Emre Vural

University of Arkansas at Little Rock, Little Rock, Arkansas, United States

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Publications (53)92.55 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To compare the removal rates of 8-hole angle strut plate and Champy line plate in repairing mandibular angle fractures. Retrospective chart review at a tertiary care academic center of adults who were at least 18 years old with at least 1 mandibular angle fracture of a traumatic origin who underwent open reduction and internal fixation by using single monocortical miniplate fixation in Champy line or by using 8-hole angle strut plate via transbuccal approach. The outcome measures were hardware removal rates and the reason for removal of the hardware. One hundred four patients with a total of 106 angle fractures met the inclusion criteria for this study. Seventy-three angle fractures were treated with the 8-hole strut, and 33 angle fractures were treated with the Champy line plates. There were 6 plates removed in both groups. This resulted in 8.2% of plates removed in the 8-hole strut plate group and 18.2% in the Champy line group (P = 0.133). Loose hardware was determined to be the cause of plate removal in 2 (2.7%) of the 8-hole strut plate group compared with all 6 (18.2%) of the Champy group (P = 0.005). Overall, removal rates between Champy line and 8-hole strut plates are not different in treating mandibular angle fractures, although the 8-hole strut plate has a lower rate of loose hardware-related plate removal compared with the Champy line plate.
    The Journal of craniofacial surgery 01/2013; 24(1):163-5. · 0.81 Impact Factor
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    ABSTRACT: To report the technical feasibility of performing transoral robotic supracricoid partial laryngectomy with preservation of the thyroid cartilage. This is a case report from a tertiary-care academic institution. A patient with recurrent T2 glottic squamous cell carcinoma of the larynx underwent supracricoid partial laryngectomy with negative margins and preservation of the laryngeal framework using transoral robotic surgery, where an adequate exposure to the endolarynx was obtained by using a Feyh-Kastenbauer retractor. The patient was successfully decannulated in postoperative week 4, and his gastrostomy tube was removed in postoperative week 6. Transoral robotic surgery may be feasible in select glottic/subglottic laryngeal lesions, if adequate exposure is obtained.
    Journal of Robotic Surgery 12/2012; 6(4).
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    ABSTRACT: Objective Concurrent chemoradiotherapy (CCRT) has become the treatment of choice for oropharyngeal and hypopharyngolaryngeal cancers in many centers. Although it has increased the rates of organ preservation, there has also been an increase in treatment-related complications. We aimed to evaluate the functional outcomes of CCRT in head and neck cancer.Study DesignCase series with chart review.SettingTertiary cancer center.Subjects and MethodsA retrospective study of patients treated with CCRT at the University of Arkansas for Medical Sciences was performed. Demographic data and treatment outcomes were extracted, specifically feeding tube and tracheotomy dependence and number of esophageal dilatations.ResultsOf the 243 patients treated with concurrent chemoradiotherapy (5-flourouracil + cysplatin and radiotherapy), 152 patients received a feeding tube. The median percutaneous gastrostomy tube (PEG) use was 9 months (range, 1-96 months). More than 70% of the patients who had a PEG more than 6 months had a T3 or T4 tumor. Thirty-seven patients underwent esophageal dilatations, (median, 1; range, 1-7). The median use of a tracheotomy was 7 months, and 77% of these patients were treated for hypopharyngolaryngeal cancer.Conclusions Despite major improvement in locoregional control rates, CCRT has a significant negative impact on the functional outcomes of head and neck cancer patients, with a high number of patients remaining PEG and tracheotomy dependent.
    Otolaryngology Head and Neck Surgery 09/2012; · 1.73 Impact Factor
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    Facial plastic surgery clinics of North America 08/2012; 20(3):365-82.
