[Show abstract][Hide abstract] ABSTRACT: Sore throat is a common, benign emergency department (ED) presentation; however, peritonsillar abscess (PTA) is a complication that requires aggressive management. Use of systemic corticosteroids (SCSs) in PTA is occurring without clear evidence of benefit. This study examined the efficacy and safety of SCS treatment for patients with PTA.
Randomized, double-blind, placebo-controlled trial.
A controlled trial with concealed allocation and double-blinding was conducted at two Canadian EDs. Following written informed consent, eligible patients received 48 hours of intravenous clindamycin and a single dose of the study drug (dexamethasone [DEX] or placebo [PLAC], intravenously [IV]). Follow-up occurred at 24 hours, 48 hours, and 7 days. The primary outcome was pain; other outcomes were side effects and return to normal activities/diet.
A total of 182 patients were screened for eligibility; 41 patients were enrolled (21 DEX; 20 PLAC). At 24 hours, those receiving DEX reported lower pain scores (1.4 vs. 5.1; P = .009); however, these differences disappeared by 48 hours (P = .22) and 7 days (P = .4). At 24 hours, more patients receiving DEX returned to normal activities (33% vs. 11%) and dietary intake (38% vs 25%); however, these differences were not significant and disappeared by 48 hours and 7 days. Side effects were rare and did not differ between groups (P > .05).
Combined with PTA drainage and IV antibiotics, 10 mg IV DEX resulted in less pain at 24 hours when compared to PLAC, without any serious side effects. This effect is short-lived, and further research is required on factors associated with PTA treatment success.
1b Laryngoscope, 2013.
[Show abstract][Hide abstract] ABSTRACT: We describe a rare case of a fourth branchial cleft cyst that had no identifiable tract. The patient was a 23-year-old man who presented with recurring neck abscesses. After six similar episodes, computed tomography finally demonstrated that the most recent abscess had extended into the thyroid gland, a finding that led to the correct diagnosis. Extensive surgical extirpation of the cyst with an adjacent neck dissection was performed, and the patient remained symptom-free at 25 months of follow-up. The occurrence of a fourth branchial cleft cyst with no clear tract presents a surgical dilemma, as complete dissection cannot be guaranteed. Consequently, such patients are predisposed to recurrence. We propose that definitive management of a fourth branchial cleft cyst with no identifiable tract focus on eliminating the likely embryologically based path of bacterial seeding. This includes a hemithyroidectomy in conjunction with a selective neck dissection to cover all areas where a fourth branchial tract may lie within the neck.
[Show abstract][Hide abstract] ABSTRACT: To review the presentation, workup, and functional outcomes of adult patients diagnosed with lingual thyroid treated by transoral subtotal excision. These results were then used to formulate a management algorithm.
Retrospective chart review (2001-2008).
Tertiary care academic hospital.
All patients diagnosed with a lingual thyroid as an adult were identified in the University of Alberta's head and neck mass database. Charts were reviewed for initial presentation, diagnostic methods, radiographic findings, and treatment and follow-up results.
Transoral subtotal excision of lingual thyroid tissue.
Postoperative swallowing function as measured by pharyngeal residue and aspiration on videofluoroscopic swallowing studies.
Five patients with lingual thyroids meeting the study criteria were identified. All were females aged 29 to 58 years (mean 44 years). Presentations ranged from asymptomatic to acute airway obstruction. Diagnosis was made with flexible nasopharyngoscopy, thyroid scintigraphy, and computed tomography. All patients underwent transoral subtotal excision of their thyroids with either a CO2 laser or electrocautery. Two patients complained of residual symptoms and received adjunctive 131I, which led to symptom resolution. Pathologic evaluation revealed benign thyroid tissue. Swallowing function remained efficacious and safe in all patients, as shown by a lack of aspiration and low pharyngeal residue scores. These results were used to propose a management algorithm for the spectrum of adult-diagnosed lingual thyroid presentations.
Transoral subtotal excision of lingual thyroid glands provides adequate resection of the lesion with good postoperative swallowing function. When appropriate, this is advocated as the treatment modality of choice.
Full-text · Article · Feb 2011 · Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale
[Show abstract][Hide abstract] ABSTRACT: There is mixed evidence regarding the association of perioperative blood transfusion to disease recurrence and mortality in head and neck cancer patients. Moreover, few investigations have examined the effects of leukocyte-depleted (leukodepleted) red cell transfusion. The presented study was undertaken to ascertain whether perioperative transfusion of leukodepleted blood is associated with recurrence and survival in head and neck cancer surgery patients.
The records of all patients having undergone head and neck surgery for malignant disease between October 1996 and October 2002 were reviewed. Hospital, blood bank, and cancer registry database records were reviewed and data were recorded onto a standardized computer spreadsheet. The primary outcome variable was the number of perioperatively transfused units of allogeneic leukodepleted blood. Multivariate analysis and Cox regression methods were employed.
