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Carmel Neiderman NN, Arbel S, Diamant N, Wolfman K, Yanko R, Lior Y, Kidron A, Ianculovici C, Kleinman S, Oestreicher-Kedem Y. Direct Transvestibular Feminization Thyroid Laryngochondroplasty. Plast Reconstr Surg 2024; 153:467-476. [PMID: 37075278 DOI: 10.1097/prs.0000000000010560] [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: 04/21/2023]
Abstract
BACKGROUND Feminization laryngochondroplasty (FLC) methods have evolved from using a midcervical incision to a submental, less visible incision. The scar may be unacceptable to the patient because it signals gender reassignment surgery. An endoscopic transoral approach to FLC inspired by transoral endoscopic thyroidectomy was recently suggested to avoid the neck scar; however, it requires special equipment and has a long learning curve. A vestibular incision is used to approach the chin in lower-third facial feminization surgery. The authors propose that this incision may be extended to the thyroid cartilage in performing direct FLCs. The authors describe their experience with a novel, minimally invasive, direct transvestibular use of the chin-reshaping incision. METHODS The medical records of all patients who underwent direct transvestibular FLC (DTV-FLC) from December of 2019 to September of 2021 were retrieved and reviewed for this retrospective cohort study. Data on the operative, postoperative, and follow-up courses, complications, and functional and cosmetic results were retrieved. RESULTS Nine transgender women were included. Seven DTV-FLCs were performed during lower-third facial feminization surgery, and two were isolated DTV-FLCs. One was a revision DTV-FLC. Transient minor complications were encountered and resolved by the postoperative visit at 1 to 2 months. Vocal fold function and voice quality remained intact. Eight available patients were satisfied with the surgical results. A blinded assessment by eight plastic surgeons determined that seven procedures were successful. CONCLUSION The novel DTV-FTLC approach either in isolation or as part of lower-third facial feminization surgery facilitated scar-free FLC with satisfactory cosmetic and functional results. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
| | - Shimrit Arbel
- From the Departments of Otolaryngology, Head and Neck Surgery, and Maxillofacial Surgery
| | - Noa Diamant
- From the Departments of Otolaryngology, Head and Neck Surgery, and Maxillofacial Surgery
| | - Karin Wolfman
- Institute for Health and Medical Professions, Ono Academic College
| | | | - Yotam Lior
- Division of Anesthesia, Intensive Care and Pain Management, Tel-Aviv Sourasky Medical Center, affiliated with School of Medicine, Tel-Aviv University
| | - Anat Kidron
- Division of Anesthesia, Intensive Care and Pain Management, Tel-Aviv Sourasky Medical Center, affiliated with School of Medicine, Tel-Aviv University
| | - Clariel Ianculovici
- From the Departments of Otolaryngology, Head and Neck Surgery, and Maxillofacial Surgery
| | - Shlomi Kleinman
- From the Departments of Otolaryngology, Head and Neck Surgery, and Maxillofacial Surgery
| | - Yael Oestreicher-Kedem
- From the Departments of Otolaryngology, Head and Neck Surgery, and Maxillofacial Surgery
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Carmel Neiderman NN, Shapira S, Klein L, Rafael D, Gorelik G, Kampel L, Arber N, Muhanna N. CD24 in Head and Neck Malignancies-An Uprising Biomarker? J Pers Med 2023; 13:1631. [PMID: 38138858 PMCID: PMC10744452 DOI: 10.3390/jpm13121631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION CD24 is often overexpressed in human tumors as a regulator of cell migration, invasion and proliferation. It has been associated with poor prognosis and chemoresistance in laryngeal cancer. In oral cavity tumors, it was correlated with better overall survival. In this study, we aimed to evaluate the role of CD24 in peripheral blood leukocytes (PBLs) as a potential marker for head and neck malignancies. MATERIALS AND METHODS CD24/CD11b expression in peripheral blood leukocytes (PBLs) of head and neck cancer patients and matched healthy controls was analyzed via flow cytometry. Tumors and healthy tissues were immune-stained for CD24 expression and the intensity of stain was ranked. Clinical data including tumor site, size, locoregional or metastatic spread, histopathological characteristics and recurrence events were analyzed. RESULTS CD24 expression in PBLs was significantly higher in a cohort of 101 head and neck cancer patients compared with 101 matched healthy controls (26.9 ± 12.9 vs. 22.4 ± 13.8; p = 0.02). No significant differences in CD24 levels in PBLs were found between different head and neck subsites involved with malignancy. Higher CD24 levels did not correlate with any adverse feature, i.e., perineural invasion or lymphovascular invasion, advanced T stage or regional spread. Immunohistochemistry analysis demonstrated that CD24 was highly expressed in tumor tissue in comparison to healthy surrounding tissue. CONCLUSIONS CD24 is a possible uprising marker for tumor identification, overexpressed in PBLs and is intensely stained in tumor tissue and pre-malignant lesions. Tumor-PBLs should be further studied.
