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ABSTRACT: OBJECTIVES/HYPOTHESIS: Document a 15-year experience with 29 cases of acute invasive fungal rhinosinusitis (AIFR) and evaluate factors predictive of disease clearance and overall survival. STUDY DESIGN: Case series with chart review. METHODS: Patients were identified by review of department billing records between 1995 and 2010. Medical records were reviewed for patient demographics, disease characteristics, clinical course including surgical and medical therapy, treatment outcomes, and long-term survival. RESULTS: Twenty-nine patients with AIFR were identified. Causes of immunosuppression included hematologic malignancy (n=16), diabetes (n=12), medication (n=10), and acquired immunodeficiency syndrome (n=1), with 10 patients having multiple causes of immunosuppression. Facial pain, swelling and orbital symptoms were the most common presenting symptoms. Fungal organisms included Mucor (n=18) and Aspergillus (n=10) species, with one patient infected with both. Disease-specific survival (DSS) from AIFR was 57%. Intracranial (P=.01) and ethmoid sinus (P=.05) involvement were significantly linked with short-term disease-related mortality. Overall survival (OS) at 6 months was 18%. For OS, intracranial involvement (hazard ratio [HR], 4.47; 95% confidence interval [CI], 1.51-13.22) and cranial neuropathy at presentation (HR, 3.2; 95% CI, 1.3-8.2) were significantly associated with shortened survival. Of the five patients surviving >6 months, two developed long-term major sinonasal complications. CONCLUSIONS: DSS and OS remain low for patients with AIFR. Extensive surgical resection in patients with these poor prognostic signs should be considered carefully in light of their poor survival. Long-term survivors are at significant risk of sinonasal complications and should be followed closely. LEVEL OF EVIDENCE: 4. Laryngoscope, 2012.
The Laryngoscope 02/2013; · 1.75 Impact Factor
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ABSTRACT: This article provides a critical review of the evidence surrounding the management of the clinical node-negative patient with early-stage oral cavity squamous cell carcinoma.
Otolaryngologic Clinics of North America 10/2012; 45(5):1181-93. · 1.65 Impact Factor
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Neil D Gross
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ABSTRACT: There are numerous potential applications of robotic technology to head and neck procedures, including thyroidectomy. The learning curve for robotic thyroid surgery appears to be steep, as highlighted in a study published in this issue. This commentary explores the challenges with learning robotic thyroid surgery and questions the potential risks and benefits of increased adoption of this approach.
Otolaryngology Head and Neck Surgery 09/2012; · 1.72 Impact Factor
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ABSTRACT: BACKGROUND: Combined inhibition of epidermal growth factor receptor (EGFR) and insulin-like growth factor-1 receptor (IGF-1R) has been proposed as a therapy for cutaneous squamous cell carcinoma of the head and neck (SCCHN). METHODS: Receptor expression and downstream signaling were assessed in cutaneous squamous cell carcinoma (SCC) cell lines and patient samples. EGFR and IGF-1R signaling was inhibited in cutaneous SCC cell lines using erlotinib and/or picropodophyllin. RESULTS: EGFR and IGF-1R were overexpressed in cutaneous SCCHN specimens relative to normal skin. Dual inhibition of both receptors prevented cell growth and decreased activation of Akt and p42/44 mitogen-activated protein kinase (MAPK) more effectively than either inhibitor alone. CONCLUSION: Dual inhibition of EGFR and IGF-1R is effective at blocking cell growth, and is correlated with inhibition of Akt and p42/44 MAPK, suggesting that this may be a promising treatment for cutaneous SCCHN. © 2012 Wiley Periodicals, Inc. Head Neck, 2012.
