Publications by authors named "Faruque Riffat"

37 Publications

Systematic review and meta-analysis of cervical metastases in oral maxillary squamous cell carcinoma.

Cancer Rep (Hoboken) 2021 May 8:e1410. Epub 2021 May 8.

University of Sydney, Camperdown, New South Wales, Australia.

Background: Management of the node-negative neck in oral maxillary squamous cell carcinoma (SCC), encompassing the hard palate and upper alveolar subsites of the oral cavity, is controversial, with no clear international consensus or recommendation regarding elective neck dissection in the absence of cervical metastases.

Aim: To assess the occult metastatic rate in patients with clinically node negative oral maxillary SCC; both as an overall metastatic rate, and a comparison of patients managed with an elective neck dissection at index surgery, compared to excision of the primary with clinical observation of the neck.

Methods And Results: A systematic review was performed by two independent investigators for studies relating to oral maxillary SCC and analysed according to PRISMA criteria. Data were extracted from Pubmed, Ovid MEDLINE, EMBASE, and SCOPUS via relevant MeSH terms. Grey literature was searched through Google Scholar and OpenGrey. Five hundred and fifty-three articles were identified on the initial search, 483 unique articles underwent screening against eligibility criteria, and 29 studies were identified for final data extraction. Incidence of occult metastases in patients with clinically node negative oral maxillary SCC was identified either on primary elective neck dissection or on routine follow up. Meta-analyses were performed. Of 553 relevant articles identified on initial search, 29 were included for analysis. The pooled overall rate of occult metastases in patients initially presenting with clinically node-negative disease was 22.2%. There is a statistically significant effect of END on decreasing regional recurrence demonstrated in this study (RR 0.36, 95% CI 0.24, 0.59).

Conclusion: The results of this systematic review and meta-analysis suggest elective neck dissection for patients presenting with hard palate or upper alveolar SCC, even in a clinically node negative neck.
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http://dx.doi.org/10.1002/cnr2.1410DOI Listing
May 2021

Thyroid gland metastasis from renal cell carcinoma: a case series and literature review.

ANZ J Surg 2021 04 14;91(4):708-715. Epub 2020 Dec 14.

Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.

Background: Renal cell carcinoma (RCC) is the most common malignancy that metastasises to the thyroid. This study aims to better understand the clinical characteristics of patients with thyroid metastasis from RCC.

Methods: A retrospective case series of patients with thyroid metastasis from RCC between 2008 and 2020 from two tertiary centres were examined. MEDLINE and PubMed database searches were performed to retrieve the relevant literature.

Results: Fifteen patients (eight males) were identified, with a median age of 57.0 (interquartile range (IQR) 51.0-63.0) at time of RCC diagnosis. Median time to thyroid metastasis was 92.0 months (IQR 40.0-156.0), with 12 (80.0%) patients undergoing thyroidectomy within 2 months of diagnosis. No patients developed post-operative complications or local thyroid recurrence. The two most common non-thyroid metastatic sites in this case series are lungs and bone (five patients, respectively; 33.3%) and pancreas (four patients; 26.7%). Ten (66.6%) patients underwent systemic chemotherapy, and five (33.4%) patients underwent radiotherapy for other sites of metastasis. Median survival following thyroid metastasis was 54.0 months (IQR 15.0-100.0). The literature review was conducted through MEDLINE and PubMed database searches, and 30 papers were considered relevant to this review. Results from our study are comparable to those reported in the literature.

Conclusion: Thyroid metastases can occur long after nephrectomy and portends a better prognosis. To prevent development of central neck disease, thyroidectomy should be considered.
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http://dx.doi.org/10.1111/ans.16482DOI Listing
April 2021

Utility of narrowband imaging in the diagnosis of laryngeal leukoplakia: Systematic review and meta-analysis.

Head Neck 2020 11 23;42(11):3427-3437. Epub 2020 Sep 23.

Department of Otolaryngology - Head and Neck Surgery, Westmead Hospital, Westmead, New South Wales, Australia.

