C Arturo Solares

Georgia Regents University, Augusta, Georgia, United States

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Publications (59)95.64 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To define transnasal endoscopic surgical landmarks for the parapharyngeal segment of the internal carotid artery (ppICA) using radiographic analysis and cadaveric dissection. Study Design: Cadaveric and radiographic study Methods: 179 CT angiography studies of the head and neck were analyzed using Osirix third-party software (Pixmeo, Switzerland). Dissection of a cadaveric specimen was used as a correlate to radiographic findings. The posterior aspect of the lateral pterygoid process and posterior border of the mandibular ramus were used as bony landmarks for the ppICA. Results: At the level of the nasal floor, the distance from the ppICA to the posterolateral pterygoid process and to the posterior mandibular ramus was 2.36 cm and 1.94 cm, respectively, in males, and 2.37 cm and 1.99 cm, respectively, in females. At the level of the skull base, the distance from the ppICA to the posterolateral pterygoid process and to the posterior mandible was 2.33 cm and 1.49 cm, respectively, in males, and 2.20 cm and 1.57 cm, respectively, in females. Cadaver dissection demonstrated the utility of identifying these landmarks. Conclusion: The posterior border of the mandibular ramus and the posterolateral aspect of the pterygoid process may serve as consistent bony landmarks for identification of the ppICA.
    The Laryngoscope 01/2014; · 1.98 Impact Factor
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    ABSTRACT: Objectives: While there are many benefits to the endoscopic endonasal approach to the infratemporal fossa, involvement of the petrous portion of the internal carotid artery (ICA) poses a unique challenge. The endoscopic endonasal approach requires establishing the relationship of the petrous ICA to anatomical landmarks to guide the surgeon. This study evaluates the relationship of petrous ICA to specific anatomic landmarks, both radiographically and through cadaveric dissections. Study Design: Cadaveric and radiographic study. Methods: An endoscopic endonasal approach was used to access the petrous carotid and infratemporal fossa. Dissections exposed the petrous portion of the carotid artery and identified the foramen rotundum, ovale, and spinosum. Both anatomical and radiographic representations of these landmarks were then evaluated and compared relative to the petrous carotid. Results: The endoscopic endonasal approach to the infratemporal fossa with exposure of the petrous ICA afforded complete visualization of the entire segment of this portion of the ICA with limited anatomical obstruction. The foramen rotundum, ovale, and spinosum were successfully identified and dissected with preservation of their neuro/vascular contents. CT analysis calculated a mean distance to the petrous ICA of 16.34mm from foramen rotundum, 4.88mm from ovale, and 5.11mm from spinosum in males. For females, the values were 16.40mm from rotundum and 4.36mm each from ovale and spinosum. Conclusion: An endonasal endoscopic approach to the infratemporal fossa with exposure of the petrous ICA is feasible. The anatomical landmarks can serve as both radiographic and surgical landmarks in this approach.
    The Laryngoscope 01/2014; · 1.98 Impact Factor
  • Jason Van Rompaey, Carrie Bush, C Arturo Solares
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    ABSTRACT: Abstract Introduction: The endoscopic approaches to the medial and inferior orbital walls have continued to grow in popularity. The ability to provide a safe approach to the orbit through this technique has been described in a handful of studies. Even though metric analyses have been conducted on orbital anatomy, few have outlined the anatomical relations pertinent to endoscopic surgery. The goal is to provide improved understanding of the complex anatomy encountered through anatomical dissections and metric analysis of the orbit. This information could assist in approach selection during preoperative planning. Methods: Anatomical dissections via transantral and endonasal approaches were used to define the limits with current endoscopic sinus surgery instrumentation. The surface area was then calculated of the floor and medial wall to assess access created by the approaches. The path of the infraorbital canal was conducted to assess its placement within the orbital floor. Results: The transantral and endonasal approaches to the orbit provided an adequate surgical window inferiorly and medially. This was confirmed by the surface area calculations. Access laterally was also possible, however, it became limited as dissection advanced superior to the lateral rectus muscle. The infraorbital canal was located consistently at midline on the orbital floor. Conclusion: Endoscopic access to the medial and inferior parts of the orbit is feasible and creates adequate access with current instrumentation. Knowing the surgical boundaries and the amount of exposure created can assist the surgeon in deciding a minimally invasive approach.
