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Otolaryngology Head and Neck Surgery 06/2011; 146(1):173-4. · 1.72 Impact Factor
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Otolaryngologic Clinics of North America 12/2010; 43(6):ix-x. · 1.65 Impact Factor
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Joseph C Sniezek
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ABSTRACT: This article provides an overview of ultrasound and the techniques for its use by otolaryngologists in diagnosing and treating neck masses and lesions. Head and neck ultrasound is extremely useful in diagnosing neck masses and lesions and in facilitating many procedures that are commonly performed on the head and neck. Although in the past these studies were generally performed by radiologists, clinicians are now able to perform high-quality ultrasound studies and ultrasound-guided procedures in the head and neck. Given the advanced knowledge of head and neck anatomy and disease processes that otolaryngologists possess, head and neck ultrasound offers a logical and valuable extension of the physical examination. Recent improvements in ultrasound resolution, portability, and affordability have provided an excellent impetus for otolaryngologists to incorporate ultrasound into their office and operative practices.
Otolaryngologic Clinics of North America 12/2010; 43(6):1143-7, v. · 1.65 Impact Factor
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ABSTRACT: Free tissue transfer is frequently incorporated into the reconstructive algorithm for a multitude of defects in the head and neck. With the increasing usage of free tissue transfer we undertook to review the most current advances in the field.
PubMed search of all pertinent articles as they related to oropharyngeal reconstruction, flap choice, new technologies and techniques, and outcomes. Articles were chosen based on reviewer selection.
The microvascular committee met and discussed the current important topics in free tissue transfer. A priority list was created and ranked. Topics were assigned to the authors who conducted a narrative review of the literature.
Free tissue transfer has evolved to the point where a limited number of specific flaps are now utilized for most defects. Composite tissue is used to reconstruct composite defects. The coupling device and implantable Doppler are demonstrating a positive impact on flap survival and efficiency. Finally, outcomes in terms of quality of life, swallowing, and return to function have been shown to improve with the use of free tissue transfer.
Free tissue transfer continues to be the reconstructive modality of choice for head and neck defects.
Otolaryngology Head and Neck Surgery 09/2007; 137(2):182-91. · 1.72 Impact Factor
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Journal of Oral and Maxillofacial Surgery 03/2006; 64(2):339-43. · 1.64 Impact Factor
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ABSTRACT: Osteoradionecrosis is a process of dysvascular bone necrosis and fibrous replacement following exposure to high doses of radiation. The poorly vascularized necrotic tissue may cause pain and/or instability, and it cannot resist infection well, which may result in secondary osteomyelitis. When these processes affect the cervical spine, the resulting instability and neurological deficits can be devastating, and immediate reestablishment of spinal stability is paramount. Reconstruction of the cervical spine can be particularly challenging in this subgroup of patients in whom the spine is poorly vascularized after radical surgery, high-dose irradiation, and infection. The authors report three cases of cervical spine osteoradionecrosis following radiotherapy for primary head and neck malignancies. Two patients suffered secondary osteomyelitis, severe spinal deformity, and spinal cord compression. These patients underwent surgery in which a vascularized fibular graft and instrumentation were used to reconstruct the cervical spine; subsequently hyperbaric oxygen (HBO) therapy was instituted. Fusion occurred, spinal stability was restored, and neurological dysfunction resolved at the 2- and 4-year follow-up examinations, respectively. The third patient experienced pain and dysphagia but did not have osteomyelitis, spinal instability, or neurological deficits. He underwent HBO therapy alone, with improved symptoms and imaging findings. Hyperbaric oxygen is an essential part of treatment for osteoradionecrosis and may be sufficient by itself for uncomplicated cases, but surgery is required for patients with spinal instability, spinal cord compression, and/or infection. A vascularized fibular bone graft is a very helpful adjunct in these patients because it adds little morbidity and may increase the rate of spinal fusion.
Journal of Neurosurgery Spine 09/2005; 3(2):159-64. · 1.53 Impact Factor
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ABSTRACT: p63, a member of the p53 family of genes, is vital for normal epithelial development and may play a critical role in epithelial tumor formation. Although p63 has been identified in various head and neck malignancies, a detailed analysis of which of the six isoforms of the p63 gene is present in normal mucosa and head and neck malignancies has not yet been performed. The study analyzed p63 isoform expression on the RNA and protein level in normal, diseased, and malignant mucosa of the head and neck to examine the differential expression of p63 isoforms in head and neck tumors versus adjacent nonmalignant tissue and to identify the predominant p63 isoform expressed in head and neck squamous cell carcinoma (HNSCC).
Three experiments were performed. In experiment 1, p63 expression was analyzed by immunohistochemical analysis in 36 HNSCC specimens and matched normal tissue control specimens harvested from the same patient. Western blot analysis was also performed on matched specimens to confirm the identity of the p63 isoforms that were found. In experiment 2, reverse transcriptase polymerase chain reaction (RT-PCR) analysis was performed on matched normal and tumor specimens to analyze and quantitatively compare p63 isoform expression at the RNA level. In experiment 3, p63 expression was evaluated by immunohistochemical analysis in oral lichen planus, a benign mucosal lesion marked by hyperdifferentiation and apoptosis.
