feature of the radiographic software, this anteroposterior (AP) position could be visualized in a coronal plane. Subsequently, the MT was viewed in a sagittal plane, where a measurement between the head of the MT and the AP position of the FOF could be performed. RESULTS The AP distance between the head of the MT and the FOF was measured in 92 patients. The head of the MT was either at or anterior to the FOF in all measured subjects. The mean anterior distance of the head of the MT to FOF was 3.6 mm (±2.4 mm) on the right, and 3.8 mm (±2.2 mm) on the left. The range in AP distance was 0 to 12 mm. There was no significant difference in AP distance between the head of the MT and FOF based on gender (P = .413) or diagnosis (P = .254). CONCLUSIONS In our study, the head of the MT was reliably at or anterior to the FOF in all subjects, suggesting its utility as a fixed landmark in endoscopic sinus surgery, particularly in the EMLP. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Isaac P Obermeyer
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Irvine, CA, USA
| | - Cecilia H Nguyen
- School of Medicine, University of California Irvine, Irvine, CA, USA
| | - Frederick Yoo
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente, Anaheim, CA, USA
| | - Rohit Garg
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente, Anaheim, CA, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Irvine, CA, USA
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2
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Pool C, Liu G, Yoo F, Garg R, Keschner D. Endoscopic endonasal recanalization of the obliterated eustachian tube via ureteral stent. Int Forum Allergy Rhinol 2024; 14:138-140. [PMID: 37365856 DOI: 10.1002/alr.23223] [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: 05/17/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
KEY POINTS Eustachian tube recanalization is a feasible procedure but additional studies are needed to determine its safety. Eustachian tube closure can result from different etiologies and can cause severe symptoms. Ureteral stents have appropriate shape and pliability for placement and long-term healing. Multidisciplinary team approach allows for simultaneous endonasal and otologic approaches.
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Affiliation(s)
- Christopher Pool
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Orange County, Irvine, California, USA
| | - George Liu
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Orange County, Irvine, California, USA
| | - Frederick Yoo
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Orange County, Irvine, California, USA
| | - Rohit Garg
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Orange County, Irvine, California, USA
| | - David Keschner
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Orange County, Irvine, California, USA
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Plawecki AM, Saleem A, Zvirbulis D, Peterson EL, Yoo F, Ali A, Craig JR. Clinical Features and Headache Diagnoses in Patients With Chief Complaint of Craniofacial Pain. Ann Otol Rhinol Laryngol 2022; 132:628-637. [PMID: 35794798 DOI: 10.1177/00034894221111254] [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: 11/16/2022]
Abstract
OBJECTIVES Investigate the use of nasal endoscopy, sinus imaging, and neurologic evaluation in patients presenting to a rhinologist primarily for craniofacial pain. METHODS This was a retrospective analysis of consecutive outpatients presenting to a rhinologist between 2016 and 2019 with chief complaints of craniofacial pain with or without other sinonasal symptoms, who were then referred to and evaluated by headache specialists. Data analyzed included sinusitis symptoms, Sino-Nasal Outcome Test (SNOT-22) scores (and facial pain subscores), pain location, nasal endoscopy, computed tomography (CT) findings, and headache diagnoses made by headache specialists. RESULTS Of the 134 patients with prominent craniofacial pain, the majority of patients were diagnosed with migraine (50%) or tension-type (22%) headache, followed by multiple other non-sinogenic headache disorders. Approximately 5% of patients had headaches attributed to sinusitis. Amongst all patients, 90% had negative nasal endoscopies. Patients with negative endoscopies were significantly less likely to report smell loss (P = .003) compared to those with positive endoscopies. Poor agreement was demonstrated between self-reported pain locations and sinus findings on CT (kappa values < 0.20). Negative nasal endoscopy showed high concurrence with negative CT findings (80%-97%). CONCLUSIONS Patients presenting with chief complaints of craniofacial pain generally met criteria for various non-sinogenic headache disorders. Nasal endoscopy was negative in 90% of patients, and CT demonstrated poor agreement with pain locations. Nasal endoscopy and CT shared high concurrence rates for negative sinus findings. The value of nasal endoscopy over sinus imaging in craniofacial pain evaluation should be explored in future studies.
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Affiliation(s)
- Andrea M Plawecki
- Department of Otolaryngology-Head & Neck Surgery, Henry Ford Health, Detroit, MI, USA
| | - Abdulmalik Saleem
- Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Dace Zvirbulis
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
| | - Edward L Peterson
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA
| | - Frederick Yoo
- Department of Otolaryngology-Head & Neck Surgery, Kaiser Permanente, Orange County, CA, USA
| | - Ashhar Ali
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
| | - John R Craig
- Department of Otolaryngology-Head & Neck Surgery, Henry Ford Health, Detroit, MI, USA
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Asmaro K, Yoo F, Yassin-Kassab A, Bazydlo M, Robin AM, Rock JP, Craig JR. Sinonasal Packing is Not a Requisite for Successful Cerebrospinal Fluid Leak Repair. Skull Base Surg 2021; 83:476-484. [DOI: 10.1055/s-0041-1740622] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
Abstract
Background Numerous methods have been described to repair nasal cerebrospinal fluid (CSF) leaks. Most studies have focused on optimizing CSF leak repair success, leading to closure rates of 90 to 95%.
Objective This study aimed to determine if excellent reconstruction rates could be achieved without using sinonasal packing.
Methods A prospective case series of 73 consecutive patients with various CSF leak etiologies and skull base defects was conducted to evaluate reconstruction success without sinonasal packing. The primary outcome measure was postoperative CSF leak. Secondary outcome measures were postoperative epistaxis requiring intervention in operating room or emergency department, infectious sinusitis, and 22-item sinonasal outcome test (SNOT-22) changes.
Results Mean age was 54.5 years and 64% were female. Multilayered reconstructions were performed in 55.3% of cases, with collagen or bone epidural inlay grafts, and nasal mucosal grafts or nasoseptal flaps for onlay layers. Onlay-only reconstructions with mucosal grafts or nasoseptal flaps were performed in 44.7% of cases. Tissue sealants were used in all cases, and lumbar drains were used in 40.8% of cases. There were two initial failures (97.4% initial success), but both resolved with lumbar drains alone (no revision surgeries). There were no instances of postoperative epistaxis requiring intervention in the operating room or emergency department. Infectious sinusitis occurred in 2.7% of patients in the first 3 months postoperatively. SNOT-22 did not change significantly from preoperatively to first postoperative visits, then improved over time.
Conclusion Nasal CSF leaks from various etiologies and defect sites were successfully repaired without using sinonasal packing, and patients experienced minimal sinonasal morbidity.
