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Hansen EE, Mitchell MB, Rahmati RW. The Role of Sialendoscopy in Parotid Duct Stenosis in Graft-Versus-Host Disease. Laryngoscope 2023; 133:279-281. [PMID: 36134758 DOI: 10.1002/lary.30402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/14/2022] [Accepted: 08/29/2022] [Indexed: 01/19/2023]
Abstract
Sialendoscopy, a minimally invasive procedure for concurrent diagnosis and treatment of salivary gland ductal pathologies, was used to alleviate recurrent left parotid gland swelling and dry mouth in a 58-year-old man with chronic graft-versus-host disease. Laryngoscope, 133:279-281, 2023.
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Affiliation(s)
- Elisabeth E Hansen
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret B Mitchell
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye & Ear, Boston, Massachusetts, USA
| | - Rahmatullah W Rahmati
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye & Ear, Boston, Massachusetts, USA
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2
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Benchetrit L, Mehra S, Mahajan A, Rahmati RW, Judson BL, Edwards HA. Major Salivary Gland Cancer With Distant Metastasis Upon Presentation: Patterns, Outcomes, and Imaging Implications. Otolaryngol Head Neck Surg 2022; 167:305-315. [PMID: 34784258 DOI: 10.1177/01945998211058354] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Given limited data availability on distant metastasis (DM) in major salivary gland (MSG) malignancy presentation, we aimed to evaluate the rate, histologic patterns, location, and predictors of DM at first MSG cancer presentation and suggest potential implications on diagnostic workup. STUDY DESIGN Retrospective cohort. SETTING Commission on Cancer-accredited hospitals. METHODS We included patients in the National Cancer Database (2010-2016) with MSG malignancy. Site and rate of DM were stratified by histologic subtype. Factors predictive of DM at presentation were determined by multivariate regression analysis. Survival analyses were conducted via the Kaplan-Meier method, log-rank test, and Cox regression analysis. RESULTS Of 5776 patients with MSG carcinoma, 333 (5.8%) presented with DM. The most common DM site was the lung (57.1%), followed by bone (46.8%) and liver (19.5%). DM was most common in adenocarcinoma-not otherwise specified (15.1%, 132/874) and salivary duct carcinoma (10.4%, 30/288). High-grade mucoepidermoid carcinoma had the highest rate of lung metastases (81.6%, 31/38). Conversely, myoepithelial carcinoma had the highest rate of bone metastases (85.7%, 6/7). DM at presentation was independently associated with an increased mortality risk (hazard ratio, 1.62; 95% CI, 1.40-1.90). CONCLUSION We identified a DM rate of 5.8% in MSG malignancy at presentation. Overall 43% of patients presented without DM to the lung but with DM to the bones, liver, and/or brain. The most common metastatic sites differed by tumor histology. Staging with computed tomography neck and chest alone may fail to detect sites of DM; this work can be used for patient counseling in the clinical setting.
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Affiliation(s)
- Liliya Benchetrit
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, Massachusetts, USA
| | - Saral Mehra
- Section of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA.,Yale Cancer Center, New Haven, Connecticut, USA
| | - Amit Mahajan
- Department of Radiology and Biomedical Imaging, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Rahmatullah W Rahmati
- Section of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA.,Yale Cancer Center, New Haven, Connecticut, USA
| | - Benjamin L Judson
- Section of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA.,Yale Cancer Center, New Haven, Connecticut, USA
| | - Heather A Edwards
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, Massachusetts, USA.,School of Medicine, Boston University, Boston, Massachusetts, USA
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3
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Izreig S, Alzahrani F, Earles J, Mehra S, Judson BL, Pan Z, Rahmati RW. Hyperprogression of a Sinonasal Squamous Cell Carcinoma Following Programmed Cell Death Protein-1 Checkpoint Blockade. JAMA Otolaryngol Head Neck Surg 2021; 146:1176-1178. [PMID: 32940637 DOI: 10.1001/jamaoto.2020.2584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Said Izreig
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Faisal Alzahrani
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.,King Saud University, Riyadh, Saudi Arabia
| | - Joseph Earles
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Saral Mehra
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Benjamin L Judson
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Zenggang Pan
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Rahmatullah W Rahmati
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
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4