Immunohistochemical analysis, RT-PCR, and Western blot analysis of p63 were performed on HNSCC specimens and matched normal tissue control specimens. p63 expression in oral lichen planus specimens was also examined by immunohistochemical analysis.
In experiment 1, analysis of 36 HNSCC specimens from various head and neck subsites showed p63 expression in all tumors and matched normal tissue specimens (36 of 36). Western blot analyses indicated that dominant negative (DeltaN) isoform p63alpha (DeltaNp63alpha) is the major isoform expressed at the protein level in tumors and adjacent normal tissue. In experiment 2, RT-PCR analyses of 10 matched specimens confirmed that, although all three DeltaNp63 isoforms (DeltaNp63alpha, DeltaNp63beta, and DeltaNp63gamma) are expressed in normal and malignant mucosa of the head and neck, DeltaNp63alpha is the predominant transcript expressed. In experiment 3, immunohistochemical analysis of p63 in the pro-apoptotic condition of lichen planus indicated that p63 is underexpressed as compared with normal mucosal specimens.
Although all three DeltaNp63 isoforms are present in HNSCC, DeltaNp63alpha protein is the predominant isoform expressed in these malignancies. DeltaNp63alpha is also overexpressed in tumors compared with matched normal tissue specimens and is underexpressed in the pro-apoptotic condition of lichen planus. These findings suggest that DeltaNp63alpha plays an anti-differentiation and anti-apoptotic role in the mucosal epithelium of the head and neck, possibly playing a pivotal role in the formation of HNSCC. Currently, DeltaNp63alpha is an attractive target for mechanistic study aimed at therapeutic intervention.
The Laryngoscope 01/2005; 114(12):2063-72. · 1.75 Impact Factor
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ABSTRACT: The objective was to describe a novel technique for reconstructing the cranial vertex without the use of free tissue transfer.
Case report, literature review, and discussion.
A 50-year-old woman presented from a remote Pacific Island community with a 12 x 14-cm, necrotic, grossly contaminated eccrine gland carcinoma of the cranial vertex that extended through the calvarium but did not invade the dura. Following tumor extirpation, the resulting bony defect was 10 x 12 cm in size, with a concomitant scalp defect of 14 x 16 cm. Free tissue transfer was impossible because of severe intimal peripheral vascular disease, posing a challenging reconstructive dilemma. After tumor resection, the bony edges were covered with local scalp flaps and the vacuum-assisted closure device was placed over the wound at a constant setting of -50 mm Hg. The vacuum-assisted closure device was changed three times per week for 3 weeks.
A thick, 1-cm bed of granulation tissue developed over the dura, allowing temporary coverage by a split-thickness skin graft, and the scalp defect decreased in size by approximately 25%. The patient did not develop meningitis, headache, or localized infection as a result of placement of the vacuum-assisted closure device and tolerated the vacuum-assisted closure well. After a requisite period of healing, tissue expanders and calvarial reconstruction will be performed.
Use of the vacuum-assisted closure device is a safe, reliable adjunct in the closure of large cranial defects with exposed dura and offers a novel reconstructive option for complex defects of the head and neck.
The Laryngoscope 07/2004; 114(6):961-4. · 1.75 Impact Factor
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ABSTRACT: Both the epidermal growth factor receptor (EGFR) and the p53 homologue p63 are overexpressed in a significant number of cases of head and neck squamous cell carcinoma (HNSCC). Epidermal growth factor receptor and p63 both possess oncogenic properties, including the potential to increase cell proliferation and antagonize apoptosis. ZD1839 ("Iressa") is an adenosine triphosphate-competitive inhibitor specific to the EGFR tyrosine kinase currently under evaluation as a chemotherapeutic agent in HNSCC. The objective was to investigate whether p63 expression is decreased after treatment of HNSCC cells with ZD1839. Downregulation of p63 by ZD1839 would identify a potential molecular relationship between EGFR signaling and p63 and could provide insight into the mechanism of action of ZD1839.
In vitro examination of p63 expression after ZD1839 treatment.
A human HNSCC cell line, SCC-012, was treated with varying doses of ZD1839. p63 protein and messenger RNA levels were analyzed by Western and Northern blot analyses. The effect of ZD1839 on SCC-012 cell cycle was analyzed by flow cytometric analysis.
In SCC-012 cells there was a dose-dependent decrease in p63 protein and messenger RNA levels over the course of ZD1839 treatment. Levels of phosphorylated MAPK decreased and p27KIP-1 levels increased after ZD1839 treatment. ZD1839 treatment induced a twofold increase in G1-phase cells and a 3.5-fold decrease in S-phase cells consistent with growth arrest.