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Affiliation(s)
- Karam Asmaro
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | - Frederick Yoo
- Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan, United States
| | | | - Michael Bazydlo
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Adam M. Robin
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | - Jack P. Rock
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | - John R. Craig
- Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan, United States
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Desiato VM, Soler ZM, Nguyen SA, Salvador C, Hill JB, Lamira J, Rowan NR, Yoo F, Little RE, Matthews LJ, Dubno JR, Schlosser RJ. Evaluating the Relationship Between Olfactory Function and Loneliness in Community-Dwelling Individuals: A Cross-sectional Study. Am J Rhinol Allergy 2020; 35:334-340. [PMID: 32915652 DOI: 10.1177/1945892420958365] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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
BACKGROUND Olfactory dysfunction (OD) has been reported to impact social interactions. However, the relationship between OD and loneliness has received little attention. The purpose of this study was to determine the association between OD and loneliness, controlling for patient factors. METHODS Subjects without otolaryngic complaints were enrolled and olfactory function was assessed using: Sniffin' Sticks test to measure threshold, discrimination and identification (TDI), Questionnaire of Olfactory Disorders Negative Statements (QOD-NS) and 9 - item Olfactory-Visual Analogue Scale (VAS). Loneliness was assessed using the De Jong Gierveld (DJG) and University of California Los Angeles (UCLA) loneliness scales. Bivariate analysis was performed followed by regression analysis, controlling for confounders. RESULTS In total, 221 subjects were included with a mean age of 50.5 years (range 20 to 93), 133 (60.2%) females and 161 (72.9%) white. Mean TDI score was 29.3 (7.0) and 49.5% of the cohort was dysosmic. Using DJG, 36.4% of the cohort were classified as lonely, whereas 35.0% were lonely using UCLA. Olfactory measures were significantly associated with DJG, including TDI (β = -0.03, p = 0.050), olfactory discrimination (β = -0.111, p = 0.005), QOD-NS (β = 0.058, p < 0.001) and olfactory-VAS (β = 0.032, p < 0.001). UCLA scores were significantly associated with QOD-NS (PR 1.061 [CI 1.018-1.107], p = 0.005) and olfactory-VAS scores (PR 1.027, [CI 1.007-1.049], p = 0.009). After controlling for confounders, the association between DJG and olfactory discrimination, as well as DJG and olfactory-VAS remained significant. CONCLUSIONS In this community-based sample of older adults, both OD and loneliness were common. Those subjects with worse olfactory function were more likely to report loneliness. Further research is necessary to establish causality, as well as explore the role of depression.
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Affiliation(s)
- Vincent M Desiato
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.,Department of Otolaryngology-Head and Neck Surgery, Geisinger Health System, Danville, Pennsylvania
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Craig Salvador
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jonathan B Hill
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jensine Lamira
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Frederick Yoo
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Ryan E Little
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Lois J Matthews
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Judy R Dubno
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.,Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
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Yoo F, Kuan EC, Batra PS, Chan CK, Tajudeen BA, Craig JR. Predictors of rhinorrhea response after posterior nasal nerve cryoablation for chronic rhinitis. Int Forum Allergy Rhinol 2020; 10:913-919. [PMID: 32445248 DOI: 10.1002/alr.22574] [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: 03/11/2020] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Posterior nasal nerve (PNN) cryoablation has shown promise in improving rhinorrhea due to allergic and nonallergic rhinitis (NAR). Early case series have shown meaningful clinical improvement in 75-80% of patients, but variables predicting PNN cryoablation success have not been studied. The purpose of this study was to evaluate whether disease features and ipratropium nasal spray response predicted rhinorrhea response after PNN cryoablation. METHODS A multi-institutional retrospective case-control study of 55 patients who underwent PNN cryoablation for bilateral rhinorrhea due to allergic, nonallergic, or mixed rhinitis was conducted at 3 tertiary medical centers. Patients received a 1-month trial of ipratropium spray. Runny Nose Scores (RNSs) of 0-5 from the 22-item Sino-Nasal Outcome Test were collected prospectively, before and after PNN cryoablation. RESULTS The mean age of subjects was 55.3 years and 54.6% were women. Mean follow-up was 170 days. NAR comprised 62% of patients. Of the 48 patients who trialed ipratropium spray, 33 (69%) had some response and 15 (31%) had no response. Mean overall preprocedural RNS was 4.2 ± 1.0. After PNN cryoablation, there was a ≥1-point decrease in RNS in 39 patients (71%). Only ipratropium spray (INS) response predicted cryoablation success. For ipratropium spray responders, 28 of 33 (85%) had improved RNS after cryoablation, whereas 5 of 15 (33%) nonresponders improved (p = 0.001). CONCLUSION In chronic rhinitis patients, rhinorrhea response to ipratropium was predictive of rhinorrhea improvement after PNN cryoablation. This study has important implications for preoperative counseling and guiding patient expectations when considering PNN cryoablation.
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Affiliation(s)
- Frederick Yoo
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, MI
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Irvine, CA
| | - Pete S Batra
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL
| | - Carmen K Chan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Irvine, CA
| | - Bobby A Tajudeen
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL
| | - John R Craig
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, MI
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7
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Schlosser RJ, Desiato VM, Storck KA, Nguyen SA, Hill JB, Washington BJ, Noonan TE, Lamira J, Mulligan JK, Rowan NR, Yoo F, Matthews LJ, Dubno JR, Soler ZM. A Community-Based Study on the Prevalence of Olfactory Dysfunction. Am J Rhinol Allergy 2020; 34:661-670. [PMID: 32345032 DOI: 10.1177/1945892420922771] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Olfactory dysfunction (OD) is common, affecting an estimated 13 million adults in the United States. Prior studies may underestimate OD prevalence due to use of brief smell identification tests or age-adjusted cutoff values, which concede that it is acceptable for older people to have a decreased sense of smell. OBJECTIVE To determine OD prevalence in the healthy community when the goal and expectation is ideal olfactory function, rather than age-based population norms. Secondary goals were to explore factors associated with OD. METHODS Subjects without otolaryngic complaints were recruited from the community surrounding the Medical University of South Carolina. Olfactory-specific information was collected, and olfactory function was assessed using the Sniffin' Sticks test (Burghardt, Wedel, Germany) to measure threshold, discrimination, and identification (TDI). OD was defined as a TDI score < 31. Bivariate analysis and linear regression were used to determine factors associated with OD. RESULTS In total, 176 subjects were included with mean age of 52 years (range: 20-93), 111 (63%) female, and 127 (72%) white. Mean TDI score was 28.8 (6.9) and OD was present in 94 (53%) subjects. Multivariate linear regression revealed that TDI decreased an average of 1 point every 5 years. TDI was also associated with Mini-Mental Status Examination (MMSE) score, asthma, and gastroesophageal reflux disease. Threshold was associated with age, heart problems, and gastroesophageal reflux disease. Discrimination was associated with age and MMSE scores. Identification was associated with age, heart problems, and anxiety. CONCLUSIONS In a community-based sample, OD affects greater than 50% of subjects. Aging impacts all aspects of olfaction, while the effects of factors such as asthma, MMSE scores, gastroesophageal reflux disease, heart problems, and anxiety may only be evident in specific olfactory subtests.