    Orbit (Amsterdam, Netherlands) 12/2013;
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    ABSTRACT: Background Traditionally, a pterional approach is utilized to access the Meckel cave. Depending on the tumor location, extradural dissection of the Gasserian ganglion can be performed. An endoscopic endonasal access could potentially avoid a craniotomy in these cases. Methods We performed an endoscopic endonasal approach as well as a lateral approach to the Meckel cave on six anatomic specimens. To access the Meckel cave endoscopically, a complete sphenoethmoidectomy and maxillary antrostomy followed by a transpterygoid approach was performed. For lateral access, a pterional craniotomy with extradural dissection was performed. Results The endoscopic endonasal approach allowed adequate access to the Gasserian ganglion. All the relevant anatomy was identified without difficulty. Both approaches allowed for a similar exposure, but the endonasal approach avoided brain retraction and improved anteromedial exposure of the Gasserian ganglion. The lateral approach provided improved access posterolaterally and to the superior portion. Conclusion The endoscopic endonasal approach to the Meckel cave is anatomically feasible. The morbidity associated with brain retraction from the open approaches can be avoided. Further understanding of the endoscopic anatomy within this region can facilitate continued advancement in endoscopic endonasal surgery and improvement in the safety and efficacy of these procedures.
    Journal of neurological surgery. Part B, Skull base. 12/2013; 74(6):331-6.
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    ABSTRACT: Objectives: In an effort to decrease morbidity skull base surgeons have explored less invasive approaches to the infratemporal fossa, including endonasal-endoscopy, minicraniotomies, and transantral endoscopic and microscopic corridors. This project presents quantitative data that assesses the practicality, and volumetric exposure afforded by endonasal and open approaches to the infratemporal fossa. Study Design: First, the study defines the anatomy of endoscopic-endonasal and preauricular approaches to the infratemporal fossa. Subsequently, the study involved the calculation of anatomical volumes using cadaveric and virtual models. Methods: CT scanning of two anatomical specimens served to recreate computer simulations of the endonasal and preauricular approaches, allowing the assessment of the infratemporal fossae volumes. In addition, the dissections served to identify and mark critical surgical landmarks and boundaries. A second CT scan, after the surgical dissection, allowed a re-analysis of the data for a volumetric comparison of the surgical approaches. Results: Pre- and post-dissection CT scans and computer simulations revealed that volumes in the open and endonasal approaches to the infratemporal fossa are strikingly similar, suggesting that volumes of surgical instrumentation and visualization may also be comparable. However, the entry gate for instrumentation differed significantly for each approach. Conclusion: This study suggests that although the entry gate for instrumentation is greater during an open approach, contrary to intuition, an open approach does not create a substantially larger working space or visual field. Analysis of volumetric measurements facilitates a better understanding of the indications for each procedure.
    The Laryngoscope 10/2013; · 1.98 Impact Factor
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    ABSTRACT: Objective: Injury to the internal carotid artery is a feared complication of endoscopic endonasal surgery of the skull base. Such an event, while rare, is associated with high morbidity and mortality. Even if bleeding is controlled, permanent neurological defects frequently persist. Many techniques have been developed to manage internal carotid artery rupture with varying degrees of success. The purpose of this study is to explore endoscopic management of arterial damage with endovascular closure devices used for a femoral arteriotomy. The ability to remotely suture a damaged artery permits the possible adaptation of this technology in managing endoscopic arterial complications. Methods: After the creation of an endoscopic endonasal corridor in a cadaveric specimen, an arteriotomy was created at the cavernous portion of the internal carotid artery. The Angioseal® Starclose® and MynxGrip® were utilized under endoscopic guidance to repair the arteriotomy. Angiography was then done on a cadaver sutured with the Starclose®. Results: Both the Angioseal® and Starclose® were deployed quickly and appeared to provide sufficient closure of the arteriotomy. The Angioseal® required the use of a guide wire and was longer to deploy when compared with the Starclose®. The Starclose® deployment was quick and facile. The MynxGrip® also deployed without difficulty. Conclusion: The Angioseal® and Starclose® systems were both successfully deployed utilizing an endoscopic endonasal approach. The MynxGrip® was the easiest to deploy and has the greatest potential to be of benefit in this application. Further studies with hemodynamic models are required to properly assess the appropriateness in this setting.
