Kerr Paul Mark Taylor S. Rigby Matthew Myers Candace Osborn Heather Lambert Pascal Sutherland Donna Fung Kevin

AbstractObjective:To compare the laryngeal preservation rates and voice outcomes after treatment of early glottic cancer between transoral laser microsurgery (TLM) and radiotherapy (RT).Design:Multicenter, retrospective consecutive cohort of stage 1 and 2 glottic carcinoma treated with TLM or RT.Setting:Three Canadian academic cancer centres.Methods and Main Outcome Measures:The patients were those of the regional cancer registries associated with each of the participating universities between 2002 and 2010. The primary oncologic end point was organ preservation. The primary functional outcome measure was the Voice Handicap Index (VHI-10).Results:A total of 234 patients were treated for early glottic cancer (143 TLM, 91 RT). At 2 years, the laryngeal preservation rate for stage 1 disease was 100% TLM and 92% RT (p < .004); for stage 2 disease, it was 100% TLM and 88% RT (p  =  not significant). There was only one laryngectomy in the TLM group over 5 years posttreatment. There were functional data on 132 patients (83 TLM, 49 RT). Median VHI-10 scores were inferior for laser patients at all three time intervals (6, 12, and 24–48 months posttreament) despite a stage bias in favour of TLM (range of median VHI score over time intervals: TLM  =  9.5–12, RT  =  3.5–8; p  =  .01–.08). However, theses scores represent mild disability in both groups.Conclusions:TLM patients have poorer voice quality than RT patients. However, the advantages of TLM in most patients outweigh the degree of voice handicap. Organ preservation rates for TLM were better than or equal to those of RT for both stage 1 and 2 glottic cancer.

Beesley Richelle Rieger Jana Compton Sharon Parliament Matthew Seikaly Hadi Wolfaardt Johan

AbstractObjective:Advanced radiotherapy (RT) such as intensity-modulated radiotherapy (IMRT) has become more common in the management of head and neck cancer (HNC). IMRT includes focused target volume coverage while sparing salivary tissues to protect function. However, the long-term effects on dentition after IMRT are not well established. This investigation sought to understand dental status by comparing tooth loss after IMRT and conventional RT in HNC patients.Methods:A retrospective chart review was conducted on individuals who received IMRT or conventional RT (± surgery, ± chemotherapy) for oropharyngeal, oral cavity, and nasopharyngeal cancer between 2000 and 2010 at the Institute for Reconstructive Sciences in Medicine. Tooth loss, the primary outcome measure, was assessed using intraoral photographs, radiographs, and clinical records. The influence of patient demographics on tooth loss was assessed as well.Results:Eighty-six patients were eligible for review at baseline; 44 received IMRT and 42 received conventional RT. Twenty-four had data collected up to 2 years after RT. After adjusting for baseline number of teeth, no significant differences were found between groups 2 years after RT using repeated measures analysis of covariance (p  =  .079). The site of disease was significantly different between groups.Conclusion:No statistically significant differences in tooth loss between RT groups were found 2 years after RT; however, trends in the data suggest that tooth loss increased each year after RT. The early findings need to be viewed with caution as data beyond 3 to 5 years and a larger sample size are needed to understand the dental effects after advanced RT.

Vaz Jason Côté David Rizk Nabil Seikaly Hadi Harris Jeffrey

AbstractBackground:The utility and safety of level VI central compartment lymph node dissection (LND) for the early detection of lymph node (LN) involvement during diagnostic hemithyroidectomy, for the evaluation of suspicious thyroid nodules, has yet to be established in the literature.Methods:A retrospective review of all patients who underwent diagnostic hemithyroidectomy with level VI LND from a large head and neck oncology program from October 1, 2001, to May 10, 2009, was performed.Results:A consecutive series of 78 patients were reviewed. Twenty-six patients (29.8%) were diagnosed with malignant neoplasm. All patients with malignant LNs (n  =  5; 6.4%) were diagnosed with papillary carcinoma. On average, 4.8 LNs were found through neck dissection in patients with positive nodes compared to 2.4 LNs in those without lymph node involvement (p  =  .04). No postoperative adverse events in the patient group were attributed to the level VI neck dissection.Conclusions:In patients undergoing diagnostic hemithyroidectomies, routine level VI LND was able to identify LN metastases in 6.4% of patients. The number of LNs was a strong predictor of positive node disease. Minimal surgical risks are associated with this procedure, and surgeons may avoid the risks of level VI reexploration in subsequent completion thyroidectomy.

Tülin Kayhan Fatma Hakan Kaya Kamil Altıntas Ahmet Fırat Pınar Sayin Ibrahim

Shakeel Muhammad Steele Peter Kamel Mahmoud Hussain Akhtar

Nhan Carol Dolev Yalon Mijovic Tamara Rivera Juan A. Kallai-Sanfaçon Mary-Ann Mlynarek Alex M. Payne Richard J.

