Dan Fliss

Dan Fliss
Ministry of Health (Israel) · Department of Otolaryngology-Head and Neck Surgery

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398
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Publications

Publications (398)
Article
Background: The presence of cervical lymph node (LN) metastasis at the initial presentation of papillary thyroid carcinoma (PTC) constitutes an independent risk factor for disease recurrence, increases the risk for mortality, and impacts overall outcome. The 2016 American Joint Committee on Cancer raised the age cutoff for PTC staging from 45 to 5...
Article
Background Masticator space involvement in oral cavity squamous cell carcinoma (OCSCC) is considered an unresectable disease. Nevertheless, achieving negative resection margins is feasible in limited masticatory space involvement. Materials and Methods A multi-institutional study on OCSCC patients with masticator space invasion who underwent surgi...
Article
Background: After diagnosing well-differentiated thyroid cancer (WDTC), assessment of the risk for disease-specific recurrence is essential for deciding between hemi-thyroidectomy (HT) and total thyroidectomy (TT). The American Thyroid Association (ATA) 2015 guidelines suggest that patients with 1-4 cm WDTC without suspicious features may be suita...
Article
Background Tracheal invasion in thyroid cancer is a well-known form of advanced disease. There is an ongoing controversy over outcomes of tracheal shaving in this situation. The aim of this study was to compare the results of tracheal shaving to radical resections in patients with low-volume tracheal involvement.Methods An institutional case series...
Article
Full-text available
Objective The presence of clinically detectable papillary thyroid carcinoma (PTC) metastases in the lateral neck is an indication for neck dissection (ND) and thyroidectomy. Although there is a consensus regarding the importance of therapeutic selective ND of involved levels II to IV in patients with clinically evident locoregional metastatic disea...
Article
Objectives Advanced cutaneous squamous cell carcinoma of the head and neck (CSCCHN) is associated with poor outcome despite multimodality therapy. Comprehensive risk stratification may pinpoint the most suitable adjuvant treatment. This study aimed to evaluate the outcomes of surgically treated locoregional CSCCHN and to identify prognostic indicat...
Article
Full-text available
PurposeThe skull base inventory (SBI) was developed to better assess health-related quality of life (HR-QOL) in patients with anterior and central skull base neoplasms treated by endoscopic and open approaches. The primary objective of this study was to prospectively assess the psychometric properties of the SBI.Methods This study is part of a mult...
Article
Full-text available
Objective Lateral and central compartments cervical lymph nodes metastases are common among patients with papillary thyroid carcinoma (PTC). Elective level VI neck dissection during thyroidectomy and lateral neck dissection (LND) for the treatment of PTC with lateral compartment lymph node metastases is controversial because of the uncertain benefi...
Article
Background The risk for occult neck nodal metastasis in carcinoma of the parotid gland is inconclusive. Therefore, addressing a negative neck prophylactically and the extent to do so remain controversial. This systematic review aimed to determine the rate of occult nodal metastasis for each neck level, and consequently, to elucidate the proper exte...
Article
Objectives/hypothesis: The effects of different electrocautery power settings on mucosal contraction and margin status in the oral cavity have not been well established. The aim of this study was to examine how different levels of electrocautery energy outputs affect oral mucosal tissue margins. Study design: Animal model. Methods: A model of...
Article
Background: The free fibula flap is commonly referred to as a "workhorse" for head and neck reconstruction. During our 21-year experience with this flap, we have performed several changes in preoperative planning, operative technique, and postoperative follow-up. Patients and methods: A retrospective cohort study designed to analyze the cohort o...
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Full-text available
Background: The global incidence of thyroid cancer (TC) has risen considerably during the last three decades, while prognosis is generally favorable. We assessed the long-term all-cause mortality in TC survivors compared to the general population, and its association with cardiovascular risk factors. Methods: Individuals diagnosed with TC during 2...
Article
Objectives Despite its technical feasibility, anterior skull base surgery still carries the risk of severe postoperative complications, morbidity, and mortality. The reported rate of complications has diminished over the past two decades, but they continue to pose various challenges. This study aims to report late complications in a relatively larg...
Article
Background The diagnostic yield of core needle biopsies (CNB) in cervical lymphadenopathy for lymphoma diagnosis is controversial. The aim of this study was to calculate the accuracy of cervical CNB in diagnosing lymphoma. Methods We conducted a meta‐analysis of all studies on patients presenting with cervical lymphadenopathy and referred to CNB....
