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McGrath H, Pennington Z, Cross MR, Hoffman EM, Gregg NM, Tasche KK, Bayan SL, Van Gompel JJ. Delayed vagal nerve compressive neuropathy following placement of vagal nerve stimulator: case report. Acta Neurochir (Wien) 2024; 166:193. [PMID: 38662025 DOI: 10.1007/s00701-024-06087-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
Vagal neuropathy causing vocal fold palsy is an uncommon complication of vagal nerve stimulator (VNS) placement. It may be associated with intraoperative nerve injury or with device stimulation. Here we present the first case of delayed, compressive vagal neuropathy associated with VNS coil placement which presented with progressive hoarseness and vocal cord paralysis. Coil removal and vagal neurolysis was performed to relieve the compression. Larger 3 mm VNS coils were placed for continuation of therapy. Coils with a larger inner diameter should be employed where possible to prevent this complication. The frequency of VNS-associated vagal nerve compression may warrant further investigation.
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Affiliation(s)
- Hari McGrath
- Department of Neurosurgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Zach Pennington
- Department of Neurosurgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | | | | | | | - Kendall K Tasche
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Semirra L Bayan
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jamie J Van Gompel
- Department of Neurosurgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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Fearington FW, Zhao CY, Romero-Brufau S, Moore EJ, Price DL, Tasche KK, Yin LX, Kunkel ET, Kisiel JB, Giridhar KV, Routman DM, Van Abel KM. Addressing positive multi-cancer early detection tests in head and neck Surgery: Experience with head and neck work up for high-risk referrals. Oral Oncol 2024; 152:106809. [PMID: 38621326 DOI: 10.1016/j.oraloncology.2024.106809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES Blood-based multi-cancer early detection (MCED) tests are now commercially available. However, there are currently no consensus guidelines available for head and neck cancer (HNC) providers to direct work up or surveillance for patients with a positive MCED test. We seek to describe cases of patients with positive MCED tests suggesting HNC and provide insights for their evaluation. METHODS Retrospective chart review of patients referred to Otolaryngology with an MCED result suggesting HNC. Patients enrolled in prospective MCED clinical trials were excluded. Cancer diagnoses were confirmed via frozen-section pathology. RESULTS Five patients were included (mean age: 69.2 years, range 50-87; 4 male) with MCED-identified-high-risk for HNC or lymphoma. Only patient was symptomatic. After physical exam and follow-up head and neck imaging, circulating tumor HPV DNA testing, two patients were diagnosed with p16 + oropharyngeal squamous cell carcinomas and underwent appropriate therapy. A third patient had no evidence of head and neck cancer but was diagnosed with sarcoma of the thigh. The remaining two patients had no evidence of malignancy after in-depth workup. CONCLUSIONS In this retrospective study, 2 of 5 patients referred to Otolaryngology with a positive MCED result were diagnosed with HPV + oropharyngeal squamous cell carcinoma. We recommend that positive HNC MCED work up include thorough head and neck examination with flexible laryngoscopy and focused CT or MRI imaging. Given the potential for inaccurate MCED tissue of origin classification, PET/CT may be useful in specific situations. For a patient with no cancer identified, development of clear guidelines is warranted.
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Affiliation(s)
| | - Conan Y Zhao
- Mayo Clinic Alix School of Medicine, 200 1(st) St SW, Rochester, MN, USA
| | - Santiago Romero-Brufau
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - Eric J Moore
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - Daniel L Price
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - Kendall K Tasche
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - Linda X Yin
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - Elizabeth T Kunkel
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - John B Kisiel
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - Karthik V Giridhar
- Department of Oncology, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA.
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Ali HM, Keaton AB, Rourk K, Lohse C, Tasche KK, Price DL, Van Abel KM, Yin LX, Moore EJ. Partial superficial parotidectomy for pleomorphic adenoma of the parotid gland: Early post-operative outcomes. Am J Otolaryngol 2024; 45:104185. [PMID: 38104469 DOI: 10.1016/j.amjoto.2023.104185] [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: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION There has been historical controversy regarding the extent of resection in the management of pleomorphic adenomas. This study aims to evaluate the extent of surgery and short-term postoperative outcomes of partial superficial parotidectomy (PSP) for the management of pleomorphic adenomas at a tertiary, high-volume center. METHODS A retrospective chart review of patients who underwent PSP was performed. Variables included demographics, pre-operative facial nerve function, operative techniques, postoperative complications/facial nerve function, and recurrence. RESULTS 151 adults who underwent PSP for pleomorphic adenoma from January 1st, 2000 to December 31st, 2022 were identified. Median age was 55 (IQR 40-66) years with females representing 74 % of the cohort. Median tumor size at presentation was 1.8 (IQR 1.3-2.3) cm. Baseline facial nerve function was excellent for most patients (House-Brackmann I, 99 %). Most patients underwent a superficial inferior parotidectomy (88 %). Modified Blair incision (70 %) was the most common incision. Intraoperatively, the facial nerve was identified in 149 (99 %) patients. The main trunk was identified in 126 (85 %) patients. No patient had tumor spillage. Only two patients required parotid bed reconstruction. The most common complication was ear numbness (60 %). Postoperatively, 114 patients were House-Brackmann grade I at both preoperative and postoperative assessment, 8 went from grade I to II, and 1 went from grade VI to II (Bell's palsy that resolved to grade II following surgery). Median follow-up was 1(IQR 1-5) month. CONCLUSION PSP is efficacious in the management of pleomorphic adenomas with preservation of facial nerve function, and minimal post-operative complications. Future study is needed to assess long term recurrence risk.
