Publications by authors named "Diana Kirke"

20 Publications

  • Page 1 of 1

Bleomycin sclerotherapy following doxycycline lavage in the treatment of ranulas: A retrospective analysis and review of the literature.

Neuroradiol J 2021 Apr 8:19714009211008790. Epub 2021 Apr 8.

Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, USA.

Objective: A ranula is a mucus-filled salivary pseudocyst that forms in the floor of the mouth, commonly arising from the sublingual or submandibular salivary glands following obstruction or trauma. Complete excision of the injured gland and removal of the cyst content is the first-choice therapy, but has the potential for complications related to injury to nearby structures. As such, minimally invasive approaches such as percutaneous sclerotherapy have been investigated. We aim to contribute to the literature by assessing the efficacy and safety of our technique through our experience with 18 patients over the last decade.

Methods: This retrospective study evaluated 18 patients with intraoral and plunging ranulas treated by percutaneous bleomycin ablation. The primary endpoint was the treatment result. Secondary endpoints included bleomycin dosage and complications.

Results: The study evaluated 12 males and six females with a median age of 23.5 years (range 13-39 years). At a final follow-up of at least 2 months (6.5±5.5 months), four patients demonstrated complete response (22%) and 14 patients demonstrated residual presence, recurrence, or regrowth of the lesion (78%). There were no statistically significant associations between outcomes and history of prior treatment, number of treatments, and size or type of ranula. No complications were noted.

Conclusions: Our findings indicate that bleomycin, while safe for use in various head and neck malformations, is of limited utility in ranula therapy when the offending gland is not addressed primarily.
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http://dx.doi.org/10.1177/19714009211008790DOI Listing
April 2021

Enhancing Patient Experience in Office-Based Laryngology Procedures With Passive Virtual Reality.

OTO Open 2021 Jan-Mar;5(1):2473974X20975020. Epub 2021 Jan 8.

Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, USA.

Objectives: Virtual reality (VR) has been used as nonpharmacologic anxiolysis benefiting patients undergoing office-based procedures. There is little research on VR use in laryngology. This study aims to determine the efficacy of VR as anxiolysis for patients undergoing in-office laryngotracheal procedures.

Study Design: Randomized controlled trial.

Setting: Tertiary care center.

Methods: Adult patients undergoing office-based larynx and trachea injections, biopsy, or laser ablation were recruited and randomized to receive standard care with local anesthesia only or local anesthesia with adjunctive VR. Primary end point was procedural anxiety measured by the Subjective Units of Distress Scale (SUDS). Subjective pain, measured using a visual analog scale, satisfaction scores, and procedure time, and baseline anxiety, measured using the Hospital Anxiety and Depression Scale (HADS), were also collected.

Results: Eight patients were randomized to the control group and 8 to the VR group. SUDS scores were lower in the VR group than in the control group with mean values of 26.25 and 53.13, respectively ( = .037). Baseline HADS scores did not differ between groups. There were no statistically significant differences in pain, satisfaction, or procedure time. Average satisfaction scores in VR and control groups were 6.44 and 6.25, respectively ( = .770). Average pain scores were 3.53 and 2.64, respectively ( = .434).

Conclusion: This pilot study suggests that VR distraction may be used as an adjunctive measure to decrease patient anxiety during office-based laryngology procedures. Procedures performed using standard local anesthesia resulted in low pain scores and high satisfaction scores even without adjunctive VR analgesia.

Level Of Evidence: 1.
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http://dx.doi.org/10.1177/2473974X20975020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797579PMC
January 2021

Implementation of a 4-dimensional computed tomography protocol for parathyroid adenoma localization.

Am J Otolaryngol 2021 May-Jun;42(3):102907. Epub 2021 Jan 12.

Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Purpose: To present the results of our implementation of a four-dimensional computed tomography- (4DCT) based parathyroid localization protocol for primary hyperparathyroidism at a safety net hospital.

