Search

Background: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is developed to aid diagnosis and management of salivary gland tumors. This study evaluates the time‐to‐treatment initiation (TTI) for parotid gland tumors in the Netherlands and relates these to the MSRSGC classification. Subsequently, the use of the MSRSGC in the Netherlands is evaluated. Methods: Data regarding fine‐needle aspiration cytology (FNAC) and histopathological resections of the parotid were gathered from the Dutch nationwide pathology data bank (PALGA). The TTI was calculated for each MSRSGC category and type of treating center. FNACs performed from 2018 to 2021 were gathered from PALGA to estimate how frequently the MSRSGC classification was applied. Results: Median TTI in days were 86 for nondiagnostic (MSRSGC I), 75 for nonneoplastic (MSRSGC II), 65 for atypia of unknown significance (AUS) (MSRSGC III), 89 for benign (MSRSGC IVa), 52 for salivary gland neoplasm of unknown malignant potential (SUMP) (MSRSGC IVb), 31 for suspected malignant (MSRSGC V), and 30 for malignant (MSRSGC VI) categories. Significant variation in the TTI between the types of treating centers was found for the nondiagnostic, nonneoplastic, AUS, SUMP, and suspected malignant categories. In the first 3 years after the introduction of the MSRSGC, the pathologist stated the MSRSGC classification in 6.4% of all reports. Conclusions: The median TTI for most categories is long, and there is significant interhospital variation in TTI. Preoperative risk stratification and treatment prioritization in parotid gland surgery in the Netherlands should be improved. The MSRSGC could contribute to this. Until 2021, the MSRSGS classification was implemented on a limited scale in the Netherlands. The median time‐to‐treatment initiation for the atypia of unknown significance (AUS) (MSRSGC III), salivary gland neoplasm of unknown malignant potential (SUMP) (MSRSGC IVb), nondiagnostic (MSRSGC I), and nonneoplastic (MSRSGC II) categories are long. There is significant interhospital variation in the time‐to‐treatment initiation for the nondiagnostic, nonneoplastic, AUS, SUMP, and suspected malignant categories. Until 2021, the MSRSGS classification was only implemented on a limited scale in the Netherlands. [ABSTRACT FROM AUTHOR]

Objective: This study aims to assess the product performance of a new moldable peristomal adhesive with corresponding heating pad designed to facilitate and improve automatic speaking valve (ASV) fixation for hands‐free speech in laryngectomized patients. Methods: Twenty laryngectomized patients, all regular adhesive users with prior ASV experience, were included. Study‐specific questionnaires were used for data collection at baseline and after two weeks of moldable adhesive use. The primary outcome parameters were adhesive lifetime during hands‐free speech, use and duration of hands‐free speech, and patient preference. Additional outcome parameters were satisfaction, comfort, fit, and usability. Results: The moldable adhesive enabled ASV fixation adequate for hands‐free speech in the majority of participants. Overall, the moldable adhesive significantly increased adhesive lifetime and duration of hands‐free speech compared to participants' baseline adhesives (p < 0.05), regardless of stoma depth, skin irritation, or regular use of hands‐free speech at baseline. The participants who preferred the moldable adhesive (55% of participants) experienced a significant increase in the adhesive lifetime (median of 24 h, range 8–144 h) and improved comfort, fit, and ease of speech. Conclusion: The moldable adhesive's lifetime and functional aspects, including the ease of use and custom fit, are encouraging outcomes and enable more laryngectomized patients to use hands‐free speech more regularly. Level of Evidence: 4 Laryngoscope, 133:2965–2970, 2023 [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the feasibility of flexible endoscopy‐guided tracer injection for sentinel lymph node (SLN) identification in patients with laryngeal and pharyngeal carcinoma. Methods: Sixteen cT1‐4N0‐2M0 patients with laryngeal or pharyngeal carcinoma underwent intra‐ and peritumoral [99mTc]Tc‐nanocolloid injections after topical anesthesia under endoscopic guidance. SPECT–CT scans were performed at two time points. Results: Tracer injection and visualization of SLNs was successful in 15/16 (94%) patients. Median number of tracer injections was 1 intratumoral and 3 peritumoral. The median duration of the endoscopic procedure including tracer injection after biopsy taking was 7 min (range 4–16 min). A total of 28 SLNs were identified which were all visualized on the early and late SPECT–CT. Most SLNs were visualized in neck levels II and III. Conclusions: Flexible endoscopy‐guided tracer injection for SLN identification is a feasible and fast procedure in laryngeal and pharyngeal carcinoma patients. [ABSTRACT FROM AUTHOR]