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    ABSTRACT: To determine the factors contributing to failure of interpolation flaps in nasal reconstruction. Retrospective medical chart review. Tertiary care academic center. A total of 107 patients with nasal defects needing reconstruction, performed at the University of Arkansas for Medical Sciences, Little Rock. Patients underwent nasal reconstruction with 2-stage paramedian forehead or nasolabial flaps (PMFF and NLF, respectively) from 2002 to 2011. Defect thickness, location, flap type, use of cartilage grafts, and comorbidities, including diabetes mellitus, peripheral vascular or coronary artery disease, and smoking habits, were recorded. Full success, partial failure, or full failure of the respective flap. Eighty-two of the patients (77%) underwent 2-stage PMFF repair and 25 (23%) underwent 2-stage NLF repair. Fifty-eight defects (54%) were full thickness, in which 46 repairs used PMFF and 12 used NLF for reconstruction. The overall failure rate was 6%. Five PMFF failed (6%); 3 of these were used for full-thickness repairs. There was only 1 NLF failure (4%), which was also performed for the repair of a full-thickness defect. Use of cartilage in the reconstruction did not affect failure rates of the different soft tissue flaps. No single comorbidity was noted to have a statistically significant effect on failure rates, although 83% of failures were observed in smokers. The overall success rate of interpolation flaps in nasal reconstruction was 94.4%. Defect thickness, use of a cartilage graft, type of flap used, and presence of comorbidities did not affect outcome. Although the comparison was not statistically significant (P = .21), flap failures were more commonly observed in smokers.
    Archives of otolaryngology--head & neck surgery 03/2012; 138(4):367-71. · 1.92 Impact Factor
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    ABSTRACT: To determine the safety and efficacy of photodynamic therapy in the treatment of oral leukoplakia with 5-aminolevulinic acid and pulsed dye laser. Nonrandomized, single-arm, single-site phase 1/2 pilot study. Academic referral center. A total of 23 patients, aged 37 to 79 years, having a confirmed diagnosis of leukoplakia with or without dysplasia measuring at least 10 mm in diameter. Application of 5-aminolevulinic acid to lesions followed by activation with high-power 585-nm pulsed dye laser. Maximum tolerated dose of laser, postprocedure complications, objective response to treatment, and immunohistochemical changes in treated tissue. No significant adverse events occurred; minor local adverse effects were observed during and following photodynamic therapy in the safety phase of the study. The maximum tolerated dose was 8 J/cm(2). Of 17 patients, 7 (41%) had more than 75% regression (significant response) and 9 (53%) had more than 25% regression (partial response), for an overall response rate of 94% at 90 days. This response rate was far higher than the null-hypothesis 20% rate (P < 10(-10)) and the alternative-hypothesis 50% rate (P = .0001) for which the study was powered. When compared with baseline levels immunohistochemically, p53 expression was increased in 8 of 11 available samples (73%) and Ki-67 expression was decreased in 7 of 12 available samples (58%). Photodynamic therapy with 5-aminolevulinic acid and pulsed dye laser could be used to achieve regression of oral leukoplakia. The treatment is safe and well tolerated. An application time of 1.5 hours and laser radiant exposure of 8 J/cm(2) with 1.5-ms pulse time were found to be the optimal settings in this study. The high-power laser used in this study allows completion of laser therapy within 1 to 3 minutes. Further studies are necessary to determine the optimal laser radiant exposure and drug application to maximize the response rate.