Methods: We performed a retrospective review of all patients who underwent parathyroidectomy for primary hyperparathyroidism at Elmhurst Hospital Center from June 2016 - September 2019. Patients treated prior to the implementation of 4DCT during October 2018 served as historical controls for comparison. Imaging-related costs and hospital charges were obtained from the Radiology Department for each patient.

Results: Forty-two patients underwent parathyroid surgery during the study period. Twenty patients had undergone 4DCT while 22 had nuclear medicine studies with or without ultrasonography. The sensitivity and specificity of 4DCT was 90.4% and 100% respectively, compared to 63% and 93.7% for nuclear imaging studies and 41% and 95% for ultrasound. The mean number of glands explored was significantly less in the 4DCT group, 1.8 ± 1.19 versus 2.77 ± 1.26 (p = 0.01). There was no increase in infrastructure or personnel costs associated with 4DCT implementation.

Conclusions: 4DCT represents an increasingly common imaging modality for pre-operative parathyroid localization. Here we demonstrate that 4DCT is associated with a reduction in the number of glands explored and enables minimally invasive parathyroid surgery. 4DCT is a cost-effective and clinically sound localization study for parathyroid localization in an urban safety-net hospital.
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http://dx.doi.org/10.1016/j.amjoto.2021.102907DOI Listing
January 2021

Modernizing the Otolaryngology Referral Workflow: The Impact of Electronic Consultation.

Laryngoscope 2021 06 15;131(6):E1792-E1796. Epub 2020 Dec 15.

Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.

Objectives/hypothesis: To determine the impact of electronic consultation on the otolaryngology clinic workflow at our high-volume public hospital.

Study Design: Retrospective Observational Study.

Methods: This is a retrospective observational analysis study. Operational data regarding clinic volume, referral patterns, and scheduling efficiency were assessed over a 9-month period in 2018 prior to implementation of electronic consultation. The same data were collected for the 9-month period immediately following implementation of electronic consultation in 2019.

Results: During the pre-implementation (pre-EC) period, 3,243 otolaryngology referrals were made as compared to 4,249 post-implementation (post-EC). 86% of referrals were scheduled for a clinic appointment pre-EC, compared to 61% post-EC (P < .00001) 24.5% of patients were evaluated within 30 days pre-EC compared to 53.6% post-EC (P < .00001). The average time to be seen by an otolaryngology provider declined from 60.8 days pre-EC to 42.8 days post-EC (P = .0029). There was a 50% decline in the percentage of appointments canceled by patients in the post-EC period as compared to pre-EC.

Conclusions: In our experience, implementation of electronic consultation significantly reduced both wait times for a clinic appointment and the percentage of no-show or canceled appointments. Electronic consultation may be a valuable tool in improving the efficiency and yield of the modern otolaryngology clinic.

Level Of Evidence: 4 Laryngoscope, 131:E1792-E1796, 2021.
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http://dx.doi.org/10.1002/lary.29333DOI Listing
June 2021

The Natural History of Vocal Fold Cysts.

Laryngoscope 2020 09 12;130(9):2202-2207. Epub 2019 Nov 12.

Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A.

Objective: To determine the natural history of vocal fold cysts, by undertaking a retrospective analysis of data from a single clinical institute.

Methods: All patients diagnosed with vocal fold cysts were identified from January 2006 to June 2018. A total of 87 patients that elected not to have surgery or who had an interval of observation greater than 90 days prior to surgical intervention were further analyzed. The primary outcome was whether the cyst enlarged, reduced in size, resolved or ruptured. The secondary outcome measures were whether cyst characteristics (translucent or opaque by gross appearance and/or the presence of inflammation), voice therapy or duration of follow up (≤/> 300 days) had an impact upon natural history.

Results: There were 65 females and 22 males (47 years ±17). The mean duration of follow up was 589 days (Range 21 - 4523 days). The majority of cysts did not change (70.11%). The rest enlarged (12.64%), reduced in size (13.79%), resolved (1.15%) or ruptured (1.15%). There was no statistically significant relationship between the presence or absence of clinical signs of inflammation (P = .633) or voice therapy (P = .785) on natural history. There was an equivocal relationship between gross cyst appearance and natural history (P = .054), however there was a statistically significant relationship between the duration of follow up (P = .006) and natural history.