Objective: Parotid surgery is historically performed as an inpatient procedure and suctions drains are predominantly used during surgery. Recent literature provides evidence that outpatient parotid surgery is safe and effective. Our study aims to describe the results of drainless outpatient parotidectomy and outpatient parotidectomy with drain placement and compare their outcomes. Design: Retrospective cohort study. Setting: Bi‐institutional retrospective cohort study. Participants: Patients that underwent outpatient drain‐less parotidectomy and patients that underwent outpatient parotidectomy with post‐operative drain placement. Main Outcome Measures: Complication rates, unplanned post‐operative visits, unplanned prolonged stay. Results: Three hundred eighty patients underwent outpatient parotidectomy with drain placement and 31 patients underwent outpatient drainless parotidectomy in two different hospitals. The incidence of haematoma (drain: 3.1% vs. drainless: 0%, p = 1), infection (drain: 14.3% vs. drainless: 13.8%, p = 1) and salivary fistula (drain: 5.6% vs. drainless: 3.4, p = 1) were comparable between both groups. Seroma or sialocele was more frequently seen in the drain‐less group (27.6% vs. 6.2%, p <.001), but were all managed conservatively. Within 10 days after surgery, unplanned visits seemed more frequent in the drain group, although the difference was not statistically significant (14.9% vs. 3.4%, p =.16). Conclusions: Outpatient parotid surgery with or without the use of a post‐operative drain is safe, practical and feasible. Same‐day discharge with and without drain placement yield comparable outcomes. However, the results need to be interpreted cautiously as this study was limited by a small cohort of parotidectomies without drain placement. Future studies should further compare both approaches. [ABSTRACT FROM AUTHOR]

Background: The Milan System for Salivary Gland Cytopathology (MSRSGC) is a categorical system for salivary gland fine‐needle aspiration cytopathology (FNAC) developed to aid clinicians in the management of salivary gland lesions. This classification is widely studied and validated, especially in cohorts that consist of mostly parotid gland lesions. However, only sparse literature describes the use of this classification for submandibular gland lesions in particular. Methods: All patients in the Netherlands that underwent a submandibular gland resection between January 1, 2006, and January 1, 2017, with a FNAC before resection were identified with the use of the Dutch Pathology Registry database (PALGA). All FNAC results were retrospectively classified according to the MSRSGC. The risk of malignancy was calculated for all the MSRSGC categories. The sensitivity and specificity of the MSRSGC classification were calculated for submandibular gland FNAC. Results: A total of 837 patients who underwent 975 FNAC aspirates from the submandibular glands were included in the analysis. Risks of malignancy for each of the MSRSGC categories were 14.4% in nondiagnostic, 4.4% in nonneoplastic, 37.0% in atypia of unknown significance, 3.9% in benign neoplasms, 40.7% in salivary gland neoplasms of unknown malignant potential, 76.2% in suspected malignant, and 91.3% in malignant cytology results. The sensitivity for diagnosing malignant submandibular gland tumors was 71.6% and specificity was 98.4%. Conclusions: The results of the present study validate the use of this classification for submandibular gland lesions. Risks of malignancy vary according to the anatomical subsites of the salivary gland lesions. Lay Summary: The risks of malignancy of the various Milan System for Salivary Gland Cytopathology (MSRSGC) categories vary according to the anatomical subsite of the salivary gland lesion.The proposed management techniques of the MSRSGC are valid for use with submandibular gland lesions. The risks of malignancy of the Milan Classification for Salivary Gland Cytopathology (MSRSGC) categories vary according to the anatomical subsite of the salivary gland lesion. The proposed management techniques of the MSRSGC classification are valid for use with submandibular gland lesions, however, because of the high risk of malignancy in the atypia of unknown significance (AUS) category, clinicians may favor surgery in case of a submandibular gland lesions with an AUS result rather than repeating the fine‐needle aspiration cytology. [ABSTRACT FROM AUTHOR]