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Affiliation(s)
- Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.,Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Vincent M Desiato
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Kristina A Storck
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jonathan B Hill
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Brandon J Washington
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Tegan E Noonan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jensine Lamira
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jennifer K Mulligan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Frederick Yoo
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Lois J Matthews
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Judy R Dubno
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Loftus CA, Soler ZM, Desiato VM, Koochakzadeh S, Yoo F, Storck KA, Schlosser RJ. Factors impacting revision surgery in patients with chronic rhinosinusitis with nasal polyposis. Int Forum Allergy Rhinol 2020; 10:289-302. [DOI: 10.1002/alr.22505] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/24/2019] [Accepted: 11/15/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Catherine A. Loftus
- Department of Otolaryngology–Head and Neck SurgeryMedical University of South Carolina Charleston SC
| | - Zachary M. Soler
- Department of Otolaryngology–Head and Neck SurgeryMedical University of South Carolina Charleston SC
| | - Vincent M. Desiato
- Department of Otolaryngology–Head and Neck SurgeryMedical University of South Carolina Charleston SC
| | - Sina Koochakzadeh
- Department of Otolaryngology–Head and Neck SurgeryMedical University of South Carolina Charleston SC
| | - Frederick Yoo
- Department of Otolaryngology–Head and Neck SurgeryMedical University of South Carolina Charleston SC
| | - Kristina A. Storck
- Department of Otolaryngology–Head and Neck SurgeryMedical University of South Carolina Charleston SC
| | - Rodney J. Schlosser
- Department of Otolaryngology–Head and Neck SurgeryMedical University of South Carolina Charleston SC
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9
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Lee JT, Yoo F, Wang M, Vengerovich G, Suh JD. Modified endoscopic Denker approach in management of inverted papilloma of the anterior maxillary sinus. Int Forum Allergy Rhinol 2020; 10:533-538. [PMID: 32104956 DOI: 10.1002/alr.22513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 05/13/2019] [Revised: 09/09/2019] [Accepted: 10/16/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Inverted papilloma (IP) is a benign epithelial tumor of the sinonasal cavity that is locally aggressive and has a propensity for recurrence. Tumors involving the anterior maxillary sinus can be challenging to reach endoscopically, and have historically been approached through a Caldwell-Luc or canine fossa trephination. We present a case series of 22 patients with maxillary IPs originating from the anterior wall, which were successfully resected using a modified endoscopic Denker (MED) procedure. This technique enables access to the entire maxillary sinus without the need for a separate transseptal or sublabial incision. METHODS A retrospective chart review was performed on patients who underwent the MED approach for management of maxillary IPs involving the anterior wall from 2012 to 2018. The demographic data, clinical presentation, radiographic findings, pathology, and surgical outcomes were reviewed. RESULTS Twenty-two patients were identified, including 13 males and 9 females. Eighteen of the 22 patients had prior surgery and all had Krouse stage 3 disease. After a mean follow-up of 24 (range, 4-63) months, only 1 patient (4.5%) developed a recurrence, which was treated successfully with endoscopic resection. Complications included 1 patient with preoperative epiphora who required dacryocystorhinostomy, epistaxis in another, and 1 patient with transient upper lip numbness. No patients developed alar notching or pyriform aperture stenosis. CONCLUSION The MED technique is highly effective for surgical resection of primary and recurrent maxillary IPs involving the anterior wall, providing complete access to the entire maxillary sinus. In many cases, the MED can obviate the need for an adjunctive sublabial or transseptal incision, while also providing excellent exposure for postoperative surveillance.
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Affiliation(s)
- Jivianne T Lee
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Frederick Yoo
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Marilene Wang
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Gennadiy Vengerovich
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Jeffrey D Suh
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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10
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Soler ZM, Yoo F, Schlosser RJ, Mulligan J, Ramakrishnan VR, Beswick DM, Alt JA, Mattos JL, Payne SC, Storck KA, Smith TL. Correlation of mucus inflammatory proteins and olfaction in chronic rhinosinusitis. Int Forum Allergy Rhinol 2019; 10:343-355. [PMID: 31856395 DOI: 10.1002/alr.22499] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/31/2019] [Accepted: 11/08/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is one of the most common causes of olfactory loss, but the pathophysiology underlying olfactory dysfunction in CRS has not been fully elucidated. Previous studies found correlations between olfactory cleft (OC) inflammatory cytokines/chemokines and olfaction in CRS. The purpose of this study was to evaluate the relationship between OC mucus inflammatory proteins and olfaction in a multi-institutional cohort. METHODS Adults with CRS were prospectively recruited. Demographics, comorbidities, olfactory assessment (Sniffin' Sticks), computed tomography (CT), and OC mucus for protein analysis were collected. Statistical analysis was performed to determine associations between olfactory function, OC mucus protein concentrations, and CT opacification. RESULTS Sixty-two patients were enrolled in the study, with an average age of 48.2 (standard deviation, 16.2) years, and 56.5% were female and 59.7% were classified as CRS with nasal polyps (CRSwNP). Ten of 26 OC mucus proteins were significantly correlated with threshold, discrimination, and identification (TDI) scores and OC opacification. Subgroup analysis by polyp status revealed that, within the CRSwNP group, C-C motif ligand 2 (CCL2), interleukin-5 (IL-5), IL-6, IL-13, IL-10, IL-9, tumor necrosis factor-α (TNF-α), CCL5, and CCL11 were significantly correlated with olfaction. For CRS without nasal polyps (CRSsNP), only C-X-C ligand 5 (CXCL5) showed a correlation. In CRSwNP, IL-6, IL-10, vascular endothelial growth factor-A, and immunoglobulin E (IgE) correlated with OC opacification, whereas, in CRSsNP, only CXCL5 showed a correlation. OC mucus proteins and Lund-Mackay score correlated only in the CRSsNP group (CXCL5, IL-5, IL-13, IgE). CONCLUSION Several OC mucus proteins have been found to correlate with olfactory function and OC opacification. The profile of OC mucus proteins differs between CRSsNP and CRSwNP subgroups, suggesting different mechanisms between groups, but further study is required.
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Affiliation(s)
- Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Frederick Yoo
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Jennifer Mulligan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Vijay R Ramakrishnan
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, CO
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, CO
| | - Jeremiah A Alt
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Jose L Mattos
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology, University of Virginia, Charlottesville, VA
| | - Spencer C Payne
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology, University of Virginia, Charlottesville, VA
| | - Kristina A Storck
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Timothy L Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, OR
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Loftus CA, Soler ZM, Koochakzadeh S, Desiato VM, Yoo F, Nguyen SA, Schlosser RJ. Revision surgery rates in chronic rhinosinusitis with nasal polyps: meta-analysis of risk factors. Int Forum Allergy Rhinol 2019; 10:199-207. [PMID: 31752051 DOI: 10.1002/alr.22487] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/21/2019] [Accepted: 10/24/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Wide variations in revision endoscopic sinus surgery (ESS) rates for chronic rhinosinusitis with nasal polyposis (CRSwNP) have been reported. It is important to understand expected revision rates and factors that impact the need for revision. METHODS A literature search was conducted on PubMed, Scopus, and the Cochrane Database of Systematic Reviews. Following PRISMA guidelines, a systematic review and meta-analysis was performed on studies that reported revision surgery data for CRSwNP patients. RESULTS Forty-five studies with 34,220 subjects were meta-analyzed, with an overall revision rate of 18.6% (95% confidence interval, 14.1%-23.6%). Studies with extractable follow-up data reported a mean revision rate of 16.2% over a weighted mean follow-up of 89.6 months. Factors associated with increased revision rates included allergic fungal rhinosinusitis (28.7%), aspirin-exacerbated respiratory disease (27.2%), asthma (22.6%), prior polypectomy (26.0%), and publication prior to 2008 (22.7%) (p < 0.05 for all). CONCLUSION Although polyps can recur after ESS, reported long-term ESS revision rates are approximately 14% to 24%. Identifying risk factors for revision surgery can help manage patient expectations and determine optimal personalized treatments.