Conclusion: Most vocal fold cysts appear to remain static in size over time. About 30% change, with half of these enlarging and half shrinking. In addition to some possibility of change in size, there is a small chance of resolution or spontaneous rupture with potentially serious consequences to the voice.

Level Of Evidence: 4. Laryngoscope, 130:2202-2207, 2020.
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http://dx.doi.org/10.1002/lary.28377DOI Listing
September 2020

Impact of an Upper Respiratory Tract Infection on Botulinum Toxin Efficacy in Spasmodic Dysphonia Patients.

Laryngoscope 2020 07 11;130(7):1746-1749. Epub 2019 Sep 11.

Head and Neck Surgical Group, New York Center for Voice and Swallowing Disorders, New York, New York, U.S.A.

Objective: To determine whether the presence of a concomitant upper respiratory tract infection (URI) impacts upon Botulinum toxin (BoNT) efficacy in spasmodic dysphonia (SD) patients.

Study Design: Case series and literature review.

Methods: All SD patients with a concurrent URI, presenting for BoNT therapy at a clinical research center from November 2016 to December 2017 were included. A total of 12 patients were identified. Patients were followed for at least two BoNT treatment cycles (approximately 6 months). The primary outcome measure was efficacy of the initial BoNT injection and the secondary outcome measure was the efficacy of the subsequent BoNT injection.

Results: All subjects had adductor type SD (ADSD). There were 10 females and two males with a median age of 55 years (±19.5). All patients were well established on a consistent BoNT treatment regime, with an average administered dose of 1.0 unit (range 0.2-1.80 units). Bilateral injections were administered to 10 patients. Regarding the primary outcome measure, five failed to have any response to BoNT (41.7%), four had a partial response (33.3%), and three had a positive response to treatment (25.0%). When patients had their follow-up injection in the absence of URI symptoms, 11 patients had a positive response to treatment (91.7%).

Conclusion: While the interplay between illness and BoNT efficacy is yet to be elucidated, we report that some patients are affected. We recommend that SD patients presenting for BoNT administration with a concomitant URI, should be counseled that their treatment might have decreased effect.

Level Of Evidence: 4 Laryngoscope, 130:1746-1749, 2020.
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http://dx.doi.org/10.1002/lary.28283DOI Listing
July 2020

Head and Neck Cancer Complications in the Geriatric Population Based on Hospital Case Volume.

Ear Nose Throat J 2021 Feb 6;100(2):NP62-NP68. Epub 2019 Jun 6.

Division of Otolaryngology - Head and Neck Surgery, 1859Beth Israel Deaconess Medical Center, Boston, MA, USA.

Objective: To determine whether surgical case volume is a predictive factor of surgical outcomes when managing geriatric patients with head andneck cancer.

Methods: A cross-sectional study design was used. Data were obtainedfrom the Vizient Database, which included a total of 93 academicinstitutions. Men and women aged between 65 and 100 years undergoing head and neck cancer surgery during 2009 and 2012,excluding cases of thyroid cancer and skin cancer of the head and neck(n = 4544) were included in the study. Hospital case volume was definedas low (≤21 cases/year), moderate (22-49 cases/year), or high (≥50 cases/year). The frequency of comorbidities and complications wasmeasured by hospital case volume using a χ test. Significancewas determined with an α level of .05.

Results: The largest number of head and neck cancer cases involving comorbidities (90.54%) and the highest rate of overall complications(27.50%) occurred in moderate case volume institutions compared to athe complication rate of 22.89% in low volume hospitals and 21.50% in highvolume hospitals ( < .0001). The most common comorbidities across all3 hospital case volumes included hypertension, metastatic cancer,and chronic pulmonary disease and the most common complicationsincluded hemorrhage/hematoma and postoperative pulmonarycompromise.