Background: Differentiating between malignant and benign salivary gland tumors with fine‐needle aspiration cytology (FNAC) can be challenging. This study was aimed at testing the validity of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) and at assessing possible differences in the sensitivity and specificity of parotid gland FNAC between dedicated head and neck (H&N) centers, subdivided into head and neck oncology centers (HNOCs) and head and neck oncology affiliated centers (HNOACs), and general hospitals (GHs). Methods: The Dutch Pathology Registry (PALGA) database was searched for patients who had undergone a salivary gland resection between January 1, 2006, and January 1, 2017, and had a preoperative FNAC result. The FNAC reports were retrospectively assigned to MSRSGC categories. The risk of malignancy (ROM) was calculated for each category. The sensitivity and specificity for diagnosing malignancy were calculated and compared among HNOCs, HNOACs, and GHs. Results: In all, 12,898 FNAC aspirates were evaluated. The ROMs for each category were as follows: 12.5% in MSRSGC I, 10.3% in MSRSGC II, 29% in MSRSGC III, 2.3% in MSRSGC IVa, 28.6% in MSRSGC IVb, 83% in MSRSGC V, and 99.3% in MSRSGC VI. The sensitivity of FNAC was highest in HNOCs (88.1%), HNOACs scored lower (79.7%), and GHs had a sensitivity of 75.0%. Conclusions: The MSRSGC is a valid tool for reporting parotid gland FNAC; therefore, these results strongly advocate its use. On the basis of the higher sensitivity of FNAC in dedicated H&N centers, the authors recommend that GHs use the presented management strategies to help to minimize the chances of a preoperative misdiagnosis. The Milan System for Reporting Salivary Gland Cytopathology is a valid tool for reporting parotid gland fine‐needle aspiration cytology. The sensitivity of fine‐needle aspiration cytology is higher at dedicated head and neck centers. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To provide insight in the thermal effects of individual laser settings in target tissues to optimize flexible endoscopic CO2 laser surgery treatment.Study Design: Experimental laboratory study.Methods: Thermal effects of the CO2 laser using a fiber delivery system were visualized using the color Schlieren technique in combination with a polyacrylamide gel tissue model. Variable settings were used for emission mode, power, laser fiber distance, and laser duration, which were evaluated in every possible combination. Collateral thermal expansion and incision depth were measured. To validate the model, the results were compared to histology after CO2 laser irradiation of ex vivo human vocal cords, and the intraclass correlation coefficient was calculated. Thermal damage and incision depth were measured by a blinded pathologist.Results: Of all parameters studied, duration of laser irradiation had the greatest effect on thermal expansion. Increased distance between laser tip and target tissue resulted in significantly reduced incision depth and increased thermal expansion. Pulsed emission modes led to increased incision depths. The intraclass correlation coefficient for consistency between the model setup and the ex vivo human vocal cords was classified as "fair."Conclusions: By using high-intensity pulsed lasers at minimal distance to the target tissue, exposure times and subsequent damage to surrounding tissue can be reduced. If an evaporation technique is used, lower power in continuous wave at a larger distance to the target tissue will lead to superficial but broader thermal effects. The model setup used in this study is a valid model to investigate laser-induced thermal effects in vocal cord tissue.Level Of Evidence: NA Laryngoscope, 130:E680-E685, 2020. [ABSTRACT FROM AUTHOR]

Background: Timely and efficient diagnostic workup of patients with head and neck cancer (HNC) is challenging. This observational study describes the implementation of an optimized multidisciplinary oncological diagnostic workup for patients with HNC and its impact on diagnostic and treatment intervals, survival, costs, and patient satisfaction.Methods: All patients with newly diagnosed HNC who underwent staging and treatment at the Radboud University Medical Center were included. Conventional workup (CW) in 2009 was compared with the fast-track, multidisciplinary, integrated care program, that is, optimized workup (OW), as implemented in 2014.Results: The study included 486 patients with HNC (218 with CW and 268 with OW). The time-to-treatment interval was significantly lower in the OW cohort than the CW cohort (21 vs 34 days; P < .0001). The 3-year overall survival rate was 12% higher after OW (72% in the CW cohort vs 84% in the OW cohort; P = .002). After correction for confounders, the 3-year risk of death remained significantly lower in the OW cohort (hazard ratio, 1.73; 95% confidence interval, 1.14-2.63; P = .010). Total diagnostic costs were comparable in the 2 cohorts. The general satisfaction score, as measured with the Consumer Quality Index for Oncological Care, was significantly better in a matched OW group than the CW group (9.1 vs 8.5; P = .007).Conclusions: After the implementation of a fast-track, multidisciplinary, integrated care program, the time-to-treatment interval was significantly reduced. Overall survival and patient satisfaction increased significantly, whereas costs did not change. This demonstrates the impact and improved quality of care achieved by efficiently organizing the diagnostic phase of HNC management. [ABSTRACT FROM AUTHOR]