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Affiliation(s)
- Catherine A Loftus
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Sina Koochakzadeh
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Vincent M Desiato
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Frederick Yoo
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
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Loftus C, Schlosser RJ, Smith TL, Alt JA, Ramakrishnan VR, Mattos JL, Mappus E, Storck K, Yoo F, Soler ZM. Olfactory cleft and sinus opacification differentially impact olfaction in chronic rhinosinusitis. Laryngoscope 2019; 130:2311-2318. [PMID: 31603563 DOI: 10.1002/lary.28332] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 08/02/2019] [Accepted: 09/10/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Prior studies have indicated that olfactory cleft (OC) opacification correlates with olfaction in patients with chronic rhinosinusitis (CRS). However, the results have been unclear in patients without polyps. The purpose of this study was to further explore the relationship between OC opacification, sinus opacification, and olfactory function in patients with CRS. METHODS One hundred and forty-eight patients with CRS were prospectively enrolled across five institutions. Olfactory function was evaluated using the Sniffin' Sticks tests (Burghardt, Wedel, Germany) and the 17-item Questionnaire of Olfactory Disorders (QOD-NS). Computed tomography (CT) scans for each patient were acquired and Lund-Mackay scores recorded. Opacification of the OC was determined using OsiriX MD (Pixmeo, Bernex, Switzerland) and correlated with olfaction scores. RESULTS A total of 148 CRS patients, 73 CRS without nasal polyps (CRSsNP) and 75 CRS with nasal polyps (CRSwNP), as well as 30 control subjects were enrolled. Overall OC opacification averaged 63.7% in CRS patients and 47.1% in control subjects (P < 0.001). In the overall cohort, OC opacification significantly correlated with threshold, discrimination, and identification (TDI) (r = -0.520; P < 0.001) and QOD-NS scores (r = 0.374; P < 0.001). CRSwNP patients demonstrated a significant correlation between OC opacification and TDI scores (r = -0.464; P < 0.001) but not the CRSsNP group (r = -0.143; P = 0.229). Lund-Mackay score correlated with TDI in both the CRSsNP (r = -0.300; P = 0.010) and CRSwNP (r = -0.271; P = 0.019) groups. CONCLUSION CT opacification is associated with olfactory dysfunction differentially based on nasal polyp status. Smell loss in CRSwNP correlated with both OC opacification and Lund-Mackay score, whereas CRSsNP correlated only with Lund-Mackay score, indicating different relationships between olfactory function and local inflammatory processes in these disorders. LEVEL OF EVIDENCE 2 Laryngoscope, 130:2311-2318, 2020.
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Affiliation(s)
- Catherine Loftus
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Timothy L Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Jeremiah A Alt
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | | | - Jose L Mattos
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, U.S.A
| | - Elliott Mappus
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Kristina Storck
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Frederick Yoo
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Loftus CA, Yoo F, Desiato VM, Schlosser RJ, Soler ZM. Treatment of Recalcitrant Maxillary Sinusitis With Endoscopic Modified Medial Maxillectomy: A Systematic Review of Safety and Efficacy. Am J Rhinol Allergy 2019; 34:127-133. [PMID: 31537079 DOI: 10.1177/1945892419876394] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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
Background Endoscopic sinus surgery is an effective treatment option for patients with chronic rhinosinusitis (CRS), although approximately 20% of patients fail to improve with standard surgical procedures. Expanded procedures such as the endoscopic modified medial maxillectomy (EMMM) have been described in management of refractory maxillary sinusitis. Objective This study aims to review the current literature on the safety and efficacy of the EMMM for treatment of refractory maxillary sinusitis. Methods A literature search was performed of PubMed, Ovid, and Cochrane databases according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. English-language articles evaluating the EMMM procedure on patients with recalcitrant maxillary sinusitis were included. Full-text articles were obtained and evaluated by 2 reviewers independently, with a third reviewer for mediation of disagreements. Results Six studies met eligibility criteria and were included into the study, with follow-up ranging from 12 to 82.8 months. Two studies contained Level 2 evidence and 4 studies contained Level 4 evidence. EMMM was found to be effective in CRS and cystic fibrosis-related CRS (0% and 9.1% revision rate, respectively). Symptom resolution was noted 60% to 80% of patients. Four studies reported complications, with a total of 4 complications out of 211 patients. Conclusions There are no high-quality Level 1 studies evaluating the efficacy and safety of the EMMM procedure. Level 2 to Level 4 studies indicate that this procedure is relatively safe with a low complication rate and symptom resolution in up to 80% of patients with recalcitrant maxillary sinusitis.
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Affiliation(s)
- Catherine A Loftus
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Frederick Yoo
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Vincent M Desiato
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Yoo F, Schlosser RJ, Storck KA, Ganjaei KG, Rowan NR, Soler ZM. Effects of endoscopic sinus surgery on objective and subjective measures of cognitive dysfunction in chronic rhinosinusitis. Int Forum Allergy Rhinol 2019; 9:1135-1143. [DOI: 10.1002/alr.22406] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/14/2019] [Accepted: 07/28/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Frederick Yoo
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology‒Head and Neck SurgeryMedical University of South Carolina Charleston SC
| | - Rodney J. Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology‒Head and Neck SurgeryMedical University of South Carolina Charleston SC
- Department of SurgeryRalph H. Johnson VA Medical Center Charleston SC
| | - Kristina A. Storck
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology‒Head and Neck SurgeryMedical University of South Carolina Charleston SC
| | - Kimia G. Ganjaei
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology‒Head and Neck SurgeryMedical University of South Carolina Charleston SC
- Rutgers: Robert Wood Johnson Medical School Piscataway NJ
| | - Nicholas R. Rowan
- Department of Otolaryngology‒Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore MD
| | - Zachary M. Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology‒Head and Neck SurgeryMedical University of South Carolina Charleston SC
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Yoo F, Soler ZM, Mulligan JK, Storck KA, Lamira JM, Pasquini WN, Hill JB, Noonan TE, Washington BJ, Schlosser RJ. Olfactory cleft mucus proteins associated with olfactory dysfunction in a cohort without chronic rhinosinusitis. Int Forum Allergy Rhinol 2019; 9:1151-1158. [PMID: 31442006 DOI: 10.1002/alr.22391] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 05/02/2019] [Revised: 06/24/2019] [Accepted: 07/04/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Olfactory dysfunction (OD) is a common problem, affecting up to 20% of the general population. Previous studies identified olfactory cleft mucus proteins associated with OD in chronic rhinosinusitis (CRS) but not in a healthy population. In this study we aimed to identify olfactory cleft mucus proteins associated with olfaction in individuals without sinus disease. METHODS Subjects free of sinus disease completed medical history questionnaires that collected data regarding demographics, comorbidities, and past exposures. Olfactory testing was performed using Sniffin' Sticks, evaluating threshold, discrimination, and identification. Olfactory cleft mucus (OC) and, in select cases, inferior turbinate mucus (IT) were collected with Leukosorb paper and assays performed for 17 proteins, including growth factors, cytokines/chemokines, cell-cycle regulators, and odorant-binding protein (OBP). RESULTS Fifty-six subjects were enrolled in the study, with an average age of 47.8 (standard deviation [SD], 17.6) years, including 33 females (58.9%). The average threshold/discrimination/identification (TDI) score was 30.3 (SD, 6.4). In localization studies, OBP concentrations were significantly higher in OC than IT mucus (p = 0.006). Cyclin-dependent kinase inhibitor 2A (CDKN2A/p16INK4a), basic fibroblast growth factor (bFGF), chemokine ligand 2 (CCL2/MCP-1), granulocyte macrophage colony-stimulating factor (GM-CSF), and chemokine ligand 20 (CCL20/MIP-3a) all inversely correlated with overall TDI (all rho ≥ -0.479, p ≤ 0.004). Stem cell factor (SCF) correlated positively with overall TDI (rho = 0.510, p = 0.002). CONCLUSION Placement of Leukosorb paper is relatively site-specific for olfactory proteins and it is feasible to collect a variety of olfactory cleft proteins that correlate with olfactory function. Further study is required to determine mechanisms of OD in non-CRS subjects.
