Elham Jouzdani

The Australian Society of Otolaryngology Head & Neck Surgery, Evans Head, New South Wales, Australia

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Publications (6)12.15 Total impact

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    ABSTRACT: To evaluate the lack of accuracy in neck staging with the classical technique (i.e., neck dissection and routine histopathology) with the sentinel node (SN) biopsy in oral and oropharyngeal T1-T2N0 cancer. Cross-sectional study with planned data collection. Tertiary center care. In 50 consecutive patients, the pathological stage of sentinel node (pSN) was established after analyzing SN biopsies (n = 148) using serial sectioning and immunohistochemistry. Systematic selective neck dissection was performed. The pN stage was established with routine histopathologic analysis of both the non-SN (n = 1075) and the 148 SN biopsies. The sensitivity and negative predictive value of pSN staging were 100 percent. Conversely, if one considers pSN staging procedure as the reference test for micro- and macro-metastasis diagnosis, the sensitivity of the classical pN staging procedure was 50 percent (9/1; 95% CI 26.9-73.1) and its negative predictive value was 78 percent (95% CI 61.9-88.8). Fifteen patients (30%) were upstaged, including nine cases from pN0 to pSN >or= 1 and six cases from pN1 to pSN2. Two of the pN0-pSN1 upstaged patients died with relapsed neck disease. The SN biopsy technique appeared to be the best staging method in cN0 patients and provided evidence that routinely undiagnosed lymph node invasion may have clinical significance.
    Otolaryngology Head and Neck Surgery 04/2010; 142(4):592-7.e1. · 1.73 Impact Factor
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    ABSTRACT: The tumour grading of primary parotid cancers (PPCs) remains controversial. A 20-year standardised single centre treatment has been assessed retrospectively. The histological review of 155 consecutively treated parotid malignancies identified 96 suitable cases for univariate and multivariate survival analyses. Treatment involved total parotidectomy, neck dissection and post-operative radiotherapy in, respectively, 91.7%, 83.3% and 70.4% of cases. The 5-year overall survival, disease-specific and recurrence-free survival rates were 79.4%, 83.5% and 70.8%, respectively. Univariate analysis confirmed the classical prognostic factors, i.e. age>60 years, male gender, facial palsy, hardness of the tumour, clinical stage, tumour grade, facial nerve invasion and lymph node metastases. Multivariate analysis identified a three-grade classification just after the clinical stage as the most important prognostic factor. This study identifies the prognostic significance of intermediate grade tumours.
    European journal of cancer (Oxford, England: 1990) 11/2009; 46(2):323-31. · 4.12 Impact Factor
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    ABSTRACT: The purpose of this study was to assess the vascularity of the platysma muscle by the branches of the facial artery, in order to determine the best means of harvesting a musculo-cutaneous flap while ensuring maximum vascular security. Ten platysma muscles were dissected on 4 fresh specimens and one formaldehyde-preserved specimen. The dissection was performed after injection of the facial artery in 6 cases, while 4 muscles were dissected without any previous injection. The vascular supply of the platysma muscle comes essentially from the branches of the submental artery and from branches descending straight from the facial artery. Other collateral branches contribute to this vascularization, but their importance is minor. All these arteries reach the muscle, entering its visceral aspect, then proceed to the sternal notch in a radial axis. The size of the flap has to be defined within a quadrilateral figure with its base formed by the mandibular edge and its apex by the inferior limit of the flap. It is essential to preserve the maximum possible muscular thickness, especially on the medial side of the flap. If the facial artery needs to be ligated, this has to be done as it enters the submandibular space in order to protect most of the collateral branches destined to the muscle. The vascularization is then taken back by the homo- and contro-lateral facial vascularisation in an inverted flow in the remaining segment of the facial artery.
    Revue de laryngologie - otologie - rhinologie 01/2009; 130(3):139-44.