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Izreig S, Hajek M, Edwards HA, Mehra S, Sasaki C, Judson BL, Rahmati RW. The role of vitamin D in head and neck cancer. Laryngoscope Investig Otolaryngol 2020; 5:1079-1088. [PMID: 33364397 PMCID: PMC7752058 DOI: 10.1002/lio2.469] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/03/2020] [Accepted: 09/18/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Head and neck squamous cell carcinoma (HNSCC) describes a set of malignancies of the head and neck that continue to inflict considerable morbidity and mortality. Because HNSCC often presents at an advanced stage, patients frequently undergo intensive multi-modal therapy with an intent to cure. Vitamin D is a precursor to the biologically active hormone calcitriol which governs bone and calcium physiology that is obtained from diet and UV-B exposure. Vitamin D is known to have pleiotropic effects on health and disease. In this review, we examine the role of vitamin D in cancer with emphasis on HNSCC and discuss potential avenues for further research that might better elucidate the role of vitamin D in the management of HNSCC. REVIEW METHODS A review of MEDLINE database indexed literature concerning the role and biology of vitamin D in HNSCC was conducted, with special consideration of recently published work and research involving immunobiology and HNSCC. CONCLUSIONS The available evidence suggests that vitamin D may play a role in protecting against HNSCC, particularly in persons who smoke, although conflicting and limited data exists. Promising initial work encourages the pursuit of further study. IMPLICATIONS FOR PRACTICE The significant morbidity and mortality that HNSCC brings warrants continued research in available and safe interventions that improve patient outcomes. With the rise of immunotherapy as an effective modality for treatment, continued research of vitamin D as an adjunct in the treatment of HNSCC is supported.
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Affiliation(s)
- Said Izreig
- Department of Surgery, Section of OtolaryngologyYale University School of MedicineNew HavenConnecticutUSA
| | - Michael Hajek
- Department of Surgery, Section of OtolaryngologyYale University School of MedicineNew HavenConnecticutUSA
| | - Heather A. Edwards
- Department of Surgery, Section of OtolaryngologyYale University School of MedicineNew HavenConnecticutUSA
- Yale Cancer CenterNew HavenConnecticutUSA
- Present address:
Department of Otolaryngology‐Head & Neck SurgeryBoston University School of MedicineBostonMassachusettsUSA
| | - Saral Mehra
- Department of Surgery, Section of OtolaryngologyYale University School of MedicineNew HavenConnecticutUSA
- Yale Cancer CenterNew HavenConnecticutUSA
| | - Clarence Sasaki
- Department of Surgery, Section of OtolaryngologyYale University School of MedicineNew HavenConnecticutUSA
- Yale Cancer CenterNew HavenConnecticutUSA
| | - Benjamin L. Judson
- Department of Surgery, Section of OtolaryngologyYale University School of MedicineNew HavenConnecticutUSA
- Yale Cancer CenterNew HavenConnecticutUSA
| | - Rahmatullah W. Rahmati
- Department of Surgery, Section of OtolaryngologyYale University School of MedicineNew HavenConnecticutUSA
- Yale Cancer CenterNew HavenConnecticutUSA
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Kasle DA, Torabi SJ, Izreig S, Rahmati RW, Manes RP. COVID-19’s Impact on the 2020-2021 Resident Match: A Survey of Otolaryngology Program Directors. Ann Otol Rhinol Laryngol 2020; 130:666-673. [PMID: 33090015 PMCID: PMC8685750 DOI: 10.1177/0003489420967045] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To determine the impact coronavirus disease of 2019 (COVID-19) will have on the
2020-2021 otolaryngology (OTO-HNS) resident application cycle. Methods: A cross-sectional survey targeting OTO-HNS program directors (PD) was created and
disseminated via email to PDs on May 28th 2020. Descriptive analyses of the 19-question
survey was performed, and free text responses for certain suitable questions were
thematically categorized into groups determined to be relevant during analysis. Results: Twenty-nine of 123 solicited PDs (23.6%) completed the survey. Nineteen (65.5%)
respondents indicated they would not host away rotations (AR) in 2020, and 9 (31.0%)
reported that they would consider away rotators without home programs. Regarding the
historical importance of AR, 21 (72.4%) PDs stated they were either “extremely” or
“very” important in evaluating candidates. Sixteen (55.2%) PDs stated that virtual
interviews would impact their ability to properly gauge candidates and 12 (41.4%) were
unsure. Eight PDs (27.6%) stated their evaluation of candidates will likely change, with
a shift toward an increased reliance on letters of recommendation, research involvement,
and clerkship grades. The large majority of PDs—25 (86.2%)—were not worried that the
COVID-19 pandemic would affect the abilities of new interns beginning in 2021. Conclusion: Virtual interviews and engagement activities will mostly supplant sub-Is and AR for the
2020-2021 OTO-HNS application cycle. Surveyed PDs largely believe these will be
insufficient in providing a comprehensive assessment of candidates, and will similarly
limit applicants’ ability to gauge residency programs. Criteria utilized to evaluate
students is expected to change.
