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ABSTRACT: Reconstruction of nasal tip support and internal lining after excision of nasal carcinoma is challenging. Since its original description by Menick in 1989, the outcomes of bipedicled septal pivot flap are rarely reported in the literature. Objective of this work is to review our results using the Septal pivoted flap in nasal reconstruction. It is a retrospective case series, Dalhousie University, Halifax, Nova Scotia. We studied six patients who underwent significant resection of the tip and dorsum of the nose for squamous or basal cell carcinoma. All involved nasal subunits were removed. Nasal reconstruction was subsequently performed using an inferiorly bipedicled pivoted composite nasal septal flap combined with a regional flap for skin coverage. The bipedicled SPF provided excellent support of the nasal tip in all six cases. All flaps in the cohort survived. Five patients had good mucosal lining from the septal flap alone and only one patient required a concurrent pericranial flap. Three patients experienced bleeding and required additional nasal packing. A bipedicled septal pivoted flap is exceptionally useful in providing a good tip support and well-vascularized nasal lining for reconstruction after major resection of the nasal tip. Bleeding is common and should be anticipated in the majority of patients.
Archives of Oto-Rhino-Laryngology 01/2013; · 1.29 Impact Factor
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ABSTRACT: BACKGROUND: Hyperparathyroidism-jaw tumor (HPT-JT) syndrome is a rare autosomal dominant multiple tumor syndrome characterized by hyperparathyroidism due to single or multiple-gland parathyroid tumor(s). Since it was first described in 1990, the genetics underlying the syndrome have been elucidated and typical clinical presentations are becoming clarified as literature describing this rare entity amasses. METHODS AND RESULTS: A 22-year-old man presented with a 2-year history of fatigue, weight loss, nausea, and vomiting. Anemia workup indicated severe hypercalcemia. Investigations were consistent with a diagnosis of HPT-JT. The patient underwent a total 4-gland parathyroidectomy with single gland reimplantation. CONCLUSION: HPT-JT is a complex syndrome with phenotypic manifestations that can seem physiologically and temporally unrelated. The risk of parathyroid carcinoma is elevated in patients with HPT-JT, necessitating rapid treatment and complete tumor resection to reduce the morbidity and mortality associated with intractable hypercalcemia due to local recurrence or metastatic disease. © 2012 Wiley Periodicals, Inc. Head Neck, 2012.
Head & Neck 02/2012; · 2.40 Impact Factor
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ABSTRACT: To assess wait times for surgery and radiotherapy in head and neck cancer patients from the Maritime provinces.
A retrospective chart review of 275 Maritime head and neck cancer patients treated between 2007 and 2009 by the tertiary Otolaryngology-Head and Neck Surgery Service at the Queen Elizabeth II Health Sciences Centre (QEII HSC) in Halifax, Nova Scotia, was conducted to assess surgical and radiotherapy wait times.
The mean wait time from referral to assessment by a head and neck surgeon was 15 days. The mean wait time from the initial consultation with a head and neck surgeon to surgery was 33 days, with 42% waiting more than 28 days and 18% waiting more than 42 days for surgery. The mean wait time from surgery to postoperative radiotherapy was 74 days, with 94% of patients waiting more than 42 days. The mean wait time from referral to Radiation Oncology to assessment by a radiation oncologist was 10 days. The mean wait time from ready to treat to radiotherapy was 21 days, with 74% of patients waiting more than 14 days.
Maritime head and neck cancer patients wait longer than established guidelines for both surgery and radiotherapy and may be at increased risk for negative outcomes because of delayed treatment.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 08/2011; 40(4):318-22. · 0.71 Impact Factor
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ABSTRACT: RESEARCH TYPE: Translational.
To review and tabulate the incidence of thromboembolic complications following head and neck surgery.
Review.
Articles were identified using the MEDLINE database search engine. The relevant articles were reviewed and any thromboembolic complications were tabulated.
Six articles, published between 1976 and 2007, were identified that reported on thromboembolic complications following head and neck surgery. Of these articles, four were retrospective reviews and two were prospective. Four of the studies looked at various methods of routine prophylaxis, which included several combinations of low-dose heparin, low-molecular-weight heparin, graduated compression stockings, and intermittent pneumatic compression devices. Two studies were simply investigating complications in general following head and neck surgery.
Head and neck cancer patients are likely at higher risk than commonly thought, and venous thromboembolism is likely much more common that what is clinically evident. It is important to develop an institutional system of risk stratification to correspond to standardizations of thromboprophylaxis that are generally accepted. Although many institutions are already attempting to do so, such as we have outlined above by extrapolating from other surgical departments, it is important to show these relationships with head and neck patients specifically to justify the high cost of these various therapies.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 06/2011; 40(3):261-5. · 0.71 Impact Factor
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ABSTRACT: In this study, we sought to determine current trends in the management of glottic cancer in Canada. We further sought to determine the approach to margin status following treatment of glottic cancer.