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Affiliation(s)
- Hawa M Ali
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States
| | - Aniya B Keaton
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States; University of Tennessee, Knoxville, TN, United States
| | - Katelyn Rourk
- Mayo Clinic Alix School of Medicine, Rochester, MN, United States
| | - Christine Lohse
- Department of Quantitative Health Sciences, Rochester, MN, United States
| | - Kendall K Tasche
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States
| | - Daniel L Price
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States
| | - Kathryn M Van Abel
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States
| | - Linda X Yin
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States
| | - Eric J Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States.
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Ali HM, Sankar GB, Stickney EA, Johns HL, Whaley RD, Rivera M, Lohse CM, Tasche KK, Price DL, Van Abel KM, Yin LX, Moore EJ. Ability for fine needle aspiration and frozen section to predict extent of parotidectomy. Head Neck 2023; 45:3006-3014. [PMID: 37752736 DOI: 10.1002/hed.27527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION Several diagnostic modalities with various sensitivity and specificities can be used to evaluate a parotid mass. The aims of this project were to compare the diagnostic actionability, accuracy, and ability to accurately predict extent of surgery for FNA and frozen section during the evaluation of a parotid mass. METHODS A retrospective chart review of patients who underwent parotidectomy for a parotid mass from January 1, 2015 to January 30, 2022 was conducted. Actionability was defined as a pathology diagnosis or the histologic grade of a lesion, as this provided clear and useful information for the surgeon to act upon. Diagnostic accuracy was determined by comparing FNA and frozen section results to final pathology. Accuracy of extent of surgery was determined by comparing predicted extent of surgery from the FNA or frozen section result to the extent of surgery predicted by the final pathology. RESULTS A total of 626 patients were included in this study. FNA was obtained in 396 (63%) patients, while all neoplasms were evaluated by frozen section analysis. FNA diagnosis was actionable in 318 (80%), while frozen section diagnosis was actionable in 616 (98%) patients. Exactly 294 (92.5%) FNA diagnoses were accurate compared with 600 (98%) frozen section diagnoses. The FNA diagnosis predicted appropriate extent of surgery in 294 (74%) while the frozen section diagnosis predicted appropriate extent of surgery in 600 (96%). Among the 396 patients with FNA, frozen section was significantly more likely to accurately predict appropriate extent of surgery compared with FNA (p < 0.001). CONCLUSION Frozen section is more likely to yield actionable and accurate results compared with FNA. Additionally, frozen section is better than FNA in predicting the appropriate extent of surgery.
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Affiliation(s)
- Hawa M Ali
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - George B Sankar
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Heather L Johns
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rumeal D Whaley
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Rivera
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Kendall K Tasche
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Linda X Yin
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
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Carlson ML, Lohse CM, Agazzi S, Babu SC, Barker FG, Barnett S, Bi WL, Biggs N, Boahene KD, Breen JT, Brown KD, Cayé-Thomasen P, Cosetti MK, Deep NL, Dey JK, Dornhoffer JR, Forner D, Gurgel RK, Hansen MR, Hunter JB, Kalamarides M, Kim IA, King AT, Kircher ML, Lassaletta L, Link MJ, Lloyd SKW, Lund-Johansen M, Marinelli JP, Matthies C, Mehta V, Moore EJ, Nassiri AM, Neff BA, Nelson RF, Olson JJ, Patel NS, Celda MP, Plitt AR, Price DL, Thomas Roland J, Sweeney AD, Tasche KK, Tatagiba M, Tveiten Ø, Van Gompel JJ, Vrabec JT, Wanna GB, Weisskopf PA. Rationale for the Development of a Novel Clinical Grading Scale for Postoperative Facial Nerve Function: Results of a Multidisciplinary International Working Group. Otol Neurotol 2023; 44:e747-e754. [PMID: 37875014 DOI: 10.1097/mao.0000000000004039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
OBJECTIVE The objective of the current study was to present the results of an international working group survey identifying perceived limitations of existing facial nerve grading scales to inform the development of a novel grading scale for assessing early postoperative facial paralysis that incorporates regional scoring and is anchored in recovery prognosis and risk of associated complications. STUDY DESIGN Survey. SETTING A working group of 48 multidisciplinary clinicians with expertise in skull base, cerebellopontine angle, temporal bone, or parotid gland surgery. RESULTS House-Brackmann grade is the most widely used system to assess facial nerve function among working group members (81%), although more than half (54%) agreed that the system they currently use does not adequately estimate the risk of associated complications, such as corneal injury, and confidence in interrater and intrarater reliability is generally low. Simplicity was ranked as the most important attribute of a novel postoperative facial nerve grading system to increase the likelihood of adoption, followed by reliability and accuracy. There was widespread consensus (91%) that the eye is the most critical facial region to focus on in the early postoperative setting. CONCLUSIONS Members were invited to submit proposed grading systems in alignment with the objectives of the working group for subsequent validation. From these data, we plan to develop a simple, clinically anchored, and reproducible staging system with regional scoring for assessing early postoperative facial nerve function after surgery of the skull base, cerebellopontine angle, temporal bone, or parotid gland.