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Affiliation(s)
- Narin N. Carmel Neiderman
- Head and Neck Cancer Research Laboratory, The Department of Otolaryngology Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (N.N.C.N.); (L.K.); (D.R.); (L.K.)
| | - Shiran Shapira
- Health Promotion Center and Integrated Cancer Prevention Center, Tel-Aviv Sourasky Medical Center, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (S.S.); (N.A.)
| | - Linor Klein
- Head and Neck Cancer Research Laboratory, The Department of Otolaryngology Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (N.N.C.N.); (L.K.); (D.R.); (L.K.)
| | - Dor Rafael
- Head and Neck Cancer Research Laboratory, The Department of Otolaryngology Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (N.N.C.N.); (L.K.); (D.R.); (L.K.)
| | - Gregory Gorelik
- Pathology Department, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel;
| | - Liyona Kampel
- Head and Neck Cancer Research Laboratory, The Department of Otolaryngology Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (N.N.C.N.); (L.K.); (D.R.); (L.K.)
| | - Nadir Arber
- Health Promotion Center and Integrated Cancer Prevention Center, Tel-Aviv Sourasky Medical Center, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (S.S.); (N.A.)
| | - Nidal Muhanna
- Head and Neck Cancer Research Laboratory, The Department of Otolaryngology Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (N.N.C.N.); (L.K.); (D.R.); (L.K.)
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Kampel L, Feldstein S, Tsuriel S, Hannes V, Carmel Neiderman NN, Horowitz G, Warshavsky A, Leider-Trejo L, Hershkovitz D, Muhanna N. Mutated TP53 in Circulating Tumor DNA as a Risk Level Biomarker in Head and Neck Squamous Cell Carcinoma Patients. Biomolecules 2023; 13:1418. [PMID: 37759818 PMCID: PMC10527516 DOI: 10.3390/biom13091418] [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: 06/25/2023] [Revised: 08/28/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023] Open
Abstract
Circulating tumor DNA (ctDNA) has been suggested as a surrogate biomarker for early detection of cancer recurrence. We aimed to explore the utility of ctDNA as a noninvasive prognostic biomarker in newly diagnosed head and neck squamous cell carcinoma (HNSCC) patients. Seventy HNSCC specimens were analysed for the detection of TP53 genetic alterations utilizing next-generation sequencing (NGS). TP53 mutations were revealed in 55 (79%). Upon detection of a significant TP53 mutation, circulating cell-free DNA was scrutinized for the presence of the tumor-specific mutation. ctDNA was identified at a minimal allele frequency of 0.08% in 21 out of 30 processed plasma samples. Detectable ctDNA correlated with regional spread (N stage ≥ 1, p = 0.011) and poorer 5-year progression-free survival (20%, 95% CI 10.9 to 28.9, p = 0.034). The high-risk worst pattern of invasion (WPOI grade 4-5) and deep invasion were frequently found in patients whose ctDNA was detected (p = 0.087 and p = 0.072, respectively). Detecting mutated TP53 ctDNA was associated with poor progression-free survival and regional metastases, indicating its potential role as a prognostic biomarker. However, ctDNA detectability in early-stage disease and the mechanisms modulating its release into the bloodstream must be further elucidated.