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Affiliation(s)
- Frederick Yoo
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Zachary M Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Jennifer K Mulligan
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Kristina A Storck
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Jensine M Lamira
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Whitney N Pasquini
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Jonathan B Hill
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Tegan E Noonan
- University of South Carolina School of Medicine, Columbia, SC
| | | | - Rodney J Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.,Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, SC
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Kuan EC, Badran KW, Yoo F, Bhandarkar ND, Haidar YM, Tjoa T, Armstrong WB, Palmer JN, Adappa ND, Wang MB, John MAS. Predictors of Short-term Morbidity and Mortality in Open Anterior Skull Base Surgery. Laryngoscope 2018; 129:1407-1412. [PMID: 30325512 DOI: 10.1002/lary.27494] [Citation(s) in RCA: 9] [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] [Accepted: 07/16/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS To describe rates of complications and mortality within 30 days of open anterior skull base surgery using a large, multi-institutional outcomes database. STUDY DESIGN Retrospective cohort study. METHODS The study included patients who underwent open anterior skull base surgery as listed in the American College of Surgeons National Surgical Quality Improvement Project database from 2007 through 2014. RESULTS A total of 336 open anterior skull base surgeries were identified. One hundred nine (32.4%) patients experienced a complication, reoperation, or mortality. The most common events were postoperative transfusion (15.8%), reoperation (10.1%), and readmission (8.0%). Significant independent predictors of any adverse event included higher American Society of Anesthesiologists (ASA) score and increased total operative time (both P < .05). The only predictor of mortality was higher ASA score (P = .02). Predictors of increased hospital stay included impaired sensorium (P = .04), coma >24 hours (P < .001), lower preoperative hematocrit (P = .02), higher ASA score (P = .04), and increased total operative time (P < .001). CONCLUSIONS Open anterior skull base surgery is understandably complex, and is thus associated with a relatively high adverse event rate. Knowledge of factors associated with adverse events has the potential to improve preoperative optimization of controllable variables and translate into improved surgical outcomes for patients. LEVEL OF EVIDENCE NA Laryngoscope, 129:1407-1412, 2019.
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Affiliation(s)
- Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, U.S.A
| | - Karam W Badran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Frederick Yoo
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Naveen D Bhandarkar
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, U.S.A
| | - Yarah M Haidar
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, U.S.A
| | - Tjoson Tjoa
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, U.S.A
| | - William B Armstrong
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, U.S.A
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Marilene B Wang
- Department of Head and Neck Surgery, University of California, Los Angeles Medical Center, Los Angeles, California, U.S.A.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles Medical Center, Los Angeles, California, U.S.A.,Head and Neck Cancer Program, University of California, Los Angeles Medical Center, Los Angeles, California, U.S.A
| | - Maie A St John
- Department of Head and Neck Surgery, University of California, Los Angeles Medical Center, Los Angeles, California, U.S.A.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles Medical Center, Los Angeles, California, U.S.A.,Head and Neck Cancer Program, University of California, Los Angeles Medical Center, Los Angeles, California, U.S.A
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Abstract
PURPOSE Pituitary tumors are the second most common intracranial tumors, however, pituitary carcinoma is a rare clinical entity which represents only 0.1-0.2% of all pituitary tumors. Diagnosis of pituitary carcinoma requires the presence of metastasis. Early identification of pituitary carcinoma is difficult, and only recently have guidelines been published for the treatment of aggressive pituitary tumors. We present two cases from our institution, with a review of other cases available in literature in order to better characterize this rare disease. METHODS A retrospective review of two patients with pituitary carcinoma treated at a tertiary medical center was performed. The MEDLINE database was searched for all cases of pituitary carcinoma. Information for age at diagnosis, sex, pituitary tumor type, latency period from pituitary tumor to presentation of carcinoma, sites of metastasis, number of surgical therapies, radiation and chemotherapy, and survival after diagnosis were collected. RESULTS A total of 69 studies were available for review for a total of 72 unique cases. The average age at diagnosis was 46.3 years. The most common tumors were ACTH-secreting (34.7%), Prolactin-secreting (23.6%), and Null Cell (15.3%). The average latency period from pituitary tumor diagnosis to metastasis was 9 years. All patients underwent surgical therapy during their treatment, with an average of 2.76 procedures. The mortality rate was 54.8% with average time to death after diagnosis of approximately 10 months. CONCLUSIONS Pituitary carcinoma is a rare disease with high mortality rate and is a diagnostic and treatment challenge. Further study is required but is difficult due to its low incidence.
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Affiliation(s)
- Frederick Yoo
- Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, 10833 Le Conte Ave. 62-132 CHS, Los Angeles, CA, 90095-1624, USA.
| | - Edward C Kuan
- Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, 10833 Le Conte Ave. 62-132 CHS, Los Angeles, CA, 90095-1624, USA
| | - Anthony P Heaney
- Department of Neurosurgery, UCLA David Geffen School of Medicine, Los Angeles, USA
- Department of Medicine, Division of Endocrinology, UCLA David Geffen School of Medicine, Los Angeles, USA
| | - Marvin Bergsneider
- Department of Neurosurgery, UCLA David Geffen School of Medicine, Los Angeles, USA
| | - Marilene B Wang
- Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, 10833 Le Conte Ave. 62-132 CHS, Los Angeles, CA, 90095-1624, USA
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Yoo F, Chan C, Kuan EC, Bergsneider M, Wang MB. Comparison of Male and Female Prolactinoma Patients Requiring Surgical Intervention. J Neurol Surg B Skull Base 2017; 79:394-400. [PMID: 30009121 DOI: 10.1055/s-0037-1615748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 11/19/2017] [Indexed: 12/20/2022] Open
Abstract
Objectives Prolactinomas are the most common functional pituitary adenoma. Symptoms of a prolactinoma stem from hormonal causes (menstrual irregularities, galactorrhea, and reduced libido) or from tumor mass effect (visual changes and headache). Gender differences have been noted in prolactinomas, with males presenting with larger tumors and sequelae of mass effect, while females present commonly with hormonal symptoms. The purpose of this study is to evaluate differences in patient and disease characteristics, and outcomes between male and female prolactinoma patients undergoing surgery. Design This was a retrospective chart review. Setting This was done at the tertiary medical center. Participants The medical records of prolactinomas patients who underwent endoscopic endonasal surgery between March 2008 and August 2016 were reviewed. Main Outcome Measures Demographic information, tumor characteristics, and treatment characteristics and outcomes were collected. Statistical analysis was performed using chi-squared test or Student's t -test as applicable. Results Seventy-nine patients were identified, 22 males and 57 females. The average age for males was 38 years and for females was 35 years. Males were more likely to present with decreased libido ( p < 0.0001), whereas females more often presented with galactorrhea ( p < 0.0001) and menstrual irregularities. Tumor size was larger in males ( p = 0.0044) with higher likelihood of suprasellar extension ( p = 0.0409) and cavernous sinus invasion ( p = 0.0026). Males were more likely to have a subtotal resection rather than gross total resection ( p = 0.0086) and less likely to have normalization of prolactin levels following surgery ( p = 0.0019) Conclusion Male prolactinoma patients tend to have larger tumors with more aggressive features. This may have a role in the differences in outcomes noted in this study.