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Affiliation(s)
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Siviero Agazzi
- Department of Neurosurgery, University of South Florida, Tampa, Florida
| | | | - Frederick G Barker
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Samuel Barnett
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nigel Biggs
- Department of Otolaryngology, Head, Neck and Skull Base Surgery, St Vincent's Hospital, Sydney, Australia
| | - Kofi D Boahene
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Joseph T Breen
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida
| | - Kevin D Brown
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Per Cayé-Thomasen
- Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Maura K Cosetti
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine of Mount Sinai, New York, New York
| | - Nicholas L Deep
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona
| | - Jacob K Dey
- Department of Otolaryngology-Head and Neck Surgery
| | | | - David Forner
- Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Richard K Gurgel
- Department of Otolaryngology, University of Utah Health, Salt Lake City, Utah
| | - Marlan R Hansen
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Jacob B Hunter
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michel Kalamarides
- Department of Neurosurgery, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Irene A Kim
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Andrew T King
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Manchester, UK
| | - Matthew L Kircher
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Chicago, Illinois
| | - Luis Lassaletta
- Department of Otolaryngology, IdiPAZ Institute for Health Research, La Paz University Hospital; Biomedical Research Networking Centre on Rare Diseases (CIBERER-U761), Institute of Health Carlos III, Madrid, Spain
| | | | - Simon K W Lloyd
- Department of Otolaryngology Head and Neck Surgery, Manchester Royal Infirmary, Manchester Academic Health Science Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | | | - Cordula Matthies
- Department of Neurosurgery, University of Würzburg, Würzburg, Germany
| | - Vikas Mehta
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery
| | - Ashley M Nassiri
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Brian A Neff
- Department of Otolaryngology-Head and Neck Surgery
| | - Rick F Nelson
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana
| | - Jeffrey J Olson
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Neil S Patel
- Department of Otolaryngology, University of Utah Health, Salt Lake City, Utah
| | | | | | | | - J Thomas Roland
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York
| | - Alex D Sweeney
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | | | - Marcos Tatagiba
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Øystein Tveiten
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | | | | | - George B Wanna
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine of Mount Sinai, New York, New York
| | - Peter A Weisskopf
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona
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Graves JP, Daher GS, Bauman MMJ, Moore EJ, Tasche KK, Price DL, Van Abel KM. Association of sarcopenia with oncologic outcomes of primary treatment among patients with oral cavity cancer: A systematic review and meta-analysis. Oral Oncol 2023; 147:106608. [PMID: 37897858 DOI: 10.1016/j.oraloncology.2023.106608] [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: 08/08/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
Abstract
GOAL We performed a systematic review of the literature and meta-analysis to determine how radiographic sarcopenia assessment methods and the presence of pre-treatment sarcopenia impact oncologic outcomes in patients with oral cavity cancer. INTRODUCTION Pre-treatment sarcopenia has been associated with poor outcomes in many different malignancies, including head and neck cancers. However, the impact sarcopenia has on outcomes for oral cavity cancer patients is not well understood. RESULTS Twelve studies met our inclusion criteria, totaling 1007 patients. 359 (36%) of these patients were reported as sarcopenic. The most commonly utilized sarcopenia assessment methods were L3 skeletal muscle index (n = 5) and C3 skeletal muscle index to estimate L3 skeletal muscle index (n = 5). The majority of studies established their sarcopenia cutoffs as the lowest quartile skeletal muscle index in their patient cohorts. Five studies were included in our meta-analysis, totaling 251 sarcopenic and 537 non-sarcopenic patients. Compared to non-sarcopenic patients, sarcopenic patients were found to have significantly poorer overall survival (univariate: HR = 2.24, 95% CI: 1.71-2.93, I2 = 0%; multivariate: HR = 1.93, 95% CI: 1.47-2.52, I2 = 0%) and disease-free survival (univariate: HR = 2.10, 95% CI: 1.50-2.92, I2 = 0%; multivariate: HR = 1.79, 95% CI: 1.29-2.47, I2 = 10%). CONCLUSIONS Over one-third of oral cavity cancer patients may present with sarcopenia. Pre-treatment sarcopenia is associated with significantly worse overall and disease-free survival.
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Affiliation(s)
- Jeffrey P Graves
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA; Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ghazal S Daher
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kendall K Tasche
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
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Douse DM, Yin LX, Olawuni FO, Glasgow AE, Habermann EB, Price DL, Tasche KK, Moore EJ, Van Abel KM. Racial disparities in surgical treatment of oropharyngeal cancer: A Surveillance, Epidemiology, and End Results review. Head Neck 2023; 45:2313-2322. [PMID: 37461323 DOI: 10.1002/hed.27467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 06/03/2023] [Accepted: 07/09/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVES Oropharyngeal squamous cell carcinoma (OPSCC) has been rising. This manuscript looks to explore racial disparities in the surgical management of OPSCC. METHODS A cancer database was queried for patients with OPSCC diagnosed from 2004 to 2017. Univariate and multivariable logistic regressions were used to evaluate associations between patient race/ethnicity, surgical treatment, and reasons for lack of surgery. RESULTS 37 306 (74.3%) patients did not undergo surgery, while 12 901 (25.7%) patients did. Non-Hispanic black (NHB) patients were less likely to undergo surgery than other races (17.9% vs. 26.5%; p < 0.0001). In clinical discussions, the Asian, Native American, Hawaiian, Pacific Islander (ANAHPI), and unknown race group was more likely to directly refuse surgery when recommended (2.5% vs. 1.5%; p = 0.015). CONCLUSION Racial differences exist in treatment for OPSCC. NHB patients are less likely to actually undergo surgical management for OPSCC, while other patients are more likely to directly "refuse" surgery outright when offered.
