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Background The purpose of this study was to assess the utility of the pectoralis major muscle flap (PMMF) in the prevention of pharyngocutaneous fistula for total laryngectomy after radiotherapy (RT) Methods We conducted a retrospective review of 166 patients who underwent a total laryngectomy after RT between 1998 and 2012 at the CHU de Quebec. Results One hundred fifteen patients underwent a total laryngectomy with primary pharyngeal closure alone and 51 patients received an onlay PMMF. The incidence of pharyngocutaneous fistula in the PMMF group was 14% compared to 36% when only primary closure was done (p = .004). However, the PMMF did not influence the treatment needed for the healing of this complication (p = 1.00). The development of pharyngocutaneous fistula increased the length of stay from 19 to 50 days (p

Objectives/Hypothesis: To determine the effectiveness of dexamethasone to reduce pain after tonsillectomy in adults by at least 13 mm on the visual analogue scale. The secondary objective was to reduce the use of narcotics by at least 20%. Study Design: This multicentric study is a prospective double-blind randomized controlled trial. Methods: A total of 102 patients were enrolled and received a 4-day trial either of dexamethasone in decreasing doses or placebo. The patients were asked to note the level of pain on the visual analogue scale daily for 7 days. They also had to record their consumption of analgesic and any eventual side effects. Results: There were no statistically or clinically significant differences between the two groups for the level of pain noted on the visual analogue scale for the first 4 and 7 days. There were no statistical differences for the consumption of hydromorphone between the two groups. Conclusion: We cannot recommend the use of dexamethasone on a routine basis following tonsillectomy in adults for the reduction of pain or narcotics consumption.

Objectives: To test the prognostic significance of standard clinicopathologic factors in patients with well-differentiated thyroid carcinoma (WDTC). Study Design: A retrospective chart review of the thyroid cancer database at Mount Sinai Hospital (Toronto, Canada 1963-2000) was carried out. Methods: All patients consecutively treated for WDTC with a follow-up period of at least 5 years were eligible for inclusion. Relevant patient, tumor, treatment, and outcome data were collected. The main outcome measures were recurrence rate, actuarial overall, and disease-specific survival at 20 years. Results: Three hundred and thirty-three patients (F 275, M 58) with a median age of 39.7 (range 9-82.9) years were eligible for inclusion in this study (median follow-up 10.4 years, range 5-34.4 years, minimum 5 years). The recurrence rate was 15.6% (52 /333). The overall and disease-specific survival at 10 years was 97.5% and 98.5%, respectively. Likewise, the overall and disease-specific survival at 20 years was 88.4% and 93.3%, respectively. Clinicopathologic factors significant on multivariate regression for the development of disease recurrence included family history of WDTC, advanced stage, and total thyroidectomy (all P

Background. Our aim was to review the presenta- tion, treatment, and outcome of patients with metastatic cu- taneous squamous cell carcinoma involving the parotid gland at a tertiary referral center. Methods. We performed a retrospective chart review of the cancer registry at the Princess Margaret Hospital, Toronto, from 1970 to 2001. All patients had a previously untreated metastatic cutaneous head and neck squamous cell carcinoma involving the parotid gland. A minimal follow-up of 1 year was mandatory for inclusion in the study. Results. Fifty-six white patients (43 men and 13 women), with a median age of 76 years (range, 49-97 years), were eligible for inclusion. The disease in all patients was retro- spectively staged according to a new system. Twenty patients had P1 disease, 14 had P2, and 22 had P3. Therapy included surgery and adjuvant external beam radiation in 37 patients, single-modality external beam radiation in 12, and surgery alone in seven patients. The overall recurrence rate was 29%. The disease-specific survival was significantly worse in patients treated with external beam radiation alone (p 6 cm (p < .01) and the presence of facial nerve involvement (p < .01) were poor prognostic factors. Conclusions. Metastatic cutaneous squamous cell carcino- ma to the parotid gland is an aggressive neoplasm that requires combination therapy. The presence of a lesion in excess of 6 cm or with facial nerve involvement is associated with a poor prognosis. A 2004 Wiley Periodicals, Inc. Head Neck 26: 727-732, 2004

Objectives:Comparing management of tracheotomies in older (>75 years old) versus younger patients ≤75 years old) for duration of hospitalization secondary to tracheotomy and finding associated risk factors.Methods:Retrospective chart review (2003-2013) for all patients >75 years old who had tracheotomy compared to patients ≤75 years old.Results:Mean age is 79.3 versus 53.1 years, respectively (P < .0001). Main reason for tracheotomy is prolonged endotracheal intubation (59/112-52.7% vs 65/99-65.7%, P = .181). There is a statistically significant difference between time performing tracheotomy and its weaning for older versus younger patients: 33.14 (24.41-41.87 confidence interval [CI] 95%) versus 22.90 days (19.22-26.59 CI 95%, < .0285). Older patients stayed 4.73 days longer at hospital specifically for tracheotomy management (1.97-41.87, CI 95%) versus 0.58 days for younger patients (0.00-1.42 CI 95%, P < .0001). When leaving hospital with a tracheotomy, discharge is delayed by 14.39 days in older (5.80...

The authors investigated the effects of detoxification on alexithymia scores in a sample of psychoactive substance-dependent patients. At baseline, 48 subjects were administered the 20-item Toronto Alexithymia Scale (TAS–20); a second measurement was carried out 4–6 weeks later. The mean TAS–20 total score of these subjects at baseline (55.5 ± 12.0) was higher than healthy population norms (46.5 ± 10.3), and no significant change in totals was elicited after detoxification. The results suggest that, in substance abusers, alexithymia tends to be a stable trait and is not significantly altered as a result of abstinence.

The authors investigated the effects of detoxification on alexithymia scores in a sample of psychoactive substance-dependent patients. At baseline, 48 subjects were administered the 20-item Toronto Alexithymia Scale (TAS-20); a second measurement was carried out 4-6 weeks later. The mean TAS-20 total score of these subjects at baseline (55-5 ± 12.0) was higher than healthy population norms (46.5 ± 10.3), and no significant change in totals was elicited after detoxification. The results suggest that, in substance abusers, alexithymia tends to be a stable trait and is not significantly altered as a result of abstinence.