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Affiliation(s)
- Liyona Kampel
- The Head and Neck Cancer Research Laboratory, The Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv 6423906, Israel; (L.K.); (N.N.C.N.)
- The Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, The Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv 6423906, Israel; (G.H.); (A.W.)
| | - Sara Feldstein
- The Cancer Research and Pathology Institute, Tel Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv 6423906, Israel; (S.F.); (S.T.); (V.H.); (L.L.-T.); (D.H.)
| | - Shlomo Tsuriel
- The Cancer Research and Pathology Institute, Tel Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv 6423906, Israel; (S.F.); (S.T.); (V.H.); (L.L.-T.); (D.H.)
| | - Victoria Hannes
- The Cancer Research and Pathology Institute, Tel Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv 6423906, Israel; (S.F.); (S.T.); (V.H.); (L.L.-T.); (D.H.)
| | - Narin N. Carmel Neiderman
- The Head and Neck Cancer Research Laboratory, The Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv 6423906, Israel; (L.K.); (N.N.C.N.)
- The Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, The Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv 6423906, Israel; (G.H.); (A.W.)
| | - Gilad Horowitz
- The Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, The Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv 6423906, Israel; (G.H.); (A.W.)
- The Cancer Research and Pathology Institute, Tel Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv 6423906, Israel; (S.F.); (S.T.); (V.H.); (L.L.-T.); (D.H.)
| | - Anton Warshavsky
- The Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, The Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv 6423906, Israel; (G.H.); (A.W.)
- The Cancer Research and Pathology Institute, Tel Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv 6423906, Israel; (S.F.); (S.T.); (V.H.); (L.L.-T.); (D.H.)
| | - Leonor Leider-Trejo
- The Cancer Research and Pathology Institute, Tel Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv 6423906, Israel; (S.F.); (S.T.); (V.H.); (L.L.-T.); (D.H.)
| | - Dov Hershkovitz
- The Cancer Research and Pathology Institute, Tel Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv 6423906, Israel; (S.F.); (S.T.); (V.H.); (L.L.-T.); (D.H.)
| | - Nidal Muhanna
- The Head and Neck Cancer Research Laboratory, The Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv 6423906, Israel; (L.K.); (N.N.C.N.)
- The Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, The Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv 6423906, Israel; (G.H.); (A.W.)
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Carmel Neiderman NN, Caspi I, Eisenberg N, Halevy N, Wengier A, Shpigel I, Ziv Baran T, Ringel B, Warshavsky A, Abergel A. Quality of life after radio frequency ablation turbinate reduction (RFATR) among patients with rhinitis medicamentosa & withdrawal from decongestant topical spray abuse. Am J Otolaryngol 2023; 44:103842. [PMID: 36989755 DOI: 10.1016/j.amjoto.2023.103842] [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] [Received: 11/29/2022] [Revised: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Radiofrequency ablation (RFA) reliefs nasal obstruction and improves quality of life (QoL) in patients suffering from inferior turbinate hypertrophy (ITH). A substantial benefit was noted among patients suffering from Rhinitis Medicamentosa (RM), enabling ending decongestant spray abuse. Our aim was to establish the benefit from RFA with respect to QoL in patients suffering from ITH, due to the presence of RM. STUDY DESIGN Prospective cohort study. METHODS Prospective Cohort study, including patients suffering from ITH undergoing RFA between 9.2017 and 9.2019 in Tel Aviv Medical Center. The cohort was divided to RM and non-RM (including allergic, non-allergic) patients. The differences between the groups were compared before and after RFA, and included patients' complaints, clinical findings and QoL questionnaires (SNOT-22 & NOSE). In the RM group, the ability to wean from decongestants was also described. RESULTS Our data demonstrated subjective QoL improvement following RFA (88.9 %, N = 90). All RM patients withdrawaled from nasal decongestant spray. NOSE questionnaire demonstrated a significant improvement in QoL after RFA in the RM group (PV = 0.025). SNOT-22 did not demonstrate significant difference in QoL between RM and the reference group (PV = 0.1). Rates of MCID>8.3 were high, without significant difference between the groups (PV = 0.2). CONCLUSION RFA demonstrated effectiveness in achieving of withdrawal from decongestant spray in RM patients and may be a possible definitive treatment option for this group. The nasal obstruction component in SNOT-22 questionnaire & NOSE questionnaire showed improved QoL in comparison to controls. High QoL after RFA was established in our entire cohort.