An online survey was distributed to all head and neck (H&N) surgeons and all radiation oncologists (ROs) in Canada. Respondents were asked to choose management recommendations for a series of tumour descriptions and to offer their opinion of margin evaluation. The results were compiled and analyzed using descriptive statistics for frequencies and chi-square analysis for comparison between H&N surgeons and ROs.
The survey attained a response rate of 60% among H&N surgeons and 20% among ROs. There was a significant difference in choice of management for T1a, T1b, T2a, and T2b tumours, with ROs heavily favouring radiation therapy and H&N surgeons' opinions divided between radiation therapy and transoral laser microsurgery (TLM). There was no significant difference of opinion in the treatment of T3 and T4a tumours. The size of an adequate margin was significantly different between ROs and H&N surgeons, as was the management of a positive margin.
Compared to previous surveys, this study reflects a move toward TLM as the preferred treatment for T1a glottic cancer among H&N surgeons, whereas ROs continue to favour radiation therapy. The results also show a split in opinions among H&N surgeons with respect to TLM versus radiation therapy for early-stage glottic tumours. The study underscores a difference of opinion between specialties regarding the management of glottic cancer and the need for a definitive comparison study to guide recommendations.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 06/2011; 40(3):205-10. · 0.71 Impact Factor
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ABSTRACT: Midline ectopic thyroid tissue is a common pathological entity. In contrast, laterally located ectopic thyroid tissue with a normally located thyroid gland is a very rare condition in head and neck surgery.
We report the association of laterally located multinodular thyroid tissue and a normally located multinodular goiter. A woman was seen in the otolaryngology clinic with a right submandibular mass. Clinical examination and investigations confirmed the presence of a multinodular goiter in an ectopic thyroid gland.
Laterally located ectopic thyroid tissue is a very rare condition. Ectopic thyroid tissues can undergo the same pathological changes as a normally located thyroid gland. Ectopic thyroid goiter together with a normally located multinodular goiter is a rare entity, and this is the first to be reported in North America.
Thyroid: official journal of the American Thyroid Association 02/2010; 20(2):217-20. · 2.60 Impact Factor
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ABSTRACT: A whistle deformity is defined as a deficiency in the vertical length of the lip so that the free margins of the upper and lower lips do not meet normally, giving the appearance of whistling. This is a common secondary deformity of the vermilion in patients with cleft lip. A case involving a 61-year-old man who developed a whistle deformity as a result of two wedge resections and postoperative radiotherapy for treatment of squamous cell carcinoma of the lower lip is presented. Hyaluronic acid-based tissue filler and autologous microfat transplantation to the lower lip were used for definitive management of the patient's whistle deformity. After one year of follow-up, the patient was pleased with the overall result and noted marked improvement of his oral competence and overall appearance of the lip. The present case demonstrates that microfat transplantation is a viable option for correcting a whistle deformity, not only after surgery, but also following adjuvant radiotherapy - both of which potentially reduce graft viability secondary to decreased vascularity of the recipient site.
The Canadian journal of plastic surgery, Journal canadien de chirurgie plastique 01/2010; 18(4):e53-4. · 0.18 Impact Factor
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ABSTRACT: To review the pectoralis major myofascial (PMMF) flap in head and neck reconstruction.
Twenty-seven consecutive patients who underwent a PMMF reconstruction between March 1, 2001, and October 1, 2004, were retrospectively reviewed, which, to date, has generated the largest documented series among the world literature. Data acquisition centred on indications for use, tumour staging, defect location, type of wound, and complications (major and minor).
Thirteen patients had resections of the primary tumour, whereas 13 others had recurrent disease. Stages varied from T0 to rN3. A variety of defects were filled, but the majority of defects were in the oral cavity (13; 48%). Indications ranged from pure soft tissue filling to salvage of previously failed reconstructions. The outcomes were evaluated as 24 (89%) successes and 6 (22%) major and 6 (22%) minor complications overall, but when only considering cases done for reconstructive salvage, the failure rate is high (3; 50%).