This systematic review and meta-analysis evaluates the validity of narrowband imaging (NBI) in differentiating between low-risk leukoplakia and high-risk leukoplakia. Medline, EMBASE, Scopus, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects were searched. Studies evaluating the diagnostic accuracy of NBI in the assessment of laryngeal leukoplakia were included. Pooled sensitivity, specificity and diagnostic odds ratio were calculated. Seven studies met the inclusion criteria assessing a total of 586 lesions with laryngeal leukoplakia. In differentiating between low-risk and high-risk leukoplakia, NBI had a pooled sensitivity and specificity of 85.4% (95% CI [76-99.9]) and 94.9% (95% CI [91.1-97.2]) respectively. Pooled diagnostic odds ratio was 99.2 (95% CI [38.28-257.18]). NBI is a useful imaging modality in differentiating between low-risk leukoplakia and high-risk laryngeal leukoplakia. The high sensitivity, specificity and diagnostic odds ratio make NBI a useful tool in the workup of laryngeal leukoplakia.
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http://dx.doi.org/10.1002/hed.26428DOI Listing
November 2020

The value of narrowband imaging using the Ni classification in the diagnosis of laryngeal cancer.

Laryngoscope Investig Otolaryngol 2020 Aug 26;5(4):665-671. Epub 2020 Jun 26.

Department of Otolaryngology, Head and Neck Surgery Westmead Hospital Westmead New South Wales Australia.

Introduction: Narrowband imaging (NBI) is a special endoscopic optical enhancement setting allowing better visualization of mucosal microvasculature compared to white light endoscopy. This study evaluates the validity of NBI using the Ni classification in the detection and differentiation of severe dysplasia (SD) and glottic squamous cell carcinoma (SCC).

Methods: Patients with suspicious vocal cord lesions underwent conventional white light endoscopy followed by clinically indicated biopsy. At the same time, NBI images were obtained and graded independently. Lesions were graded from I to V according to the Ni classification and compared to histopathological findings.

Results: Fifty-two patients were included in this study (40 SCC and 12 SD). The sensitivity and specificity of NBI in diagnosing laryngeal cancer was 95.0% (CI, 83.9%-99.4%) and 83.3% (CI, 51.6%-97.9%), respectively. The negative likelihood ratio was 0.06. Higher Ni grades correlated very strongly with more advanced disease.

Conclusions: NBI using the Ni classification is a sensitive diagnostic tool for the detection and differentiation of early neoplastic and preneoplastic glottic lesions. As higher Ni classification correlates strongly with advanced disease, it serves as a useful adjunct to white light endoscopy in the diagnosis of laryngeal cancer.Level of Evidence: Level IV.
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http://dx.doi.org/10.1002/lio2.414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444790PMC
August 2020

Use of Purastat, a novel haemostatic matrix based on self-assembling peptides in the prevention of nasopharyngeal adhesion formation.

Int J Surg Case Rep 2020 8;70:227-229. Epub 2020 May 8.

Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Westmead, NSW, Australia; Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.

Introduction: Purastat is a novel haemostatic agent that has recently been used effectively in nasal procedures, specifically in functional endoscopic endonasal surgery in the prevention of post-operative epistaxis while minimising adhesion formation. This study presents a case of successful application of Purastat following division of a nasopharyngeal/palatal stenosis following radiotherapy.

Presentation Of Case: A 49-year-old male developed severe nasopharyngeal stenosis following concurrent chemoradiotherapy with curative intent a HPV positive base of tongue squamous cell carcinoma. Following treatment, while the patient experienced excellent metabolic response, he began to progressive nasal obstruction which he reported to be significantly affecting his quality of life. Following multidisciplinary team discussion, division of the stenosis was considered appropriate. Under general anaesthesia, the patient was positioned lying supine with the neck extended. A Boyle-Davis gag with lip and teeth protection was placed and a Y-suction catheter inserted to lift the palate from the posterior pharyngeal wall. Coblation using a PDW wand was used to divide the area of fibrosis bilaterally toward the superior tonsillar pillar until palatopharyngeus musculature was visible. Injection of 4 mg of Dexamethasone with a hypodermic needle was then performed followed by application of 4 ml of topical Purastat onto the raw surfaces after haemostasis was confirmed. The patient was discharged the same day on simple analgesia and instructions to avoid exertion for two weeks. He attended follow-up in the outpatient department two months later and reported persisting resolution of his nasal obstructive symptoms. No evidence of recurrence or residual adhesion tissue was noted.
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http://dx.doi.org/10.1016/j.ijscr.2020.04.027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231812PMC
May 2020

Colonization rates of tracheostomy tubes associated with the frequency of tube changes.