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Neiderman NNC, Netanyahu Madar Y, Ungar OJ, Handzel O, Masarwy R, Abu-Eta R, Reicher L, Oron Y. Bell's Palsy and Pregnancy: Incidence, Comorbidities and Complications. A Meta-analysis and Systematic Review of the Literature. Clin Otolaryngol 2023. [PMID: 36811230 DOI: 10.1111/coa.14042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 12/22/2022] [Accepted: 01/07/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Data on the association between Bell's palsy (BP) and pregnancy is scarce and there is an ongoing debate regarding the association of BP and pregnancy. We aimed to investigate the prevalence of BP among pregnant patients and determine the frequency of pregnant women in BP cohorts and vice versa, assess which term of the pregnancy and peripartum bears a higher risk for BP occurrence, and determine the prevalence of maternal comorbidities associated with BP during pregnancy MATERIALS AND METHODS: Screening standard articles and extracting data from Ovid MEDLINE (1960-2021), Embase (1960-2021), and Web of Science (1960-2021). All study types were included except for case reports. PRISMA guidelines were followed. Data were pooled by means of both fixed and random-effects models. RESULTS The search strategy identified 147 records. Twenty-five of the studies that met our inclusion criteria described 809 pregnant patients with BP in a total of 11,813 BP patients and they were included in the meta-analysis. The incidence of BP among the pregnant patients was 0.05%; The incidence of pregnant patients among all BP patients was 6.62%. Most of the BP occurrences were during the third trimester (68.82%). The pooled incidence of gestational diabetes mellitus; hypertension; pre-eclampsia/eclampsia and fetal complications among the pregnant patients with BP was 6.3%, 13.97%, 9.54%, and 6.74%, respectively. CONCLUSIONS This meta-analysis revealed a low incidence of BP during pregnancy. A Higher proportion occurred during the third trimester. The association of BP and pregnancy warrants further exploration.
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Affiliation(s)
- Narin N Carmel Neiderman
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv. Israel, affiliated to the Sackler School of Medicine. Tel-Aviv University, Tel-Aviv, Israel
| | | | - Omer J Ungar
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv. Israel, affiliated to the Sackler School of Medicine. Tel-Aviv University, Tel-Aviv, Israel
| | - Ophir Handzel
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv. Israel, affiliated to the Sackler School of Medicine. Tel-Aviv University, Tel-Aviv, Israel
| | - Razan Masarwy
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv. Israel, affiliated to the Sackler School of Medicine. Tel-Aviv University, Tel-Aviv, Israel
| | - Rani Abu-Eta
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv. Israel, affiliated to the Sackler School of Medicine. Tel-Aviv University, Tel-Aviv, Israel
| | - Lee Reicher
- Department of Obstetrics and Gynecology, Tel-Aviv Sourasky Medical Center, Tel Aviv. Israel, affiliated to the Sackler School of Medicine. Tel-Aviv University, Tel-Aviv, Israel
| | - Yahav Oron
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv. Israel, affiliated to the Sackler School of Medicine. Tel-Aviv University, Tel-Aviv, Israel
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Carmel Neiderman NN, Eisenberg N, Caspi I, Halevy N, Shpigel I, Ziv Baran T, Horowitz G, Ringel B, Warshavsky A, Abergel A. The effect of septal deviation on postoperative quality of life in patients undergoing radiofrequency‐assisted turbinate reduction. Laryngoscope Investig Otolaryngol 2022; 7:325-334. [PMID: 35434331 PMCID: PMC9008147 DOI: 10.1002/lio2.759] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Narin N. Carmel Neiderman
- Department of Otolaryngology–Head and Neck Surgery Tel‐Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel‐Aviv University Tel Aviv Israel