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Affiliation(s)
- Frederick Yoo
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Carmen Chan
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Edward C Kuan
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Marvin Bergsneider
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Marilene B Wang
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
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Kuan EC, Yoo F, Chyu J, Oh A, Bergsneider M, Wang MB. Quality of Life before and after Endoscopic Pituitary Surgery as Measured by the Short-Form-36. J Neurol Surg B Skull Base 2017; 79:314-318. [PMID: 29765831 DOI: 10.1055/s-0037-1608648] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022] Open
Abstract
Objectives/Hypotheses To assess quality of life (QOL) after transnasal, endoscopic pituitary surgery using the 36-item short form (SF-36) instrument. Design Retrospective review was used for this study. Setting The study was conducted in a tertiary academic medical center. Participants Patients who underwent endoscopic, transnasal, transsphenoidal surgery for pituitary adenomas between January 1, 2007 and July 1, 2016 and completed preoperative and postoperative SF-36 surveys. Main Outcome Measures SF-36 survey data as measured by its eight domains (physical functioning, physical role functioning, emotional role functioning, energy/fatigue, emotional well-being, social functioning, pain, and general health). Results There were 18 preoperative, 13 short-term (2 weeks or less after surgery) postoperative, and 14 longer term (>2 weeks after surgery) postoperative surveys. There was no significant difference between preoperative and long-term postoperative SF-36 scores across domains ( p > 0.05). In comparing short-term postoperative and preoperative scores, tumor size was positively associated with emotional well-being ( p = 0.049) and general health scores ( p = 0.031), while visual changes preoperatively were positively associated with general health scores ( p = 0.046). Compared with standard U.S. general population summary data, these patients scored lower preoperatively in all domains except for emotional role functioning and pain ( p < 0.05). Postoperatively, patients improved to baseline general population data scores with the exception of the physical role functioning domain ( p < 0.0001). Conclusion Patients undergoing endoscopic, transnasal, transsphenoidal surgery for pituitary adenomas had lower QOL in six of eight domains preoperatively, but improved to baseline values on the long run after surgery in seven of eight domains. This suggests that minimally invasive pituitary surgery has a restorative role in general QOL as measured by the SF-36.
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Affiliation(s)
- Edward C Kuan
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles (UCLA) Medical Center, Los Angeles, California, United States
| | - Frederick Yoo
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles (UCLA) Medical Center, Los Angeles, California, United States
| | - Jennifer Chyu
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles (UCLA) Medical Center, Los Angeles, California, United States
| | - Angela Oh
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles (UCLA) Medical Center, Los Angeles, California, United States
| | - Marvin Bergsneider
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles (UCLA) Medical Center, Los Angeles, California, United States
| | - Marilene B Wang
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles (UCLA) Medical Center, Los Angeles, California, United States
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Yoo F, Ference EH, Kuan EC, Lee JT, Wang MB, Suh JD. Evaluation of patient nasal saline irrigation practices following endoscopic sinus surgery. Int Forum Allergy Rhinol 2017; 8:32-40. [DOI: 10.1002/alr.22034] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 10/02/2017] [Accepted: 10/06/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Frederick Yoo
- Department of Head and Neck Surgery; University of California Los Angeles; Los Angeles CA
| | - Elisabeth H. Ference
- Department of Head and Neck Surgery; University of California Los Angeles; Los Angeles CA
| | - Edward C. Kuan
- Department of Head and Neck Surgery; University of California Los Angeles; Los Angeles CA
| | - Jivianne T. Lee
- Department of Head and Neck Surgery; University of California Los Angeles; Los Angeles CA
| | - Marilene B. Wang
- Department of Head and Neck Surgery; University of California Los Angeles; Los Angeles CA
| | - Jeffrey D. Suh
- Department of Head and Neck Surgery; University of California Los Angeles; Los Angeles CA
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Kuan EC, Yoo F, Patel PB, Su BM, Bergsneider M, Wang MB. An Algorithm for Sellar Reconstruction Following the Endoscopic Endonasal Approach: A Review of 300 Consecutive Cases. J Neurol Surg B Skull Base 2017; 79:177-183. [PMID: 29868324 DOI: 10.1055/s-0037-1606293] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 03/11/2017] [Accepted: 07/15/2017] [Indexed: 12/17/2022] Open
Abstract
Objectives/Hypotheses The endoscopic endonasal approach (EEA) is the workhorse endoscopic procedure for sellar and parasellar pathology. Various reconstruction techniques have been reported following EEA surgery, ranging from no reconstruction to vascularized flaps. We review our institution's experience with sellar reconstruction following EEA and propose an evidence-based algorithm. Design Retrospective review. Setting Tertiary academic medical center. Participants Patients who underwent endoscopic EEA surgery for sellar or parasellar pathology between March 1, 2013 and August 31, 2016. Main Outcome Measures Patient demographic and clinicopathologic data were collected. Outcome measures included intraoperative and postoperative cerebrospinal fluid (CSF) leak rates and extent of resection (gross or subtotal). Results Three hundred consecutive patients were included. Depending on the presence and grade of intraoperative CSF leak, cases were reconstructed using either a free mucosal graft (FMG) or nasoseptal flap (NSF). Intraoperative and postoperative CSF leak rates were 30.7% and 2.3%, respectively. Multivariable logistic regression found that intraoperative CSF leak was associated with recurrent disease (odds ratio [OR] 2.47, p = 0.004), with no apparent predictors of postoperative CSF leak. Conclusions Based on this large series, we propose the following algorithm for sellar reconstruction: FMG for no CSF leak; fat graft + FMG ± rigid fixation for low-grade leaks; and fat graft + NSF ± rigid fixation for high-grade leaks.
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Affiliation(s)
- Edward C Kuan
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles (UCLA) Medical Center, Los Angeles, California, United States
| | - Frederick Yoo
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles (UCLA) Medical Center, Los Angeles, California, United States
| | - Pratik B Patel
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles (UCLA) Medical Center, Los Angeles, California, United States
| | - Brooke M Su
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles (UCLA) Medical Center, Los Angeles, California, United States
| | - Marvin Bergsneider
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles (UCLA) Medical Center, Los Angeles, California, United States
| | - Marilene B Wang
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles (UCLA) Medical Center, Los Angeles, California, United States
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Patel PB, Kuan EC, Peng KA, Yoo F, Nelson SD, Abemayor E. Angiosarcoma of the tongue: A case series and literature review. Am J Otolaryngol 2017; 38:475-478. [PMID: 28478092 DOI: 10.1016/j.amjoto.2017.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 03/18/2017] [Accepted: 04/09/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE Angiosarcoma of the tongue is an exceedingly rare malignancy of the head and neck. Such lesions can be primary in nature or occur in a previously irradiated field. We examine a series of cases with relation to clinical presentation, diagnosis, management, and outcomes. MATERIALS AND METHODS Retrospective chart review of all patients with angiosarcoma of the tongue at a tertiary academic institution yielded a single case between 2005 and 2016. The MEDLINE database was additionally searched for all case series or reports of angiosarcoma arising in the tongue, and pertinent clinical data were extracted. RESULTS The clinical presentation, disease course, and management of a patient with angiosarcoma of the tongue are presented. Institutional and literature search yielded a total of eight patients with angiosarcoma of the tongue. The most common primary sites were dorsal and lateral oral tongue. Treatment consisted of surgical resection in 63% of cases with adjuvant therapy administered in 75% of cases. Follow-up times varied per patient, but 63% had persistent or recurrent disease and 67% died of or with disease within two years of index presentation. CONCLUSION Angiosarcoma of the tongue is a rare and highly aggressive tumor, accounting for fewer than 1% of all head and neck malignancies. The mainstay of treatment is surgical resection with negative margins followed by adjuvant chemoradiation for high-risk features. Due to rarity of the disease, consensus on optimal treatment approach is lacking, and multi-center prospective studies would be helpful to set clinical guidelines.