Objective: Patients with laryngeal pathology are often treated with CO2 laser surgery, usually in the operating room under general anesthesia. Although office-based laser surgery using several other laser types has been investigated, prospective studies on office-based CO2 laser surgery are scarce. Our goal was to investigate the feasibility of office-based CO2 laser surgery for benign and premalignant laryngeal pathology by analyzing completion rate, safety, effect on voice quality, and success rate (i.e., no residual or recurrent disease).Methods: A prospective cohort study was performed of 30 consecutive procedures. Inclusion started in June 2016 and was completed in August 2018. Adult patients with clinically benign or premalignant laryngeal lesions who could not undergo transoral laser microsurgery in the operating room under general anesthesia were included. Reasons were either contraindications for general anesthesia, previously failed therapeutic laryngoscopy under general anesthesia, and preference of a procedure under topical anesthesia by the patient. The mean follow-up was 9 months.Results: Thirty procedures were performed in 27 patients (24 males) with an average age of 62 years. Twenty-nine (97%) procedures were fully completed without complications. The mean preoperative Voice Handicap Index (VHI) score (VHI 44) significantly decreased 2 months (VHI 28, P = 0.032) and 6 months (VHI 14, P < 0.001) after the procedure. Almost two-thirds of patients showed no residual or recurrent disease at their follow-up visits.Conclusion: Office-based CO2 laser surgery is a feasible and safe procedure that results in significant voice-quality improvement. Almost two-thirds of patients did not require further treatment.Level Of Evidence: 2 Laryngoscope, 130:1503-1507, 2020. [ABSTRACT FROM AUTHOR]

Objectives: An office-based workup strategy for patients with laryngopharyngeal lesions suspicious for carcinoma is analyzed. The feasibility of office-based transnasal flexible endoscopic biopsies under local anesthesia and the impact on the diagnostic workup are evaluated. Methods: This study is a prospective analysis of patients with laryngeal, oropharyngeal, and hypopharyngeal lesions suspicious for carcinoma. One hundred eighty-eight participants were divided into 2 groups. The first group underwent an office-based biopsy procedure under local anesthesia using a flexible digital video laryngoscope with instrument channel (n = 53), and the second group underwent a biopsy procedure under general anesthesia using rigid laryngopharyngoscopy (n = 135). Results: Office-based flexible endoscopic biopsies were tolerated well, and there were no complications. These biopsies were 92.5% successful in acquiring a definitive diagnosis. Costs were reduced. Diagnostic workup time and time until start of therapy were reduced to 2 days and 27 days, respectively. Conclusion: Office-based biopsy under local anesthesia using flexible digital video laryngoscopy is safe, cost-effective, and successful in providing a histopathological diagnosis. It reduces the diagnostic workup time significantly in patients with laryngeal, oropharyngeal, and hypopharyngeal cancer, while also reducing the necessity to subsequently perform a rigid laryngopharyngoscopy under general anesthesia. [ABSTRACT FROM AUTHOR]

Aim Several surgical techniques are available to treat drooling in neurologically disabled children and adolescents, with bilateral submandibular gland excision being the only transcervical procedure. External scars can be a reason to decline for this surgical approach. We investigated which factors influenced caregiver satisfaction by evaluating the long-term scar in relation to treatment outcome. Methods We identified a historical cohort, in which all neurologically disabled patients who underwent bilateral submandibular gland excision for drooling between January 2009 and December 2013 were identified (n = 41). The Patient and Observer Scar Assessment Scale (POSAS) was used to evaluate observer and clinician satisfaction. All included patients were contacted by telephone and completed a digital questionnaire that included digital images of the scars. Results Of the caregivers that responded the questionnaire 76% (19/25) were satisfied with the overall outcome. Twenty-four (96%) caregivers considered the scars acceptable. Caregiver satisfaction was not correlated to the appearance of scars, but was significantly correlated with the decrease in drooling severity on a visual analogue scale ( p = 0.035) and decrease in lower respiratory tract infections ( p = 0.042). Interpretation The appearance of scars does not influence satisfaction after bilateral submandibular gland excision for drooling. As expected, satisfaction is correlated to the treatment outcome. [ABSTRACT FROM AUTHOR]