AbstractObjective:To determine whether patients with vitamin D deficiency (VDD) are at increased risk for hypocalcemia following total thyroidectomy.Methods:A retrospective study of 246 consecutive patients undergoing thyroidectomy at a McGill University teaching hospital was conducted. Patients who had subtotal thyroidectomy or concomitant parathyroidectomy or whose laboratory tests were incomplete for analysis were excluded, as were pediatric patients. The remaining 139 patients had preoperative 25-hydroxyvitamin D [25(OH)D], corrected calcium, and parathyroid hormone (PTH) measured. Postoperatively, PTH and serum calcium were measured to assess for hypocalcemia. Low vitamin D (LVD) was defined as 25(OH)D ≤ 70 nmol/L (≤ 28 ng/mL), which includes vitamin D insufficiency, 25(OH)D > 35 nmol/L (> 14 ng/mL) but ≤ 70 nmol/L (≤ 28 ng/mL), and VDD, 25(OH)D ≤ 35 nmol/L (≤ 14 ng/mL). Adequate vitamin D (AVD) corresponded to levels > 35 nmol/L (> 14 ng/mL), whereas optimal vitamin D (OVD) levels corresponded to levels > 70 nmol/L (> 28 ng/mL).Results:The rate of postthyroidectomy hypocalcemia in OVD patients was 10.4% (8 of 77) compared to 3.2% (2 of 62) in LVD patients (odds ratio  =  0.29, p  =  .10). There was no hypocalcemia in the 9 VDD patients, meaning that all hypocalcemic episodes occurred in patients with AVD (7.7%; 10 of 130). The mean preoperative PTH levels for LVD patients was 4.65 pmol/L (43 ng/L) compared to 4.18 pmol/L (38.9 ng/L) for OVD patients (p  =  .073).Conclusions:In this series, preoperative LVD did not predict early postthyroidectomy hypocalcemia. On the contrary, it showed a trend toward protective effect. Adaptive changes in the parathyroid glands, such as hypertrophy, hyperplasia, or the ability to secrete more hormone secondary to prolonged VDD, may contribute to this phenomenon. A large prospective study is needed to better understand the relationship between preoperative vitamin D levels and postoperative hypocalcemia.

Hanna Bassem M.N. Kilty Shaun J.

AbstractBackground:Lateralization of the middle turbinate following endoscopic sinus surgery (ESS) can lead to increased patient morbidity. Numerous techniques have been proposed to avoid this complication, including middle turbinectomy, stents, controlled synechiae formation, and metal clips.Objectives:To determine if a suture technique is an effective middle turbinate stabilization procedure and to determine the cost savings of this technique compared to commercially available middle meatal stents.Material and Methods:Retrospective review of 60 cases, all performed by the senior author using a middle turbinate suture technique, and the 3-month postoperative results. The efficacy of the technique was determined, as well as its cost compared to other materials for middle meatal preservation.Results:A total of 110 turbinates were treated with the suture technique in 60 patients. The success rate was 98.2% (108 of 110). Commercial stent use cost ranged from 8 to 83 times the price of the suture depending on the stent.Conclusion:The middle turbinate suture technique is effective in preventing turbinate lateralization and has a significantly lower cost than commercially available middle meatal spacer materials.

Habib Al-Rahim R. Hathorn Iain Sunkaraneni Vishnu S. Srubiski Aviva Javer Amin R.

AbstractBackground:Endoscopic resection of sinonasal inverted papilloma (SNIP) tumours has been shown to reduce intraoperative blood loss and recovery time compared to open approaches.Objective:The purpose of this study was to investigate the incidence and requirements of blood transfusion for endoscopic SNIP surgeries.Study Design:Individual retrospective cohort study.Setting:St. Paul's Sinus Centre, a tertiary referral rhinology centre.Methods:An individual retrospective cohort study of endoscopic SNIP surgeries over a 10-year period was performed. Age, sex, pre-existing comorbidity, use of anticoagulants, tumour type and stage, time of surgery, estimated blood loss, and requirement for blood transfusion were recorded.Main Outcome Measures:Incidence of blood transfusion, type and screen, and crossmatch requisitions.Results:Eighty-two patients were included (57 males, 25 females). Four (5%) stage 1, 7 (8.5%) stage 2, 62 (75.5%) stage 3, and 9 (11%) stage 4 SNIP tumours were identified according to the Krouse staging system. Three (4%) patients required blood transfusion. Three of the nine (33%) stage 4 tumours required blood transfusion. Stage 4 tumours were significantly associated with blood transfusion (p < .05). Higher-staged tumours were associated with greater blood loss (p < .05) than lower-staged cases. No other tumour stage required blood transfusion, and no other preoperative variable was associated with the requirement for blood transfusion.Conclusion:Endoscopic SNIP resections rarely require blood transfusions. No preoperative factor other than tumour stage is associated with the requirement for blood transfusion. We therefore suggest that only stage 4 SNIP tumours require preoperative type and screen testing.

