Otolaryngology- Head and Neck Surgery最新文献

Objective: Our study objectives were to evaluate the relationship between Thyroid Imaging Reporting and Data System (TI-RADS) and Bethesda classification and to compare both TI-RADS and Bethesda classification for the diagnosis of papillary thyroid carcinoma (PTC) within the pediatric population.

Study design: Retrospective case series.

Setting: Academic pediatric hospital.

Methods: A 13-year retrospective review was performed of all pediatric patients undergoing thyroid fine needle aspiration (FNA) and ultrasound at our institution. Demographics, TI-RADS scoring, FNA results, surgical history, and final pathology were collected. High-risk ultrasonography and cytopathology were defined as TI-RADS 3-5 and Bethesda 5-6, respectively. Spearman's rank correlation was determined for TI-RADS and Bethesda classification. Relative risks of high-risk TI-RADS and Bethesda classification for predicting PTC were calculated.

Results: A total of 157 patients (21.7% male, median age at time of FNA 15 years, and range 2.7-21 years) underwent ultrasound and FNA during the study. The Spearman's rank correlation coefficient for TI-RADS compared with the Bethesda classification was 0.41 (P < .001). The relative risk of high-risk TI-RADS scores to predict the presence of PTC was 7.99 (95% CI 1.16-54.90). High-risk Bethesda classification demonstrated a relative risk for predicting PTC of 6.62 (95% CI 4.22-10.41).

Conclusion: In our cohort, there was a moderate correlation between TI-RADS and Bethesda classifications. Patients with a TI-RADS score ≥3 and Bethesda classification 3 or 4 are at intermediate risk for harboring PTC and should be counseled accordingly.

Objective: The prognostic accuracy of the American Joint Committee on Cancer (AJCC) 8th staging system for hypopharyngeal cancer remains uncertain. We aim to assess its survival prediction accuracy and compare it with the 7th edition.

Study design: Retrospective investigation of prospective data.

Setting: Single-institution tertiary referral center.

Methods: A cohort of 200 patients with hypopharyngeal squamous cell carcinoma who underwent surgical intervention as primary treatment between 2007 and 2019 was analyzed. We evaluated overall survival (OS) and disease-specific survival (DSS) using the Kaplan-Meier method and the log-rank test for each AJCC edition. The Akaike information criterion (AIC) was used to assess prognostic prediction performance.

Results: The median follow-up was 67 months (29-100 months). In total, 93% of the patients (N = 186) underwent at least one side of neck dissection. In total, 41% of patients (N = 82) were upstaged as per the AJCC 8th, all resulting from the redistribution of N stage. Survival curves for DSS were better distinguished for stages I, II, and IVb in the AJCC 8th edition, yet an overlap was observed between stages III and IVa. The combination of extranodal extension (ENE) and cervical metastasis level well-differentiated the survival curves for OS and DSS. The AJCC 8th system outperformed the 7th, with lower AIC values for OS (1092 vs 1098) and DSS (654 vs 666).

Conclusion: The AJCC 8th edition improves survival prediction in hypopharyngeal cancer compared to the 7th, especially with the inclusion of ENE status and nodal metastasis classification revisions.

Objective: The aim of our study was to determine the factors influencing the evolution of the total volume and bone volume of free flaps commonly used in head and neck surgery, with a 30-month prospective study, to establish volume change predictions and thus propose a degree of overcorrection to be expected before reconstruction.

Study design: We prospectively included all consecutive free flap.

Setting: Our maxillofacial surgery department between August 2021 and January 2024.

Methods: We collected information on preoperative, per-operative, and postoperative factors, on patients, surgical techniques, and adjuvant treatments. We measured on each postoperative imaging the overall flap volume and bone volume if applicable. Multivariate mixed models were then used to select clinical parameters associated with volume loss.

Results: We included 166 flaps, performed on 155 patients. The mean age was 60.1 ± 15.1 years. A total of 634 imagings were segmented (487 computed tomography [CT] scans, 77%; 147 magnetic resonance imagings [MRIs], 23%). The use of the superior thyroid or lingual veins for venous anastomosis, such as the use of small couplers, resulted in negative volume changes. Predicted bone volumes decreased by 23% at 30 months for deep circumflex iliac artery (DCIA) free flaps, 19% for fibula free flap (FFF), and 38% for scapular system free flap (SFF).

