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Badaoui JN, Choby G, McMillan RA, Goates AJ, Cofer SA. Triple Layer Oronasal Fistula Repair Using Local Endonasal Flaps: Case Series of Three Patients. Cleft Palate Craniofac J 2023; 60:359-366. [PMID: 35244480 DOI: 10.1177/10556656211062040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/04/2023] Open
Abstract
Oronasal fistula (ONF) is a common complication encountered after palatoplasty. Repair is indicated when symptoms impact speech and swallowing. In spite of the variety of surgical approaches described to repair these defects, recurrence rates remain high. Traditionally, successful closure is said to be achieved in using a double-layered approach due to the three-dimensional aspect of the defect. The extent of the fistula into the nasal cavity has incited an increased curiosity in using local endonasal flaps. In recent years, endonasal reconstructive procedures have seen increased interest and application, from cranial base defect repairs to orbital reconstruction and beyond. The nasoseptal (NSF) and inferior turbinate flaps (ITF) possess a robust arterial supply and an exceptional reach with excellent results demonstrated in large defect repair. However, the use of these flaps in ONF repair is scarcely discussed in the literature, and their effectiveness is relatively undetermined. In this manuscript, we present a series of three patients who underwent a triple layer ONF closure, with the oral portion incorporating a turn-in mucosal flap plus a local palate rotation flap or greater palatine artery pedicled-rotation flap, and a NSF or an ITF for the nasal portion of the defect.
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Affiliation(s)
- Joseph N Badaoui
- Department of Otorhinolaryngology - Head and Neck Surgery, 6915Mayo Clinic, Rochester, Minnesota, USA
| | - Garret Choby
- Department of Otorhinolaryngology - Head and Neck Surgery, 6915Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan A McMillan
- Department of Otorhinolaryngology - Head and Neck Surgery, 6915Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew J Goates
- Department of Otorhinolaryngology - Head and Neck Surgery, 6915Mayo Clinic, Rochester, Minnesota, USA
| | - Shelagh A Cofer
- Department of Otorhinolaryngology - Head and Neck Surgery, 6915Mayo Clinic, Rochester, Minnesota, USA
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Haller TJ, Van Abel KM, Yin LX, Lohse CM, Douse D, Badaoui JN, Price DL, Kasperbauer JL, Moore EJ. Ultrasound Guided Biopsy in Patients With HPV-Associated Oropharyngeal Squamous Cell Carcinoma. Laryngoscope 2022; 132:2396-2402. [PMID: 35275423 DOI: 10.1002/lary.30105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To identify the differences in sensitivity and accuracy between ultrasound-guided and palpation-guided fine needle aspirations (FNA) of suspicious lymph nodes in patients with human papillomavirus (HPV) (+) oropharyngeal squamous cell carcinoma (OPSCC). Additional objectives included identifying patient specific factors affecting biopsy accuracy and evaluating potential differences in accuracy between fine and core needle biopsies. STUDY DESIGN Retrospective chart review. MATERIALS AND METHODS A retrospective study of diagnostic sensitivity was completed at a single tertiary care center between 1/1/2006-12/31/2016. Participants included patients who underwent pretreatment FNA biopsy with HPV(+)OPSCC confirmed pathologically following neck dissection or excisional lymph node biopsy. A true positive (TP) on FNA biopsy was defined as an FNA biopsy concerning for squamous cell carcinoma (SCC) that was confirmed on excisional biopsy or neck dissection. A false negative (FN) was defined as a negative FNA but metastatic disease identified on excisional biopsy or neck dissection. Sensitivity was calculated as TPs/(TPs + FNs). Sensitivity was compared among techniques using chi-square and Fisher exact tests. RESULTS A total of 209 FNA biopsies among 198 patients were included in the study, including 31 (15%) palpation-guided FNAs, 160 (77%) ultrasound-guided FNAs, and 18 (9%) ultrasound-guided FNA + core biopsies. Sensitivity was significantly different among palpation-guided FNA, ultrasound-guided FNA, and ultrasound-guided FNA + core biopsies (48% vs. 83% vs. 94%, respectively; P < .001) but there was no significant difference in sensitivity between ultrasound-guided FNA versus ultrasound-guided FNA + core biopsies (P = .31). CONCLUSION The use of ultrasound guidance in FNA biopsies of nodal metastases in HPV(+)OPSCC improves sensitivity compared to palpation guidance alone. Ultrasound guided biopsies are preferred in patients with suspected nodal metastasis from HPV(+)OPSCC. LEVEL OF EVIDENCE 3 Laryngoscope, 132:2396-2402, 2022.