The PMMF flap remains a successful reconstructive option; however, when used in the context of previously failed reconstructive efforts, the morbidity of the PMMF flap is much higher.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 12/2009; 38(6):632-41. · 0.71 Impact Factor
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ABSTRACT: The need for elective neck dissection in patients with early stage oral cancer is controversial. A preoperative predictor of the risk of subclinical nodal metastasis would be useful. Studies have shown a strong correlation between histological tumor depth and the risk of nodal metastasis. To determine if preoperative ultrasonography is an accurate measure of tumor depth in oral carcinoma. To assess if preoperatively measured tumor depth predicts an increased risk of subclinical metastatic neck disease and thus the need for elective neck dissection. Twenty one consecutive patients with biopsy proven squamous cell carcinoma of the tongue/floor of mouth were analyzed prospectively. Each patient received a preoperative ultrasonography to assess tumor depth which was compared to histological measures. Univariate analysis was used to correlate tumor thickness and T stage with neck metastasis. There was a significant correlation between the preoperative ultrasonography and histological measures of tumor depth (correlation coefficient 0.981, P<0.001). The overall rate of lymph node metastasis was 52%. The rate of metastasis was 33% in N0 necks. In the group with tumors<5mm in depth, the neck metastatic rate was 0%, as compared with 65% in the group 5mm. Using univariate analysis tumor depth and T stage were significant predictors of cervical metastasis (P=0.0351 and P=0.0300, respectively). Preoperative ultrasonography is an accurate measure of tumor depth in oral carcinoma. Tumor thickness is a significant predictor of nodal metastasis and elective neck dissection should be considered when this thickness is 5mm.
Oral Oncology 11/2009; 46(1):38-41. · 2.86 Impact Factor
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ABSTRACT: Adenoid cystic carcinoma (ACC) of the external auditory canal is a rare neoplastic condition. The purpose of this study was to conduct a quantitative review of case reports to assess the efficacy of treatment options and assess prognostic factors.
Cases were identified using PubMed. Kaplan-Meier curves were used to plot overall and disease-free survival. The log-rank test was used to compare survival curves in the univariate analysis for perineural invasion, margin status, and specific treatment modalities. A Cox proportional hazard model was used for multivariate analysis.
Sixty-six cases were identified. The univariate analysis suggests an increased overall (p = .03) and disease-free (p = .03) survival for those treated with parotidectomies, whereas temporal bone resection decreased survival (p = .07). There was no overall or disease-free survival advantage using radiation (p = .8). Positive margins decreased both overall (p = .05) and disease-free survival (p = .02). Perineural invasion was not significant. The multivariate analysis confirmed the findings for parotidectomies (p = .02) and temporal bone resections (p = .01).
Although the short-term survival for ACC is high, the risk of metastasis and poor long-term survival is high. In addition to local excision with negative margins, the surgeon should perform a parotidectomy.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 08/2009; 38(4):468-76. · 0.71 Impact Factor
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ABSTRACT: To report outcomes of definitive radiotherapy for early-stage squamous cell carcinoma of the larynx.
Retrospective outcome analysis.
Tertiary referral centre.
A total of 373 cases of laryngeal cancer reported in Nova Scotia from 1990 through 2001 were reviewed. All cases were classified by T stage (T1 = 137, T2 = 90, T3 = 89, T4 = 57) and affected sites (glottic = 233, supraglottic = 136, subglottic = 4). We focused on those patients with T1 and T2 cancers of both the glottis and the supraglottis who received radiotherapy as a primary modality.
Eighty-eight percent (150 of 170) of T1/T2 glottic cancers were first treated with radiotherapy. Seventy-one percent (80 of 112) and 63.3% (24 of 38) of T1 and T2 glottic cancers, respectively, were controlled by radiation, with an average follow-up of 37 months. Of those T1 glottic cancers unsuccessfully treated by radiotherapy, 14 underwent surgical salvage, with 9 of these patients being free of disease following an average of 57 months. For T2 glottic cancers unsuccessfully treated by radiotherapy, five patients underwent surgical salvage, of whom four (68.4%) were free of disease after an average follow-up of 62 months. Seventy-five percent of T1 (3 of 4) and 70.6% (25 of 35) of T2 supraglottic cancers were successfully controlled by radiotherapy. Salvage surgery was attempted in five patients; however, all patients except one died of disease.
Although radiotherapy is a standard treatment for early laryngeal cancers, the results of this review may suggest considering other modalities in the treatment of early laryngeal cancer.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 08/2009; 38(4):434-9. · 0.71 Impact Factor
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ABSTRACT: The T stage of oral cavity and oropharyngeal squamous cell cancer lesions has a significant impact on patient treatment and overall outcome. Determining the presence and size of palpable lymph nodes also plays an important role in the complex staging of oral cancer. Oral cavity lesions and lymph nodes are often assessed by visual approximation and palpation. The focus of this study was to determine if the introduction of a measurement tool (a ruler) changes the T stage of oral cavity and oropharyngeal lesions and the N stage of lymph nodes.