Background: Total laryngectomy with or without adjuvant (chemo)radiation often induces speech, swallowing and neck and shoulder problems. Speech, swallowing and shoulder exercises may prevent or diminish these problems. The aim of the present paper is to describe the study, which is designed to investigate the effectiveness and cost-utility of a guided self-help exercise program built into the application "In Tune without Cords" among patients treated with total laryngectomy.Methods/design: Patients, up to 5 years earlier treated with total laryngectomy with or without (chemo)radiation will be recruited for participation in this study. Patients willing to participate will be randomized to the intervention or control group (1:1). Patients in the intervention group will be provided access to a guided self-help exercise program and a self-care education program built into the application "In Tune without Cords". Patients in the control group will only be provided access to the self-care education program. The primary outcome is the difference in swallowing quality (SWAL-QOL) between the intervention and control group. Secondary outcome measures address speech problems (SHI), shoulder disability (SDQ), quality of life (EORTC QLQ-C30, QLQ-H&N35 and EQ-5D), direct and indirect costs (adjusted iMCQ and iPCQ measures) and self-management (PAM). Patients will be asked to complete these outcome measures at baseline, immediately after the intervention or control period (i.e. at 3 months follow-up) and at 6 months follow-up.Discussion: This randomized controlled trial will provide knowledge on the effectiveness of a guided self-help exercise program for patients treated with total laryngectomy. In addition, information on the value for money of such an exercise program will be provided. If this guided self-help program is (cost)effective for patients treated with total laryngectomy, the next step will be to implement this exercise program in current clinical practice.Trial Registration: NTR5255 Protocol version 4 date September 2015. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Endoscopic cricopharyngeal myotomy (ECPM) using CO2 laser surgery presents a less invasive treatment technique when compared to transcervical cricopharyngeal myotomy. Methods Forty-seven patients who underwent ECPM from 2002 until 2013 were included in this study. Patient characteristics, and preoperative and postoperative outcome and complications were scored by retrospective chart review and by using the Deglutition Handicap Index (DHI). Results Overall, 40 of 47 patients (85%) experienced relief of symptoms postoperatively. Ten patients (25%) developed recurrent symptoms of dysphagia requiring re-laser surgery. All 40 patients were satisfied at the postoperative visit after an average of 1.3 interventions. DHI scores were better in patients with idiopathic dysfunction and neurologic disease, compared to dysfunction because of prior treatment of head and neck cancer. One patient developed mediastinitis that was successfully treated with antibiotics. There was no mortality. Conclusion ECPM is an effective treatment for cricopharyngeal dysfunction with a low rate of surgical morbidity and complications. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1022-1027, 2016 [ABSTRACT FROM AUTHOR]

Conclusions: Selecting patients that are candidates for surgical treatment is important in the work-up of patients with tracheal cancer. Toward this goal, centralization of care concerning tracheal tumors is advised. Centralization may increase long-term survival and decrease operative morbidity and mortality even further. Objective: Primary tracheal tumors pose a diagnostic and therapeutic challenge for the physician when confronted with this mostly malignant tumor. Diagnosis is often delayed for months or years due to its aspecific and asthma-mimicking symptoms. Knowledge from retrospective series is limited and few clinicians have gained experience with this tumor. The available literature on the diagnosis and management of this group of tumors is reviewed to summarize the available knowledge about these uncommon tumors. New diagnostic, staging, and treatment guidelines are proposed. Methods: PubMed was searched for English publications from 1960. The available literature was reviewed and summarized. Results: Surgical resection and primary reconstruction is the best curative treatment modality available at present. In centers of experience, more than half of all patients with tracheal cancer may be candidates for surgical resection, although in population-based studies this treatment is applied in only 10–25% of patients. [ABSTRACT FROM AUTHOR]