Conclusion: With more geriatric patients requiring surgery for head andneck cancer, it would be beneficial to manage the more complex cases at high volume centers and to develop multidisciplinary teams to optimizecase management and minimize complications.
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http://dx.doi.org/10.1177/0145561319856006DOI Listing
February 2021

Interesting case of late Gore-Tex extrusion following medialization laryngoplasty.

Laryngoscope 2019 06 8;129(6):1420-1422. Epub 2018 Nov 8.

Head and Neck Surgical Group, New York, New York, U.S.A.

A 65-year-old female presented with a foreign body sensation following an asthmatic attack associated with severe coughing. Six years earlier, the patient underwent medialization laryngoplasty (ML), which was complicated by a small tear (2 mm) in the right ventricle. One year following this, the patient developed Gore-Tex extrusion but elected only for partial removal. Healing was complete until 5 years later; on examination, the patient had evidence of Gore-Tex extrusion through the right ventricle. Implant extrusion is a recognized complication of ML. This case demonstrates several important surgical steps that can benefit otolaryngologists at all stages of their surgical career. Laryngoscope, 129:1420-1422, 2019.
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http://dx.doi.org/10.1002/lary.27514DOI Listing
June 2019

Role of adjuvant chemoradiotherapy in T4N0 stage IV head and neck cancer: A National Cancer Database analysis.

Head Neck 2018 06 8;40(6):1174-1184. Epub 2018 Feb 8.

Department of Radiation Oncology, Boston Medical Center, Boston, Massachusetts.

Background: The purpose of this study was to evaluate the role of postoperative adjuvant radiotherapy (surgery + adjuvant RT) versus adjuvant chemoradiotherapy (surgery + adjuvant CRT) in patients with T4N0M0, stage IV head and neck squamous cell carcinoma (HNSCC).

Methods: Between 1998 and 2011, 3518 and 885 patients were treated with surgery + adjuvant RT and surgery + adjuvant CRT, respectively. Three-year overall survival (OS) rates were determined and crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were computed.

Results: Median follow-up was 41.8 months with 2193 reported deaths. The 3-year OS was 67.5% for surgery + adjuvant RT and 70.5% for surgery + adjuvant CRT (P = .013). For negative margins, the corresponding 3-year OS was 70.1% and 74.9% (P = .005). For positive margins, the corresponding 3-year OS was 56.0% and 60.6% (P = .079). On multivariate analysis, the beneficial effect for adjuvant CRT over adjuvant RT was not significant (HR 0.90; CI 0.79-1.03; P = .124).

Conclusion: In this cohort of patients with T4N0 HNSCC treated with surgery, there was no observed survival benefit of adjuvant CRT over adjuvant RT on multivariate analysis.
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http://dx.doi.org/10.1002/hed.25087DOI Listing
June 2018

Marital status as a predictor of survival in patients with human papilloma virus-positive oropharyngeal cancer.

Am J Otolaryngol 2017 Nov - Dec;38(6):654-659. Epub 2017 Sep 19.

Department of Otolaryngology Head and Neck Surgery, Boston Medical Center, Boston, MA, United States; Boston University School of Medicine, Boston, MA, United States. Electronic address:

Purpose: Determine whether marital status is a significant predictor of survival in human papillomavirus-positive oropharyngeal cancer.

Materials And Methods: A single center retrospective study included patients diagnosed with human papilloma virus-positive oropharyngeal cancer at Boston Medical Center between January 1, 2010 and December 30, 2015, and initiated treatment with curative intent at Boston Medical Center. Demographic data and tumor-related variables were recorded. Univariate analysis was performed using a two-sample t-test, chi-squared test, Fisher's exact test, and Kaplan Meier curves with a log rank test. Multivariate survival analysis was performed using a Cox regression model.