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Affiliation(s)
- Dontre' M Douse
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Linda X Yin
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Felicia O Olawuni
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy E Glasgow
- Division of Health Care Policy and Research and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Elizabeth B Habermann
- Division of Health Care Policy and Research and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kendall K Tasche
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Karp EE, Yin LX, Xie KZ, O'Byrne TJ, Wallerius KP, Tasche KK, Van Abel KM, Kasperbauer JL, Moore EJ, Price DL. Safety outcomes and patient convenience in outpatient parotidectomy. Am J Otolaryngol 2023; 44:103806. [PMID: 36842422 DOI: 10.1016/j.amjoto.2023.103806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Parotidectomies have historically been performed on an inpatient basis despite being well-tolerated surgeries with minimal postoperative wound care and low rates of complications at high-volume institutions. Past studies have supported the safety of outpatient surgery for parotidectomy but have been limited to superficial parotidectomy and have not addressed the patient experience surrounding the surgical intervention such as pre-operative and post-operative care and communication. PURPOSE This study assesses the impact of outpatient superficial, deep, and partial parotid surgery on various parameters including surgical safety, distance traveled for care, utilization of telehealth, and patient-initiated communication. MATERIALS AND METHODS Retrospective study from January 2020 to October 2021. Patients undergoing superficial lobe, deep lobe, and partial parotidectomies for benign and malignant pathologies were divided into inpatient and outpatient cohorts. A multivariable model examined the relationship between admission status and surgical complications, adjusted for age, sex, and tumor size. RESULTS 159 patients total, 94 outpatient and 65 inpatients. No statistical difference in rates of surgical complications with the exception of salivary leak. There was an increased rate of salivary leak reported in the inpatient group (OR 5.4, 95 % CI 1.6 to 18.0, p = 0.01). Mean patient travel distance of 354 miles one-way. Post-operatively, 76 % were evaluated via video visit. Following discharge, >55 % of patients initiated communication with the surgical team, which was not statistically different between the groups. CONCLUSIONS Outpatient parotidectomy is safe and can be more convenient, but telehealth communication must be balanced with rigorous attention to patient education.
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Affiliation(s)
- Emily E Karp
- Mayo Clinic Department of Otolaryngology Head & Neck Surgery, Rochester, MN, USA
| | - Linda X Yin
- Mayo Clinic Department of Otolaryngology Head & Neck Surgery, Rochester, MN, USA
| | | | - Thomas J O'Byrne
- Mayo Clinic Department of Quantitative Health Sciences, Rochester, MN, USA
| | | | - Kendall K Tasche
- Mayo Clinic Department of Otolaryngology Head & Neck Surgery, Rochester, MN, USA
| | - Kathryn M Van Abel
- Mayo Clinic Department of Otolaryngology Head & Neck Surgery, Rochester, MN, USA
| | - Jan L Kasperbauer
- Mayo Clinic Department of Otolaryngology Head & Neck Surgery, Rochester, MN, USA
| | - Eric J Moore
- Mayo Clinic Department of Otolaryngology Head & Neck Surgery, Rochester, MN, USA
| | - Daniel L Price
- Mayo Clinic Department of Otolaryngology Head & Neck Surgery, Rochester, MN, USA.
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Anagnos VJ, Brody RM, Carey RM, De Ravin E, Tasche KK, Newman JG, Shanti RM, Chalian AA, Rassekh CH, Weinstein GS, O'Malley BW, Cannady Md SB. Post-operative Monitoring for Head and Neck Microvascular Reconstruction in the Era of Resident Duty Hour Restrictions: A Retrospective Cohort Study Comparing 2 Monitoring Protocols. Ann Otol Rhinol Laryngol 2023; 132:310-316. [PMID: 35473389 DOI: 10.1177/00034894221088176] [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 To determine whether 2 different methods of post-operative head and neck free flap monitoring affect flap failure and complication rates. METHODS A retrospective chart review of 803 free flaps performed for head and neck reconstruction by the same microvascular surgeon between July 2013 and July 2020 at 2 separate hospitals within the same healthcare system. Four-hundred ten free flaps (51%) were performed at Hospital A, a medical center where flap checks were performed at frequent, scheduled intervals by in-house resident physicians and nurses; 393 free flaps (49%) were performed at Hospital B, a medical center where flap checks were performed regularly by nursing staff with resident physician evaluation as needed. Total free flap failure, partial free flap failure, and complications (consisting of wound infection, fistula, and reoperation within 1 month) were assessed. RESULTS There were no significant differences between Hospitals A and B when comparing rates of total free flap failure, partial free flap failure, complication, or re-operation (P = .27, P = .66, P = .65, P = .29, respectively). There were no significant differences in urgent re-operation rates for flap compromise secondary to thrombosis and hematoma (P = .54). CONCLUSIONS In our series, free flap outcomes did not vary based on the degree of flap monitoring by resident physicians. This data supports the ability of a high-volume, well-trained, nursing-led flap monitoring program to detect flap compromise in an efficient fashion while limiting resident physician obligations in the age of resident duty hour restrictions.