Head & Neck 04/2012; · 2.40 Impact Factor
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ABSTRACT: BACKGROUND: The purpose of this study was to report the incidence of venous thromboembolism (VTE) in patients with head and neck cancer after surgery. METHODS: This was a single-institution, retrospective cohort: 134 patients underwent resection and simultaneous microvascular reconstruction. The primary endpoint was identification of confirmed or suspicious VTE within 30 days of surgery. RESULTS: Two subjects (1.4%) with confirmed VTE (1 pulmonary embolism, 1 deep venous thrombosis) and 6 subjects (4.4%) with suspicious VTE (1 acute respiratory failure, 1 sudden cardiac arrest, and 4 cases of leg edema without imaging) were identified. The strongest predictors of possible VTE were prior VTE (p = .004; odds ratio [OR], 25.11; 95% confidence interval [CI], 1.13-556.40), red cell transfusion (p = .009; OR, 1.80; 95% CI, 1.16-2.80), high body mass index (p = .015, OR, 1.29, 95% CI, 1.05-1.58), and older age (p = .046; OR, 1.10; 95% CI, 1.00-1.19). CONCLUSION: The incidence of VTE in patients with head and neck cancer after resection and microvascular reconstruction ranged from 1.4% to 5.8%. © 2012 Wiley Periodicals, Inc. Head Neck, 2012.
Head & Neck 02/2012; · 2.40 Impact Factor
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ABSTRACT: Open airway reconstruction is considered definitive treatment of laryngotracheal stenosis (LTS). Although most cases of LTS are not autoimmune, there are few data reported in patients with Wegener's granulomatosis. In this study, we aimed to assess outcomes of airway reconstruction in LTS patients with Wegener's compared to nonautoimmune patients.
Retrospective chart review of LTS cases managed with open airway reconstruction at an academic medical center.
Patients who underwent open airway reconstruction for LTS due to Wegener's or nonautoimmune causes were identified from 1995 to 2010. Clinical, demographic, and procedural data were recorded. Fisher exact test, Mann-Whitney U test, and McNemar's test were used to test for significance.
A total of 53 patients were identified; eight Wegener's, 45 nonautoimmune, with median follow-up time of 8.3 and 1.8 years, respectively. Before reconstruction, there was no statistical difference between Wegener's and nonautoimmune patients with previous dilations (88% vs. 68%, P = .41) and tracheostomy dependence (50% vs. 42%, P = .72). Following reconstruction, 75% Wegener's and 36% nonautoimmune patients required further dilations (P = .05), with a decannulation rate of 75% and 58% (P = 1.0), respectively.
Wegener's patients have an increased need for dilations after open airway reconstruction for LTS. However, these patients can be decannulated after surgery at a rate similar to patients with nonautoimmune LTS.
The Laryngoscope 12/2011; 121(12):2566-71. · 1.75 Impact Factor
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ABSTRACT: The aim of this study was to demonstrate the technical feasibility and potential benefits of using a circular mechanical stapler with free jejunal transfer for jejunoesophageal anastomosis in total laryngopharyngectomy reconstruction while comparing the rates of fistula and stricture.
This study was a retrospective review of 12 free jejunal flaps completed with circular mechanical stapler for the jejunoesophageal anastomosis with comparison to 17 jejunal free flaps where all anastomoses were hand sewn.
In all, 29 patients underwent free jejunal transfer: 12 had jejunal free flap with circular mechanical stapler for jejunoesophageal anastomosis, whereas 17 patients had hand-sewn anastomosis. Corresponding rates of fistula and stricture were 0/12 fistulas and 3/12 strictures in the stapler cohort and 2/17 fistulas with 0/17 strictures in the hand-sewn cohort. No statistically significant difference in rate of fistula was observed between each cohort, whereas a trend toward increased rate of stricture (p = .06) was observed in the stapled anastomosis cohort.
Use of circular mechanical stapler appears to be a safe and effective technique at the jejunoesophageal anastomosis for total laryngopharyngeal defects with comparable fistula and stricture rates to grafts that are hand sewn.