| | - Netanela Eisenberg
- Department of Otolaryngology–Head and Neck Surgery Tel‐Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel‐Aviv University Tel Aviv Israel
| | - Inbar Caspi
- Department of Otolaryngology–Head and Neck Surgery Tel‐Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel‐Aviv University Tel Aviv Israel
| | - Nir Halevy
- Department of Otolaryngology–Head and Neck Surgery Tel‐Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel‐Aviv University Tel Aviv Israel
| | - Iris Shpigel
- Department of Otolaryngology–Head and Neck Surgery Tel‐Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel‐Aviv University Tel Aviv Israel
| | - Tomer Ziv Baran
- Department of Epidemiology and Preventive Medicine School of Public Health, Sackler Faculty of Medicine, Tel‐Aviv University Tel Aviv Israel
| | - Gilad Horowitz
- Department of Otolaryngology–Head and Neck Surgery Tel‐Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel‐Aviv University Tel Aviv Israel
| | - Barak Ringel
- Department of Otolaryngology–Head and Neck Surgery Tel‐Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel‐Aviv University Tel Aviv Israel
| | - Anton Warshavsky
- Department of Otolaryngology–Head and Neck Surgery Tel‐Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel‐Aviv University Tel Aviv Israel
| | - Avraham Abergel
- Department of Otolaryngology–Head and Neck Surgery Tel‐Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel‐Aviv University Tel Aviv Israel
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Carmel Neiderman NN, Duek I, Ravia A, Yaka R, Warshavsky A, Ringel B, Muhanna N, Horowitz G, Ziv Baran T, Fliss DM. The incidence of postoperative re-stratification for recurrence in well-differentiated thyroid cancer-a retrospective cohort study. Gland Surg 2021; 10:2354-2367. [PMID: 34527547 DOI: 10.21037/gs-21-105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 07/22/2021] [Indexed: 12/17/2022]
Abstract
Background After diagnosing well-differentiated thyroid cancer (WDTC), assessment of the risk for disease-specific recurrence is essential for deciding between hemi-thyroidectomy (HT) and total thyroidectomy (TT). The American Thyroid Association (ATA) 2015 guidelines suggest that patients with 1-4 cm WDTC without suspicious features may be suitable for HT. Patients' preoperatively determined risk levels are re-stratified according to surgical and final histopathological findings. The incidence and clinical implications of high-risk features discovered postoperatively in patients with preoperatively determined low-risk WDTC are yet to be better defined. Methods Thyroidectomies performed in the Tel-Aviv Sourasky Medical Center (TASMC) [2006-2018] were included. Patients with 1-4 cm WDTC without evidence of positive cervical lymph nodes, invasion to adjacent structures, or high-risk cytology were considered at low risk for disease-specific recurrence-suitable for lobectomy. Patients were stratified according to their risk for disease-specific recurrence, pre- and postoperatively, and the rate of completion thyroidectomy was determined. Results In total, 301 (21%) patients were preoperatively stratified as low risk. Forty-six of them (15%) were re-stratified postoperatively as intermediate-to-high-risk. There were no significant differences in the characteristics of the patients who maintained their original stratification to patients who were upscaled to a higher risk level postoperatively. Conclusions We report a 15% rate of postoperative risk escalation of patients who required completion thyroidectomy according to current ATA guidelines. In our opinion, this rate of postoperative WDTC upscaling of risk requiring more radical surgery than originally planned, is acceptable. Meticulous preoperative personalized evaluation by an experienced multidisciplinary dedicated team is essential.