ANZ J Surg 2020 11 17;90(11):2310-2314. Epub 2020 May 17.

Department of Otolaryngology-Head and Neck Surgery, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia.

Background: Tracheostomy-tube change protocols are implemented primarily due to concern regarding infections. Currently changes vary from within 4 weeks post-insertion to 3 monthly thereafter. However, currently no evidence-based guidelines exist to justify these protocols. This study aims to assess the colonization of tracheostomy-tubes associated with the frequency of changes.

Methods: A prospective cohort study over 18-months of adult tracheostomy patients at a single institution (inpatient/outpatients). Patients were grouped based on whether tubes were changed at ≤4 weeks or >4 weeks and microbiology swabs sent for microscopy, culture and sensitivities.

Results: A total of 65 patients were enrolled. No statistically significant difference in colonization in patients undergoing tube changes more than every 4 weeks to those less than every 4 weeks was found (56.2% versus 57.1%, χ = 0.004, P = 0.95).

Conclusion: The timing of tracheostomy-tube changes may not affect colonization and infection rates. Routine changes for the purpose of reducing infection risk may not be needed unless clinically indicated.
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http://dx.doi.org/10.1111/ans.15970DOI Listing
November 2020

Risk factors associated with microbial colonisation and infection of tracheostomy tubes.

Am J Otolaryngol 2020 Jul - Aug;41(4):102495. Epub 2020 Apr 18.

Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, University of Sydney, Camperdown, NSW 2006, Australia; Department of Otolaryngology, Head and Neck Surgery, Macquarie University Hospital, Australia; Chris O'Brien Lifehouse, Sydney, Australia.

Background: A long-term tracheostomy tube has the potential to cause significant morbidity and mortality in both hospitalised patients and those in the community. This study aims to assess the rates of microbial colonisation and infection of tracheostomy tubes.

Materials And Methods: Consecutive patients were enrolled from both inpatient and outpatient settings during their routine tracheostomy changes. During changes, culture swabs were taken from the cuff/outer-cannula and inner-cannula. Analysis were performed to compare culture results with risk factors.

Results: 65 patients were enrolled in the study. Inpatients (65.9% vs 38.1%, χ 4.48, p = 0.03), increasing acuity of care (from outpatient; ward; HDU; and ICU in increasing acuity) (τ = 0.289, p = 0.012), cuffed tracheostomy tubes, (66.7% vs 39.1%; χ 4.59, p = 0.032); diabetics (64.6% vs 35.3%; χ 4.39, p = 0.036); and males were associated with increased colonisation (72.4% vs 44.4%; χ 5.12, p = 0.024).

Conclusion: Factors associated with an increase in colonisation and infection of tracheostomy tubes were location, and in males, diabetics and in cuffed tubes.
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http://dx.doi.org/10.1016/j.amjoto.2020.102495DOI Listing
August 2020

Comparison of arytenoid vertical height discrepancy in normal versus patients with vocal cord palsy.

Am J Otolaryngol 2020 Jan - Feb;41(1):102323. Epub 2019 Oct 24.

Department of Otolaryngology-Head and Neck Surgery, Westmead Hospital, University of Sydney, Sydney, Australia.

Objective: Cadaveric experiments and more recently clinical data have demonstrated that patients with vertical height discrepancy between their arytenoids experience poorer voice outcomes in patients with unilateral vocal cord palsy (UVP) after medialisation laryngoplasty. However, the presence or severity of height discrepancy in normal patients without UVP has not yet been clearly defined.

Study Design: Case-control study.

Setting: Tertiary Australian hospitals.

Subjects And Methods: A retrospective review was performed on patients who underwent high computed tomography imaging of the neck. Scans were assessed for discrepancy in arytenoid vertical height discrepancy and compared to a cohort with known UVP.