Article
Objectives Reconstruction of surgical defects by free tissue transfer following resection of head and neck tumors in children are sparse. This study aims to assess the feasibility and safety of free flap reconstruction following surgical ablation of head and neck and skull base tumors in children based on our experience and the recent literature....
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Full-text available
The 2019 novel coronavirus (SARS-CoV-2) and the disease it causes - coronavirus disease 2019 (COVID-19) have rapidly swept across the world since the first known human manifestation on December 8, 2019 in Wuhan (Hubei Province, China)1,2. The epidemic of the COVID-19 has presented as a grim and complex situation, causing great impact on economy and...
Article
Importance Peristomal pathologies in tracheostomized children are common and often difficult to treat. They may preclude decannulation even after the initial pathology that required tracheostomy had been resolved. Objective We evaluated the safety and effectiveness of combined direct laryngoscopy and trans-stomal endotracheal surgery in the treatm...
Article
Introduction Direct laryngoscopy in children is usually performed with spontaneous ventilation and monitored by pulse oximetry. It is currently unknown if spontaneous ventilation has an effect on cerebral oxygenation. We hypothesized that cerebral oxygenation may be impeded during direct laryngoscopy with spontaneous ventilation in children. Objec...
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Full-text available
Purpose of review: To provide an overview of the feasibility and safety of current minimally invasive remote-access approaches for thyroid surgery, in view of the amounting new challenges and paradigm shifts in the management of thyroid pathologies. Recent findings: Over the past two decades, several remote-access approaches for thyroid surgery...
Preprint
Full-text available
Background: The global incidence of thyroid cancer (TC) has risen considerably during the last three decades, while prognosis is generally favorable. We assessed the association between long-term all-cause mortality and cardiovascular risk factors in TC survivors compared to the general population. Methods: Individuals diagnosed with TC during 2001...
Preprint
Full-text available
Background: The global incidence of thyroid cancer (TC) has risen considerably during the last three decades, while prognosis is generally favorable. We assessed the long-term all-cause mortality in TC survivors compared to the general population, and its association with cardiovascular risk factors. Methods: Individuals diagnosed with TC during 20...
Preprint
Full-text available
Background: The global incidence of thyroid cancer (TC) has risen considerably during the last three decades, while prognosis is generally favorable. We assessed the long-term all-cause mortality in TC survivors compared to the general population, and its association with cardiovascular risk factors. Methods: Individuals diagnosed with TC during 20...
Article
Full-text available
Introduction Isolated nasal obstruction (INO) is a common complaint of multiple etiology. The preoperative evaluation of patients presenting with nasal obstruction and deviated nasal septum (DNS) does not typically include imaging. The benefits of performing computed tomography (CT) in the preoperative setting are inconclusive. Objective Assessing...
Article
Objectives/Hypothesis To describe the histopathology of the invasion patterns of advanced‐stage external auditory canal (EAC) squamous cell carcinoma (SCC). Study Design Retrospective cohort study. Methods Retrospective analysis of medical records of patients diagnosed with EAC SCC available at the Massachusetts Eye and Ear temporal bone (TB) coll...
Article
Purpose Acute supraglottitis (SG) can potentially lead to rapid airway obstruction. The last few decades have witnessed a shift towards a more conservative approach in airway management of adult SG. This study aims to evaluate this watchful approach based on a large case series combined with a high-level meta-analysis of all reports in the English...
Article
Background: The treatment of patients with advanced head and neck cancers requires an extensive oromandibular and craniomaxillofacial resection in many cases. The reconstruction after these extensive resections presents many challenges to the reconstructive surgical team. The purpose of the reconstruction is not only to rehabilitate the physical f...
Article
Objectives Reconstruction after open surgery of anterior skull base lesions is challenging. The fascia lata graft is our workhorse for achieving dural sealing and preventing cerebrospinal fluid leak and meningitis. This study seeks to analyze the donor and recipient site complication rates after fascia lata reconstruction. Methods This is a retrosp...
Article
Objectives: To prove that temporal bone tegmen attenuation in patients with idiopathic intracranial hypertension (IIH) is progressive. Study design: Retrospective blind study at a tertiary academic medical center. Methods: Enrolled were medical records of patients with IIH that included at least two sequential computed tomography (CT) scans. T...
Chapter
Treating malignant tumors of the anterior skull base (ASB) is a challenging task, given their late presentation, diverse histology, and involvement of an intricate anatomical space requiring complex surgery. Advances in imaging, gradual refinement of surgical and reconstruction techniques, and improvement of perioperative care during recent decades...