Head & Neck 07/2011; 34(5):721-6. · 2.40 Impact Factor
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Archives of otolaryngology--head & neck surgery 07/2011; 137(7):718, 721. · 1.92 Impact Factor
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ABSTRACT: The results of sentinel lymph node biopsy (SLNB) can be useful for staging and deciding on adjuvant treatment for patients with head and neck melanoma. False-negative SLNB can result in treatment delay. This study aimed to evaluate the characteristics and outcome of patients with false-negative SLNB in cutaneous melanoma of the head and neck.
Longitudinal cohort study using a prospective institutional tumor registry.
Academic health center.
Data from 153 patients who underwent SLNB for melanoma of the head and neck were analyzed. False-negative biopsy was defined as recurrence of tumor in a previously identified negative nodal basin. Statistical analysis was performed on registry data.
Positive sentinel lymph nodes were identified in 19 (12.4%) patients. False-negative SLNB was noted in 9 (5.9%) patients, with a false-negative SLNB rate of 32.1%. Using multivariate regression analysis, only examination of a single sentinel lymph node was a significant predictor of false-negative SLNB (P = .01). The mean treatment delay for the false-negative SLNB group was 470 days compared with 23 days in the positive SLNB group (P < .001). The 2-year overall survival of patients with false-negative SLNB was 75% compared with 84% and 98% in positive and negative SLNB groups, respectively (P = .02).
False-negative SLNB is more likely to occur when a single sentinel lymph node is harvested. There is significant treatment delay in patients with false-negative SLNB. False-negative SLNB is associated with poor outcome in patients with melanoma of the head and neck.
Otolaryngology Head and Neck Surgery 06/2011; 145(4):606-11. · 1.72 Impact Factor
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Otolaryngology Head and Neck Surgery 03/2011; 145(3):513-4. · 1.72 Impact Factor
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ABSTRACT: Survival for cancer patients is usually only reported as survival from time of diagnosis. For patients who survive 1 or more years after diagnosis, however, survival probability changes over time and is more accurately depicted by conditional survival. The specific aim of this project was to build a survival regression model and Web-based tool to make individualized estimates of conditional survival for patients with head and neck cancer based on tumor and patient characteristics. Using data from the Surveillance, Epidemiology, and End Results (SEER) database, a prediction modeling tool was built that can estimate prognosis for patients with head and neck cancer who have already survived a period of time after diagnosis. Having more accurate prognostic information may empower both patients and clinicians to make more appropriate decisions regarding follow-up, surveillance testing, and future treatment.
Otolaryngology Head and Neck Surgery 03/2011; 145(1):71-3. · 1.72 Impact Factor
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ABSTRACT: Nasolacrimal tuberculosis is rare. The authors present a young Peruvian-born female with subacute onset of right eye epiphora, isolated right inferior turbinate enlargement, and ipsilateral cervical lymphadenopathy. Turbinate and neck mass incisional biopsies demonstrated histopathological findings consistent with tuberculosis. QuantiFERON-TB Gold-In-Tube testing was positive. Complete resolution of symptoms occurred after dacryocystorhinostomy and 9 months of standard 4-drug antituberculosis therapy. Tuberculosis of the nasolacrimal duct is highly unusual but should be considered in patients with tuberculosis risk factors who present with nasolacrimal obstruction from an inferior turbinate mass.
Ophthalmic plastic and reconstructive surgery 01/2011; 27(5):e129-31. · 0.69 Impact Factor
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ABSTRACT: There is a paucity of outcomes data for patients with lymph node metastasis from cutaneous squamous cell carcinoma of head and neck (SCCHN).
Patients from a tertiary care center with cutaneous SCCHN metastatic to parotid and or cervical lymph nodes were identified. Data were abstracted and analyzed using COX multivariate analysis.
Fifty-one patients (47 men, and 4 women) with a median age of 73 years were identified. Eight patients (16%) had recurrent disease and 11 (22%) were immunosuppressed. Forty patients (71%) received adjuvant radiation therapy. Median overall survival was 23 months (range, 3-148 months). Recurrent disease was associated with higher risk of death (hazard ratio [HR], 2.7; 95% confidence interval [CI] 1.1-6.9) and radiation therapy with reduced risk (HR, 0.18; 95% CI, 0.06-0.54).
