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Objectives/Hypothesis To determine the effect of preoperative parathyroid hormone (PTH) level on the extent of surgery and the accuracy of parathyroid imaging in primary hyperparathyroidism. Study Design Retrospective cohort. Methods Final diagnosis of single-gland adenoma and its location versus multigland disease was established in this retrospective cohort study. Positive predictive value, negative predictive value, and accuracy of imaging were analyzed in relation to preoperative PTH levels. Results Eighty-seven percent of the 218 patients enrolled in the study underwent unilateral targeted operation and had a 97.9% (95% confidence interval: 95.8%–100%) success rate. However, in patients with PTH

Keywords: Parathyroidectomy; parathyroid autotransplantation; parathyroid autotransposition; hyperparathyroidism; end-stage renal disease; parathyroid hormone

To determine the effect of preoperative parathyroid hormone (PTH) level on the extent of surgery and the accuracy of parathyroid imaging in primary hyperparathyroidism.Retrospective cohort.Final diagnosis of single-gland adenoma and its location versus multigland disease was established in this retrospective cohort study. Positive predictive value, negative predictive value, and accuracy of imaging were analyzed in relation to preoperative PTH levels.Eighty-seven percent of the 218 patients enrolled in the study underwent unilateral targeted operation and had a 97.9% (95% confidence interval: 95.8%-100%) success rate. However, in patients with PTH65 pg/mL, 28.6% had bilateral exploration compared to 10.3% in those with PTH ≥65 pg/mL (P = .042). In patients with PTH65 pg/mL, 7/21 (33.3%) had inaccurate sestamibi findings compared to 24/174 (13.8%) in patients with PTH ≥65 pg/mL (P = .047).Accuracy of sestamibi drops significantly, by threefold, in patients with mild primary hyperparathyroidism and PTH65 pg/mL. Patients with PTH 65 pg/mL have a 2.5-fold higher rate of bilateral operation to identify the hypersecreting gland(s) compared to patients with PTH ≥65 pg/mL.4. Laryngoscope, 128:1016-1021, 2018.

Objective: The objective of this study is to assess the effectiveness of selective parathyroid exploration, using preoperative image localization and intraoperative rapid-parathormone (rPTH) assay. The kinetics of intraoperative rPTH in parathyroid adenoma vs. multiglandular disease is assessed. Design: This is a prospective noncontrolled study of a cohort of 100 patients with primary hyperparathyroidism, at a single academic institution. The patients underwent selective parathyroidectomy after preoperative localization, including sestamibi scan and ultrasonography. Intraoperative rPTH assay was used to determine the extent and success of parathyroidectomy. Frozen sections were used as additional confirmation. Follow-up serum calcium levels were used to assess the effectiveness of selective parathyroidedcomy. Results: Mean preoperative serum calcium (Ca) and baseline intact-parathormone were 11.6 mg/dL and 136, respectively. Data were available in 96 cases: 87 single-gland adenoma with two in ectopic mediastinal position, two double adenoma and seven cases of hyperplasia. Ten percent of patients with adenoma needed bilateral exploration for nonlocalizing or false negative imaging, or for intraoperative rPTH failure to decay. All of the patients undergoing unilateral targeted exploration were normocalcemic on follow up. There were only one failed exploration and two cases of recurrent mild hypercalcemia, all three in bilateral exploration cases. Intraoperative rPTH reduction by standard curves was predictive of successful excision of all of the abnormal glands, as confirmed by postoperative serum calcium levels. More than one postexcision rPTH measurement was useful by showing failure of a decaying slope in multiglandular disease. Conclusion: Targeted parathyroidectomy, when appropriately selected and carried out, is an effective treatment of primary hyperparathyroidism in most cases. Intraoperative rPTH can correctly guide removal of hyperfunctioning glands. Targeted parathyroidectomy offers the advantage of less invasive surgery with less tissue dissection confined to one side and avoids surgically disturbing the remainder of the neck. This should reduce postoperative complications and allow for easier and safer re-exploration in the few cases with persistent or recurrent disease.

A murine model for the immunotherapy of head and neck cancer was established. The AT-84 tumor, a spontaneously arising oral squamous cell tumor of C3H mice, was evaluated for susceptibility to lymphokine-activated killer (LAK) cells. In vitro chromium-release assays demonstrated that AT-84 is sensitive to LAK-cell-mediated killing. Furthermore, in vivo experiments employing a lung metastasis model demonstrated a 50% reduction in the number of metastases in LAK-cell-treated mice as compared with untreated controls (P2 = .001). These experiments showed that AT-84 is an appropriate model for the immunotherapy of head and neck cancer. This model should be invaluable for further study of the mechanisms involved in immune-mediated therapy of head and neck cancer.

We describe a simple method to create a reusable and customizable dental guard using readily available materials. Our method does not require an extra patient visit and does not add operative time. Furthermore, our guard is rigid, which allows force to be distributed over adjacent teeth, unlike soft mouth guards.

Objective: To describe the new technique of transnasal endoscopic medial maxillectomy. Study Design: Study design included application of the new technique in the management of five patients with inverting papilloma; retrospective review of five patients who had lateral rhinotomy with medial maxillectomy for inverting papilloma; comparison of transnasal endoscopic medial maxillectomy to open medial maxillectomy for scope of resection, margin control, operative time, and surgical access; and detailed description of transnasal endoscopic medial maxillectomy. Methods: Charts were reviewed and tabulated for operative time, duration of follow-up, and recurrence. Pathology reports were reviewed for number and orientation of the specimens and for margin control. Results: Operative time was shorter for patients managed with transnasal endoscopic medial maxillectomy. All patients with transnasal endoscopic medial maxillectomy had one large, well-oriented specimen with margin control. There was no recurrence in either group. Conclusions: Transnasal endoscopic medial maxillectomy providing full access to the maxillary and ethmoid sinuses is described in detail. Transnasal endoscopic medial maxillectomy is an effective, reproducible technique with less operative time and morbidity and, possibly, better pathological tumor mapping than open medial maxillectomy for selected patients. Maxillary sinus involvement with inverting papilloma is not a contraindication for this technique. Strong illumination, superior resolution, and angled visualization, coupled with exact osteotomies, make transnasal endoscopic medial maxillectomy an efficacious technique for inverting papilloma with extension limited to the maxillary and ethmoid sinuses.

We describe a simple method to create a reusable and customizable dental guard using readily available materials. Our method does not require an extra patient visit and does not add operative time. Furthermore, our guard is rigid, which allows force to be distributed over adjacent teeth, unlike soft mouth guards.

Objectives In select hosts fungal species may become invasive and opportunistic, resulting in severe morbidity and mortality. We report a rare case of invasive Aspergillus, diagnosed on initial presentation as chronic fungal otitis externa.