ZD1839 downregulates p63 expression at the messenger RNA level, suggesting that p63 is a downstream target of EGFR signaling.
The Laryngoscope 07/2003; 113(6):936-9. · 1.75 Impact Factor
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ABSTRACT: p63 is a recently identified homolog of p53 that is found in the basal layer of several stratified epithelial tissues such as the epidermis, oral mucosa, prostate, and urogenital tract. Studies with p63(-/-) mice and analysis of several human autosomal-dominant disorders with germ line p63 mutations suggest p63 involvement in maintaining epidermal stem cell populations. The p63 gene encodes six splice variants with reported transactivating or dominant-negative activities. The goals of the current study were to determine the splice variants that are expressed in primary human epidermal keratinocytes (HEKs) and the biochemical activity p63 has in these epithelial cell populations. We found that the predominant splice variant expressed in HEKs was Delta Np63 alpha, and it was present as a phosphorylated protein. During HEK differentiation, Delta Np63 alpha and p53 levels decreased, while expression of p53 target genes p21 and 14-3-3 sigma increased. Delta Np63 alpha had transcriptional repressor activity in vitro, and this activity was reduced in Delta Np63 alpha proteins containing point mutations, corresponding to those found in patients with Hay-Wells syndrome. Further, we show that Delta Np63 alpha and p53 can bind the p21 and 14-3-3 sigma promoters in vitro and in vivo, with decreased binding of p63 to these promoters during HEK differentiation. These data suggest that Delta Np63 alpha acts as a transcriptional repressor at select growth regulatory gene promoters in HEKs, and this repression likely plays an important role in the proliferative capacity of basal keratinocytes.
Molecular and Cellular Biology 05/2003; 23(7):2264-76. · 5.53 Impact Factor
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ABSTRACT: Inflammatory thyroid disorders encompass a broad spectrum of diseases that are generally self-limited, and relatively easy to diagnose and manage. Autoimmune subtypes are by far the most commonly encountered diagnoses and create the most confusion because of simultaneous overlap and the potential for interconversion among the subtypes. The otolaryngologist will frequently see these disorders and provide valued consultative care and surgical intervention as needed.
Otolaryngologic Clinics of North America 03/2003; 36(1):55-71. · 1.65 Impact Factor
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ABSTRACT: Although the vast majority of thyroid cancers are well-differentiated and carry an excellent prognosis, several rare tumors occasionally involve the thyroid gland and require unique treatment paradigms. Anaplastic carcinoma of the thyroid is an extremely aggressive neoplasm that is generally best managed with surgery followed by a multimodality regimen of radiotherapy and chemotherapy. Squamous cell carcinoma of the thyroid often mimics the clinical course of anaplastic carcinoma and is best treated with aggressive surgery followed by postoperative radiotherapy. Treatment and prognosis of lymphoma of the thyroid varies depending upon the specific pathological subtype, with combination chemotherapy and radiation therapy used primarily. Sarcomas of the thyroid are primarily managed with surgery, although radiation and chemotherapy are indicated in some cases.
Otolaryngologic Clinics of North America 03/2003; 36(1):107-15. · 1.65 Impact Factor
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ABSTRACT: Our goal was to analyze p63 and 14-3-3sigma expression in normal and hyperdifferentiated head and neck mucosa.
Compare the in vivo expression of p63 and 14-3-3sigma by immunohistochemistry in normal mucosa and oral lichen planus, a benign mucosal lesion marked by hyperdifferentiation and apoptosis.
p63 is underexpressed and 14-3-3sigma is overexpressed in lichen planus on immunohistochemical analysis.
The findings support the hypothesis that p63 plays an antidifferentiation role, whereas 14-3-3sigma plays a prodifferentiation role in the upper aerodigestive tract epithelium. Lichen planus is a valuable model for the study of p63, 14-3-3sigma, and mucosal differentiation. p63 and 14-3-3sigma may be molecular markers for oral lichen planus.
Otolaryngology Head and Neck Surgery 07/2002; 126(6):598-601. · 1.72 Impact Factor
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ABSTRACT: The reconstruction of burns of the face and neck is challenging. Although the treatment of facial burns has traditionally involved skin grafting and local flaps, these modalities often lead to suboptimal functional and aesthetic results. The recent use of tissue expanders and expanded full-thickness skin grafts has improved the ability to reconstruct burn defects of the cervicofacial region. Likewise, advancements in free-tissue transfer techniques such as prefabricated flaps and the use of megaflaps have increased the quality of facial burn reconstruction and offer a new approach to treating massive burns of this region. This paper reviews the most recent techniques and opinions of reconstructive surgeons involved with the care of cervicofacial burns. Curr Opin Otolaryngol Head Neck 2000, 8:277-281 © 2000 Lippincott Williams & Wilkins, Inc.
Current Opinion in Otolaryngology & Head and Neck Surgery 07/2000; 8(4):277-281. · 1.83 Impact Factor