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Affiliation(s)
- Travis J Haller
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Dontre' Douse
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Joseph N Badaoui
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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Portela R, Vahibe A, Badaoui JN, Hassan OU, Mckenzie TJ, Kellogg TA, Ghanem OM. Bariatric Surgery in Patients with Existing Ostomy: A Preliminary Feasibility Study. Bariatr Surg Pract Patient Care 2022; 17:127-130. [PMID: 35765305 PMCID: PMC9233518 DOI: 10.1089/bari.2021.0131] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ray Portela
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmet Vahibe
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | - Todd A. Kellogg
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Omar M. Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Badaoui JN, Yin LX, Sauer AB, Moore EJ, Lohse CM, Price DL, Kasperbauer JL, Noel DB, Olsen KD, Van Abel KM. Transpharyngeal Approaches for Management of Oropharyngeal Squamous Cell Carcinoma: Mayo Clinic Institution Experience. Otolaryngol Head Neck Surg 2022; 167:509-516. [PMID: 35041566 DOI: 10.1177/01945998211071000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Investigate oncologic and functional outcomes associated with transhyoid and lateral pharyngotomy (transpharyngeal) approaches in the treatment of oropharyngeal squamous cell carcinoma (OPSCC). STUDY DESIGN Retrospective review. SETTING Single institution (tertiary care center). METHODS This is a retrospective case series of patients with OPSCC undergoing transpharyngeal resection from 1990 to 2017 at Mayo Clinic. Oncologic outcomes, postoperative complications, objective swallowing data, and rates of tracheostomy and percutaneous gastrostomy tube dependence were recorded. RESULTS Of 83 patients meeting inclusion criteria, 56 (68%) were human papillomavirus positive. Overall survival rates at 5 and 10 years following surgery were 85% and 80%, respectively. Cancer-specific survival rates at these same time points were 90% and 88%. Following treatment, 35 of 49 patients (71%) had a Functional Oral Intake Scale score ≥5, indicating total oral intake of multiple consistencies; 79 of 82 (96%) were without tracheostomy or laryngectomy; and 71 of 81 (88%) were on a full oral diet. CONCLUSION Transpharyngeal approaches provide adequate functional and oncologic outcomes in the majority of patients with OPSCC. These results may have important implications for patients who are not candidates for, or are unwilling to undergo, nonoperative therapy or for those without access to radiation therapy.
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Affiliation(s)
- Joseph N Badaoui
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam B Sauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel B Noel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kerry D Olsen
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Ghanem OM, Badaoui JN. Comment on: Conversion of laparoscopic sleeve gastrectomy to Roux-en-Y gastric bypass: patterns predicting persistent symptoms after revision. Surg Obes Relat Dis 2021; 17:1690-1691. [PMID: 34275762 DOI: 10.1016/j.soard.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Omar M Ghanem
- Department of General Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph N Badaoui
- Division of Breast, Endocrine, Metabolic, and GI Surgery, Mayo Clinic, Rochester, Minnesota
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Badaoui JN, Kellogg TA, Dayyeh BA, Ghanem OM. Sleeve to Colon Fistula: Laparoscopic Conversion to Roux-en-Y Gastric Bypass. Obes Surg 2021; 31:2837-2838. [PMID: 33675020 DOI: 10.1007/s11695-021-05325-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA. .,Division of Breast, Endocrine, Metabolic, and GI Surgery, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN, 55905, USA.
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Karthikeyan R, Takla H, Delko T, Badaoui JN, Kellog TA, Ghanem OM. The enemy of good is better, colonic obstruction post gastric bypass: an international video case series. Surg Obes Relat Dis 2021; 17:931-932. [PMID: 33715990 DOI: 10.1016/j.soard.2021.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/23/2021] [Accepted: 01/28/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Hany Takla
- Department of Surgery, Winchester Hospital, Winchester, Massachusetts
| | - Tarik Delko
- Department of Surgery, University Hospital of Basel, Basel, Switzerland
| | | | - Todd A Kellog
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota.
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Cofer SA, Badaoui JN, Boesch RP, Balakrishnan K. Endotracheal metallic stent removal: A novel ABC (airway balloon collapse) technique. Int J Pediatr Otorhinolaryngol 2021; 140:110490. [PMID: 33229032 DOI: 10.1016/j.ijporl.2020.110490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 10/23/2022]
Abstract
To illustrate a previously unreported method of tracheal stent removal that appears to cause less mucosal injury we present a case of a 9-year-old Down syndrome patient with a history of tracheoesophageal fistula, brought to our attention after recurrent bouts of exacerbating cough and tracheo-bronchitis. Endoscopic examination under general anesthesia noted the presence of severe tracheomalacia with inspiratory collapse, and a 10-mm balloon expandable metallic stent (BEMS) was deployed and symptomatic improvement was noted. The initial stent was then removed to consider a definitive procedure using the typical grasping fashion with an alligator forceps and expected mucosal excoriation was noted. Due to symptom recurrence, the patient underwent placement of a second BEMS stent. Initial improvement was noted followed by recurrent episodes of respiratory distress due to granulation tissue formation and stent compression and a decision to remove the stent was made. A new method of stent removal deemed ABC (airway balloon collapse) method was utilized where an expandable airway balloon is placed outside the stent between the stent and tracheal wall and then inflated to collapse the stent, facilitating easy removal.
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Affiliation(s)
- Shelagh A Cofer
- Department of Otorhinolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Joseph N Badaoui
- Department of Otorhinolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - R Paul Boesch
- Division of Pediatric Pulmonology, Mayo Clinic, Rochester, MN, USA
| | - Karthik Balakrishnan
- Department of Otorhinolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
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Ghanem OM, Badaoui JN. Comment on: High acquisition rate and internal validity in the Scandinavian Obesity Surgery Registry. Surg Obes Relat Dis 2020; 17:615-617. [PMID: 33272855 DOI: 10.1016/j.soard.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/07/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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