    Archives of otolaryngology--head & neck surgery 11/2011; 137(11):1117-23. · 1.92 Impact Factor
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    ABSTRACT: To identify unique epigenetic signature in cancer stem cells (CSCs) in head and neck squamous cell carcinoma (HNSCC). Molecular and microarray studies. Tertiary referral center. Head and neck CSCs were isolated in HNSCC cells by CD44 staining and flow cytometry sorting. CSCs with highest CD44 expression (CD44(hi)) and non-stem cells (non-SCs) with lowest CD44 expression (CD44(low)) were then characterized for stemness gene expression and their responses to chemotherapeutic agents, followed by high-throughput epigenetic profiling using the Illumina BeadChip Array, targeting 28,544 CpG sites covering more than 14,956 genes. CD44(hi) CSCs expressed higher levels of stem cell markers and were more resistant to chemotherapeutic agents as compared to CD44(low) non-SCs. By DNA methylation microarray analysis, 17 hypomethylated and 9 hypermethylated genes were identified in CD44(hi) CSCs as compared to non-SCs in most HNSCC cell lines. Cluster analysis using these 26 genes showed that CD44(hi) CSCs were epigenetically distinct from the CD44(low) non-SCs in all 5 HNSCC cell lines. A unique epigenetic profile consisting of 17 hypomethylated and 9 hypermethylated genes was seen in HNSCC CSCs. These genes may be critically required in maintaining the stemness or pluripotency of CSCs and may represent novel molecular targets for anticancer therapies aimed at eradicating CSCs in HNSCC.
    Otolaryngology Head and Neck Surgery 06/2011; 144(6):900-9. · 1.73 Impact Factor
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    ABSTRACT: The purpose of this study was to investigate the potential role of variable microRNA (miRNA) expression in the development of multidrug resistance (MDR) in head and neck cancer. Head and neck squamous cell carcinoma cell lines UMSCC-1 and SQ20B were treated with docetaxel at increasing concentrations to develop resistant cell lines. Parental and resistant cells were treated with cisplatin, 5-fluorouracil, paclitaxel, methotrexate, and doxorubicin to confirm cross-resistance. The miRNA pattern of resistant cells was then compared with their parental cells. Docetaxel treatment successfully induced resistance primarily and induced multidrug cross-resistance. Resistant cells showed significant downregulation of miR-100, miR-130a, and miR-197 and upregulation in miR-101, miR-181b, miR-181d, and miR-195 expression when compared with their parent cells (p < .01). Real-time polymerase chain reaction (PCR) analysis confirmed statistically significant downregulation in miR-100 and miR-130a and upregulation in miR-181d expression (p < .001). Alterations in miRNA expression has direct relationship to MDR in head and neck cancer and may serve as biomolecular targets for reversal of MDR.
    Head & Neck 06/2011; 33(6):786-91. · 2.83 Impact Factor
  • Jennings R Boyette, Emre Vural
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    ABSTRACT: To present the authors' experience and outcomes in the reconstruction of midfacial defects using cervicofacial advancement-rotation flaps (CARFs) based on a method of determining forward or reverse design in relation to the proportions of the defect. Case series with retrospective chart review. Tertiary care academic medical center. Patients who underwent CARF reconstruction and the subset of patients with midfacial defects medial to the lateral canthus were included. CARF was designed in a forward fashion with an anteromedial movement for the defects with a larger vertical dimension and in a reverse fashion with a posterosuperior movement for the defects with a larger horizontal dimension. Thirteen of 45 patients who underwent CARF reconstruction qualified for the analysis as a subset based on defect location. CARF was used in a forward fashion in 7 patients and in a reverse fashion in 6 patients. The largest defect in this subset was measured as 9 × 6 cm, while the smallest defect was 3 × 2 cm. Average follow-up was 11.5 months. None of the patients developed partial or total flap loss. Six patients had mild ectropion, which was managed with conservative measures only. The outcome of the reconstruction was satisfactory in all cases. Designing the CARF based on the proportion of the vertical and horizontal diameters of the selected midfacial defects as described allows for closure of the defects with minimal tension and minimizes the amount of discarded healthy skin overlapping at the suture lines.