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Affiliation(s)
- Vincent J Anagnos
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert M Brody
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Ryan M Carey
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Emma De Ravin
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kendall K Tasche
- Department of Otorhinolaryngology: Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jason G Newman
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Rabie M Shanti
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA.,Department of Oral and Maxillofacial Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Ara A Chalian
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher H Rassekh
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory S Weinstein
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Bert W O'Malley
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven B Cannady Md
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
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10
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Gao RW, Routman DM, Harmsen WS, Ebrahimi S, Foote RL, Ma DJ, Neben-Wittich M, McGee LA, Patel SH, Moore EJ, Choby GW, Tasche KK, Price KA, Gamez ME, Lester SC. Adenoid cystic carcinoma of the head and neck: Patterns of recurrence and implications for intensity-modulated radiotherapy. Head Neck 2023; 45:187-196. [PMID: 36222355 DOI: 10.1002/hed.27223] [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: 07/05/2022] [Revised: 09/13/2022] [Accepted: 10/04/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We seek to inform radiotherapy (RT) delivery for adenoid cystic carcinoma of the head and neck (ACC) by evaluating RT techniques and recurrence patterns. METHODS We identified patients with ACC treated with curative-intent RT from 2005 to 2021. Imaging was reviewed to determine local recurrence (LR). RESULTS Ninety-one patients were included. The 5-year LR risk was 12.2% (6.6-22.7). One patient each experienced a marginal and out-of-field recurrence. Patients receiving >60 Gy postoperatively had a 5-year LR risk of 0% compared to 10.7% (4.2-27.2) with ≤60 Gy. Those receiving 70 and <70 Gy definitively had a 5-year LR risk of 15.2% (2.5-91.6) and 33.3% (6.7-100.0), respectively. No patients had regional nodal failure. CONCLUSIONS Modern, conformal RT for ACC results in low rates of LR. Doses >60 and 70 Gy may improve control in the postoperative and definitive settings, respectively. Elective nodal treatment can be omitted in well-selected patients.
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Affiliation(s)
- Robert W Gao
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - William S Harmsen
- Department of Biostatistics & Information, Mayo Clinic, Rochester, Minnesota, USA
| | - Sasha Ebrahimi
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Eric J Moore
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Garret W Choby
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kendall K Tasche
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Katharine A Price
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mauricio E Gamez
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
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11
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Karp EE, Yin LX, O'Byrne TJ, Lu LY, Routman DM, Lester SC, Neben Wittich MA, Ma DJ, Price KA, Chintakuntlawar AV, Tasche KK, Price DL, Moore EJ, Van Abel KM. Diagnostic Delay in Human Papillomavirus Negative Oropharyngeal Squamous Cell Carcinoma. Laryngoscope 2022; 133:1394-1401. [PMID: 35851669 DOI: 10.1002/lary.30307] [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: 02/14/2022] [Revised: 05/26/2022] [Accepted: 07/04/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Failure to recognize symptoms of non-human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV(-)OPSCC) at presentation can delay diagnosis and treatment. We aim to identify patient factors and provider practice patterns that delay presentation and care in HPV(-)OPSCC. METHODS Retrospective review at a tertiary care center. Patients with HPV(-)OPSCC receiving treatment from 2006 to 2016. Patients were excluded if their date of symptom onset or diagnosis was unknown after thorough review of the electronic medical record or their tissue was not tested for HPV or p16. Clinical data, workup, and care timelines were abstracted. Univariate and multivariable linear regressions were performed to determine associations between patient and provider factors and delays in care. RESULTS Of 70 included patients, 52 (74%) were male and mean age was 60.5 (SD = 9.0). Median time to diagnosis was 69 days (IQR = 32-127 days), with a median latency of 30 days (IQR = 12-61 days) from symptom onset to first presentation and 19.5 days (IQR = 4-46 days) from the first presentation to diagnosis. Most patients visited at least 2 providers (n = 52, 74%) before diagnosis. Evaluation by 3 or more providers prior to diagnosis was associated with significant delays in diagnosis of nearly a year (357.7 days, p < 0.001) and being treated or prescribed analgesia prior to diagnosis was significantly associated with delays in diagnosis (p = 0.004) on univariate regression analysis. CONCLUSIONS Delays in care related to evaluations by multiple providers and misdiagnosis prolonged time to diagnosis in HPV(-)OPSCC. Improved patient and provider education is necessary to expedite the diagnosis of HPV(-)OPSCC. LEVEL OF EVIDENCE 4 Laryngoscope, 133:1394-1401, 2023.
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Affiliation(s)
- Emily E. Karp
- 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
| | | | - Lauren Y. Lu
- Alix School of Medicine Mayo Clinic Rochester Minnesota USA
| | - David M. Routman
- Department of Radiation Oncology Mayo Clinic Rochester Minnesota USA
| | - Scott C. Lester
- Department of Radiation Oncology Mayo Clinic Rochester Minnesota USA
| | | | - Daniel J. Ma
- Department of Radiation Oncology Mayo Clinic Rochester Minnesota USA
| | | | | | - Kendall K. Tasche
- Department of Otolaryngology, Head and Neck Surgery Mayo Clinic Rochester Minnesota USA
| | - Daniel L. Price
- 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
| | - Kathryn M. Van Abel
- Department of Otolaryngology, Head and Neck Surgery Mayo Clinic Rochester Minnesota USA
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12
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Johnson BJ, Diehn FE, Nagelschneider AA, Tasche KK, Carlson ML. Markedly asymmetric facial nerve hypertrophy simulating a schwannoma in a patient with Charcot-Marie-Tooth disease. Am J Otolaryngol 2022; 43:103513. [PMID: 35636090 DOI: 10.1016/j.amjoto.2022.103513] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022]
Affiliation(s)
- B Jake Johnson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - Felix E Diehn
- Department of Radiology, Mayo Clinic, Rochester, MN, United States of America
| | | | - Kendall K Tasche
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States of America.