Lymph node metastases from cutaneous SCCHN is associated with poor survival.
Head & Neck 01/2011; 33(7):999-1004. · 2.40 Impact Factor
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ABSTRACT: To determine the risk of nodal metastases to the central compartment from differentiated papillary thyroid carcinoma (PTC) relative to known prognostic variables.
A 7-year single-institutional retrospective review.
Tertiary academic center.
A total of 115 patients undergoing central neck dissection (CND) for PTC or follicular variant PTC (FVPTC).
Number, location, and positivity of lymph nodes for malignant disease in the central compartment based on patient age, sex, extrathyroidal extension, and primary tumor size, histologic type, and focality.
Eighty-seven percent of patients had PTC, and 13% had FVPTC. Bilateral (64%) or ipsilateral (36%) CND was performed in patients with PTC. Patients with FVPTC underwent only ipsilateral CND. There was no significant difference in the number of lymph nodes retrieved based on patient age or sex, histologic type of the primary tumor, size or focality, or surgeon or pathologist. Seventy-eight percent of patients with PTC had malignant lymph nodes in the ipsilateral (75%) or bilateral/contralateral (69%) central compartment. Ipsilateral nodal metastases directly correlated with tumor multifocality (r = 0.93; P = .001) and size (r = 0.89; P = .001). Bilateral nodal metastases directly correlated with tumor multifocality (r = 0.92; P = .001) but was independent of size (r = 0.56; P = .001). No malignant lymph nodes were identified in the central compartment of FVPTC.
Malignant central nodal metastases occur with high frequency in PTC but not in FVPTC. The risk of metastases correlated with the size and multifocality of the primary tumor. Additional studies are warranted to determine the extent of CND in patients with and without known multifocal disease and to determine the role of CND in patients with FVPTC.
Archives of otolaryngology--head & neck surgery 07/2010; 136(7):692-6. · 1.92 Impact Factor
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ABSTRACT: We sought to better define the results of anterior skull base surgery in pediatric and young adult patients. We performed a single-institution, retrospective cohort study in a tertiary-care academic cancer center. Between 1973 and 2005, 234 patients underwent anterior skull base surgery at Memorial Sloan-Kettering Cancer Center. Of these, 19 patients were <21 years of age. Surgical indications, findings, and complications were reviewed. Survival outcomes were analyzed using the Kaplan-Meier method and compared with patients >/=21 years old. Nineteen patients <21 years old underwent a total of 20 procedures for lesions of the anterior skull base. Sarcoma was the most common indication for surgery including 6 (32%) patients treated for radiation-induced malignancies. Minor complications were noted with 6 (30%) procedures. There were no major complications and no perioperative deaths. The difference in 3-year recurrence-free (68% versus 59%; p = 0.623) and overall survival (83% versus 66%; p = 0.309) compared with patients >/=21 years old did not reach statistical significance. Anterior skull base surgery is well tolerated in pediatric and young adult patients <21 years of age. Survival is comparable to older patients treated similarly and appears strongly influenced by histology.