Abstract: Objective: We investigate the influence of tumour and resection characteristics on survival in adenoid cystic carcinoma (ACC) of the trachea. Methods: A retrospective study of 12 laryngotracheal, 58 tracheal and 38 carinal resections for primary ACC in 108 consecutive operative survivors between 1962 and 2007 was conducted. Postoperative radiotherapy was administered to 82% of patients (89/108). Depth of invasion, extramural extent, organ invasion, perineural growth, margin status and lymph node involvement were described. Results: The tumour was intramural in 15% (16/108), extramural in 85% (92/108) and invaded adjacent organs in 20% (22/108). Airway margins were grossly positive in 9 (8%), microscopically positive in 59 (55%) and negative in 40 (37%) of 108 resections. Adventitial (radial) margins of transmural sections were grossly positive in 3 (3%), microscopically positive in 95 (88%) and negative in 10 (9%) cases. Perineural growth was present in 37 (34%) and absent in 12 (11%); it was not observed in 59 (55%) cases. Lymph nodes were positive in 16 (15%) and negative in 45 (42%) cases; it was not sampled in 47 (44%) cases. Median overall survival (OS) and disease-free survival (DFS) for the entire group were 17.7 and 10.2 years, respectively. OS was longer after resection with: negative airway margins (20.4 vs 13.3 years, P =0.028) and negative radial margins (21.7 vs 13.3 years, P =0.050); absence of extramural disease (21.7 vs 13.3 years, P =0.007), perineural growth (22.8 vs 7.5 years, P =0.011) or lymph node metastases (16.8 vs 6.1 years, P =0.017). DFS was longer after resection with: negative airway margins (16.6 vs 9.3, P =0.005) and absence of extramural disease (17.9 vs 9.3 years, P =0.008), perineural growth (17.9 vs 6.6 years, P =0.033) or lymph node metastases (10.2 vs 3.0 years, P =0.005). Conclusions: After tracheal resection for ACC, limited tumour extent and complete resection are associated with longer overall and disease-free survival. Long-term survival (>10 years), however, is also observed after tracheal resection of locally advanced ACC. [Copyright &y& Elsevier]

Objectives/Hypothesis: To describe the controversies in the management of thyroid carcinoma invading the airway. Study Design: Contemporary review of literature; level of evidence: 5. Results: Invasion of the larynx or trachea by thyroid carcinoma is uncommon and often identified at the time of operation, when the surgeon must decide the extent of resection. Invasion of the airway is associated with loss of tumor differentiation and a reduction in long-term survival compared to tumors limited to the thyroid gland. Whether or not the invaded airway should be resected remains controversial. Tangential shave excision of tumor is commonly performed, despite a marked risk of local recurrence. Circumferential sleeve resection of the larynx and trachea is safe and lowers the risk of local recurrence. In recurrent disease, laryngotracheal resection provides effective palliation of airway obstruction and hemoptysis. Conclusions: Long-term (>10-20 years) prospective studies are required to compare the outcome after shave excision with segmental airway resection for thyroid carcinoma. Based on the current literature and on our experience, we advocate circumferential tracheal resection in the setting of airway involvement. Laryngoscope, 2010 [ABSTRACT FROM AUTHOR]

While squamous cell carcinoma (SCC) is the most common tracheal malignancy, few reports describe the pathologic considerations that may guide intraoperative decisions and prognostic assessment. We reviewed 59 tracheal SCC treated between 1985 and 2008 by segmental resection of the trachea, including resection of the carina in 24% and inferior larynx in 14%. We classified these tumors by grading histologic differentiation and microscopic features used in SCC of other sites. Of 59 tumors, 24% (14 of 59) were well differentiated, 49% (29 of 59) were moderately differentiated, and 27% (16 of 59) were poorly differentiated. Unfavorable prognostic factors were tumor extension into the thyroid gland (all of five so-afflicted patients died of tumor progression within 3 years) and lymphatic invasion (mean survival 4.6 versus 7.6 years). Keratinization, dyskeratosis, acantholysis, necrosis, and tumor thickness did not predict prognosis. As surgical resection is the only curative treatment; the surgeon should establish clean lines of resection using, as appropriate, intraoperative frozen section. The pathologist can provide additional important prognostic information, including tumor differentiation and extent, invasion of surgical margins, and extension into the thyroid. [ABSTRACT FROM AUTHOR]

Background: Laryngotracheal invasion worsens prognosis in patients with thyroid carcinoma. The extent of resection is controversial. Methods: We performed a retrospective study of patients with thyroid carcinoma and invasion of the larynx or trachea between 1964 and 2005. Results: Eighty-two patients, mean age 64 years and 50% female, underwent segmental airway resection. Differentiated carcinoma was present in 76% (62 of 82 patients), prior tracheal “shave” procedures in 40% (33 of 82 patients), transmural invasion in 58% (48 of 82 patients), and preoperative vocal cord paralysis in 35% (29 of 82 patients). There were 29 tracheal and 40 laryngotracheal resections (reconstruction group: 69 patients); 5 underwent laryngectomy, 7 cervical exenteration, and 1 tracheal resection after exenteration (salvage group: 13 patients). Operative mortality was 1.2% (1 of 82 patients) and anastomotic dehiscence 4.3% (3 of 69 patients). Tracheostomy was permanent in 4.3% (3 of 69 patients). Mean follow-up was 6.1 years. After reconstruction, mean survival was 9.4 years and 10-year survival was 40%; after salvage, these were 5.6 years and 15%, respectively. In differentiated carcinoma, thyroidectomy, immediate shave procedure, and delayed (mean, 67 months) resection of airway recurrence in 15 patients resulted in overall and disease-free survival of 13.1 and 5.1 years, respectively, compared with 17.9 and 14.6 years, respectively, after thyroidectomy and early airway resection in 11 patients. Airway symptoms, metastases at presentation, recurrent disease, and salvage operation were associated with decreased survival; airway resection early after thyroidectomy, complete resection, and well-differentiated tumors were associated with improved prognosis. Conclusions: Segmental airway resection for invasive thyroid cancer is safe, preserves the voice, and relieves airway obstruction. Complete resection of laryngeal and tracheal invasion during or early after thyroidectomy is associated with improved survival. [Copyright &y& Elsevier]