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Full-text available
The necessity to routinely carry out histopathologic examinations of surgically removed polyps in patients with chronic rhinosinusitis with bilateral nasal polyps (CRSwNP) is uncertain. The aim of this study was to describe the histopathology of polyps from a large series of patients who underwent endoscopic sinus surgery for CRSwNP and the rate of...
Article
Objectives To study optimal head position after intratympanic steroid injections to enhance drug bioavailability. Study Design Application of virtual and in vitro models of the intratympanic anatomy. Setting The surgical 3-dimensional printing laboratory of a tertiary academic medical center. Subjects and Methods A high-resolution computerized t...
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Purpose Acute supraglottic laryngitis (ASL) is manifested by supraglottic inflammation that has the potential for rapid and fatal airway obstruction. Complete/incomplete vocal fold immobility (VFIm) in the setting of ASL may contribute to airway obstruction. The rate of VFIm complicating ASL is not known, and it is not clear whether its occurrence...
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Full-text available
Purpose The endoscopic endonasal approach is increasingly being used for resection and reconstruction of anterior skull base lesions. The vascularized nasoseptal flap (NSF) has become the workhorse for reconstruction of anterior skull base defects, resulting in a significant decrease in the incidence of cerebrospinal fluid (CSF) leak. This study pr...
Article
Background: The aims of this study were to report our center's experience with infratemporal fossa (ITF) tumors, to review the treatment modalities and outcomes. Methods: Data of patients that underwent resection of ITF tumors in a single tertiary referral medical center were collected and analyzed. Results: Sixty-three patients were included....
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Full-text available
Objective To report a simple and novel method for intra-operative planning of fibula free flap reconstruction by means of a balsa wood (BW) model. Study design Retrospective chart review. Methods Between 2010 and 2015, 29 patients underwent mandibular reconstruction by a BW osteotomy design in which a single BW beam (US$4) is cut into segments to...
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Full-text available
Purpose To compare short- and long-term quality of life (QOL) scores in patients undergoing mandibular resection and reconstruction. Materials and methods All the patients who underwent resection and reconstruction of the mandible between 2000 and 2015 at a large tertiary center were retrospectively reviewed. Their QOL was measured by the Universi...
Article
Background: Marfan syndrome (MFS) is a genetic disorder affecting connective tissue. The composition of the dura can change. Consequently, lumbo-sacral dural herniations and cerebrospinal fluid (CSF) leaks are encountered, however, they have yet to been described in the temporal bone. Aims/Objectives: To define the prevalence of temporal bone menin...
Article
Pediatric skull base and craniofacial surgery presents a unique challenge since the potential benefits of therapy must be balanced against the cumulative impact of multimodality treatment on craniofacial growth, donor-site morbidity, and the potential for serious psychosocial issues. Skull base reconstruction using locoregional flaps or free flaps...
Article
The purpose of this study was to identify the factors that impact the quality of life (QOL) scores of patients undergoing mandibulectomy. All patients with a diagnosis of an oral cavity neoplasm involving the mandible who underwent a mandibulectomy between January 1, 2000 and December 31, 2015 and completed a University of Washington QOL questionna...
Article
Background We aimed to investigate whether depth of invasion (DOI) should be an independent indication for postoperative radiotherapy (PORT) in small oral squamous cell carcinomas (SCC). Methods Retrospective analysis of DOI (<5, 5 to <10, ≥10 mm) and disease‐specific survival (DSS) in a multi‐institutional international cohort of 1409 patients wi...
Article
Objectives To present our method of median anterior skull base (ASB) reconstruction using a subcranial approach with a free flap in cases of naso-fronto-orbital (NFO) bony segment failure and in patients at high risk for future failure of the bony frontal segment. Design This study presents as a retrospective case series. Setting Tertiary universit...
Article
Background The prognostic value of the first posttreatment whole body integrated positron emission tomography‐computed tomography (PET/CT) scanning in patients with sinonasal/skull base malignancies is undetermined. Methods We retrospectively reviewed the data of all patients that underwent surgery for sinonasal/skull base malignancies in 2000‐201...
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Full-text available
PurposeVentilation tubes (VT) in the tympanic membrane expose the middle ear (ME) to the external auditory canal and its content. It carries the risk of penetration of contaminated material and could provide a pathway for the delivery of drugs into the ME. The aim of this study was to use a printed 3D-model of the external auditory canal (EAC) and...