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Affiliation(s)
- Pratik B Patel
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Edward C Kuan
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kevin A Peng
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Frederick Yoo
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Scott D Nelson
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Elliot Abemayor
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
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Kuan EC, Yoo F, Kim W, Badran KW, Heineman TE, Sepahdari AR, Bergsneider M, Wang MB. Anatomic Variations in Pituitary Endocrinopathies: Implications for the Surgical Corridor. J Neurol Surg B Skull Base 2017; 78:105-111. [PMID: 28321371 PMCID: PMC5357235 DOI: 10.1055/s-0036-1585588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 03/12/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022] Open
Abstract
Objectives/Hypotheses Functioning pituitary adenomas may produce endocrinopathies such as acromegaly and Cushing syndrome. Both conditions lead to characteristic anatomic variations as a result of hormonally induced abnormal soft tissue deposition. We evaluate the anatomic differences between acromegalics and Cushing disease patients and compare these dimensions to controls. Design Radiographic review of preoperative magnetic resonance images (MRI) of the pituitary gland. Setting Tertiary academic medical center. Participants Patients who underwent transnasal, transsphenoidal surgery for pituitary adenomas found to have acromegaly or pituitary Cushing between January 1, 2007 and September 1, 2015. A total of 15 patients with similar MRIs and no history of pituitary or sinonasal disease were selected as controls. Main Outcome Measures Dimensions assessed were intercarotid distance; carotid canal width; piriform aperture width; distance from the piriform aperture to the anterior face of the sphenoid; sphenoid sinus height, width, and length; angle from anterior nasal spine to anteroinferior face of sphenoid sinus; choanal height; and nasal cavity height at the level of the vertical segment of the middle turbinate. Sphenoid sinus pneumatization patterns were recorded. Results There were 30 acromegalics and 31 Cushing disease patients. When compared with controls, both acromegalics and Cushing disease patients had significantly wider piriform apertures and a longer distance from the piriform aperture to the anterior face of the sphenoid sinus (p < 0.05). Acromegalics had a significantly less acute angle (19 ± 3 degrees) from the anterior nasal spine to the sphenoid (p < 0.05). Cushing disease patients had significantly lower sphenoid sinus length and shorter nasal cavity height (p < 0.05). There were no differences in intercarotid distance or carotid canal width. Conclusions As acromegalics and Cushing disease patients have known anatomic variations, the skull base surgeon should be aware of these differences and adapt their techniques and approaches as needed.
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Affiliation(s)
- Edward C. Kuan
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles (UCLA) Medical Center, Los Angeles, California, United States
| | - Frederick Yoo
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles (UCLA) Medical Center, Los Angeles, California, United States
| | - Won Kim
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles (UCLA) Medical Center, Los Angeles, California, United States
| | - Karam W. Badran
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles (UCLA) Medical Center, Los Angeles, California, United States
| | - Thomas E. Heineman
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles (UCLA) Medical Center, Los Angeles, California, United States
| | - Ali R. Sepahdari
- Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA) Medical Center, Los Angeles, California, United States
| | - Marvin Bergsneider
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles (UCLA) Medical Center, Los Angeles, California, United States
| | - Marilene B. Wang
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles (UCLA) Medical Center, Los Angeles, California, United States
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Kuan E, Yoo F, Patel P, Su B, Bergsneider M, Wang M. An Algorithm for Sellar Reconstruction Following Transnasal Transsphenoidal Surgery: A Review of 300 Consecutive Cases. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600657] [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: 10/20/2022]
Affiliation(s)
- Edward Kuan
- University of California, Los Angeles, California, United States
| | - Frederick Yoo
- University of California, Los Angeles, California, United States
| | - Pratik Patel
- University of California, Los Angeles, California, United States
| | - Brooke Su
- University of California, Los Angeles, California, United States
| | | | - Marilene Wang
- University of California, Los Angeles, California, United States
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Yoo F, Kuan E, Bergsneider M, Wang M. Comparison of Male and Female Prolactinoma Patients Requiring Surgical Intervention. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600564] [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: 10/20/2022]
Affiliation(s)
- Frederick Yoo
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, United States
| | - Edward Kuan
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, United States
| | - Marvin Bergsneider
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States
| | - Marilene Wang
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, United States
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Kuan E, Yoo F, Chyu J, Oh A, Huang W, Bergsneider M, Wang M. Quality of Life before and after Endoscopic Pituitary Surgery as Measured by the SF-36. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600841] [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: 10/20/2022]
Affiliation(s)
- Edward Kuan
- UCLA, Los Angeles, California, United States
| | | | | | - Angela Oh
- UCLA, Los Angeles, California, United States
| | - Wendy Huang
- UCLA, Los Angeles, California, United States
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Yoo F, Kuan EC, Bergsneider M, Wang MB. Free Mucosal Graft Reconstruction of the Septum after Nasoseptal Flap Harvest: A Novel Technique Using a Posterior Septal Free Mucosal Graft. J Neurol Surg B Skull Base 2016; 78:201-206. [PMID: 28321387 DOI: 10.1055/s-0036-1597086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 04/13/2016] [Accepted: 10/14/2016] [Indexed: 10/20/2022] Open
Abstract
Objectives The nasoseptal flap (NSF) has become the workhorse for reconstruction in endoscopic endonasal skull-base surgery. The NSF, though useful in reconstruction, may lead to significant donor site morbidity. Published techniques to reduce the donor site morbidity, free mucosal grafts, and septal rotational flaps have shown to reduce crusting and remucosalization times. We present a novel technique utilizing posterior septal mucosa as a free mucosal graft for reconstruction of the anterior septal donor site. The septal mucosal graft is taken from the mucosa overlying the posterior septectomy site of the endonasal approach to skull base tumors. Design Retrospective chart review. Setting Single tertiary academic medical center. Participants All patients who underwent endoscopic endonasal skull-base surgery between November 1, 2014 and August 30, 2015 with free mucosal graft reconstruction of the NSF donor site. Main Outcome Measures Postoperative graft success. Results Fifteen patients underwent septal reconstruction using a septal free mucosal graft. There was a 100% graft success rate with near complete remucosalization by 6 weeks postoperatively. Conclusions The posterior septal free mucosal graft is a simple, reliable method for reconstructing the NSF donor site. The advantages of this technique include utilization of native septal mucosal tissue and middle turbinate preservation.
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Affiliation(s)
- Frederick Yoo
- Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States
| | - Edward C Kuan
- Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States
| | - Marvin Bergsneider
- Department of Neurosurgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States
| | - Marilene B Wang
- Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States
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Yoo F, Wang MB, Bergsneider M, Suh JD. Single Layer Repair of Large Anterior Skull Base Defects without Vascularized Mucosal Flap. J Neurol Surg B Skull Base 2016; 78:139-144. [PMID: 28321377 DOI: 10.1055/s-0036-1593438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 07/19/2016] [Accepted: 08/22/2016] [Indexed: 10/20/2022] Open
Abstract
Objectives Bilateral anterior skull base (ASB) defects following endoscopic endonasal tumor resection are most commonly repaired utilizing multilayered reconstruction with a vascularized mucosal flap. Single-layer closure of large ASB defects has been described in the literature but this technique has yet to gain a widespread use. We report our experience with a series of patients who underwent reconstruction of large ASB defects using a single-layer intradural graft, without nasoseptal flaps. We also compared the use of acellular dermal matrix (AlloDerm, LifeCell, Branchburg, New Jersey, United States) or collagen matrix xenograft (Duramatrix, Stryker, Kalamazoo, Michigan, United States) as the graft biomaterial. Design A retrospective case series. Setting Tertiary academic medical center. Main Outcome Measures Postoperative cerebrospinal fluid leak, the number of postoperative debridements, the number of postoperative infections, and time to remucosalization. Results Two patients were reconstructed with AlloDerm and three with Duramatrix, with all patients receiving postoperative external beam radiation. There were no postoperative cerebrospinal fluid leaks identified in these patients during follow-up. The AlloDerm group showed increased postsurgical crusting, the number of clinically apparent postoperative infections, and an increased time to remucosalization. Conclusions Single-layer repair without a vascularized mucosal flap is a viable method of skull base repair for large ASB defects. We found repair with Duramatrix was superior, with less graft crusting and infection, requiring fewer debridements.