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13
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Tasche KK, Dorneden AM, Swift WM, Boyd NH, Shonka DC, Pagedar NA. Airway Management in Substernal Goiter Surgery. Ann Otol Rhinol Laryngol 2021:34894211014794. [PMID: 34032125 DOI: 10.1177/00034894211014794] [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
OBJECTIVE(S) To review the experience of 3 hospitals with airway management during surgery for substernal goiter and identify preoperative factors that predict the need for advanced airway management techniques. METHODS A retrospective chart review between 2009 and 2017 of patients with substernal goiter treated surgically at 1 of 3 hospitals was performed. RESULTS Of the 179 patients included in the study, 114 (63.7%) were female, the mean age was 55.1 years (range 20-87). Direct laryngoscopy or videolaryngoscopy was successful in 162 patients (90.5%), with fiberoptic intubation used for the remaining 17 patients. Thirty-one patients (17.4%) required >1 intubation attempt; these patients had larger thyroids (201.3 g, 95% CI 155.3-247.2 g) than those intubated with 1 attempt (144.7 g, 95% CI 127.4-161.9 g, P = .009). Those who required >1 attempt had higher BMI (38.3, 95% CI 34.0-42.6 vs. 32.9, 95% CI 31.5-34.3, P = .02). Mallampati score was found to be a predictor of >1 attempt, though tracheal compression and tracheal shift were not found to be predictors of >1 attempt, nor was the lowest thyroid extent. BMI was the only independent factor on multivariable logistic regression of needing >1 attempt (odds ratio 1.056, 95% CI 1.011-1.103, P = .015). CONCLUSIONS The majority of patients undergoing surgery for substernal goiter can be intubated routinely without the need for fiberoptic intubation. Thyroid-specific factors such as lowest thyroid extent and mass effect of the gland on the trachea do not appear to be associated with difficult intubation, whereas classic patient factors associated with difficulty intubation are. LEVEL OF EVIDENCE VI.
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Affiliation(s)
- Kendall K Tasche
- Department of Otolaryngology-Head & Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Ashley M Dorneden
- Division of Otolaryngology, Department of Surgery, University of New Mexico Health Sciences, Albuquerque, NM, USA
| | - William M Swift
- Department of Otolaryngology-Head & Neck Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Nathan H Boyd
- Division of Otolaryngology, Department of Surgery, University of New Mexico Health Sciences, Albuquerque, NM, USA
| | - David C Shonka
- Department of Otolaryngology-Head & Neck Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Nitin A Pagedar
- Department of Otolaryngology-Head & Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
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14
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Luu NN, Yver CM, Douglas JE, Tasche KK, Thakkar PG, Rajasekaran K. Assessment of YouTube as an Educational Tool in Teaching Key Indicator Cases in Otolaryngology During the COVID-19 Pandemic and Beyond: Neck Dissection. J Surg Educ 2021; 78:214-231. [PMID: 32646815 PMCID: PMC7338020 DOI: 10.1016/j.jsurg.2020.06.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/17/2020] [Accepted: 06/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES YouTube has become the preferred resource for trainees in otolaryngology to prepare for surgery. This study aimed to compare the evaluation by 2 attending physicians and 2 resident physicians of the quality of videos on YouTube on neck dissection, a key indicator case in head and neck surgery. The authors aimed to assess the quality and quantity of YouTube videos available for development of a virtual surgical educational curriculum for trainees in otolaryngology. METHODS Using the YouTube search feature, the top 10 videos by relevance and view count were compiled using the following search terms: radical neck dissection, selective neck dissection, modified radical neck dissection, lateral neck dissection, levels I-III neck dissection, levels II-IV, left neck dissection, right neck dissection, cervical nodal dissection, and supraomohyoid neck dissection. A total of 37 videos on neck dissection were identified and analyzed using the LAP-VEGaS criteria as well as author-specific modified LAP-VEGaS criteria. RESULTS The mean comprehensive LAP-VEGaS score was 8.74 (SD 3.10). The majority of videos (24/37) were designated as medium quality; 10 of 37 videos were low quality and 3 of 37 videos were high quality. In the total group analysis, there was excellent inter-rater reliability between attending physicians (Cohen's kappa coefficient of 0.84) and good inter-rater reliability between resident physicians (Cohen's kappa coefficient of 0.58). There was no correlation between total view count, video age, or number of likes/dislikes and the overall LAP-VEGaS score. The presence of audio or written commentary had a moderate positive correlation with LAP-VEGaS score (adjusted R2 of 0.36). There was no statistically significant difference in video quality between videos posted by US and non-US based physicians (95% confidence interval -0.10 to 4.10; p = 0.06). However, videos made by an otolaryngology-trained physician had a LAP-VEGaS score that was 3.93 points higher (95% confidence interval 2.34-5.52; p < 0.001) than that of videos made by a nonotolaryngology-trained physician. CONCLUSIONS Online videos of neck dissection represent an increasingly ubiquitous and appropriate resource for trainees in learning otolaryngology key indicator cases. While free-to-access video repositories, such as YouTube, have become increasingly popular among trainees as a primary resource for learning and preparing for surgical cases, they lack consistent quality and as such, global efforts should be taken to improve the breadth and depth of educational video content in otolaryngology.