Five hundred twenty patients met the criteria for inclusion in the study. Recurrence and mortality rates were significantly different between transfusion and no-transfusion groups, in favour of the no-transfusion group. In addition to age, T stage, and N stage, multivariate analysis revealed leukodepleted blood transfusion to be an independent predictor of both recurrence (odds ratio 1.6) and survival (hazard ratio 1.5).
Perioperative transfusion of leukodepleted blood is associated with higher recurrence rates and decreased survival in head and neck cancer surgery.
Full-text · Article · Oct 2010 · Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale
[Show abstract][Hide abstract] ABSTRACT: Tumours of the parotid gland are generally managed surgically without reconstruction. The usual long-term outcomes of these techniques are facial scars, asymmetry, and permanent contour deficits. These cosmetic deformities can significantly affect patients' self-image and negatively impact their quality of life. Free tissue transfers have been used increasingly over the past years to improve patients' cosmetic and satisfaction outcomes.
The purpose of this study was to evaluate the cosmetic and symmetry outcomes of patients undergoing free flap reconstruction after parotid surgery.
The study was approved by the ethics review board at the University of Alberta. All patients undergoing total parotid surgery were offered a free flap tissue transfer reconstructive procedure. Seven consecutive patients undergoing the reconstruction option were included in the study. The control group was composed of seven patients who had undergone total parotid surgery without reconstruction. Data regarding demographics, surgical procedure, pathology, and postoperative complications were collected. Facial symmetry was evaluated with questionnaires and laser surface scanning.
There were no statistically significant differences between the two groups with regard to age, sex, timing of surgery, or pathology. The reconstructed patients tended to perceive a better symmetry when compared to the nonreconstructed patients (p = .0014). The reconstructed patients had all experienced a slight volume increase on the operative side compared to the contralateral side, with a mean difference of 4.99% increase in volume. Conversely, the nonreconstructed patients all experienced a notable volume deficit on the operative side compared to the nonoperative side-an average 12.15% volume loss was seen postoperatively. This difference was statistically significant (p ≤ .0001).
Free tissue transfer reconstruction is an effective means of reconstructing postparotidectomy defects in patients for whom facial volume asymmetry is a concern.
Full-text · Article · Oct 2010 · Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale
[Show abstract][Hide abstract] ABSTRACT: To compare minimally invasive parathyroidectomy (MIP) under local anesthesia (MIPULA) to minimally invasive parathyroidectomy performed under general anesthesia (MIPUGA) in terms of postoperative pain, postanesthetic side effects, patient satisfaction, and overall outcome.
Prospective comparative cohort study.
Consecutive consenting patients presenting to a single surgeon's practice were enrolled into MIPULA or MIPUGA groups if inclusion criteria were satisfied. A standard anesthesia and surgical protocol was followed for all included patients. Subjective outcome measurements (pain, overall satisfaction, and other variables) were achieved through questionnaires. Objective outcomes were also measured.
Seventy-four patients were enrolled: 58 in the MIPULA group and 16 in the MIPUGA group. Operative time and hospital stay were significantly shorter in the MIPULA group. Subjectively, the MIPULA group was significantly more ready for discharge versus the MIPUGA group. No significant difference in overall satisfaction between groups was noted. Biochemical cure and conversion (MIPULA to general anesthesia open exploration) rates for our cohort were 100% and 4%, respectively.
MIPULA confers significantly shorter operative time and hospital stay with no significant difference in subjective postoperative pain, patient satisfaction, overall outcome, or cure rate when compared to MIPUGA. Provided that appropriate preoperative localization and surgical experience are present, MIPULA can be offered to patients as a safe and reasonable alternative to MIPUGA.
No preview · Article · Aug 2010 · Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale
[Show abstract][Hide abstract] ABSTRACT: To determine which method of skin incision has superior cosmetic and patient satisfaction outcomes.
Consenting patients undergoing bilateral neck dissection who met the inclusion criteria were prospectively enrolled. Each side of the neck was randomly assigned into one of the following two groups: scalpel incision and electrocautery incision. Cosmetic and patient satisfaction outcomes were collected prospectively with patients and outcome assessors blinded to group assignment. Validated self-report questionnaires and objective scar measures were used.
Nineteen patients met the criteria for inclusion. Analysis revealed no significant differences between groups in terms of cosmetic or satisfaction outcomes. Use of the steel scalpel was found to result in significantly greater incision-related blood loss compared with use of the electrocautery blade.
Steel scalpel or electrocautery may be used to incise the skin of patients undergoing bilateral neck dissection with no difference in cosmetic or patient satisfaction outcome. The steel scalpel yields greater incision-related blood loss compared with the electrocautery blade.
Full-text · Article · Aug 2009 · Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale
[Show abstract][Hide abstract] ABSTRACT: To determine which method of fascial dissection and skin graft reconstruction of radial forearm free flap defects has superior functional and cosmetic outcomes.
Consenting patients undergoing major head and neck operative resection and reconstruction with a radial forearm free flap were prospectively enrolled and randomized into one of the following four groups: (1) suprafascial dissection with meshed graft reconstruction; (2) suprafascial dissection with sheet graft reconstruction; (3) subfascial dissection with meshed graft reconstruction; and (4) subfascial dissection with sheet graft reconstruction. Functional, cosmetic, and tendon exposure outcomes were collected prospectively with patients and outcome assessors blinded to treatment group assignment. Validated self-report questionnaires and objective functional measures were used.