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Affiliation(s)
- Narin N Carmel Neiderman
- Department of Otolaryngology, Head and Neck, Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Irit Duek
- Department of Otolaryngology, Head and Neck, Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Adi Ravia
- Department of Otolaryngology, Head and Neck, Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ronel Yaka
- Department of Otolaryngology, Head and Neck, Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Anton Warshavsky
- Department of Otolaryngology, Head and Neck, Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Barak Ringel
- Department of Otolaryngology, Head and Neck, Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nidal Muhanna
- Department of Otolaryngology, Head and Neck, Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gilad Horowitz
- Department of Otolaryngology, Head and Neck, Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tomer Ziv Baran
- School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dan M Fliss
- Department of Otolaryngology, Head and Neck, Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Ungar OJ, Baris H, Oron Y, Shilo S, Handzel O, Warshavsky A, Horowitz G, Abu Eta R, Muhanna N, Carmel Neiderman NN. Meta-analysis of time to extrusion of tympanostomy tubes by tympanic membrane quadrant. Clin Otolaryngol 2021; 46:1165-1171. [PMID: 34329540 DOI: 10.1111/coa.13843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the published time to extrusion of tympanostomy tubes inserted in the various quadrants of the tympanic membrane. METHODS Publications were selected by a search with 'PubMed', 'Embase' and 'Web of Science'. A meta-analysis of time to extrusion as a function of tympanic membrane quadrant intubation was performed. DESIGN, SETTING, PARTICIPANT-NOT RELEVANT MAIN OUTCOME MEASURED Extrusion rate of tympanostomy tubes inserted in the various quadrants of the tympanic membrane. RESULTS Eleven studies describing 2232 tympanostomy tubes were enrolled into the quantitative meta-analysis. The extrusion rate was evaluated at 3-month intervals up to 24 months post-intubation, and it did not differ significantly at any of the time points tested for the superior and inferior anterior quadrants. The cumulative extrusion rates were as follows: 11 and 9%, 32 and 23%, 59 and 36%, 80 and 67%, 87 and 70%, 88 and 82%, and 96 and 89% in the superior and anterior quadrants, respectively, at 3, 6, 9, 15, 18, 21 and 24 months post-intubation, respectively. CONCLUSION Time to extrusion of tympanostomy tubes are similar for all 3 tympanic membrane quadrants. The anterior superior quadrant intubation has no superiority in terms of intubation time.
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Affiliation(s)
- Omer J Ungar
- Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Harel Baris
- Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yahav Oron
- Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shahaf Shilo
- Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ophir Handzel
- Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anton Warshavsky
- Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Horowitz
- Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rani Abu Eta
- Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nidal Muhanna
- Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Narin N Carmel Neiderman
- Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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9
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Neiderman NNC, Baris H, Duek I, Warshavsky A, Ringel B, Izkhakov E, Horowitz G, Fliss DM. Lateral Neck Dissection for Well-Differentiated Thyroid Carcinoma: Is Prophylactic Level V Neck Dissection Necessary? A Retrospective Cohort Study. Ear Nose Throat J 2021:1455613211003805. [PMID: 33915059 DOI: 10.1177/01455613211003805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The presence of clinically detectable papillary thyroid carcinoma (PTC) metastases in the lateral neck is an indication for neck dissection (ND) and thyroidectomy. Although there is a consensus regarding the importance of therapeutic selective ND of involved levels II to IV in patients with clinically evident locoregional metastatic disease, the prognostic benefit of level V prophylactic ND remains debatable. METHODS All patients who underwent thyroidectomy with ND for metastatic PTC between 2006 and 2019 were included in a single-institution retrospective study. Preoperative characteristics at initial presentation, imaging workup, intraoperative findings, and the final histopathological reports were retrieved from the institutional database. RESULTS A total of 189 patients with locally advanced PTC were identified, of whom 22 (11.6%) patients underwent therapeutic selective ND at levels II to IV together with level V dissection due to clinical involvement. Comparison of the patients who were operated on level V to those who were not revealed no significant difference. The disease recurrence rate was 20.1% throughout an average follow-up of 5.1±3.1 years. No significant differences in recurrence rate were found between patients who underwent and those who did not undergo level V ND (22.7% vs 19.8%, P = .648). No recurrence at resected level V was detected during follow-up, while recurrence at level V was found in 4 (2.1%) patients who did not undergo level V dissection. Evidence of macroscopic and microscopic extrathyroidal extension was significant predictors of disease recurrence risk. CONCLUSION There were no significant associations between level V dissection and risk for recurrence. Recurrence at level V was rare (4/189 patients, 2.1%). Our study's findings suggest a low prophylactic benefit of an elective level V ND. Elective level V ND should not be done routinely when lateral ND is indicated but should rather be considered after careful evaluation in high-risk patients.