Results: 44 normal patients (50% female, mean age 57.6 ± 14.8 years) were compared to 23 patients with UVP (43.4% female, mean age 52.3 ± 14.9 years.) Normal patients were found to have a smaller height discrepancy compared to UVP patients (student's t-test,2.00 mm ± 0.00 vs 2.39 mm ± 0.72, p < .001.) CONCLUSION: This study suggests that discrepancy is pathologic, and it is plausible that this results in acoustic consequences.
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http://dx.doi.org/10.1016/j.amjoto.2019.102323DOI Listing
April 2020

Diagnostic utility of microsurgical carbon dioxide laser excision of oral potentially malignant lesions vs incisional biopsy: a retrospective histopathological review.

Oral Surg Oral Med Oral Pathol Oral Radiol 2019 Jun 14;127(6):516-525. Epub 2018 Dec 14.

Faculty of Dentistry, The University of Sydney, Sydney, New South Wales, Australia; Department of Oral Medicine Oral Pathology and Special Care Dentistry, Level 3, Westmead Centre for Oral Health, Westmead Hospital, Westmead, New South Wales, Australia.

Objective: Complete excision of oral potentially malignant lesions (OPMLs) could result in improved and earlier detection of more severe grades of oral epithelial dysplasia and/or frank malignancy. Transoral microsurgical carbon dioxide laser techniques allow for resection of OPMLs, even those that are extensive. The advantages are improved diagnostic yield, improved viability of the specimen for pathologic evaluation, reduced postoperative morbidity, and easier postoperative clinical surveillance.

Study Design: Retrospective review of the histopathology slide material and attendant clinical notes of 31 sequential patients with OPMLs demonstrated the following histopathologic diagnoses on conventional incisional biopsy (CIB): verrucous hyperplasia (2 patients); mild dysplasia (11 patients), moderate dysplasia (3 patients) or severe dysplasia (15 patients); and subsequently, these patients went on to have laser excision biopsy (LEB) of their OPMLs.

Results: Histologic diagnosis was upgraded after LEB in 14 (45%) patients (P < .001), with unexpected findings of cancer in 9 cases (29%) and more severe dysplasia in 5 cases (16%).

Conclusions: Use of LEB to supplement CIB appears superior in the detection of severe dysplasia and frank malignancy in OPMLs compared with use of CIB alone. Prospective trials are indicated to determine if the superior diagnostic utility of LEB improves patient outcomes with regard to earlier detection of oral squamous cell and/or verrucous carcinoma.
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http://dx.doi.org/10.1016/j.oooo.2018.12.010DOI Listing
June 2019

Validity of narrow band imaging in the detection of oral and oropharyngeal malignant lesions: A systematic review and meta-analysis.

Head Neck 2019 07 9;41(7):2430-2440. Epub 2019 Mar 9.

Department of Otolaryngology, Westmead Public Hospital, Sydney, New South Wales, Australia.

Background: This meta-analysis describes the validity of narrow band imaging (NBI) in the assessment of suspicious oral lesions.

Methods: Medline, EMBASE, and Scopus were searched for trial studies comparing NBI with conventional modalities in the oral cavity (OC) and oropharynx (OP) for the detection of dysplastic and malignant change.

Results: Seven studies were found, and generally supported the utility of NBI in different clinical settings, although there were exceptions. Pooled data from 4 studies of NBI validity demonstrated high summary specificity and sensitivity for a wide range of suspicious lesions of the OC or OP (75.7% with 95% CI 65.1%-83.9%, and 91.5% with 95% CI 81.8%-96.3%, respectively). Summary positive likelihood ratio (LR+) was 8.91 (95% CI 4.1-19.6) and 0.27 (95% CI 0.18-0.39), respectively.

Conclusions: NBI is a promising diagnostic and surveillance tool for suspicious lesions in the OC or OP; however, higher powered studies will define precise NBI criterion and clinical recommendations.
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http://dx.doi.org/10.1002/hed.25724DOI Listing
July 2019

Arytenoid vertical height discrepancy in predicting outcomes after unilateral vocal cord medialization.

Laryngoscope 2020 02 7;130(2):418-422. Epub 2019 Mar 7.

Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia.

Objectives/hypothesis: Unilateral vocal fold paralysis is a structural abnormality that often occurs secondary to dysfunction of the recurrent laryngeal nerve and typically presents as a breathy voice. Medialization laryngoplasty is a constellation of procedures that improves apposition of the vocal cords. Many patients, however, fail to experience sufficient improvement in vocal quality postoperatively despite apparent glottic closure on stroboscopy. This suggests that asymmetry in other cord characteristics may also have acoustic consequences. Our hypothesis is that arytenoid height symmetry may play a significant role in vocal quality. To our knowledge there are no human observational studies examining this topic. We therefore aimed to correlate asymmetry in arytenoid height and patient-reported satisfaction in voice quality after thyroplasty.