    The Laryngoscope 09/2013; · 1.98 Impact Factor
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    ABSTRACT: Background: Non-melanoma skin cancer (NMSC) with perineural invasion (PNI) is most commonly seen in cutaneous squamous cell carcinoma of the head and neck (CSCCHN). The cranial nerves are a conduit for skin cancer to reach the brainstem. Methods: The histopathological features of 51 tissue specimens from 49 patients with CSCCHN and clinical PNI were assessed with consecutive transverse and longitudinal sections. Results: No skip lesions were identified. Tumor spread was contiguous in all specimens. No tumor spread into the perineural space from surrounding or adjacent tumor was seen. Proximal large cranial nerves showed epineural involvement in 3.9% in areas with large tumor bulk, extensive PNI and intraneural invasion. Conclusions: Perineural tumor spread in CSCCHN was contiguous and no skip lesions were evident in nerve specimens assessed in this series. Spread beyond cranial nerve perineurium was uncommon, reflecting its multi-layer barrier function at this level. These findings may have treatment implications. © 2013 Wiley Periodicals, Inc. Head Neck, 2013.
    Head & Neck 09/2013; · 2.83 Impact Factor
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    ABSTRACT: Advances in the field of skull base surgery aim to maximize anatomical exposure while minimizing patient morbidity. The petroclival region of the skull base presents numerous challenges for surgical access due to the complex anatomy. The transcochlear approach to the region provides adequate access; however, the resection involved sacrifices hearing and results in at least a grade 3 facial palsy. An endoscopic endonasal approach could potentially avoid negative patient outcomes while providing a desirable surgical window in a select patient population. Cadaveric study. Endoscopic access to the petroclival region was achieved through an endonasal approach. For comparison, a transcochlear approach to the clivus was performed. Different facets of the dissections, such as bone removal volume and exposed surface area, were computed using computed tomography analysis. The endoscopic endonasal approach provided a sufficient corridor to the petroclival region with significantly less bone removal and nearly equivalent exposure of the surgical target, thus facilitating the identification of the relevant anatomy. The lateral approach allowed for better exposure from a posterolateral direction until the inferior petrosal sinus; however, the endonasal approach avoided labyrinthine/cochlear destruction and facial nerve manipulation while providing an anteromedial viewpoint. The endonasal approach also avoided external incisions and cosmetic deficits. The endonasal approach required significant sinonasal resection. Endoscopic access to the petroclival region is a feasible approach. It potentially avoids hearing loss, facial nerve manipulation, and cosmetic damage. Laryngoscope, 2013.
    The Laryngoscope 09/2013; · 1.98 Impact Factor
  • 09/2013;
  • Benedict Panizza, C Arturo Solares
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    ABSTRACT: Choosing the optimal approach to a given skull base tumor continues to be a matter of great debate. While endoscopy has revolutionized the management of various cranial base pathologies a thorough understanding of all approaches available to the skull base team is critical in order to properly manage these lesions. Herein, we present an overview of the most relevant approaches used to access the skull base. It is important for the skull base surgeon to be familiar with these approaches and understand what each approach can achieve.
    Operative Techniques in Otolaryngology-Head and Neck Surgery 09/2013; 24(3):140-145.
  • Brian Ho, C Arturo Solares, Benedict Panizza
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    ABSTRACT: The temporal bone can be affected by primary or secondary malignancies. The latter are far more common. The complex anatomy of this region requires a thorough understanding in order to manage these lesions safely. Herein we present a brief description of the techniques used to resect malignant temporal bone lesions.
    Operative Techniques in Otolaryngology-Head and Neck Surgery 09/2013; 24(3):179-183.