Objectives: Myospherulosis is a foreign body reaction induced by the application of oil-based ointments. Myospherulosis in the ear is extremely rare. Only 4 cases have been described, all of which occurred after (repeated) mastoid surgery. Methods: We present a case of persistent otorrhea and conductive hearing loss caused by myospherulosis in the middle ear following tympanoplasty. Results: The patient underwent revision middle ear surgery with removal of abnormally thick, pale tissue in the middle ear. Histology showed a foreign body reaction with signs of myospherulosis. Conclusions: Myospherulosis is a very rare complication of the use of oil-based ointments. Surgeons should be aware that these products might cause a foreign body reaction leading to myospherulosis. In patients who have chronic otorrhea after previous mastoid or middle ear surgery, myospherulosis should be considered in the differential diagnosis. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To provide insight in the thermal effects of individual laser settings in target tissues to optimize flexible endoscopic CO 2 laser surgery treatment., Study Design: Experimental laboratory study., Methods: Thermal effects of the CO 2 laser using a fiber delivery system were visualized using the color Schlieren technique in combination with a polyacrylamide gel tissue model. Variable settings were used for emission mode, power, laser fiber distance, and laser duration, which were evaluated in every possible combination. Collateral thermal expansion and incision depth were measured. To validate the model, the results were compared to histology after CO 2 laser irradiation of ex vivo human vocal cords, and the intraclass correlation coefficient was calculated. Thermal damage and incision depth were measured by a blinded pathologist., Results: Of all parameters studied, duration of laser irradiation had the greatest effect on thermal expansion. Increased distance between laser tip and target tissue resulted in significantly reduced incision depth and increased thermal expansion. Pulsed emission modes led to increased incision depths. The intraclass correlation coefficient for consistency between the model setup and the ex vivo human vocal cords was classified as "fair.", Conclusions: By using high-intensity pulsed lasers at minimal distance to the target tissue, exposure times and subsequent damage to surrounding tissue can be reduced. If an evaporation technique is used, lower power in continuous wave at a larger distance to the target tissue will lead to superficial but broader thermal effects. The model setup used in this study is a valid model to investigate laser-induced thermal effects in vocal cord tissue., Level of Evidence: NA Laryngoscope, 130:E680-E685, 2020., (© 2020 The Authors. The Laryngoscope published by Wiley Periodicals, Inc. on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: Patients with laryngeal pathology are often treated with CO 2 laser surgery, usually in the operating room under general anesthesia. Although office-based laser surgery using several other laser types has been investigated, prospective studies on office-based CO 2 laser surgery are scarce. Our goal was to investigate the feasibility of office-based CO 2 laser surgery for benign and premalignant laryngeal pathology by analyzing completion rate, safety, effect on voice quality, and success rate (i.e., no residual or recurrent disease)., Methods: A prospective cohort study was performed of 30 consecutive procedures. Inclusion started in June 2016 and was completed in August 2018. Adult patients with clinically benign or premalignant laryngeal lesions who could not undergo transoral laser microsurgery in the operating room under general anesthesia were included. Reasons were either contraindications for general anesthesia, previously failed therapeutic laryngoscopy under general anesthesia, and preference of a procedure under topical anesthesia by the patient. The mean follow-up was 9 months., Results: Thirty procedures were performed in 27 patients (24 males) with an average age of 62 years. Twenty-nine (97%) procedures were fully completed without complications. The mean preoperative Voice Handicap Index (VHI) score (VHI 44) significantly decreased 2 months (VHI 28, P = 0.032) and 6 months (VHI 14, P < 0.001) after the procedure. Almost two-thirds of patients showed no residual or recurrent disease at their follow-up visits., Conclusion: Office-based CO 2 laser surgery is a feasible and safe procedure that results in significant voice-quality improvement. Almost two-thirds of patients did not require further treatment., Level of Evidence: 2 Laryngoscope, 130:1503-1507, 2020., (© 2019 The Authors. The Laryngoscope published by Wiley Periodicals, Inc. on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Importance: Antibiotic prophylaxis is widely used after surgical procedures operating on the mucosal tissues of the aerodigestive tract, but the optimal duration of these prophylactic therapies is often unclear., Objective: To compare short-course antibiotic prophylaxis (≤24 hours) vs extended-course antibiotic prophylaxis (≥72 hours) after ear, nose, throat, and oral and maxillofacial surgery., Data Sources and Study Selection: Literature searches of PubMed were completed in October 2017 and included prospective trials that compared antibiotic prophylaxis courses of 24 hours or less vs 72 hours or more after ear, nose, throat, and oral and maxillofacial surgery. Some studies were also handpicked from reference lists of studies found with the initial search terms. All analysis was performed between September 2017 and October 2018., Data Extraction and Synthesis: All review stages were conducted in consensus by 2 reviewers. Data extraction and study quality assessment were performed with the Cochrane data extraction form and the Cochrane risk of bias tool. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for reporting. The fixed-effects Mantel-Haenszel method was used for meta-analysis., Main Outcomes and Measures: Relative risk (RR) of surgical site infections, microbial origins of surgical site infections, adverse events, duration of hospital stay, and treatment costs., Results: Included in the meta-analysis were 21 articles with a cumulative 1974 patients. In patients receiving 24 hours or shorter vs 72 hours or longer antibiotic prophylaxis regimens, no significant difference was found in the occurrence of postoperative infections in the pooled population (RR, 0.90; 95% CI, 0.67-1.19), or in the ear, nose, throat (RR, 0.89; 95% CI, 0.54-1.45), and oral and maxillofacial populations (RR, 0.88; 95% CI, 0.63-1.21), separately. No heterogeneity was observed overall or in the subgroups. Patients receiving extended-course antibiotic prophylaxis were significantly more likely to develop adverse events unrelated to the surgical site (RR, 2.40; 95% CI, 1.20-3.54)., Conclusions and Relevance: No difference was found in the occurrence of postoperative infections between short-course and extended-course antibiotic prophylaxis after ear, nose, throat, and oral and maxillofacial surgery. Therefore, a short course of antibiotic prophylaxis is recommended unless documented conditions are present that would be best treated with an extended course. Using short-course antibiotics could avoid additional adverse events, antibiotic resistance development, and higher hospital costs. Future research should focus on identifying risk groups that might benefit from prolonged prophylaxis.