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    ABSTRACT: Fourth branchial pouch sinus (FBPS) is rare and frequently unknown to clinicians. Misdiagnosis is common and definitive surgery is often made difficult by previous episodes of infection and failed attempts at excision. The purpose of this paper is to clarify the diagnostic criteria and the methods used for the surgical management of FBPS. From a series of 265 head and neck cysts and fistulae, 7 cases of FBPS were retrospectively reviewed. The surgical technique is detailed. Six cases were located on the left side and one on the right. CT scanning showed an air-filled structure on both sides of the lesser horn of the thyroid cartilage in 2 cases out of 4, and barium swallow found a FBPS in 1 case out of 3. Direct pharyngoscopy allowed confirmation of the diagnosis in all cases and permitted catheterization of the tract with the spring guidewire of a vascular catheter which helped surgical location and subsequent dissection. The recurrent laryngeal nerve was systematically dissected to avoid inadvertent damage. A hemi-thyroidectomy was performed in one case. A transient laryngeal paralysis (lasting 9 months) was noted in a 3-week-old newborn operated on. None of the 7 cases had a recurrence after complete resection of the FBPS (3.7 years average follow-up). Symptoms on the right side do not exclude the diagnosis of a FBPS. Endoscopy is the key investigation. It allows confirmation of the diagnosis and catheterization of the tract, which aids the surgical dissection. Total removal of the sinus tract tissue with dissection and preservation of the recurrent laryngeal nerve is recommended. EBM rating: A-1.
    Otolaryngology Head and Neck Surgery 02/2006; 134(1):157-63. · 1.73 Impact Factor
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    ABSTRACT: Laryngeal cysts were classified by de Santo et al as saccular, ductal, and foraminal cysts of the thyroid cartilage. The latter appear like a projection of the subglottic laryngeal mucosa herniating through the persistent foramina, occasionally seen in the anterior lateral part of the thyroid ala (congenital defect of the cartilage at the site of vessel penetration). The laryngeal cysts are lined by respiratory epithelium, columnar epithelium, or less commonly by stratified squamous epithelium or by the combination of those patterns. The foraminal cysts are extremely rare and their existence is quite controversial. We report a case that seems to belong to the foraminal cyst category. A 13-year old boy had a 1-year history of a nontender cartilaginous painless and stable cervical mass, palpable in front of the left thyroid ala. There was no history of trauma. Indirect laryngoscopy was normal; there was no displacement of the vocal fold in the laryngeal lumen. http://www.entnet.org/journal/casereports/OTO-07.pdf/
    Otolaryngology Head and Neck Surgery 11/2005; 133(4):641. · 1.73 Impact Factor
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    ABSTRACT: We evaluated the functional and oncologic results of supraglottic hemipharyngolaryngectomy as treatment for T1 and T2 lateral laryngeal margin and piriform sinus carcinomas. Eighty-seven patients underwent this surgical treatment. The disease was classified T1 in 14 of these cases (16.1%) and T2 in 73 cases (83.9%). The nodal status indicated 39 cases of N0 (44.8%), 18 cases of N1 (20.7%), 28 cases of N2 (32.2%), and two cases of N3 (2.2%). With regard to the N0 cases, 15 (38.4%) were positive at the histologic examination. Within the N+ group, 52.1% involved capsular rupture. Two patients died of complications during the postoperative period. The mean duration of nasogastric tube feeding was 20 days. Six patients (7.27%) had feeding resumption problems. All patients were decanulated after a mean period of 16 days. All patients underwent postoperative radiation therapy, except two with T1N0N- disease and three who had previously undergone this treatment. The 5-year actuarial survival rate was 60.3% (T1, 83.3%; T2, 49.9%). The rates of local and regional recurrence, second primary cancer, and metastasis were 19.5%, 24.1%, and 28.1%, respectively. The infringement of the pharyngoepiglottic fold was significantly correlated with locoregional recurrence. The survival rate was significantly correlated with the nodal status and extracapsular spread. Initial staged cancers of the laryngeal margin and piriform sinus can be successfully managed with conservative surgery called supraglottic hemipharyngolaryngectomy combined with nodal neck dissection. Postoperative radiation therapy is still recommended in most cases because of the high recurrence potential and prevalence of secondary regional cancers. This combined treatment seems to be a suitable therapeutic choice in the treatment of patients with T1 and T2 carcinomas of the laryngeal margins and piriform sinus.
    Head & Neck 09/2004; 26(8):701-5. · 2.83 Impact Factor