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    ABSTRACT: Recent advances in endonasal endoscopy have facilitated the surgical access to the lateral skull base including areas such as Meckel's cave. This approach has been well documented, however, few studies have outlined transantral specific access to Meckel's. A transantral approach provides a direct pathway to this region obviating the need for extensive endonasal and transsphenoidal resection. Our aim in this study is to compare the anatomical perspectives obtained in endonasal and transantral approaches. We prepared 14 cadaveric specimens with intravascular injections of colored latex. Eight cadavers underwent endoscopic endonasal transpterygoid approaches to Meckel's cave. Six additional specimens underwent an endoscopic transantral approach to the same region. Photographic evidence was obtained for review. 30 CT scans were analyzed to measure comparative distances to Meckel's cave for both approaches. The endoscopic approaches provided a direct access to the anterior and inferior portions of Meckel's cave. However, the transantral approach required shorter instrumentation, and did not require clearing of the endonasal corridor. This approach gave an anterior view of Meckel's cave making posterior dissection more difficult. A transantral approach to Meckel's cave provides access similar to the endonasal approach with minimal invasiveness. Some of the morbidity associated with extensive endonasal resection could possibly be avoided. Better understanding of the complex skull base anatomy, from different perspectives, helps to improve current endoscopic skull base surgery and to develop new alternatives, consequently, leading to improvements in safety and efficacy.
    Archives of Oto-Rhino-Laryngology 06/2013; · 1.29 Impact Factor
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    ABSTRACT: OBJECTIVES/HYPOTHESIS: A subtemporal preauricular approach to the infratemporal fossa and parapharyngeal space has been the traditional path to tumors of this region. The morbidity associated with this procedure has lead to the pursuit of less invasive techniques. Endoscopic access using a minimally invasive transmaxillary/transpterygoid approach potentially may obviate the drawbacks associated with open surgery. The anatomy of the parapharyngeal space is complex and critical; therefore, a comparison of the anatomy exposed by these different approaches could aid in the decision making toward a minimally invasive surgical corridor. STUDY DESIGN: Technical Note. METHODS: The parapharyngeal space was accessed endonasally by removal of the medial and posterior walls of the maxillary sinus. To allow better visualization and increased triangulation of a bimanual dissection technique, a sublabial canine fossa antrostomy was created. The medial and lateral pterygoid plates were removed. Further lateral dissection exposed the relevant anatomy of the parapharyngeal space. A subtemporal preauricular infratemporal approach was also completed. RESULTS: The endoscopic approach provided sufficient access to the superior portion of the parapharyngeal space. The open approach also provided adequate access; however, it required a larger surgical window, causing greater injury. A significant advantage of the subtemporal approach is the improved access to the petrous portion of the internal carotid artery. Conversely, the endonasal approach provided improved access to the anterior and medial portions of the superior parapharyngeal space. CONCLUSION: Endoscopic endonasal access utilizing a transmaxillary/transpterygoid approach provides a sufficient surgical window for tumor extirpation. Utilization of this approach obviates some of the morbidity associated with an open procedure. LEVEL OF EVIDENCE: 5. Laryngoscope, 2013.
    The Laryngoscope 05/2013; · 1.98 Impact Factor
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    ABSTRACT: Endoscopic endonasal transpterygoid approaches (EETA) use the pneumatization of the sinonasal corridor to control lesions of the middle and posterior skull base. These surgical areas are complex and the required surgical corridors are difficult to predict. Define anatomical landmarks for the preoperative planning of EETAs. Anatomical study. We reviewed images from high-resolution maxillofacial CT scans with (0.6-mm axial slice acquisition). Cephalometric measurements were obtained using Kodak Carestream Image Software (Rochester, NY). Average distance from midline to the vidian canal was 12.78 mm (range 9.4-15.8 mm). Average horizontal distance from the vidian canal to the foramen rotundum was 5.6 mm (range 2.8-11.5 mm). Average vertical distance from the vidian canal to the foramen rotundum was 6.22 mm (range 4.3-9.3 mm). These landmarks are consequential during the preoperative planning of the surgical corridor. To facilitate communication, we classified EETAs as: A) Partial removal of the pterygoid plates (transposition of temporo-parietal fascia); B) removal of anteromedial aspect of the pterygoid process (lesions involving the lateral recess of the sphenoid sinus); C) involves dissecting the vidian nerve to control the petrous ICA and removing the pterygoid plates base to reach the petrous apex, Meckel's cave, or cavernous sinus; D) variable removal of the pterygoid plates to access the infratemporal fossa; and E) removal of pterygoid process and medial third of the Eustachian tube to expose the nasopharynx. Our novel classification and landmarks system helps to understand the anatomy of this complex area and to accurately plan the EETA.