    Otolaryngology Head and Neck Surgery 02/2011; 144(2):196-200. · 1.73 Impact Factor
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    ABSTRACT: To compare the diagnostic adequacy of ultrasound-guided fine-needle aspiration biopsy (USFNA) of the head and neck with immediate on-site microscopic evaluation and feedback by a cytopathologist (IMMEDIATE) versus delayed examination without immediate feedback (DELAYED). Retrospective chart review of office-based USFNA performed in both IMMEDIATE and DELAYED settings by the same otolaryngologist. A total of 199 USFNA procedures in the head and neck were performed by one practitioner. Of these procedures, 137 biopsies were performed in the DELAYED setting, whereas 62 biopsies were performed in the IMMEDIATE setting. Cytopathology reports were reviewed for diagnostic conclusions as well as adequacy of biopsies. The results from both settings were compared using Pearson χ2 test. The ability to obtain a diagnosis from USFNA was 73.0% in the DELAYED group as compared with 90.3% in the IMMEDIATE group. The rate of adequate cells on biopsy was 89.1% in the DELAYED group as compared with 96.8% in the IMMEDIATE group. There was a statistically significant difference between observed and expected diagnostic rates (χ(2)[1] = 7.568, P = .006) and a trend toward a significant difference between the observed and expected adequacy rates (χ(2)[1] = 3.259, P = .071) when IMMEDIATE evaluation by a cytopathologist was performed. An immediate microscopic evaluation of USFNA specimens to confirm adequacy of sampling is strongly recommended. Diagnostic conclusions were increased when an evaluation of the specimen was performed at the time of biopsy. The specimen adequacy rate tended to increase with an immediate cytopathologic assessment. Laryngoscope, 2010.
    The Laryngoscope 10/2010; 120(10):1979-84. · 1.98 Impact Factor
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    ABSTRACT: To compare the "take" rates of skin grafts between myeloid-selective hypoxia-inducible factor (HIF) 1alpha knockout (KO) and wild-type (WT) mice. Production of the alpha subunit of HIF-1alpha is increased in healing wounds, which stimulates expression of vascular endothelial growth factor (VEGF) to promote angiogenesis. Therefore, the take rate of skin grafts may be closely associated with the presence or absence of HIF-1alpha production in the recipient bed. The percentage of healthy graft areas obtained by planimetry and scores for epithelialization and granulation tissue formation obtained by histopathologic analysis were compared in 12 KO and 12 WT mice following skin grafting. The graft take rate was significantly impaired in the KO group (P = .009), whereas epithelialization (P = .46) or granulation (P = .41) tissue formation scores did not reveal any significant differences. Hypoxia-inducible factor 1alpha in myeloid cells may be an important molecule for revascularization of avascular tissues such as skin grafts, probably owing to its stimulating effect on angiogenesis.
    Archives of otolaryngology--head & neck surgery 07/2010; 136(7):720-3. · 1.92 Impact Factor
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    ABSTRACT: Study the survival of patients with cervical lymphatic squamous cell carcinoma recurrence. Review of tumor registry database. Academic health science center. Forty-seven isolated neck recurrence patients identified from 224 recurrences from a total of 1291 patients treated between 1998 and 2007. The main outcome measurements were neck lymph nodal recurrence, treatment-specific survival, and overall survival. A total of 47 patients had neck recurrence; 10 of the neck recurrence patients (21.3%) had regional disease (N+) at initial presentation. Median survival for patients with neck recurrence was 14.7 months (95% confidence interval [CI] 8.6-18.1 mo), and five-year survival for this group was five percent (95% CI 0%-30%). Neck dissection salvage therapy for neck recurrence resulted in the best survival. Neck dissection as a salvage therapy for neck recurrence resulted in the best survival, and there was no survival benefit in terms of whether a patient had a neck dissection or not as his or her initial therapy.