Conclusion: These findings allow us to envisage a volume overcorrection of around 60% for fasciocutaneous or osteocutaneous flaps, and 75% for muscle or osteomuscular flaps. The choice of vein and microsurgical technique seems to have more impact on the evolution of free flap volume than patient characteristics or adjuvant treatments.

Objective: Low-grade parotid malignancies have high overall survival rates; however, controversy remains about the appropriate extent of surgery. We aim to explore the trends in the extent of parotidectomy performed over time in low-grade parotid malignancies in the United States, with a hypothesis that there has been a trend towards less aggressive surgery.

Study design: Retrospective cohort study of all low-grade (grade I) acinic cell carcinoma (ACC) and mucoepidermoid carcinoma (MEC) in the Surveillance, Epidemiology, and End Results (SEER) from 2004 to 2020.

Setting: Geographic areas served by SEER.

Methods: Trends were assessed using Cochran-Armitage tests and logistic regression; Kaplan-Meier survival curves were used to analyze overall and cancer-specific survival, and chi-square tests were used to analyze patient characteristics.

Results: In total, 1288 patients were identified (916 MEC; 372 ACC). Most patients (n = 772, 60%) were non-Hispanic white, with an average age of 50.6 years and had a slight female predominance (1.58:1). Most of the cohort presented with tumor stage T1 or T2 (84%), N0 (90.1%), and M0 (96.9%). Treatment with total parotidectomy decreased significantly (34.6 vs 17.7%, P = .02) whereas sacrificing the facial nerve (FN) slightly decreased (20 vs 15.7%, P = .1). A significant increase in N0 patients (71%-94%, P < .0001) was observed, whereas T staging remained stable (61%-64%, P = .3). Overall, both ACC and MEC had excellent cancer-specific survival.

Conclusion: Over the last 17 years, there has been a significant de-escalation in the extent of parotidectomy for low-grade parotid malignancy in the United States.

Objective: Determine the incidence of cochlear nerve deficiency in pediatric subjects with auditory neuropathy spectrum disorder in the setting of single-sided deafness.

Study design: Retrospective chart review of pediatric subjects with single-sided deafness.

Setting: Single tertiary care institution from January 2014 to October 2019.

Methods: Subjects with unilateral severe-to-profound hearing loss were included if they had both magnetic resonance imaging and auditory brainstem response testing available. The incidence of auditory neuropathy spectrum disorder was assessed based on auditory brainstem response testing, and the incidence of cochlear nerve deficiency was determined from imaging review by a neurotologist. Mean pure tone audiometry at 500, 1000, and 2000 Hz of subjects within the auditory neuropathy spectrum disorder population was calculated.

Results: In total, 103 pediatric subjects were included. The incidence of auditory neuropathy spectrum disorder in this population was 30% (31 subjects). Within this group, 77.4% had cochlear nerve deficiency on imaging (24 subjects) and 22.6% (7 subjects) had normal cochlear nerves. Of the abnormal cochlear nerves, 18 nerves were aplastic and 6 hypoplastic. In subjects with auditory neuropathy spectrum disorder, there was no statistically significant difference in mean pure tone audiometry (P = .579) between ears with normal and deficient cochlear nerves.

Conclusion: There is a high incidence of auditory neuropathy spectrum disorder in pediatric subjects with single-sided deafness, and the majority of ears with auditory neuropathy spectrum disorder also demonstrated cochlear nerve deficiency on imaging. It is imperative to pursue a thorough audiologic and radiographic work-up in this population to fully assess nerve status.

Objective: To investigate the impact of positive end-expiratory pressure (PEEP) titrations or tracheostomy size change (trach change) on ventilation stability in infants with tracheobronchomalacia.

Study design: A retrospective chart review.

Setting: Tertiary care children's hospital from 2015 to 2023.

Methods: A retrospective chart review on ventilator and tracheostomy-dependent patients <1 year of age. Demographics, bronchoscopic findings, and ventilator outcomes within 14 days were recorded. Analysis was performed with chi-square, Fisher's exact, binomial regression analysis, and two-tailed t tests.