    The Laryngoscope 04/2013; 123(4):811-5. · 1.98 Impact Factor
  • Jason Van Rompaey, C. Arturo Solares
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    ABSTRACT: The infratemporal fossa posses significant challenges to surgical access. Complete extirpation of the pathology in the region most be balanced with iatrogenic deficits and tumor biology. The advent of endoscopy has expanded the reach of anterior transnasal transmaxillary approaches. Herein we present a brief description of these techniques.
    Operative Techniques in Otolaryngology-Head and Neck Surgery 01/2013; 24(4):218–221.
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    ABSTRACT: The clivus is centrally located in the skull base surrounded by critical neurovascular structures making surgical access difficult. Several approaches to this region have been described. Herein we discuss the transfacial approaches to the clivus with emphasis on endoscopic approaches.
    Operative Techniques in Otolaryngology-Head and Neck Surgery 01/2013; 24(4):213–217.
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    ABSTRACT: BACKGROUND: Oncologic resection of the nasopharynx is challenging due to its complex and deep-seated nature. We aimed to illustrate the anatomic landmarks of endoscopic nasopharyngectomy and design a surgical training model that could facilitate learning of this technique. METHODS: An endoscopic endonasal dissection of the nasopharynx was completed in fresh cadaveric specimens under conditions similar to those of our operating suite. Digital data from a high-resolution CT scan were imported to an image guidance system to be used during the dissections. RESULTS: We expanded the sinonasal corridor, harvested a contralateral nasoseptal flap, and exposed the pterygopalatine and infratemporal fossae. A detailed anatomic dissection of the nasopharynx was correlated to multiplanar images provided by the image guidance system, highlighting appropriate bony, neural, and vascular landmarks. CONCLUSIONS: Understanding the anatomy-based endoscopic modular approaches facilitates planning and safe execution of an oncologic nasopharyngectomy. Clinical experience remains mandatory because anatomic models fall short of clinical scenarios. © 2012 Wiley Periodicals, Inc. © 2012 Wiley Periodicals, Inc. Head Neck, 2012.
    Head & Neck 06/2012; · 2.83 Impact Factor
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    ABSTRACT: Anterior cranial base meningiomas have traditionally been addressed via frontal or frontolateral approaches. However, with the advances in endoscopic endonasal treatment of pituitary lesions, the transphenoidal approach is being expanded to address lesions of the petrous ridge, anterior clinoid, clivus, sella, parasellar region, tuberculum, planum, olfactory groove, and crista galli regions. The expanded endoscopic endonasal approach (EEEA) has the advantage of limiting brain retraction and resultant brain edema, as well as minimizing manipulation of neural structures. Herein, we describe the techniques of transclival, transphenoidal, transplanum, and transcribiform resections of anterior skull base meningiomas. Selected cases are presented.
    Journal of neurological surgery. Part B, Skull base. 06/2012; 73(3):147-56.