    Otolaryngology Head and Neck Surgery 05/2010; 142(5):722-7. · 1.73 Impact Factor
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    Head & Neck Oncology 01/2010; · 3.13 Impact Factor
  • Emre Vural
    Otolaryngology Head and Neck Surgery 01/2010; 142(1):152-3; author reply 153. · 1.73 Impact Factor
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    ABSTRACT: The study is designed to elucidate the relationship between epigenetic silencing of the hMLH1 (human MutL homologue 1) gene and microsatellite instability (MSI) and the prognostic values of hMLH1 promoter methylation and MSI in head and neck squamous cell carcinoma (HNSCC). Cross-sectional study. Tertiary referral center. A total of 120 cases of HNSCC were analyzed for hMLH1 promoter hypermethylation, protein expression, and MSI by using methylation-specific polymerase chain reaction, immunohistochemical staining, and polymerase chain reaction amplification with the use of 16 fluorescent-labeled microsatellite markers, followed by fragment analysis. Of 120 HNSCCs, hMLH1 promoter hypermethylation and decreased hMLH1 protein expression were shown in 39 (32.5%) and 22 (18.3%), respectively. hMLH1 promoter hypermethylation was detected in 13 of 52 (25%) normal-appearing squamous mucosa adjacent to invasive carcinoma. MSI was detected in 21 (17.5%) tumors at two or more markers and in 99 (82.5%) tumors with no evidence of MSI or at only one marker. Hypermethylation of the hMLH1 gene is significantly associated with decreased hMLH1 protein expression (P < 0.001). High-frequency MSI was significantly associated with promoter hypermethylation (P = 0.01) but not with decreased protein expression (P = 0.069) of hMLH1 gene. hMLH1 promoter hypermethylation is significantly associated with decreased cause-specific survival for HNSCC patients (P = 0.03). Promoter hypermethylation of the hMLH1 gene could be detected early in head and neck squamous carcinogenesis and may be associated with increased MSI and poor survival in HNSCC.
    Otolaryngology Head and Neck Surgery 10/2009; 141(4):484-90. · 1.73 Impact Factor
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    ABSTRACT: To determine whether the presence of a tooth in the line of mandibular angle fracture increases the incidence of complications and whether removing these teeth has an effect on complication rates. Case series with chart review. The analysis was performed on 83 patients who underwent open reduction and internal fixation for mandibular angle fractures. Lower molar teeth involved in the fracture line were extracted if they were loose, fractured, or grossly infected or prevented satisfactory reduction. Data regarding demographics, involvement of a molar tooth, management of the involved tooth, and postoperative outcome were analyzed. Statistical analysis was performed by using likelihood ratio chi(2) and logistic regression. The revision surgery in fractures with molar tooth involvement was 28.9 percent, compared to 12.9 percent when no tooth was involved (P = 0.084). When a tooth was involved in the fracture, the revision surgery rate was 25 percent when it was removed and 30% when it was preserved (P = 0.734). Postoperative complications, especially the revision surgery rates, may not increase by involvement of lower molar teeth in the fracture line and selective removal of these teeth by using commonly accepted guidelines may not decrease complication rates in angle fractures.
    Otolaryngology Head and Neck Surgery 07/2009; 140(6):845-8. · 1.73 Impact Factor
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    ABSTRACT: To evaluate free tissue transfer (FTT) as a safe and effective reconstructive technique to treat arteriovenous malformations. Vascular lesions that present a significant clinical challenge to the head and neck reconstructive surgeon are often difficult to treat and can leave large, complex defects. Retrospective, single-institution case series. We describe 8 patients treated for extensive lesions in various parts of the head and neck reconstructed with free flaps. These malformations have a tendency to recur, which was the case in 75% of our patients (6 of 8) during a mean follow-up period of 5 years. Revision procedures are expected at a mean rate of 6.75 per person in our series. Arteriovenous malformations are uncommon and challenging lesions. Use of FTT can ameliorate the large defects resulting from excision of these lesions.
