Search

Objective: To examine the clinical presentation, diagnostic evaluation, and management of Killian–Jamieson diverticula (KJD) through literature review.Methods: A comprehensive literature review was conducted through December 2018 using keywords Killian–Jamieson diverticula/diverticulum. Data extracted included clinical presentation, imaging characteristics, surgical management, and postoperative care.Sources: PubMed and Google Scholar.Results: Sixty-eight cases of KJD in 59 reports (29M:39F; median 58 years old) were identified for review. The most common presentation was dysphagia (n = 39), suspected thyroid nodule (n = 24) and globus (n = 14). The majority of KJD (n = 51) occur on the left, with rare reports of right side (n = 11) and bilateral (n = 5) presentation. Thirty-two cases describe surgical management: 22 utilizing a transcervical approach, with (n = 13) or without (n = 9) cricopharyngeal myotomy; and 10 reported endoscopic surgery. Diverticula managed transcervically averaged 3.8 cm in size in comparison to average 2.8 cm in the endoscopic group. Time to diet initiation after transcervical surgery averaged 4 days versus 2 days after endoscopic surgery. Complications were reported in 2/68 cases; both were diverticula recurrence after endoscopic surgery.Conclusion: Killian–Jamieson diverticula is a rare diagnosis that should be considered in the evaluation of dysphagia, globus, and also suspected thyroid nodule. When patient symptoms warrant intervention, a transcervical approach, with or without cricopharyngeal myotomy, is most commonly utilized. In recent years, an endoscopic approach has been presented as an alternative for smaller diverticula. Further understanding of the optimal treatment and postoperative management for KJD requires larger cohorts.Level of Evidence: 4

Objectives:The primary objective was to identify the incidence of neoplastic disease in patients referred for epistaxis. Secondary objectives included identification of any mass lesion, and the need for further workup with imaging and/or biopsy as well as risk factors associated with identification of a mass lesion. Study Design:Retrospective cohort study. Methods:Medical records of adult patients who presented to Tufts Medical Center over an 11 year period (2010-2021) with a chief complaint of epistaxis were reviewed. The primary outcome was identification of a nasal or nasopharyngeal mass. Patient characteristics including age, sex, race, smoking status, anticoagulation, comorbidities (hypertension, allergic rhinitis, vasculitis), and treatment of epistaxis (used as surrogate for severity of epistaxis) were also examined. Results:A total of 1164 patients met inclusion and exclusion criteria. Thirty-six nasal masses were found among patients presenting with epistaxis (3.09%, P< .001), comprised primarily of benign etiology (2.66%) including nasal polyposis and thornwaldt cyst. Asian race correlated with finding of mass lesion (75%, P= .007). Five malignancies were found (0.43%) including nasopharyngeal carcinoma (2 patients), extranodal natural killer T-cell lymphoma (2 patients), and nasal adenocarcinoma (1 patient). Conclusions:Epistaxis is a common cause for referral to otolaryngology. Although the incidence of neoplasm in our patient population was low, nasal mass lesions warranting further workup were identified in 36 patients. Findings of neoplasm were more common in patients of Asian ethnicity, which may reflect the increased prevalence of nasopharyngeal carcinoma in this population. Otolaryngologic evaluation and nasal endoscopy should be considered in all cases of epistaxis.

Breast cancer is the most common cancer in women and is the second most common cause of cancer-related death. Despite the relatively high prevalence of this disease, breast cancer manifestations in the head and neck are relatively rare. Supraclavicular lymphadenopathy and bony metastases to the mandible and maxilla are the most common manifestation of breast cancer in the head and neck. Head and neck metastases are the first presentation of distant disease in approximately one-third of cases. The prognosis of breast cancer with distant metastases to the head and neck is generally poor, and the management of these lesions is controversial. Overall extent of disease and individual patient prognosis must guide treatment decisions. Atypical cases including maxillary sinus mass, jugular foramen mass, and dermal metastases are presented. Metastatic breast cancer is a rare diagnosis in the head and neck, yet metastatic disease from an infraclavicular primary deserves inclusion on any comprehensive differential diagnosis list. In women, breast carcinoma is the most common infraclavicular primary to metastasize to the head and neck.

OBJECTIVES To review the clinical characteristics of patients who had a short hospital stay (&lt;24 hours) following neck dissection, and to assess the incidence and type of complications in this patient group. DESIGN Case series. SETTING University-based academic medical center. PATIENTS All patients who underwent neck dissection at our institution from July 2004 through June 2008 and were discharged within 24 hours postoperatively (short stay) were included. MAIN OUTCOME MEASURES Patient demographics, cancer site and type, and details of the procedures performed were quantified. In addition, medical records were reviewed for complications requiring readmission within 30 days postoperatively. RESULTS Review of a prospectively maintained surgical database identified 122 consecutive neck dissections performed at our institution from July 1, 2004, to June 30, 2008. Of these 122 procedures, 71 involved a subsequent postoperative stay of less than 24 hours. These 71 procedures were performed in 69 patients; they had a mean age of 59 years and a sex distribution that was 33% female and 67% male. Neck dissection alone was performed in 22 of the 71 short-stay cases (31%). The most commonly performed concurrent procedures included limited oral cavity or oropharyngeal resections (21 patients) and parotidectomy (13 patients). Modified radical neck dissection was performed in 22 of the 71 cases (31%); the remaining procedures were selective neck dissections. Cranial nerve XI, the internal jugular vein, and the sternocleidomastoid muscle were all preserved in 57 cases (80%). Of the 71 short-stay cases, only 2 (3%) required readmission for a surgical complication within 30 days of their procedure. CONCLUSIONS In carefully selected patients, discharge within 24 hours following neck dissection seems to be safe and appropriate. Given the potential for substantial cost savings, short stay should be studied further in this patient population.Arch Otolaryngol Head Neck Surg. 2010;136(8):773-776--

Objectives: This study compares hospital-generated online ratings to patient-generated online ratings in academic otolaryngology and evaluates physician factors influencing these results.Methods: Websites of academic otolaryngologists were assessed for inclusion of hospital-generated Press Ganey surveys. Corresponding scores on Healthgrades and Vitals.comwere identified via internet search. Hospital ratings were compared with patient-generated ratings, including score, demographics, and number of ratings. All data was collected between July 15th 2019 and August 22nd 2019.Results: 742 academic otolaryngologists with hospital-generated ratings were identified. Mean hospital-generated rating was significantly higher ((4.70, 95% CI 4.69-4.72) than patient-generated rating (Vitals:4.26, 95% CI 4.18-4.34, and Healthgrades:4.02, 95% CI 3.87-4.18; P< .001). In patient-generated rating, an increased number of rating scores (>20) was associated with male gender, professor ranking, and >30 years in practice (P< .005). Physician demographics did not impact number of ratings in hospital-generated setting. With patient-generated, lower aggregate score was associated with professor ranking (P= .001). In hospital-generated, lower score was associated with >30+ years in practice (P= .023). Across all platforms, comprehensive otolaryngologists and neurotologists/otologists were rated lower in comparison to other specialties (PGS:P< .001,Vitals:P= .027,Healthgrades:P= .016).Conclusion: Hospital-generated ratings yield higher mean scores than patient-generated platforms. Between sources, Healthgrades.comscores were lower than those of Vitals.com. Professors with >30 years of practice generated more reviews in patient-generated ratings, and these physicians were generally rated lower. Access to patient-generated ratings is universal and physicians should be aware of variability between online rating platforms as scores may affect referrals and practice patterns.