Sixty-two patients met the criteria for inclusion. Analysis revealed that suprafascial dissection with sheet graft reconstruction yielded superior functional, cosmetic, and tendon exposure outcomes.
Suprafascial dissection with sheet graft reconstruction should be offered to patients requiring radial forearm free flap reconstruction of major head and neck defects.
Full-text · Article · May 2009 · Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale
[Show abstract][Hide abstract] ABSTRACT: To evaluate the effectiveness of once-daily lansoprazole in the typical globus pharyngeus patient, who presents with a normal head and neck examination and without other sinister otolaryngologic complaints.
Prospective, randomized, double-blind, placebo-controlled trial.
Outpatient otolaryngology office practice.
After meeting the inclusion criteria, patients were randomized to a 3-month course of either treatment (30 mg lansoprazole daily) or placebo (lactose). All patients were given a medication diary and instructed to take the medication daily on waking. During the office visit, counseling regarding lifestyle modifications for gastroesophageal reflux disease was provided to all patients.
The Glasgow-Edinburgh Throat Scale questionnaire was given prior to treatment and at 1- and 3-month intervals during treatment.
Forty patients were enrolled between June 2005 and December 2006. Nineteen patients were randomized to the lansoprazole treatment arm, whereas 21 were enrolled in the placebo arm. Both groups were similar with regard to age, sex, and smoking history. The globus symptom score improved an average of 6.7 of 70 points in the treatment group and 2.9 points in the placebo group. There was no clinically or statistically significant difference between the two groups at any time point.
The globus pharyngeus patient who presents with a normal head and neck examination and without sinister otolaryngologic complaints does not benefit from once-daily lansoprazole therapy.
No preview · Article · Nov 2008 · Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale
[Show abstract][Hide abstract] ABSTRACT: The purpose of this article is to review and document the differing methods of functional outcome measurements following treatment for oral and oropharyngeal carcinoma.
Articles were identified using the MEDLINE database search engine. The "Methods" sections of relevant articles were then reviewed, and functional outcomes assessment methods were tabulated.
We identified 60 articles published in the last 7 years (2000-2007) that reported on functional outcomes following treatment for oral or oropharyngeal cancer. Twenty-three studies used quality of life questionnaires and 12 used clinical observations to describe function. Swallowing was assessed objectively in 29 studies, with videofluoroscopic swallowing studies as the primary method of assessment. Speech was assessed in only 10 articles, with perceptual analysis used as the primary assessment modality.
Preserving good speech and swallowing function following treatment for oral and oropharyngeal cancer remains an extremely important aspect of cancer care. Nevertheless, there is a clear lack of uniform methods for assessing functional outcomes. We propose that functional outcome studies should include both objective and subjective assessments of swallowing and speech to gain sufficient information on posttreatment function.
Full-text · Article · Mar 2008 · Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale
[Show abstract][Hide abstract] ABSTRACT: To evaluate the use of surgical drains in thyroid surgery.
Randomized, prospective, clinical trial.
Patients were randomized into drain and no drain groups by a blinded observer. Inclusion criteria included all patients presenting for total, hemi-, or completion thyroidectomies. Those with massive goitres or nodules greater than 6 cm were excluded. Fifty-five patients were enrolled in the study. Complications, length of hospital stay, and overall cost were evaluated.
In the no drain group, there was a 1.12-day reduction in hospital stay (p < .01), with no increase in postoperative complications. This translated into a cost savings of $2177 per patient.
Thyroid surgery without the use of a drain decreases the length of hospital stay, with no increase in patient morbidity. The overall cost is significantly reduced.
Full-text · Article · Feb 2008 · Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale
[Show abstract][Hide abstract] ABSTRACT: Mandibular reconstruction continues to challenge most head and neck reconstructive surgeons despite the tremendous advances in surgical and fixation techniques. We recently described the clavipectoral osteocutaneous flap for mandibular reconstruction. This flap encompasses the clavicle and the clavicular head of the pectoralis major with overlying skin.
The purpose of this article is to report our prospective clinical experience with the use of clavipectoral osteocutaneous flap in the reconstruction of oromandibular defects.
Prospective case series.
Five patients with significant mandibular defects underwent reconstruction using the newly described clavipectoral flap. All patients had shoulder range of motion testing preoperatively and at 3 and 6 months postoperatively. Panorex and bone scans were obtained on the seventh postoperative day.
All five flaps survived. The transferred clavicles demonstrated good vascularity on the postoperative bone scans. The shoulder morbidity was minimal, with all patients resuming their preoperative level of activity.
The clavipectoral flap has bone and soft tissue components that are especially suited for composite mandibular defects, but it should be used as a second-line flap owing to the short pedicle and the regular need for vein grafts.
Full-text · Article · Jul 2007 · The Journal of otolaryngology