Results: A total of 65 patients were included in the study with 24 patients described as married and 41 patients described as single. There was no significant difference in most demographic variables or tumor related variables between the two study groups, except single patients were significantly more likely to have government insurance (p=0.0431). Furthermore, there was no significant difference in 3-year overall survival between married patients and single patients (married=91.67% vs single=87.80%; p=0.6532) or 3-year progression free survival (married=79.17% vs single=85.37%; p=0.8136). After adjusting for confounders including age, sex, race, insurance type, smoking status, treatment, and AJCC combined pathologic stage, marital status was not a significant predictor of survival [HR=0.903; 95% CI (0.126,6.489); p=0.9192].

Conclusions: Although previous literature has demonstrated that married patients with head and neck cancer have a survival benefit compared to single patients with head and neck cancer, we were unable to demonstrate the same survival benefit in a cohort of patients with human papilloma virus-positive oropharyngeal cancer.
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http://dx.doi.org/10.1016/j.amjoto.2017.09.003DOI Listing
July 2018

Adjuvant chemoradiation does not improve survival in elderly patients with high-risk resected head and neck cancer.

Laryngoscope 2018 04 21;128(4):831-840. Epub 2017 Aug 21.

Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A.

Objectives/hypothesis: Randomized trials have demonstrated that adjuvant chemoradiotherapy (CRT) confers an overall survival (OS) benefit over adjuvant radiation therapy (RT) alone in patients with resected head and neck squamous cell carcinoma (HNSCC) with adverse pathologic features (positive surgical margins [SM+] and/or extracapsular extension [ECE]). Whether this OS benefit exists in an elderly population remains unknown.

Study Design: Retrospective database study.

Methods: Using the National Cancer Database, we identified 1,686 elderly patients (age ≥70 years) with resected HNSCC with SM+ and/or ECE, who received adjuvant CRT (491 patients, 29%) or adjuvant RT alone (1,195 patients, 71%) between 1998 and 2011. Three-year survival rates were estimated using the Kaplan-Meier method both before and after propensity score matching (PSM). Crude and adjusted hazard ratios (HR) with 95% confidence intervals (CI) were computed using Cox regression modeling.

Results: Median follow-up was 23.5 and 42.8 months for all and surviving patients, respectively. Three-year OS was 50.7% and 44.4% among patients receiving adjuvant CRT and RT alone, respectively (P = .002). On multivariate analysis, there was no significant improvement in OS with adjuvant CRT relative to adjuvant RT alone (HR: 0.88, 95% CI: 0.73-1.06). Similarly, a PSM cohort showed no significant difference in the 3-year OS for patients receiving adjuvant CRT versus adjuvant RT alone (48.8% and 50.9%, respectively; P = .839).

Conclusions: Although the addition of chemotherapy to adjuvant RT has been proven effective in randomized trials of patients with resected HNSCC with SM+ or ECE, it may be less efficacious in an elderly patient population treated outside of a controlled trial setting.

Level Of Evidence: 2c. Laryngoscope, 128:831-840, 2018.
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http://dx.doi.org/10.1002/lary.26798DOI Listing
April 2018

Patient education materials assessment tool for laryngectomy health information.

Head Neck 2017 11 16;39(11):2256-2263. Epub 2017 Aug 16.

Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, Massachusetts.

Background: The decision to undergo laryngectomy carries medical, social, and emotional consequences. This study evaluates the understandability and actionability of current laryngectomy information.

Methods: Laryngectomy-related educational materials from an online search were evaluated using the validated Patient Education Materials Assessment Tool (PEMAT). Reading difficulty was calculated using the Flesch-Kincaid Level, Flesch Reading Ease, Gunning-Fog Index (GFI), Coleman-Liau Index, Automated Readability Index, and Simple Measure of Gobbledygook (SMOG) score. Interrater agreement was assessed using Cohen's kappa. Pearson's correlation coefficient was used to determine the relationship among readability, understandability, and actionability.