Skull Base 03/2010; 20(2):75-81. · 0.66 Impact Factor
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Vikram D Kekatpure,
Jay O Boyle,
Xi Kathy Zhou,
Anna J Duffield-Lillico, Neil D Gross,
Nancy Y Lee,
Kotha Subbaramaiah,
Jason D Morrow,
Ginger Milne,
Scott M Lippman,
Andrew J Dannenberg
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ABSTRACT: Cyclooxygenase (COX)-derived prostaglandin E(2) (PGE(2)) plays a role in the development and progression of several tumor types including head and neck squamous cell carcinoma (HNSCC). Measurements of urinary PGE metabolite (PGE-M) can be used as an index of systemic PGE(2) production. In ever smokers, increased levels of urinary PGE-M reflect increased COX-2 activity. In this study, we determined whether baseline levels of urinary PGE-M were prognostic for ever smoker HNSCC patients. A retrospective chart review of ever smoker HNSCC patients treated with curative intent was done. Fifteen of 31 evaluable patients developed progressive disease (recurrence or a second primary tumor) after a median follow-up of 38 months. There were no statistically significant differences between patients with (n = 15) or without disease progression (n = 16) with regard to stage, site, treatment received, smoking status, and aspirin use during follow-up. Median urinary PGE-M levels were significantly higher in HNSCC patients with disease progression (21.7 ng/mg creatinine) compared with patients without (13.35 ng/mg creatinine; P = 0.03). Importantly, patients with high baseline levels of urinary PGE-M had a significantly greater risk of disease progression (hazard ratio, 4.76, 95% CI, 1.31-17.30; P < 0.01) and death (hazard ratio, 9.54; 95% CI, 1.17-77.7; P = 0.01) than patients with low baseline levels of urinary PGE-M. These differences were most evident among patients with early-stage disease. Taken together, our findings suggest that high baseline levels of urinary PGE-M indicate a poor prognosis in HNSCC patients. Possibly, HNSCC patients with high COX-2 activity manifested by elevated urinary PGE-M will benefit from treatment with a COX-2 inhibitor.
Cancer Prevention Research 11/2009; 2(11):957-65. · 4.91 Impact Factor
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Neil D Gross
Head & Neck 09/2009; 32(3):283-4. · 2.40 Impact Factor
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Archives of otolaryngology--head & neck surgery 08/2009; 135(7):720, 722. · 1.92 Impact Factor
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ABSTRACT: Reconstruction following total laryngopharyngectomy and total glossectomy is quite challenging. Many free flaps are not options for reconstruction of this particular defect because of the large area that requires reconstruction and the size discrepancies of the oral and esophageal stomas. We propose a modified ileocolic free flap for reconstruction of these defects.
We conducted a retrospective chart review.
Two patients underwent a modified ileocolic free flap following total laryngopharyngectomy and total glossectomy. One of these patients was able to tolerate thin liquids by mouth, and 1 patient developed severe trismus limiting oral intake. There were no significant flap-related complications aside from fistula in 3 patients that healed with conservative management.
The modified ileocolic free flap is a viable option for reconstruction following total laryngopharyngectomy and total glossectomy.
Head & Neck 05/2009; 31(9):1215-9. · 2.40 Impact Factor
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Jamie O. Lo BA,
PhD Stephen M. Weber MD,
Peter E. Andersen MD,
Neil D. Gross MD,
Marc Gosselin MD,
Mark K. Wax MD,
Jamie O. Lo,
Stephen M. Weber,
Peter E. Andersen, Neil D. Gross,
Marc Gosselin,
Mark K. Wax
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ABSTRACT: Background.Atelectasis is commonly encountered in patients undergoing rectus abdominus tissue transfer. Primary closure of the anterior rectus sheath may contribute to this process. Augmentation of the closure with mesh may decrease the incidence of Atelectasis.Methods.In this retrospective review 32 patients with preoperative and postoperative augmentation were compared to 23 who had primary closure of the anterior rectus sheath.Results.Augmentation consisted of acellular dermis (25) ormesh (7). Postoperative atelectasis was radiographically detected in: 91% (n = 29) of augmented patients versus 83% (n = 19) of primary closure patients. Major atelectasis in 41% (n= 13) of augmented patients versus 61% (n = 14) of primary closure patients p <.05. The incidence of atelectasis was independent of skin flap size and operative times.Conclusions.The use of acellular dermis or mesh to augment the abdominal wall appears to reduce the high incidence of postoperative atelectasis following rectus-free flap harvest. © 2008 Wiley Periodicals, Inc. Head Neck, 2008
Head & Neck 09/2008; 30(10):1339 - 1343. · 2.40 Impact Factor