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    ABSTRACT: Perineural invasion (PNI) in cutaneous squamous cell carcinoma of the head and neck (CSCCHN) is associated with decreased survival. Large-nerve PNI presents with clinical signs and symptoms and/or magnetic resonance imaging evidence of cranial nerve involvement. We sought to determine which variables predict a worse outcome and to analyze patterns of failure. Case series with planned data collection. Tertiary care center. Patients with large-nerve PNI from CSCCHN between 1996 and 2006 were identified from a prospectively collected database. Clinical and demographic variables were recorded. Local control rates and survival analysis were performed using Kaplan-Meier curves. Thirty-six patients were identified (28 men and 8 women). The mean age was 61 years. Twenty-nine were treated with curative intent, and 7 received palliation. The mean follow-up was 35 months. Involvement of V3, disease zone, and the type of therapy were significantly associated with overall survival (P < .05). The 5-year disease-free survival for patients by therapy was 50% for subcranial surgeries, 53.6% for skull base surgery, and 0% for radiation and palliative therapies (P < .001). None of the patients treated with a skull base resection had a central recurrence, while all patients who received palliation had a central failure. Disease extent, type of therapy, and involvement of V3 are all significant predictors of survival in PNI from CSCCHN. We confirmed that the natural history of the disease is central progression and that this can be halted, if detected early enough, by a properly planned skull base resection.
    Otolaryngology Head and Neck Surgery 01/2012; 146(5):746-51. · 1.73 Impact Factor
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    ABSTRACT: Perineural invasion (PNI) in cutaneous squamous cell carcinoma of the head and neck (SCCHN) is associated with decreased survival. Patients with large nerve or clinical PNI present with clinical signs and symptoms or MRI evidence of cranial nerve involvement. These patients often succumb to disease that spreads into the brainstem. In our experience, when the disease extends up to the Gasserian or Geniculate ganglion, surgical resection with negative margins provides the best chance for cure. Herein we review our experience to validate our clinical observations. We identified patients with large nerve PNI from cutaneous SCCHN between January 1996 and 2006 from a prospectively collected database. Patients who underwent surgical resection as their primary mode of therapy were included. Clinical and demographic variables were recorded. Survival analysis was performed with Kaplan-Meier curves, and the log-rank test was used for significance testing between groups. Twenty-one patients were identified. The mean age was 60 (range, 38-86) years, with 15 men and 6 women. Nineteen patients had a formal skull base resection, whereas 2 patients had a subcranial resection. We had 3 complications in our series: extradural hemorrhage (n = 1), cerebrospinal fluid leak (n = 1), and wound infection (n = 1). None of the patients who underwent a formal skull base resection to include the lateral cavernous sinus (ie, Gasserian ganglion) suffered ocular palsies or permanent morbidity when the orbit was preserved (n = 11). We had no surgical deaths. The average length of stay was 9 days (SD 6.3 days). The 5-year disease specific survival rate for the entire group was 64.3%. V3 involvement resulted in lower, although not significant, 5-year disease-free survival rates- 0% for those patients with involvement (n = 4) versus 66.8% for no involvement of V3 (n = 17). Appropriately planned surgical resection of PNI in cutaneous SCCHN up to the ganglion as dictated by the disease extent may improve survival without significant added morbidity. © 2011 Wiley Periodicals, Inc. Head Neck 2011.
    Head & Neck 12/2011; 34(11):1622-7. · 2.83 Impact Factor

Publication Stats

579 Citations
95.64 Total Impact Points

Institutions

  • 2013–2014
    • Georgia Regents University
      • Department of Otolaryngology
      Augusta, Georgia, United States
    • The Ohio State University
      • Department of Otolaryngology - Head & Neck Surgery
      Columbus, OH, United States
  • 2009–2013
    • Georgia Health Sciences University
      • Department of Otolaryngology
      Augusta, Georgia, United States
    • University of Pittsburgh
      • Department of Neurological Surgery
      Pittsburgh, Pennsylvania, United States
  • 2012
    • Tehran University of Medical Sciences
      Teheran, Tehrān, Iran
  • 2011
    • Medical College of Georgia
      Augusta, Georgia, United States
  • 2008–2009
    • Princess Alexandra Hospital (Queensland Health)
      • Division of Medicine
      Brisbane, Queensland, Australia
  • 2005–2009
    • Cleveland Clinic
      • Head and Neck Institute
      Cleveland, Ohio, United States
  • 2006
    • Sydney Head and Neck Cancer Institute
      Sydney, New South Wales, Australia
  • 2003–2006
    • Lerner Research Institute
      Cleveland, Ohio, United States
    • McGill University
      • Department of Medicine
      Montréal, Quebec, Canada