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IMPORTANCE: Emerging computed tomographic (CT) imaging techniques for the localization of primary hyperparathyroidism (PHPT) may be superior to the current imaging standard, thus necessitating a critical review and pooling of available evidence. OBJECTIVE: Primary hyperparathyroidism requires accurate imaging to guide definitive surgical management. Advanced techniques including 4-dimensional computed tomographic (4D-CT) scan have been investigated over the past decade. We sought to evaluate the efficacy of these emerging imaging techniques through pooled analysis of the existing evidence. DATA SOURCES: PubMed, Embase, and Web of Science databases were queried for original English articles without any restrictions on date. STUDY SELECTION: We included comparative observational studies but excluded animal studies, case reports, and case series. Overall, 353 abstracts were screened independently by 2 investigators along with a third reviewer to resolve conflicts. A total of 26 full-text articles were included in this review. DATA EXTRACTION AND SYNTHESIS: This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Data was independently extracted by 2 investigators and subsequently pooled into a meta-analysis using a random-effects model. MAIN OUTCOMES AND MEASURES: Measures of imaging diagnostic performance such as sensitivity, specificity, positive predictive value, and negative predictive value were the primary outcomes of interest. RESULTS: Overall, of 34 articles screened, 26 met criteria for qualitative synthesis, and 23 of these were appropriate for meta-analysis. Of the 26 studies included, there were 5845 patients, of which 4176 were women (79.2%). The average of mean ages reported in 23 studies was 60.9 years. Meta-analysis in all patients with PHPT revealed pooled sensitivity that was greater with 4D-CT (81%; 95% CI, 77%-84%; I2 = 88%) compared with the current first-line modality of sestamibi–single-photon emission CT (SPECT/CT) (65%; 95% CI, 59%-70%; I2 = 93%). For patients with recurrent PHPT requiring reoperation, 4D-CT pooled sensitivity was 81% (95% CI, 64%-98%; I2 = 93%) in contrast to 53% (95% CI, 35%-71%; I2 = 81%) for sestamibi-SPECT/CT. The overall quality of the 26 studies was moderate with a median (range) Methodological Index for Nonrandomized Studies score for all included studies of 15.5 (13-19). CONCLUSIONS AND RELEVANCE: The findings of this systematic review and with meta-analyses of numerous studies from the past decade suggest that the 4D-CT can be more sensitive and specific than sestamibi-SPECT/CT in localizing PHPT. More research is needed to determine the clinical significance of this improvement in localization.

Abstract Malignant eccrine acrospiromas are rare. Clinically, they resemble other cutaneous lesions. A high index of suspicion must be maintained in cases of histologically benign eccrine acrospiromas for three reasons: [...]

Salivary gland tumors are an uncommon heterogeneous group of neoplasms that vary in their anatomical site, histology, and biologic behavior. Pleomorphic adenoma is the most common benign tumor, and mucoepidermoid and adenoid cystic carcinoma are the most common malignant tumors. Evaluation and diagnosis of these tumors include not only a complete history and head and neck exam, but also biopsy and imaging of the tumors. Controversy remains regarding the necessity and type of biopsy to be performed and the usefulness of imaging. This manuscript describes the utility of different diagnostic procedures in evaluating salivary gland neoplasms. [ABSTRACT FROM AUTHOR]

Survivorship encompasses the entire therapeutic, psychosocial, functional, and financial experience of living with and through a cancer diagnosis. The period of survivorship starts on the day of the cancer diagnosis and lasts until the end of the survivor’s life, regardless of the cause of death. The National Cancer Institute’s Office of Cancer Survivorship expands the term “survivor” to include, importantly, caregivers, family, and friends close to the survivor who also live through this period.

To present a case of mucosal melanoma of the Eustachian tube with a focus on surgical technique and to review the literature on treatment of mucosal melanoma of the head and neck, and review cases involving the middle ear andor Eustachian tube.

Radiation recall reactions, in particular dermatitis, are well documented in the literature. However, radiation recall mucositis is a rare clinical phenomenon. We report a case of a 45-year-old man diagnosed with squamous cell carcinoma of the base of tongue. He was treated with surgery followed by chemotherapy and radiation therapy. Several months after completing treatment, he had a recurrence develop outside of the previously irradiated field. He was offered radiation therapy concurrent with docetaxel as salvage therapy. During salvage therapy, acute recall mucositis developed corresponding to his previously irradiated fields. His chemotherapy with docetaxel was withheld, and his symptoms rapidly improved. This case describes radiation recall mucositis associated with docetaxel, a rare but potentially serious clinical situation. Given the potential severity of the reaction and increasing use of docetaxel as second-line treatment of recurrent head and neck cancers, it is important to be aware of this phenomenon. © 2004 Wiley Periodicals, Inc. Head Neck 26: 197–200, 2004

Craniofacial reconstruction may be limited by the paucity of autologous materials available and donor site morbidity. Recent advances in the development of biomaterials have given the reconstructive surgeon new options for restoring form and function. There are now biomaterials (second generation) that can elicit a controlled action and reaction to the surrounding tissue environment (bioactive), and those that can exhibit a controlled chemical breakdown and resorption, with ultimate replacement by regenerating tissue (resorbable). Third-generation biomaterials are being designed to stimulate regeneration of living tissues using tissue engineering and in situtissue regeneration methods. These techniques will lead to limitless possibilities for tissue regeneration and repair. At present, biomaterials that may find future use in craniofacial reconstruction include newly developed bone and skin substitutes and soft-tissue fillers.

ObjectivesThere is controversy regarding the existence of branchial cleft carcinomas. The objectives are to familiarize the clinician with the presentation and treatment of cystic metastases from head and neck primary sites and differentiate these from primary branchial cleft cyst carcinomas.

ObjectiveAt the conclusion of the current presentation, the participants should be able to describe the etiology, presentation, histopathologic identification, and treatment options for schwannoma of the larynx.

Objectives/HypothesisPatients undergoing contaminated head and neck surgery with flap reconstruction have wound infection rates of 20% to 25% with parenteral antibiotic prophylaxis. Studies suggest that perioperative antimicrobial mouthwash reduces oropharyngeal flora and may prevent wound infections. We hypothesized that the addition of topical antibiotics to a parenteral prophylactic regimen would reduce the incidence of wound infection in these high‐risk patients.

ObjectivesInverting papilloma of the temporal bone is exceedingly rare. The objective is to familiarize the clinician with the clinical presentation and prognosis of this entity.

Objective:To determine the prevalence of herpes simplex virus (HSV) in malignant laryngeal lesions.

Tobacco use is the number one preventable cause of morbidity and mortality in the United States. Recent advances in the understanding of nicotine addiction have given rise to new therapeutic approaches. New pharmacologic approaches for the treatment of tobacco addiction include nicotine replacement products (transdermal patch, nasal spray, and inhaler) and the use of anti-depressant drugs (bupropion). Pharmacologic treatments should be used in combination with behavioral counseling to increase effectiveness. Guidelines exist for the incorporation of tobacco cessation practices into the physician’s daily practice, and physicians are urged to offer tobacco cessation programs to all patients suffering from nicotine addiction.