Results: Forty-four articles were included. Interrater agreement was substantial (κ = 0.71). Mean understandability was 68.3% ± 17% and mean actionability was 66.3% ± 24%. Average reading difficulty exceeded the ability of an average American adult. There was a negative correlation between readability and understandability (R = -0.49; P < .05).

Conclusion: Most laryngectomy information is too difficult for the average person to read, understand, or act upon. Revisions may be warranted to benefit a larger readership.
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http://dx.doi.org/10.1002/hed.24891DOI Listing
November 2017

Outcomes of head and neck cancer surgery in the geriatric population based on case volume at academic centers.

Laryngoscope 2017 11 12;127(11):2539-2544. Epub 2017 Jul 12.

Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, U.S.A.

Objectives/hypothesis: Evaluate the impact of case volume and other variables on cost and mortality after head and neck oncologic surgery in the geriatric population.

Study Design: Cross-sectional study.

Methods: The Vizient database was accessed for data on geriatric patients (age ≥65 years) who underwent surgery for head and neck cancers (excluding thyroid and skin cancer) at full member academic medical centers between 2009 and 2012. Multivariate, linear regression analyses, χ tests, and analysis of variance were applied to evaluate significant associations between hospital case volume and independent variables including cost, cost index, mortality, mortality index, length of stay, length of stay index, and readmission rates.

Results: A total of 4,544 patients were included. Total length of stay was 6.72 days in high-volume hospitals, compared to 8.12 days and 7.91 days in moderate- and low-volume hospitals, respectively (P = .0144). Frequency of intensive care unit stays was 36.5% in high-volume hospitals, compared to 42.19% and 40.29% in moderate- and low-volume hospitals, respectively (P = .0048). Mortality (0.78%) and average cost per case ($21,834) was lower, but nonsignificant in high-volume hospitals. Using multiple regression analysis, major severity of disease was positively associated with complication rate (P < .0001) and length of stay (P = .0481).

Conclusions: After controlling for other factors, high-volume academic medical centers have a lower intensive care unit stay, but no difference in mortality or average cost per case when compared to low-volume hospitals.

Level Of Evidence: 2b. Laryngoscope, 127:2539-2544, 2017.
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http://dx.doi.org/10.1002/lary.26750DOI Listing
November 2017

Comparison of facility type outcomes for oral cavity cancer: Analysis of the national cancer database.

Laryngoscope 2017 11 3;127(11):2551-2557. Epub 2017 Jul 3.

Department of Otolaryngology Head and Neck Surgery, Boston, Massachusetts, U.S.A.

Objective: Determine whether facility type effects overall survival in patients with oral cavity cancer.

Study Design: Retrospective cohort study.

Methods: Patients included in the National Cancer Database who were diagnosed with oral cavity cancer between 1998 and 2011 were included in the study. Data was stratified by facility where care was provided, including community cancer programs (CCP), comprehensive community cancer programs (CCCP), and academic centers (AC). Univariate analysis was performed using analysis of variance, chi squared, and log-rank test, whereas multivariate analysis was performed using Cox regression.

Results: A total of 32,510 patients were included in the study, with 7.58% of patients receiving care at CCPs (n = 2,553), 39.53% at CCCPs (n = 12,852), and 52.61% at ACs (n = 17,105). Between 1998 and 2011, there was a greater percentage of patients receiving care at ACs, and a greater percentage of patients receiving surgical therapy versus nonsurgical therapy. Patients treated at ACs had the best 5-year overall survival of 51.26%, with a significant difference across facility types (P < 0.01). After adjusting for confounders, receiving care at ACs was a positive predictor of survival (hazard ratio: 0.95 95% confidence interval [0.91,0.98])).

Conclusion: Patients treated at ACs are more likely to receive surgical treatment, and have a greater 5-year overall survival compared to those patients treated at CCPs and CCCPs. Therefore, we advocate referring patients with advanced oral cavity cancers to ACs.

Level Of Evidence: 4. Laryngoscope, 127:2551-2557, 2017.
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http://dx.doi.org/10.1002/lary.26632DOI Listing
November 2017

Adenoid cystic carcinoma of the base of tongue: A population-based study.