Results: Of 71 patients (66% male, median 6.1 months old [interquartile range, IQR, 4.6-7.3]) who underwent 74 initial bronchoscopies, the PEEP titration cohort (n = 37) experienced an improvement (narrower) in 24-hour mean ventilatory ranges (peak inspiratory pressure [PIP] 5.6 pre vs 2.9 post, P = .01; fraction of inspired oxygen [FiO₂] range 5% vs 3%, P = .04), whereas the trach change cohort did not (PEEP 5.9 vs 5.6, P = .8; FiO₂ 10% vs 5%, P = .07). In patients with airway malacia, the PEEP titration cohort had improved PIP ranges postintervention (5.5 vs 3.0, P = .02), whereas the trach change cohort did not (4.4 vs 6.6, P = .13). In patients without airway malacia, trach change correlated with improved PIP (8.4 vs 3.8, P = .04). Repeat bronchoscopy after initial intervention was significantly more common after trach change compared to PEEP titration (22% vs 3%, P = .01).

Conclusion: PEEP titration was associated with improved PIP and FiO₂ ventilatory outcomes with a lower rate of repeat bronchoscopy compared to trach change, suggesting trach change alone may have little impact with greater subsequent interventional needs compared to PEEP titration.

Objective: We assessed correlations between tumor carbonic anhydrase IX (CAIX) staining, as a marker of tumor hypoxia, and CD8⁺ T-cell infiltration in a cohort of patients with advanced laryngeal squamous cell carcinoma undergoing a bioselection approach for definitive treatment.

Study design: Retrospective cohort study.

Setting: Tertiary care hospital.

Methods: Patients with stage III to IV laryngeal squamous cell carcinoma treated under a bioselection paradigm were included. Immunohistochemistry for CD8⁺ T-cells and CAIX was performed. Nonparametric tests and Kaplan-Meier survival analyses were used to compare tumor CAIX status by clinicopathologic variables and CD8⁺ T-cell infiltration and to evaluate the role of CAIX and combination CAIX/tumor infiltrating lymphocytes (TIL) category on survival.

Results: Our cohort included 92 patients (n = 68 [73.9%] supraglottic). No difference in CAIX staining was seen by tumor subsite, stage, and response to induction chemotherapy (all P > .05). Thirteen (14.1%) tumors were CAIX-positive and showed significantly lower CD8⁺ T-cell infiltration than CAIX-negative tumors (18 [0-62] vs 32 [0-399], P = .028). Combination CAIX/TIL category was significantly associated with the likelihood of response (CAIX-/TIL[high] were less likely to respond) and in the group of responders, was predictive of a higher degree of tumor shrinkage (>80%).

Conclusion: CAIX staining correlates with reduced CD8⁺ T-cell infiltration in patients with advanced laryngeal squamous cell carcinoma undergoing bioselection. The combination CAIX/TIL category is associated with the likelihood and degree of response to induction. The utility of CAIX status and other combination immune and hypoxia signatures as a biomarker of induction response and survival merits prospective evaluation.

Objective: This study aims to determine the incidence and prognosis of dysphagia in pediatric patients with true vocal fold (TVF) immobility or hypomobility.

Study design: A single-center retrospective chart review.

Setting: A single-institution tertiary-care center.

Methods: A total of 89 pediatric patients diagnosed with vocal fold hypo/immobility with a modified barium swallow (MBS) performed were examined. Patient demographic information and etiology of vocal fold immobility as well as laterality were reviewed. Changes in MBS findings over time were assessed.

Results: A total of 89 pediatric patients were identified with a mean follow-up of 35.4 months. The most common etiology of TVF hypo/immobility was cardiothoracic surgery (58.4%).Immobility was observed in 80.6% of patients. Patients with unilateral disease were more likely to present with dysphonia than bilateral disease (40.3% vs 9.1%, odds ratio [OR] 6.75, 95% confidence interval [CI] 1.77-44.5, P = .01). MBS results did not vary statistically with respect to laterality, hypomobility versus immobility, or etiology. Of the 33 children who demonstrated aspiration on their initial MBS, 48.5% demonstrated complete resolution over median of 10.5 weeks. Rates of recovery differed only with respect to hypomobility versus immobility (87.5% vs 33.3%, OR 14.0, 95% CI 2.01-286, P = .0133).

Conclusion: Based on the study results, about half of pediatric patients with vocal fold hypo/immobility will have resolution of dysphagia at about 10.5 weeks. This may helpful when deciding on when to obtain follow up imaging/exam on pediatric patients with dysphagia. The only factor that confers improved prognosis is hypomobility when compared to complete immobility.