Article
Objective: Myxedema coma is a serious complication of hypothyroidism that can be precipitated by major surgery. It is extremely rare, with only a few reports in the literature. This study aims to present a relatively large case series of post-surgical myxedema coma and to analyze medical and surgical risk factors. Methods: Analysis of the patien...
Article
Objectives/Hypothesis Anterior skull base operations pose the risk for postoperative cerebrospinal fluid (CSF) leak. Routine lumbar continuous drainage catheter (LD) placement is intended to decrease CSF leaks and central nervous system (CNS) complications, but there are no sound evidence‐based data on its efficacy. The primary goal of this study w...
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Full-text available
Introduction The impact of the dimensional parameters of the pharyngeal bony frame by its length, width and the position of the hyoid upon the severity of obstructive sleep apnea syndrome (OSAS) has not been investigated in depth. Interactions of those parameters with body mass index (BMI) and their overall reciprocal effect on OSAS severity have a...
Article
Background: Direct laryngoscopy and rigid bronchoscopy are currently performed using 2-dimensional endoscopic systems. Our objective was to determine whether a 3-dimensional endoscopic system can enhance visualization of the surgical field in pediatric direct laryngoscopy and rigid bronchoscopy. Methods: A prospective cohort study was conducted....
Article
BACKGROUND Up to half of patients with oral cavity squamous cell carcinoma (OCSCC) have stage I to II disease. When adequate resection is attained, no further treatment is needed; however, re‐resection or radiotherapy may be indicated for patients with positive or close margins. This multicenter study evaluated the outcomes and role of adjuvant tre...
Article
Objective: To discuss the clinical implications of the association between temporal bone tegmen dehiscence (TD) necessitating surgical correction and the adjacent dehiscent superior semicircular canal (SSCD). Study design: Retrospective. Setting: Tertiary referral center. Patients: Sixteen patients with idiopathic TD, with or without SSCD, r...
Article
Abstract Background Sorafenib improves progression-free survival in patients with progressive radioactive iodine-refractory differentiated thyroid carcinoma, but causes severe side effects. Estrogens may accelerate thyroid carcinoma cell growth. Our group recently reported that isoflavone derivative 7-(O)-carboxymethyl daidzein conjugated to N-t-bo...
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Full-text available
Background: The purpose of this study was to investigate the association between isolated serous otitis media (SOM) and/or conductive hearing loss (CHL) and nasopharyngeal carcinoma (NPC) in a low-to-intermediate endemic area. Methods: Medical records of all adult patients (≥17 years) with SOM/CHL who underwent endoscopic-guided nasopharyngeal b...
Article
Introduction The steady increase in average life expectancy has led to a rise in the number of referrals of elderly patients for major operations. It is not clear whether age itself is a risk factor for morbidity and mortality after skull base operations. We investigated a possible link among a cohort of patients older than 80 years of age who unde...
Article
Full-text available
Aim: Solitary cystic masses of the lateral neck in an adult patient can pose a diagnostic dilemma. Malignancy must be ruled out since metastases arising from H&N cancers may mimic the presentation of benign cystic masses. Only a small number of studies have investigated the diagnostic management and malignancy rate of clinically benign solitary ce...
Article
Introduction Skull base lesions in children and adolescents are rare, and comprise only 5.6% of all skull base surgery. Anterior skull base lesions dominate, averaging slightly more than 50% of the cases. Until recently, surgery of the anterior skull base was dominated by open procedures and endoscopic skull base surgery was reserved for benign pat...
Article
Juvenile angiofibroma (JA) is a benign, highly vascular tumor which is diagnosed on the basis of clinical and imaging features. It has a characteristic pattern of spread commonly involving the pterygopalatine fossa and pterygoid base. The mainstay of treatment is surgery, while radiotherapy is rarely used for the treatment of recurrent lesion. Endo...
Article
Objective The endoscopic endonasal approach is being increasingly used for the resection and reconstruction of anterior skull base (ASB) lesions. Vascularized nasoseptal flaps (NSF) have become the workhorse for the reconstruction of ASB defects, resulting in a significant decrease in the incidence of cerebrospinal fluid (CSF) leaks. The objective...
Article
Introduction Pediatric skull base and craniofacial reconstruction presents a unique challenge since the potential benefits of therapy must be balanced against the cumulative impact of multimodality treatment on craniofacial growth, donor-site morbidity, and the potential for serious psychosocial issues. Objectives To suggest an algorithm for skull...