Various pieces of felt that represented oral cavity and oropharyngeal lesions were placed on the tongues of cadaver specimens. Several pieces of felt of different shapes were used to represent each T stage in the oral cavity and oropharyngeal tumour staging system (American Joint Committee on Cancer). Pieces of round clay, of differing sizes, were also placed in the neck of one of the cadavers once a subplatysmal flap was raised. These pieces of clay represented the various node sizes. The study participants were four head and neck surgeons, four senior residents, four junior residents, and five medical students. All subjects were asked to visually inspect the oral cavity and oropharynx of the cadaver and approximate, to the nearest 0.5 cm, the size of the lesion. The subjects were then asked to identify the lymph nodes in the same manner. Once the participants had recorded their answers, they were asked to repeat the process with the aid of a ruler and measure the same lesions and lymph node to the nearest 0.5 cm.
In staging of oral cavity and oropharyngeal cancer, the use of a ruler is necessary to increase the accuracy of tumour staging. There was a statistically significant difference in the estimated size of tumours and nodes when using a ruler. The average absolute error using visual estimation of the tumour size was 5.6 mm. When using the ruler, the error was reduced to 1.7 mm. The node size showed the same trend, with average absolute error on visual estimation being reduced from 7.4 mm to 5.2 mm.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 05/2009; 38(2):197-207. · 0.71 Impact Factor
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Otolaryngology Head and Neck Surgery 01/2009; 139(6):869-70. · 1.72 Impact Factor
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ABSTRACT: Selective neck dissections (SNDs) can yield outcomes that are oncologically similar to radical dissections but with less morbidity. The rate of metastasis to level IIb is not clear, and its dissection involves cranial nerve XI traction and devascularization, causing much morbidity. Our study examined the prevalence and predictors of cancer within the submuscular recess (SMR).
All SNDs performed by the authors were prospectively included from July 1, 2002, to March 31, 2006. Level IIb was sent as a distinct specimen.
One hundred fifty-two dissections were performed. Only 12 (7.9%) were node positive in IIb. The SMR contained diseased nodes in 12.2% of N+ necks and 3.0% of N0 necks (p = .04); 23.1% (3 of 13) of laryngeal (1 of 8) and hypopharyngeal (2 of 5) tumours were node positive in IIb versus 6.4% in the oral cavity (p = .07) and 5.3% in oropharyngeal lesions.
This is one of the largest prospective studies examining the role of level IIb dissection. It suggests that level IIb dissection might be unnecessary, especially in an N0 neck.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 11/2008; 37(5):689-93. · 0.71 Impact Factor
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ABSTRACT: Adenoid cystic carcinoma (ACC) of the head and neck is a rare malignancy of salivary gland origin. Few epidemiologic studies exist assessing the incidence of this tumour. The purpose of the current study was to determine the incidence of ACC of the head and neck in Nova Scotia. Furthermore, we assessed survival outcomes based on presentation sites.
Nova Scotia is an ideal geographic location in which to conduct retrospective case reviews as there are centralized tertiary care centres and minimal population migration. Furthermore, there is an externally and internally validated cancer registry housed in Cancer Care Nova Scotia. Records at Cancer Care Nova Scotia were retrospectively reviewed to identify all reported cases of ACC since 1979. Age-adjusted incidence rates were calculated standardized to the 2001 Canadian population. Survival curves were plotted to allow assessment of overall survival. A log-rank test was used to compare survival curves for age (> 65 and < 65 years old) and presentation sites.
One hundred thirty cases of ACC were identified, with 110 presenting as primary tumours in head and neck sites. The mean (standard error) age-adjusted incidence of ACC in Nova Scotia is 4.5 (0.6) cases per 1 000,000. The incidence did not change significantly over time. The most common site of presentation was the minor salivary glands (40%), followed by the submandibular gland (18.2%) and the parotid gland (17.3%). There was no significant difference for overall and disease-free survival between nonsalivary, major salivary, and minor salivary tumours (p = .97). Significant reductions in survival were found for those diagnosed at > 65 years of age (p < .014) and those with a sinus presentation (p < .005). Sixteen percent of all head and neck cancer patients experienced a distant metastasis of their primary tumour.
ACC of the head and neck is a rare neoplastic condition that most commonly affects the minor and major salivary glands. Although short-term survival is high, nearly half of all patients will develop metastasis or die of complications of local recurrences.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 10/2008; 37(5):642-8. · 0.71 Impact Factor
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Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 05/2008; 37(2):E59-61. · 0.71 Impact Factor
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Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 03/2008; 37(1):E15-8. · 0.71 Impact Factor