    Archives of facial plastic surgery: official publication for the American Academy of Facial Plastic and Reconstructive Surgery, Inc. and the International Federation of Facial Plastic Surgery Societies 05/2009; 11(3):171-7. · 1.31 Impact Factor
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    ABSTRACT: Rhinophyma is a disfiguring disorder of the nasal skin characterized by hypervascularity, sebaceous gland hyperplasia, occluded sebaceous ducts, and dermal fibrosis. It has no known effective medical treatment; however, a myriad of surgical treatments have been reported. We report an effective, efficient, and safe approach to treat this disorder using the Shaw scalpel to surgically sculpt the nose. To evaluate the efficacy and safety of using the Shaw scalpel to treat rhinophyma. We performed a retrospective review of 7 male patients (age range, 58-81 years) who underwent primary surgical treatment of rhinophyma with the Shaw scalpel. A good to excellent outcome was noted in all 7 patients. No perioperative complications occurred. Essentially no blood loss was noted during or after the procedures. Use of the Shaw scalpel as the sole surgical instrument and method is a safe, efficient, and effective means to treat rhinophyma.
    Archives of facial plastic surgery: official publication for the American Academy of Facial Plastic and Reconstructive Surgery, Inc. and the International Federation of Facial Plastic Surgery Societies 01/2009; 11(4):263-6. · 1.31 Impact Factor
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    ABSTRACT: To investigate the expression of vascular endothelial growth factor (VEGF) and its receptor (VEGF-R2) in port-wine stains (PWSs). An immunohistochemistry (IHC) study on formalin-fixed, paraffin-embedded specimens. Representative sections from surgical resection specimens of 12 PWS patients and 12 control specimens stained with routine IHC by using polyclonal anti-VEGF and anti-VEGF-R2 antibodies. Slides were evaluated semiquantitatively for the intensity of staining for VEGF and VEGF-R2 by using a scoring system varying from 0 to 3+. PWS specimens showed statistically significant overexpression of both VEGF and VEGF-R2 molecules when compared with control specimens (P < 0.005). VEGF and its receptor may play an important role in the pathogenesis of PWS. It is possible that PWS may progress by hyperplasia in addition to hypertrophy. VEGF-R blockade may have a potential role as a targeted approach in the treatment of this disfiguring condition in the future.
    Otolaryngology Head and Neck Surgery 11/2008; 139(4):560-4. · 1.73 Impact Factor
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    ABSTRACT: To report the occlusal outcomes of manually provided temporary intraoperative maxillomandibular fixation (MMMF) for the open repair of selected mandibular fractures. STUDY DESIGN/SUBJECTS AND METHODS: A retrospective chart review of the patients who underwent open reduction and internal fixation of mandibular fractures with MMMF was performed. Twenty-six patients underwent open reduction and internal fixation with MMMF. Postoperative data were available for only 16 patients who kept their follow-up appointments. With the exception of one patient who experienced minimal cross-bite in the right molar region, all of the patients had their original normocclusion. Preliminary results of MMMF suggest that satisfactory postoperative occlusal outcomes may be obtained without the use of wire-based maxillomandibular fixation methods in selected mandibular fractures.
    Otolaryngology Head and Neck Surgery 05/2008; 138(4):528-30. · 1.73 Impact Factor

Publication Stats

551 Citations
92.55 Total Impact Points

Institutions

  • 1998–2013
    • University of Arkansas at Little Rock
      • Department of Psychology
      Little Rock, Arkansas, United States
  • 2012
    • University of Texas Health Science Center at San Antonio
      • Department of Oral and Maxillofacial Surgery
      San Antonio, TX, United States
  • 2011
    • Hokkaido University
      • Department of Otolaryngology−Head and Neck Surgery
      Sapporo-shi, Hokkaido, Japan
  • 2006–2011
    • University of Arkansas for Medical Sciences
      • • Department of Otolaryngology-Head and Neck Surgery
      • • Department of Surgery
      Little Rock, Arkansas, United States
  • 2008–2009
    • Central Arkansas Veterans Healthcare System
      Washington, Washington, D.C., United States
  • 2007
    • Cincinnati Children's Hospital Medical Center
      Cincinnati, Ohio, United States