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Affiliation(s)
| | - Harel Baris
- Department of Otolaryngology-Head and Neck, Maxillofacial Surgery, Israel
| | - Irit Duek
- Department of Otolaryngology-Head and Neck, Maxillofacial Surgery, Israel
| | - Anton Warshavsky
- Department of Otolaryngology-Head and Neck, Maxillofacial Surgery, Israel
| | - Barak Ringel
- Department of Otolaryngology-Head and Neck, Maxillofacial Surgery, Israel
| | - Elena Izkhakov
- Institute of Endocrinology, Metabolism and Hypertension, 26738Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Horowitz
- Department of Otolaryngology-Head and Neck, Maxillofacial Surgery, Israel
| | - Dan M Fliss
- Department of Otolaryngology-Head and Neck, Maxillofacial Surgery, Israel
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10
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Izkhakov E, Keinan-Boker L, Barchana M, Shacham Y, Yaish I, Carmel Neiderman NN, Fliss DM, Stern N, Meyerovitch J. Long-term all-cause mortality and its association with cardiovascular risk factors in thyroid cancer survivors: an Israeli population-based study. BMC Cancer 2020; 20:892. [PMID: 32942995 PMCID: PMC7500542 DOI: 10.1186/s12885-020-07401-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/13/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The global incidence of thyroid cancer (TC) has risen considerably during the last three decades, while prognosis is generally favorable. We assessed the long-term all-cause mortality in TC survivors compared to the general population, and its association with cardiovascular risk factors. METHODS Individuals diagnosed with TC during 2001-2014 (TC group) and age- and sex-matched individuals from the same Israeli healthcare system without thyroid disease or a cancer history (non-TC group) were compared. Cox regression hazard ratios (HRs) and 95% confidence intervals (95%CIs) for all-cause mortality were calculated by exposure status. RESULTS During a 15-year follow-up (median 8 years), 577 TC survivors out of 5677 (10.2%) TC patients and 1235 individuals out of 23,962 (5.2%) non-TC patients died. The TC survivors had an increased risk of all-cause mortality (HR = 1.89, 95%CI 1.71-2.10), after adjusting for cardiovascular risk factors already present at follow-up initiation. This increased risk was most pronounced in the 55- to 64-year-old age group (HR = 1.49, 95%CI 1.33-1.67). The TC survivors who died by study closure had more hypertension (14.6% vs. 10.3%, P = 0.002), more dyslipidemia (11.4% vs. 7.2%, P < 0.001), and more cardiovascular disease (33.6% vs. 22.3%, P = 0.05) compared to those who died in the non-TC group. CONCLUSIONS This large cohort study showed higher all-cause mortality with a higher prevalence of hypertension, dyslipidemia, and cardiovascular disease among TC survivors compared to matched non-TC individuals. Primary and secondary prevention of cardiovascular risk factors in TC survivors is mandatory.