Article
Full-text available
Background Chordoma is a rare bony malignancy known to have a high rate of local recurrence after surgery. The best treatment paradigm is still being evaluated. We report our experience and review the literature. We emphasize on the difference between endoscopic and open craniotomy in regard to the anatomical compartment harboring the tumor, the li...
Article
Full-text available
The prognosis and recurrence rate of inverted papilloma (IP) with concomitant cellular dysplasia are not well-delineated. Demographic, clinical and imaging data of all patients who were surgically treated for sinonasal inverted papilloma (SNIP) in our center between 1996 and 2013 were reviewed. Data regarding the coexistence of dysplastic changes o...
Article
Background: The use of bisphosphonates is very common among patients with osteoporosis and multiple myeloma as well as those with bone metastases from various malignancies. The benefits of bisphosphonates are well recognized, but it became evident during the past decade that these medications portend the major adverse effect of osteonecrosis of th...
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Full-text available
Purpose of Review Treating malignant tumors of the anterior skull base (ASB) is a challenging task, involving complex surgery in an intricate anatomical space. The effective treatment of ASB tumors requires careful pretreatment evaluation and preoperative surgical planning by the skull base surgical team. Recent Findings Review of the available li...
Article
Importance: The elective management of no clinical or radiologic evidence of lymph node metastasis in the neck (cN0) in early stage T1-T2 oral tongue squamous cell carcinoma (OTSCC) has been the subject of much debate during the past 3 decades and continues to be controversial. Objective: To systematically review the literature and carry out a m...
Article
Objective: Informed consent is an important part of the surgical process. Based on our clinical experience, we hypothesized that parents providing consent for their children's tonsillectomy do not comprehend all the information that is given to them by the operating surgeon at the time of a conventional consent process. Materials and methods: Pa...
Article
Objective: To evaluate the accuracy and utility of intraoperative frozen section examination (iFSE) in patients with a preoperative fine-needle aspiration (FNA) cytology of "suspicious for malignancy" (SFM)-Bethesda V, after the adoption of the Bethesda System for Reporting Thyroid Cytopathology. Study design: Case series with chart review. Set...
Article
Whether initial clinical presentation and thyroid ultrasound (US) referral indications can significantly predict malignant/suspicious for malignancy (Bethesda V/VI) thyroid US-guided fine-needle aspiration (USG-FNA) cytology results is unknown. Between 1/2010-5/2014, we performed 705 thyroid USG-FNA biopsies according to American Thyroid Associatio...
Chapter
Since the developments and popularization of modern skull base approaches through the twentieth century, surgical extirpation of tumors has become the mainstay of treatment for both benign and malignant diseases. Open and endoscopic approaches allow intradural and extradural tumor resection, and they can be performed in a single procedure that also...
Chapter
The subcranial approach is a single-stage open procedure for patients with tumors involving the anterior skull base. It is also known as the subfrontal or the transglabellar approach. The concept of a broad subcranial approach to the entire anterior skull base was first introduced by Raveh for cases of traumatic injuries and was later adapted for s...
Chapter
Conventional open transfacial approaches involve various skin incisions and osteotomies of the maxillary, frontal, and ethmoidal bones. The exposure of the suprastructure of the maxilla involved lateral rhinotomy incision, whereas suprastructure maxillectomy and infrastructure maxillectomy are performed via Weber-Ferguson incisions. Lynch incision...
Chapter
In recent decades, technological advances in clinical diagnosis, preoperative imaging, neurophysiological monitoring, intraoperative microscopy, and multispecialty surgery employing minimally invasive techniques and guidance have advanced the frontiers of the management of skull base pathologies. Current therapeutic techniques include surgical rese...
Chapter
The parapharyngeal space (PPS) is a potential space between the skull base above and the hyoid bone below. It has an inverted teepee shape. Its borders include the nasopharynx and oropharynx medially, the masticator space anterolaterally, the deep lobe of the parotid gland posterolaterally, and the retropharyngeal space posteromedially. The PPS can...
Chapter
The skull base is located in a confluence of vital anatomical structures that affect our ability to perform safe and efficacious surgery. Generally, the skull base can be divided into four parts: anterior, lateral, posterior, and central. Traditionally, tumors located in each of these compartments were approached by different open approaches, neces...
Chapter
The translabyrinthine (TL) approach is the most direct course to the internal auditory canal (IAC) and cerebellopontine angle (CPA). It was described as a route for removing vestibular schwannomas as early as the beginning of the twentieth century, in the early days of surgical treatment of this pathology, but the procedure was established as one o...