Hu Amanda Sardesai Maya G. Merati Albert L. Fung Kevin

AbstractObjectives:There is no standardized curriculum for laryngology within otolaryngology residency programs despite the fact that laryngology is a significant portion of the Royal College of Physicians and Surgeons of Canada examination. Our objective was to evaluate trainee perceptions of laryngology within otolaryngology residency programs.Design:Cross-sectional survey.Setting:Canadian otolaryngology residency programs.Methods:A Web-based, anonymous survey was conducted among otolaryngology residents. The survey was based on Royal College learning objectives for laryngology. The survey was administered using Dillman's Total Design Method and distributed in English and French.Results:Sixty-four of 150 (42.6%) residents responded to the survey (55.6% male; mean age 29.3 years). About half of the respondents agreed or strongly agreed that the amount of didactic and clinical laryngology instruction was adequate. About 41.0% agreed or strongly agreed that the amount of operative laryngology instruction was adequate. Cited areas for improvement included injection laryngoplasty, botulinum toxin injection, medialization thyroplasty, care of the professional voice, phonosurgery, and videostroboscopy. Areas of strength included flexible nasopharyngoscopy, laryngeal anatomy, hoarseness, stridor, laryngopharyngeal reflux disease, and vocal cord paralysis. Overall, 40.7% felt somewhat comfortable providing laryngology care. The presence of a laryngology fellowship at the training program, respondent interest in pursuing a fellowship, completion of a laryngology elective, and previous laryngology research did not affect the residency experience. Senior residents are more comfortable with providing laryngology care than juniors.Conclusions:Several areas of strengths and areas for improvement in laryngology appear to exist within otolaryngology residency programs as perceived by current trainees.

Yeung Jeffrey C. Fung Kevin Wilson Timothy D.

AbstractObjective:Advancements in technology and personal computing afford the development of novel teaching modalities such as online Web-based modules. These modules are currently being incorporated into undergraduate medical curricula and, in some paradigms, have been shown to be superior to traditional methods of instruction. The purpose of this study was to evaluate the ability of a computer-assisted learning (CAL) module to demonstrate content and spatial information in the context of cranial nerve anatomy.Study Population:Undergraduate anatomy students.Methods:A prospective, randomized, controlled trial was conducted comparing a CAL module to traditional text-/image-based learning supplements. Indications of the participants' ability to translate spatial relationships between the trigeminal nerve and the craniofacial skeleton were assessed via a postintervention knowledge quiz.Results:No significant difference was identified between the CAL module and the control group. Students in both groups performed poorly in questions testing spatial relationships.Conclusions:The CAL module used in the present study did not objectively contribute to the understanding of spatial anatomic relationships of the cranial nerves in novice students. Despite this, these modules may help pique student interest and motivation and, as such, may be used in the context of supplemental learning resources in existing university curricula.

Ramírez-Camacho Rafael Trinidad Almudena Vicente Javier Salas Isabel Roldán Amaya Casares Celia

Akhan Galip Ayik Sibel Songu Murat

AbstractObjective:The aim of the present study was to investigate cerebral hemodynamics in patients with sleep-disordered breathing of variable severity using cerebral near-infrared spectroscopy.Design:Prospective study.Setting:Tertiary training and research hospital.Methods:The study was performed in patients referred for daytime sleepiness, habitual nocturnal snoring, and witnessed apnea spells from October 2009 to March 2010. Full-night polysomnography was coupled with cerebral near-infrared spectroscopy recording.Main Outcome Measures:Cerebral O2 and peripheral capillary O2 saturation indexes were measured before sleep and during different stages of sleep.Results:Thirty-one patients who fulfilled the inclusion criteria were recruited for the study. During wakefulness, mean peripheral capillary O2 saturation was 96.39 ± 1.54% (range 93–99%), whereas mean cerebral O2 saturation was 69.19 ± 6.96% (range 55–86%). Mean peripheral capillary O2 saturation decreased to 80.42 ± 9.73% (range 51–94%), whereas cerebral O2 saturation decreased to 61.91 ± 7.23% (range 45–79%) during sleep. Peripheral and cerebral hemodynamic status during sleep differed significantly in patients with different disease severity. Indeed, peripheral and cerebral O2 saturation levels were lower in patients with severe obstructive sleep apnea compared to those with mild and moderate apneas (p  =  .001 and p  =  .002, respectively).Conclusion:Our data suggest that acute cerebral hemodynamic consequences of sleep-disordered breathing are determined by the duration and type of the respiratory event and that the combination of the two determinants can lead to a failure of cerebral circulatory mechanisms and, eventually, brain tissue hypoxia.