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Publications (4)5.55 Total impact

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    ABSTRACT: We demonstrate indications for external mechanical stapler diverticulectomy in the modern era of endoscopic treatment. We review treatment of a large diverticulum and discuss considerations that should be made in deciding on the type of surgical treatment. The index case was in a 75-year-old man who had undergone open cricopharyngeal myotomy with diverticulopexy 35 years earlier. He presented with 25 years of recurrent symptoms. A swallow study showed a 6.5 x 5.0-cm diverticulum. The diverticulum was deemed too large for standard endoscopic myotomy, so diverticulectomy was performed with a stapler. The patient was discharged on postoperative day 3 without complications. A swallow study on postoperative day 5 demonstrated no diverticulum or extravasation of barium. The patient resumed a normal diet with resolution of dysphagia. Two additional patients with large Zenker's diverticula that were managed similarly are also discussed. Although endoscopic laser cricopharyngeal myotomy and stapler diverticulostomy have become standard treatments for Zenker's diverticulum, this case of a large recurrent diverticulum illustrates a situation in which older techniques may be preferred. Use of the mechanical stapler allowed for a shorter surgery time than traditional suture techniques, and the potential for an earlier return to a normal diet.
    The Annals of otology, rhinology, and laryngology 12/2013; 122(12):729-33. DOI:10.1177/000348941312201201 · 1.05 Impact Factor
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    ABSTRACT: Objective: 1) Demonstrate a novel method to repair a full thickness tracheal wall laceration. 2) Discuss the relationship of this new technique in regard to current accepted methods of treatment reported in the literature. 3) Learn that full thickness tracheal tears, although rare, are possible following routine tracheal balloon dilation. Method: We review a patient's case of symptomatic idiopathic subglottic stenosis. One year after initial dilation, balloon dilation was performed and an 8-cm full-thickness tracheal laceration occurred. We report successful repair with a covered tracheobronchial stent and review the literature relating our repair to other accepted techniques. Results: Following tracheal balloon dilation, staying within recommended limits, a complete tear was identified. Using flexible endoscopy and fluoroscopic guidance the tear was measured to be 8 cm. An 80 × 20 mm covered tracheobronchial stent was deployed into position to overlie the area of tracheal disruption. Intraoperative computed tomography demonstrated minimal air extravasation, thus the patient was extubated. The patient's course was uncomplicated and discharged three days later. Review of current literature demonstrates a variety of repair techniques including soft tissue reconstruction. Our technique is advantageous because it can be done at the time of surgery with excellent outcomes and less morbidity. Conclusion: Endotracheal balloon dilation is an established and safe method to restore airway volume; however full thickness lacerations can occur. This case demonstrates that deployment of an appropriate tracheobronchial stent at the time of surgery is a viable treatment option with low comorbidity. Close postoperative monitoring is vital to successful outcome. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2012.
    Otolaryngology Head and Neck Surgery 08/2012; 147(2 Suppl):P194-P194. DOI:10.1177/0194599812451426a219 · 1.72 Impact Factor
  • Rachel B Cain, April M Landry, Michael L Hinni
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    ABSTRACT: Objective: Recognize hibernoma as an uncommon, benign tumor composed of brown adipose tissue that can occur in the head and neck. Learn the unique radiographic features of this rare tumor, and understand the principles of treatment. Method: A systematic review of the English literature was conducted. In addition, we present a series of 2 laryngeal hibernomas treated with transoral laser microsurgical resection at a tertiary referral center over a period of 18 years. Results: Nineteen cases of hibernoma in the cervicofacial region have been described in the literature. This includes only 2 cases of laryngeal hibernoma ever reported. We present a series of 2 laryngeal hibernomas encountered at our institution. In each case, preoperative imaging demonstrated a well-circumscribed neoplasm with fat density compatible with lipoma, but internal heterogeneity and vascularity seen in the context of liposarcoma. Transoral laser microsurgical resection was successfully completed in each case. Grossly, the tumors had the fatty appearance of a lipoma, however final pathology revealed myxoid hibernoma. Both patients healed well with normal speech and swallowing postoperatively. Conclusion: Hibernoma is a tumor composed of brown adipose tissue. There have been only 2 cases of para-glottic hibernoma reported to date. We report 2 additional cases of laryngeal hibernoma. In our experience, complete resection via transoral laser microsurgery is a safe and effective treatment modality with very little associated morbidity. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2012.
    Otolaryngology Head and Neck Surgery 08/2012; 147(2 Suppl):P163-P164. DOI:10.1177/0194599812451426a122 · 1.72 Impact Factor
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    ABSTRACT: Intraoral exposure to dental restorations can cause contact allergy that may induce carcinogenesis. We investigated the relationship of intraoral metal contact allergy to epithelial carcinogenesis. The prevalence of positive patch test reactions to dental restoration metals in 65 prospectively enrolled patients with newly or previously diagnosed oral squamous cell carcinoma (SCC) was compared to that in 48 control patients. The relative risk of oral SCC was estimated by calculating odds ratios for exposure to dental metals resulting in allergy. Of the 65 patients with oral SCC, 34% were allergic to at least 1 adjacent metal. They were 1.57 times as likely as control patients to have metal contact allergy (odds ratio, 1.57; 95% confidence interval, 0.65 to 3.80) and more than 3 times as likely to react to mercury (odds ratio, 3.20; 95% confidence interval, 0.42 to 33.20). Patients with oral SCC who have metal dental restorations should undergo patch testing and possible removal of the restorations if their reactions are positive.
    The Annals of otology, rhinology, and laryngology 06/2012; 121(6):389-94. DOI:10.1177/000348941212100605 · 1.05 Impact Factor