Am J Otolaryngol 2017 May - Jun;38(3):279-284. Epub 2017 Jan 18.

Department of Otolaryngology, Head & Neck and Skull Base Surgery, Boston Medical Center, Boston, MA, United States. Electronic address:

Background: The objective was to assess demographic and survival patterns in patients with adenoid cystic carcinoma of the base of tongue.

Methods: Patients were extracted from the Surveillance, Epidemiology and End Results (SEER) database from 1973 through 2012 and were categorized by age, gender, race, historical stage A, and treatment. Incidence and survival were compared with Kaplan Meier curves and mortality hazard ratios.

Results: A total of 216 patients were included. After adjusting for age, gender, race and tumor-directed treatment, patients over the age of 70years had a significantly increased mortality [HR=2.847, 95% CI (1.499, 5.404) p=0.0014]. Furthermore mortality among patients with distant disease was significantly increased [HR=2.474 95% CI (1.459, 4.195) p=0.00008].

Conclusion: By examining the largest collection of patients we have demonstrated that there is a significant difference in mortality based on both the age at diagnosis and in the setting of distant disease.
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http://dx.doi.org/10.1016/j.amjoto.2017.01.010DOI Listing
April 2018

Using 3D computer planning for complex reconstruction of mandibular defects.

Cancers Head Neck 2016 9;1:17. Epub 2016 Dec 9.

1Department of Otolaryngology Head & Neck Surgery, Boston Medical Center, Boston, MA USA.

For complex reconstruction of osseous defects of the head and neck, three-dimensional (3D) computer planning has been available for over 20 years. However, despite its availability and recent refinements, it is a technology that has not been widely adopted. While 3D computer planning has been proposed to improve surgical precision, reduce operating time and enhance functional outcomes, the objective evidence supporting these claims is limited. Here we review the recent literature that supports the use of 3D computer planning for complex osseous defects of the mandible. We highlight a case example where 3D modeling played a critical role, particularly during the virtual surgical planning stage. Finally, we propose that routine post-operative 3D analysis become an essential element in determining operative success. Critical evaluation of outcomes will better define its use in complex reconstruction of osseous defects.
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http://dx.doi.org/10.1186/s41199-016-0019-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6460653PMC
December 2016

Neural correlates of dystonic tremor: a multimodal study of voice tremor in spasmodic dysphonia.

Brain Imaging Behav 2017 02;11(1):166-175

Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1137, NY, 10029, USA.

Tremor, affecting a dystonic body part, is a frequent feature of adult-onset dystonia. However, our understanding of dystonic tremor pathophysiology remains ambiguous as its interplay with the main co-occurring disorder, dystonia, is largely unknown. We used a combination of functional MRI, voxel-based morphometry and diffusion-weighted imaging to investigate similar and distinct patterns of brain functional and structural alterations in patients with dystonic tremor of voice (DTv) and isolated spasmodic dysphonia (SD). We found that, compared to controls, SD patients with and without DTv showed similarly increased activation in the sensorimotor cortex, inferior frontal (IFG) and superior temporal gyri, putamen and ventral thalamus, as well as deficient activation in the inferior parietal cortex and middle frontal gyrus (MFG). Common structural alterations were observed in the IFG and putamen, which were further coupled with functional abnormalities in both patient groups. Abnormal activation in left putamen was correlated with SD onset; SD/DTv onset was associated with right putaminal volumetric changes. DTv severity established a significant relationship with abnormal volume of the left IFG. Direct patient group comparisons showed that SD/DTv patients had additional abnormalities in MFG and cerebellar function and white matter integrity in the posterior limb of the internal capsule. Our findings suggest that dystonia and dystonic tremor, at least in the case of SD and SD/DTv, are heterogeneous disorders at different ends of the same pathophysiological spectrum, with each disorder carrying a characteristic neural signature, which may potentially help development of differential markers for these two conditions.
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http://dx.doi.org/10.1007/s11682-016-9513-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4972702PMC
February 2017

Alcohol responsiveness in laryngeal dystonia: a survey study.