Background: In this study we focus on functional outcomes after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis, with a specific interest in the impact of laryngeal involvement on postoperative outcome., Methods: All patients who underwent (laryngo)tracheal surgery for benign pathology between 1996 and 2017 in our centre were included in this retrospective study. Surgical outcomes were procedural success rate, and airway- and voice-related complications. Functional results were assessed using (standardized) questionnaires for quality of life, sensation of dyspnea, swallowing function, and voice perception., Results: Of 119 consecutive patients, 47 underwent laryngotracheal resection and reconstruction and 72 underwent segmental tracheal surgery (78% with an end-to-end tracheal anastomosis and 22% with a cricotracheal anastomosis). Overall success rate was 92% and was similar for all groups, with an overall significant improvement in quality of life when compared to the preoperative situation. However, after laryngotracheal surgery, airway-related complications were more common when compared to segmental resections with an end-to-end tracheal anastomosis (30% versus 7%, P=0.003). Additionally, early voice alterations without recurrent nerve palsy were reported twice as often (34% versus 16%, P=0.034) and voice quality experienced during follow-up was significantly worse when compared to segmental resections. Overall response rate to the questionnaires on functional outcome was 63%., Conclusions: (Laryngo)tracheal surgery is safe and beneficial, with significant functional improvement during mid- and long-term follow-up. However, laryngeal involvement is a predictor for increased surgical airway-related complications. Additionally, voice alterations without recurrent nerve palsy are far more common after laryngotracheal resection and are a serious handicap. This aspect is underexposed in current literature and deserves further attention during preoperative counseling and patient follow-up. However, the results on functional outcome of this current study should be interpreted with caution due to the somewhat low response rate of the questionnaires., Competing Interests: Conflicts of Interest: The abstract of this manuscript was presented at the 31st EACTS Annual Meeting in Vienna, Oct 10, 2017.