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Affiliation(s)
- David A. Kasle
- Division of Otolaryngology, Department of
Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sina J. Torabi
- Division of Otolaryngology, Department of
Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Said Izreig
- Division of Otolaryngology, Department of
Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rahmatullah W. Rahmati
- Division of Otolaryngology, Department of
Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - R. Peter Manes
- Division of Otolaryngology, Department of
Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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6
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Abstract
Objectives: To capture the perspectives of candidates applying for otolaryngology residency positions in the 2020-21 cycle, in the context of disruption caused by the coronavirus disease 2019 (COVID-19) pandemic. Subjects and methods: Candidates planning to apply to the otolaryngology 2020-21 match were invited to complete a cross-sectional online survey. Distribution was via otomatch.com and word of mouth. Descriptive statistics were performed. Results: Of 85 eligible responses (estimated 18.9% of all applicants), many have had at least one board examination (71.8%) disrupted. A majority (85.9%) believe evaluation of candidates will change due to the pandemic, and 54.1% report they were now less confident in matching. Female applicants (37.6% of respondents) were found to have significantly higher odds of decreased confidence in matching (OR 2.781 [95% CI 1.045-7.4044]; P = .041). Many report a move to virtual interviews would increase the number of applications submitted (45.9%) and the number of interviews attended (77.6%). Some applicants (36.5%) did not believe residency programs would gather sufficient information about their candidacy to make an informed decision, and most (62.4%) did not believe that they would gather sufficient information to inform their own rank list. Conclusions: We find that candidates believe their candidacy will be assessed differently in light of the COVID-19 pandemic, are largely less confident in successfully matching, and are planning to apply and interview more broadly. These data are relevant to otolaryngology residency leadership to inform clear dialogue and a smooth transition into an unprecedented application cycle.
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Affiliation(s)
- Said Izreig
- Department of Surgery (Division of Otolaryngology), Yale University School of Medicine, New Haven, CT, USA
| | - Sina J Torabi
- Department of Surgery (Division of Otolaryngology), Yale University School of Medicine, New Haven, CT, USA
| | - David A Kasle
- Department of Surgery (Division of Otolaryngology), Yale University School of Medicine, New Haven, CT, USA
| | - Rahmatullah W Rahmati
- Department of Surgery (Division of Otolaryngology), Yale University School of Medicine, New Haven, CT, USA
| | - R Peter Manes
- Department of Surgery (Division of Otolaryngology), Yale University School of Medicine, New Haven, CT, USA
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Kim M, Rahmati RW, Gudis DA. Nasopharyngeal Swelling in a Patient With Cystic Fibrosis Following Endoscopic Sinus Surgery. JAMA Otolaryngol Head Neck Surg 2018; 144:268-269. [PMID: 29270634 DOI: 10.1001/jamaoto.2017.2764] [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)
- Matthew Kim
- Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Rahmatullah W Rahmati
- Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - David A Gudis
- New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York
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Chao JW, Taylor EW, Rahmati RW, Rohde CH. Continuous high-dose vasopressors in free anterolateral thigh flap transfer for pharyngeal reconstruction: a report of two cases. Microsurgery 2014; 34:237-9. [PMID: 24745088 DOI: 10.1002/micr.22208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Use of vasopressors is controversial in patients undergoing free flap reconstruction. Recent literature has suggested that it is safe to administer vasopressors intraoperatively during these procedures. However studies have not addressed whether this safety extends to continuous high dose use. We present two cases of patients who underwent surgery for squamous cell carcinoma of the pharyngeal region, requiring laryngopharyngectomy. Both had pharyngeal reconstruction with a free anterolateral thigh (ALT) flap. The first required intraoperative vasopressors throughout the surgery, extending into the postoperative period. The second required vasopressors in the postoperative period continuously for weeks after surgery. Vasopressors were administered at treatment levels for shock. Neither developed flap compromise, suggesting that pharyngeal reconstruction with an ALT flap may be safely performed in the setting of continuous high-dose vasopressors.
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