J Neurol 2015 Jun 1;262(6):1548-56. Epub 2015 May 1.

Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1137, New York, NY, 10029, USA.

Laryngeal dystonia (LD) is a task-specific focal dystonia of unknown pathophysiology affecting speech production. We examined the demographics of anecdotally reported alcohol use and its effects on LD symptoms using an online survey based on Research Electronic Data Capture (REDCap™) and National Spasmodic Dysphonia Association's patient registry. From 641 participants, 531 were selected for data analysis, and 110 were excluded because of unconfirmed diagnosis. A total of 406 patients (76.5 %) had LD and 125 (23.5 %) had LD and voice tremor (LD/VT). The consumption of alcohol was reported by 374 LD (92.1 %) and 109 LD/VT (87.2 %) patients. Improvement of voice symptoms after alcohol ingestion was noted by 227 LD (55.9 % of all patients) and 73 LD/VT (58.4 %), which paralleled the improvement observed by patient's family and/or friends in 214 LD (57.2 %) and 69 LD/VT (63.3 %) patients. The benefits lasted 1-3 h in both groups with the maximum effect after 2 drinks in LD patients (p = 0.002), whereas LD/VT symptoms improved independent of the consumed amount (p = 0.48). Our data suggest that isolated dystonic symptoms, such as in LD, are responsive to alcohol intake and this responsiveness is not attributed to the presence of VT, which is known to have significant benefits from alcohol ingestion. Alcohol may modulate the pathophysiological mechanisms underlying abnormal neurotransmission of γ-aminobutyric acid (GABA) in dystonia and as such provide new avenues for novel therapeutic options in these patients.
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http://dx.doi.org/10.1007/s00415-015-7751-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4674786PMC
June 2015

Pathologic occult neck disease in patients with metastatic cutaneous squamous cell carcinoma to the parotid.

Otolaryngol Head Neck Surg 2011 Apr 3;144(4):549-51. Epub 2011 Feb 3.

Department of Otolaryngology Head & Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.

Objective: The aim of this study was to document the rate of pathologic neck disease in patients presenting with metastatic cutaneous squamous cell carcinoma (CSCC) to the parotid gland following parotidectomy and neck dissection in the clinically and radiologic negative neck.

Study Design: Case series with chart review.

Setting: Tertiary referral center.

Subjects And Methods: The study involved a retrospective chart review from 1999 to 2008 of patients presenting with metastatic CSCC to the parotid at the Princess Alexandra Hospital, Brisbane, Australia.

Results: Eighty-one patients with metastatic parotid disease were identified. A total of 51 (63%) patients had no clinical or radiological evidence of cervical nodal disease. Forty-five patients (88%) were male, median age was 69 (range, 42-91) years, and the median follow-up was 16 (interquartile range, 9-44) months. Thirty-four of these patients underwent a parotidectomy and neck dissection with/without postoperative radiotherapy (RT). Occult pathological cervical nodal disease was found in 5 (14.7%) patients. Of those who received a neck dissection, 3 patients relapsed in the parotid, 1 in the neck alone, and 1 distantly.

Conclusion: This series has shown that the rate of pathologically involved neck nodes in patients with metastatic CSCC to the parotid in the clinically node negative neck is low. Given many of these patients warrant postoperative RT to the parotid bed, an elective neck dissection may not be warranted as the parotid and neck may be treated in continuity with RT.
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http://dx.doi.org/10.1177/0194599810395361DOI Listing
April 2011

Floor of mouth and tongue metastasis from malignant pleural mesothelioma.

ANZ J Surg 2010 Jul-Aug;80(7-8):556-8

Department of Ear Nose and Throat Surgery, Greenslopes Hospital, Greenslopes, Brisbane, Queensland, Australia.

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http://dx.doi.org/10.1111/j.1445-2197.2010.05383.xDOI Listing
December 2010
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