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Affiliation(s)
- Frederick Yoo
- Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States
| | - Marilene B Wang
- Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States
| | - Marvin Bergsneider
- Department of Neurosurgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States
| | - Jeffrey D Suh
- Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States
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Kuan EC, Yoo F, Chyu J, Bergsneider M, Wang MB. Treatment Outcomes of Rathke's Cleft Cysts Managed with Marsupialization. J Neurol Surg B Skull Base 2016; 78:112-115. [PMID: 28321372 DOI: 10.1055/s-0036-1585088] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 03/12/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022] Open
Abstract
Objectives Rathke's cleft cysts (RCC) are benign cystic lesions of the sella resulting from incomplete obliteration of Rathke's cleft. Symptomatic lesions often require surgical decompression, which is often amenable to a transnasal, transsphenoidal (TNTS) approach. We report our experience with marsupialization of RCC and describe a novel technique to promote re-epithelization of the cyst cavity. Design Retrospective review. Setting Tertiary academic medical center. Participants Patients who underwent TNTS for RCC between 2007 and 2015. Main Outcome Measures Demographics, lesion characteristics, and reconstruction and treatment outcomes. Results In total, 52 patients were identified. The mean age was 41 ± 18 years. The mean RCC size was 13 ± 5 mm. Intraoperative cerebrospinal fluid (CSF) leak was encountered in 14 (27%) patients; all were repaired. There were six complications (12%) and no deaths. Mean follow-up was 20 ± 18 months, with five (10%) recurrences. RCC size was associated with intraoperative CSF leak (p = 0.04). In 12 patients, the marsupialized cyst cavity was lined with a free mucosal graft (FMG) to promote healing and re-epithelialization. Conclusions The TNTS approach is safe and effective in surgical decompression of RCC. Lining the exposed cyst cavity with an FMG is a simple intervention without added morbidity that may promote formation of an epithelialized tract. Level of Evidence Not applicable.
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Affiliation(s)
- Edward C Kuan
- Departments of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, California, United States
| | - Frederick Yoo
- Departments of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, California, United States
| | - Jennifer Chyu
- Departments of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, California, United States
| | - Marvin Bergsneider
- Departments of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, California, United States
| | - Marilene B Wang
- Departments of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, California, United States
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Kuan E, Yoo F, Kim W, Heineman T, Badran K, Bergsneider M, Wang M. Anatomic Variations in Pituitary Endocrinopathies: Implications for the Surgical Corridor. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1579934] [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: 10/22/2022]
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Yoo F, Kuan E, Bergsneider M, Wang M. Free Mucosal Graft Reconstruction of the Septum after Nasoseptal Flap Harvest: A Novel Technique using a Posterior Septal Free Mucosal Graft. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1579831] [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: 10/22/2022]
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Abstract
IMPORTANCE The incidence of thyroid cancer has been steadily increasing; however, no clear reason for the increase in incidence has been identified. OBJECTIVES To compare incidentally discovered (ID) thyroid cancer via non-thyroid-related imaging with nonincidentally discovered (NID) thyroid cancer, as well as determine if differences in tumor characteristics and patient presentation in ID thyroid cancer may help elucidate the increasing incidence of this disease. DESIGN, SETTING, AND PARTICIPANTS Retrospective medical record review at an academic tertiary care medical center of 31 patients with ID thyroid cancer and 207 patients with NID thyroid cancer evaluated at our institution during a 12-month period. MAIN OUTCOMES AND MEASURES Patient demographics, tumor pathology, stage, tumor size, invasion, and metastasis were recorded. RESULTS Mean age at diagnosis was 56.4 years for the ID group and 41.8 years for the NID group (P < .001). The ID group was 54.8% male compared with 13.5% in the NID group (P < .001). The ID group had higher stage disease compared with the NID group (P = .003). There was no difference in tumor size (P = .91), invasion (P = .76), lymph node involvement, or distant metastases (P > .99). CONCLUSIONS AND RELEVANCE Patients with ID thyroid cancer tend to be older at presentation, have higher stage disease, and are more likely to be male compared with patients with NID thyroid cancer. There does not appear to be a significant difference in the size, pathology, or behavior of the tumor at presentation between ID and NID thyroid cancers. These findings imply that improved detection may not represent the only cause of the increased incidence of thyroid cancer.
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Affiliation(s)
- Frederick Yoo
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, The Pennsylvania State University-Milton S. Hershey Medical Center, Hershey
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Goyal N, Yoo F, Setabutr D, Goldenberg D. Surgical anatomy of the supraglottic larynx using the da Vinci robot. Head Neck 2013; 36:1126-31. [DOI: 10.1002/hed.23418] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 04/15/2013] [Accepted: 06/10/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Neerav Goyal
- Department of Surgery; Division of Otolaryngology - Head and Neck Surgery; The Pennsylvania State University - Penn State Milton S. Hershey Medical Center; Hershey Pennsylvania
| | - Frederick Yoo
- Department of Surgery; Division of Otolaryngology - Head and Neck Surgery; The Pennsylvania State University - Penn State Milton S. Hershey Medical Center; Hershey Pennsylvania
| | - Dhave Setabutr
- Department of Surgery; Division of Otolaryngology - Head and Neck Surgery; The Pennsylvania State University - Penn State Milton S. Hershey Medical Center; Hershey Pennsylvania
| | - David Goldenberg
- Department of Surgery; Division of Otolaryngology - Head and Neck Surgery; The Pennsylvania State University - Penn State Milton S. Hershey Medical Center; Hershey Pennsylvania
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Chaikhoutdinov I, Mitzner R, Yoo F, Fornadley J, Goldenberg D. Incidental Thyroid Nodules: Clinical Presentation and Outcomes. Otolaryngol Head Neck Surg 2013. [DOI: 10.1177/0194599813495815a102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Examine patients with incidentally discovered thyroid nodules (IDTNs) with focus on identification, evaluation, surgical intervention, and rates of malignancy. Methods: Retrospective chart review performed at a tertiary care medical center. Patients were identified by cross-referencing thyroid diagnosis codes with ultrasound (US) codes, identifying a total of 1408 thyroid patients evaluated between July 2008 and June 2009. Information regarding demographics, follow-up, and outcomes was extracted from the medical record. Results: A total of 249 patients with IDTNs were identified. Most were identified on chest CT (44.6%). Most commonly, imaging was obtained for evaluation of an unrelated malignancy (26.9%). Initial evaluation of IDTNs was performed by US in 62.2% and US with fine needle aspiration (FNA) in 36.1% of patients. Patients with US as the initial study appeared to undergo more studies than patients who underwent US/FNA. 170 (68.3%) underwent ultrasound (US)/FNA. The most common pathology was benign follicular nodule (64.1%) and papillary thyroid cancer (PTC) (13.5%). Fifty-five (22.1%) patients underwent thyroidectomy. Forty-seven patients underwent surgery for suspicion of malignancy. Preoperative FNA pathology was PTC in 22 patients, followed by follicular neoplasm in 17 patients. On final pathology, 33 malignancies were present. Of these, 28 were PTC. The overall malignancy rate for incidental thyroid nodules was 13.3%. Conclusions: This study identified a surprisingly high rate of malignancy of at least 13.3% in IDTNs, reaffirming that incidental thyroid nodules should undergo thorough workup. Obtaining US/FNA early in the workup appears to decrease the number of studies ordered.
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