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Affiliation(s)
- Neil N Luu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Christina M Yver
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer E Douglas
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kendall K Tasche
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Punam G Thakkar
- Department of Otolaryngology - Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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15
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Tasche KK, Samuelson MI, Pagedar NA. Unilateral Nasal Mass in a Woman in Her 20s. JAMA Otolaryngol Head Neck Surg 2019; 145:862-863. [PMID: 31294763 DOI: 10.1001/jamaoto.2019.1671] [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: 11/14/2022]
Affiliation(s)
- Kendall K Tasche
- Department of Otolaryngology-Head & Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City
| | - Megan I Samuelson
- Department of Pathology, University of Iowa Hospitals & Clinics, Iowa City
| | - Nitin A Pagedar
- Department of Otolaryngology-Head & Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City
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16
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Pagedar NA, Kahl AR, Tasche KK, Seaman AT, Christensen AJ, Howren MB, Charlton ME. Incidence trends for upper aerodigestive tract cancers in rural United States counties. Head Neck 2019; 41:2619-2624. [PMID: 30843640 DOI: 10.1002/hed.25736] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/24/2019] [Accepted: 02/21/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Recent declines in cancer incidence and mortality have not been distributed equally across the United States. Factors such as tobacco cessation and human papillomavirus presence might differentially affect urban and rural portions of the country. METHODS We used the Surveillance, Epidemiology, and End Results database to assess cancer incidence rates and trends from 1973 to 2015. We compared incidence rates for oral cavity, oropharynx, and larynx cancer in urban and rural counties and identified trends using Joinpoint software. RESULTS Incidence of larynx and oral cavity cancer are decreasing faster in urban areas than in rural areas, while incidence of oropharynx cancer is increasing faster in rural areas than urban areas. CONCLUSIONS Relative trends in incidence of larynx, oral cavity, and oropharynx cancer over the past 40 years are unfavorable for rural United States counties compared with urban areas. Cancer control programs should take this into account.
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Affiliation(s)
- Nitin A Pagedar
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa, Iowa City, Iowa
| | - Amanda R Kahl
- Department of Epidemiology, University of Iowa, Iowa City, Iowa
| | - Kendall K Tasche
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa, Iowa City, Iowa
| | - Aaron T Seaman
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Alan J Christensen
- Department of Psychology and Brain Sciences, University of Iowa, Iowa City, Iowa
| | - M Bryant Howren
- Department of Psychology and Brain Sciences, University of Iowa, Iowa City, Iowa.,VHA Office of Rural Health Resource Center, Iowa City VA Healthcare System, Iowa City, Iowa
| | - Mary E Charlton
- Department of Epidemiology, University of Iowa, Iowa City, Iowa
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17
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Tasche KK, Buchakjian MR, Pagedar NA, Sperry SM. Definition of "Close Margin" in Oral Cancer Surgery and Association of Margin Distance With Local Recurrence Rate. JAMA Otolaryngol Head Neck Surg 2019; 143:1166-1172. [PMID: 28445581 DOI: 10.1001/jamaoto.2017.0548] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kendall K Tasche
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City
| | - Marisa R Buchakjian
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City
| | - Nitin A Pagedar
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City
| | - Steven M Sperry
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City
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18
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Buchakjian MR, Ginader T, Tasche KK, Pagedar NA, Smith BJ, Sperry SM. Independent Predictors of Prognosis Based on Oral Cavity Squamous Cell Carcinoma Surgical Margins. Otolaryngol Head Neck Surg 2018; 159:675-682. [PMID: 29737907 DOI: 10.1177/0194599818773070] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective To conduct a multivariate analysis of a large cohort of oral cavity squamous cell carcinoma (OCSCC) cases for independent predictors of local recurrence (LR) and overall survival (OS), with emphasis on the relationship between (1) prognosis and (2) main specimen permanent margins and intraoperative tumor bed frozen margins. Study Design Retrospective cohort study. Setting Tertiary academic head and neck cancer program. Subjects and Methods This study included 426 patients treated with OCSCC resection between 2005 and 2014 at University of Iowa Hospitals and Clinics. Patients underwent excision of OCSCC with intraoperative tumor bed frozen margin sampling and main specimen permanent margin assessment. Multivariate analysis of the data set to predict LR and OS was performed. Results Independent predictors of LR included nodal involvement, histologic grade, and main specimen permanent margin status. Specifically, the presence of a positive margin (odds ratio, 6.21; 95% CI, 3.3-11.9) or <1-mm/carcinoma in situ margin (odds ratio, 2.41; 95% CI, 1.19-4.87) on the main specimen was an independent predictor of LR, whereas intraoperative tumor bed margins were not predictive of LR on multivariate analysis. Similarly, independent predictors of OS on multivariate analysis included nodal involvement, extracapsular extension, and a positive main specimen margin. Tumor bed margins did not independently predict OS. Conclusion The main specimen margin is a strong independent predictor of LR and OS on multivariate analysis. Intraoperative tumor bed frozen margins do not independently predict prognosis. We conclude that emphasis should be placed on evaluating the main specimen margins when estimating prognosis after OCSCC resection.