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Affiliation(s)
- Elena Izkhakov
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
| | - Lital Keinan-Boker
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- National Cancer Registry, Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Micha Barchana
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Yacov Shacham
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Iris Yaish
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Narin N Carmel Neiderman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dan M Fliss
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Naftali Stern
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Meyerovitch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Community Division, Clalit Health Services, Tel Aviv, Israel
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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11
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Ringel B, Horowitz G, Shilo S, Carmel Neiderman NN, Abergel A, Fliss DM, Oestreicher-Kedem Y. Acute supraglottic laryngitis complicated by vocal fold immobility: prognosis and management. Eur Arch Otorhinolaryngol 2019; 276:2507-2512. [PMID: 31214824 DOI: 10.1007/s00405-019-05508-3] [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: 04/01/2019] [Accepted: 06/05/2019] [Indexed: 05/30/2023]
Abstract
PURPOSE Acute supraglottic laryngitis (ASL) is manifested by supraglottic inflammation that has the potential for rapid and fatal airway obstruction. Complete/incomplete vocal fold immobility (VFIm) in the setting of ASL may contribute to airway obstruction. The rate of VFIm complicating ASL is not known, and it is not clear whether its occurrence alters the course and the management of ASL, particularly the need to secure the airway (by endotracheal intubation/tracheostomy). This study seeks to describe the natural history of VFIm associated with ASL (ASLIm) and to determine the added effect of VFIm on ASL severity, management, and the need for intervention to secure the airway. METHODS This is a retrospective cohort study in a tertiary referral center. The medical records of all patients hospitalized due to ASL between January 2007 and December 2016 were reviewed. RESULTS Of the 214 patients admitted due to ASL, VFIm was identified in 9 (4.2%). The VFIms resolved within 1-90 days in all 8 patients with available follow-up of 1-3 months. One patient required endotracheal intubation. The 9 ASLIm patients had significantly higher rates of hoarseness and a history of diabetes mellitus. There was no group difference in the need to secure the airway. CONCLUSIONS VFIm is an apparently uncommon finding among patients with ASL. It appears to be usually transient, short-lasting, and full recovery can be expected. VFIm did not alter the ASL course, nor did it put our patients at increased risk for the need for intervention to secure the airway. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Barak Ringel
- The Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv, 6423906, Israel
| | - Gilad Horowitz
- The Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv, 6423906, Israel
| | - Shahaf Shilo
- The Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv, 6423906, Israel
| | - Narin N Carmel Neiderman
- The Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv, 6423906, Israel
| | - Avraham Abergel
- The Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv, 6423906, Israel
| | - Dan M Fliss
- The Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv, 6423906, Israel
| | - Yael Oestreicher-Kedem
- The Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv, 6423906, Israel.
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12
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Ben-Ari O, Wengier A, Ringel B, Carmel Neiderman NN, Ram Z, Margalit N, Fliss DM, Abergel A. Nasoseptal Flap for Skull Base Reconstruction in Children. J Neurol Surg B Skull Base 2018; 79:37-41. [PMID: 29404239 DOI: 10.1055/s-0037-1617435] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Objective The endoscopic endonasal approach is being increasingly used for the resection and reconstruction of anterior skull base (ASB) lesions. Vascularized nasoseptal flaps (NSF) have become the workhorse for the reconstruction of ASB defects, resulting in a significant decrease in the incidence of cerebrospinal fluid (CSF) leaks. The objective of this study was to investigate the efficacy and safety of NSF in children. Methods This is a retrospective analysis of the medical records of all patients under the age of 18 years who underwent endoscopic repair of ASB lesions with the use of NSF at our tertiary medical center between 1/2011 and 8/2016. Results Twelve children underwent ASB defect repair for both benign and malignant neoplasms using the endoscopic endonasal NSF technique. Four children had previously undergone ASB surgery. The male-to-female ratio was 1:1, the average age was 12.3 years, the average hospitalization time was 8.3 days, and the maximum follow-up period was 24 months, during which craniofacial growth appeared to be unimpaired. A lumbar drain was used postoperatively in six cases. Crust formation and synechia were observed in two cases. There was one case of a major long-term complication (a CSF leak followed by meningitis). Conclusions Endoscopic endonasal NSF was both an effective and a safe technique for ASB defect reconstruction in 12 children for both benign and malignant neoplasms. It had a high success rate and a low complication rate. No apparent negative influence on craniofacial growth was observed in our series.
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Affiliation(s)
- Oded Ben-Ari
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Wengier
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barak Ringel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Narin N Carmel Neiderman
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvi Ram
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nevo Margalit
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan M Fliss
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avraham Abergel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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