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Affiliation(s)
- Marisa R Buchakjian
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Timothy Ginader
- 2 Biostatistics Core, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa, USA
| | - Kendall K Tasche
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Nitin A Pagedar
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Brian J Smith
- 2 Biostatistics Core, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa, USA
| | - Steven M Sperry
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
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19
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Buchakjian MR, Tasche KK, Robinson RA, Pagedar NA, Sperry SM. Association of Main Specimen and Tumor Bed Margin Status With Local Recurrence and Survival in Oral Cancer Surgery. JAMA Otolaryngol Head Neck Surg 2017; 142:1191-1198. [PMID: 27423460 DOI: 10.1001/jamaoto.2016.2329] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance There is controversy surrounding surgical margins in oral cavity squamous cell carcinoma (OCSCC), with debate regarding the assessment and prognostic value of margins. Objective To analyze a large cohort of OCSCC cases for correlation between tumor specimen margins and intraoperative tumor bed frozen margins and evaluate how margin status associates with local recurrence and survival. Design, Setting, and Participants Retrospective cohort study of 406 patients treated with OCSCC resection between 2005 and 2014 at the University of Iowa Hospitals and Clinics. Included cases underwent margin evaluation on the tumor specimen and intraoperative frozen margin assessment from the tumor bed. Main Outcomes and Measures Findings of intraoperative frozen margin analysis as a test of tumor specimen margins; local recurrence and survival based on margin findings; prognosis based on clearance of positive frozen margins. To evaluate whether additional resection to "clear" positive frozen margins affected prognosis, we compared local recurrence rates for patients in 3 groups: group A included those patients with negative margins on both intraoperative and permanent specimens; group B included those with positive intraoperative margins subsequently cleared by additional resection to negative margins; and group C included those with negative intraoperative but positive permanent specimen margins. Results The median age of the 406 patients (234 men and 172 women) was 61 years (interquartile range, 53-72 years). When frozen margins were correlated with tumor specimen margins, frozen margin accuracy was 65%, with a 46% false-negative rate. We observed a local recurrence rate of 36% (95% CI, 24%-49%) when invasive carcinoma was present at an intraoperative frozen margin and 45% (95% CI, 34%-57%) when invasive carcinoma was found on the permanent specimen margin compared with 19% (95% CI, 14%-26%) and 13% (95% CI, 7%-22%) for completely negative frozen and permanent margin findings, respectively. There was a significant difference in local recurrence between group A (13%) and group B (27%) (absolute difference, 14%; 95% CI, 3%-26%) and between group A and group C (34%) (absolute difference, 21%; 95% CI, 8%-34%), but there was no difference between groups B and C (absolute difference, 7%; 95% CI, -8% to 22%), suggesting that additional resection to clear positive frozen margins does not improve prognosis. Conclusions and Relevance Intraoperative frozen margins from the tumor bed are not ideal predictors of positive margins on the main specimen. Both frozen and specimen margins are associated with local recurrence, but the specimen margin has the stronger association. Importantly, we demonstrate that clearing positive frozen margins from the tumor bed is not associated with improved outcomes.
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Affiliation(s)
- Marisa R Buchakjian
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Kendall K Tasche
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Robert A Robinson
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Nitin A Pagedar
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Steven M Sperry
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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20
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Abstract
Most otolaryngology-related complaints are straightforward and easily recognized and treated. However, given the proximity of the ears, nose, and throat to numerous vital structures in the head and neck, the potential for serious consequences exists if disease processes go unrecognized and untreated. This article serves to familiarize the primary care provider with the clinical presentation of various complications associated with common otolaryngologic complaints. Clinicians who care for patients presenting with otolaryngologic complaints should keep these entities in mind and attempt to rule out any serious complication.
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Abstract
Objectives: To identify the utility of peak inspiratory flow (PIF) in the assessment and management of subglottic stenosis through correlation of clinical presentation with PIF. Study Design: Case report. Methods: Review of the clinical course of a 31-year-old woman with the diagnosis of granulomatosis with polyangiitis. Repeated PIF measurements at clinic visits were obtained over a 30-month follow-up. Results: Twenty-seven PIF measurements were obtained at 31 otolaryngology clinic visits. Correlations were identified between low PIF measurements with the clinical symptom shortness of breath (2.04 ± 0.38 L/s, n = 10), clinically recorded stridor at rest (1.64 ± 0.41 L/s, n = 3), and urgent operative intervention (1.60 ± 0.23 L/s, n = 5). Correlations were identified between high PIF measurement with patient report of normal breathing (3.07 ± 0.35 L/s, n = 16) and clinical observation of absence of stridor at rest (2.81 ± 0.32 L/s, n = 23). There was a statistically significant difference in the patient’s PIF values with patient-documented shortness of breath vs no shortness of breath ( P = .001) and clinician-noted stridor vs no stridor ( P = .017). Conclusion: Peak inspiratory flow measurements correlate with degree of airway compromise and are helpful to monitor the degree of airway obstruction and document response to treatment.
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Affiliation(s)
- Kendall K. Tasche
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Semirra Bayan
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Nathan M. Schularick
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Jeff Wilson
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Henry T. Hoffman
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Bailey AD, Baru AR, Tasche KK, Mohan RS. Environmentally friendly organic synthesis using bismuth compounds: bismuth(III) iodide catalyzed deprotection of acetals in water. Tetrahedron Lett 2008. [DOI: 10.1016/j.tetlet.2007.11.127] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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