Study Design: Retrospective cohort analysis.

Methods: A retrospective review of prospectively collected data on consecutive patients who underwent medialization thyroplasty at a tertiary Sydney, Australia hospital was performed. Data collected included age, sex, onset of symptoms, as well as well as preoperative and 3-month postoperative maximum phonation time and Voice Handicap Index (VHI). Preoperative computed tomography scans were assessed for discrepancy of arytenoid vertical height discrepancy.

Results: Twenty-three patients (56.5% female) with mean age of 52.4 ± 14.9 years were included. Most patients underwent injection thyroplasty (78.3%, n = 5), whereas the remaining underwent an open approach. A statistically significant inverse correlation was found between increasing height discrepancy and VHI improvement (r = -0.6, P = .003.) Revision surgery was associated with increased height discrepancy.

Conclusions: Findings of this study may affect future recommendations to address height discrepancy in surgery to treat unilateral vocal cord paralysis.

Level Of Evidence: 3 Laryngoscope, 130:418-422, 2020.
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http://dx.doi.org/10.1002/lary.27900DOI Listing
February 2020

Thyroidectomy in octogenarians is not associated with poorer postoperative outcomes.

Head Neck 2019 08 4;41(8):2500-2506. Epub 2019 Mar 4.

Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia.

Background: The elderly represents one of the most rapidly growing subsets of the population. This population experiences a higher incidence of thyroid pathology. However, there are concerns that the elderly also experiences increased perioperative complications and are poor candidates for thyroidectomy.

Methods: Patients who underwent thyroidectomy over the age of 80 years at three tertiary head and neck units were included. Data regarding age, sex, presenting symptoms, comorbidities, preoperative investigations, type of surgery, postoperative complications, and final thyroid pathology were retrieved from hospital records.

Results: Of a total of 39 patients (69% women, mean age 83.1), the majority (40.1%) presented with a combination of symptoms: shortness of breath, feeling of pressure in the neck, dysphagia, or tiredness. Two (5.1%) were asymptomatic. Low rates of postoperative complications were encountered and were minor (n = 5). No intensive care unit admissions or mortality was experienced.

Conclusion: Thyroid surgery in octogenarians carries an acceptable complication profile.
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http://dx.doi.org/10.1002/hed.25712DOI Listing
August 2019

Trans-Frontal Five-Fluorouracil (TraFFF): a novel technique for the application of adjuvant topical chemotherapeutic agents in sinonasal adenocarcinoma.

BMJ Case Rep 2018 Oct 24;2018. Epub 2018 Oct 24.

Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, NSW, Australia.

Sinonasal adenocarcinoma has traditionally been treated with surgery (craniofacial or endoscopic) and adjuvant radiotherapy. Two large series have demonstrated favourable 5-year survival using surgery with adjuvant topical chemotherapy applied repeatedly over several weeks. The authors describe a novel, transnasal application of topical 5-fluorouracil. However, complete coverage of the frontal region of the anterior skull base can be difficult to achieve with a purely transnasal approach in an outpatient setting. We present a novel adjunct method of delivering chemotherapeutic agents into this key area used in a 37-year-old man with T2N0M0 ethmoid adenocarcinoma. The procedure was well tolerated in an outpatient setting and remains disease free at 3 years postoperatively. We suggest that frontal trephination is a useful adjunct to aid accurate placement of adjuvant topical chemotherapeutic agents in the treatment of sinonasal adenocarcinoma.
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http://dx.doi.org/10.1136/bcr-2018-226234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203002PMC
October 2018

Buccal space tumours.

Auris Nasus Larynx 2019 Apr 18;46(2):160-166. Epub 2018 Jul 18.

Department of Otolaryngology-Head & Neck Surgery, Westmead Hospital, Westmead, Australia.

Objective: To review the available literature as it pertains to the buccal space with a specific focus on the pathologies encountered within this space. Clinical presentation, investigations, and surgical approaches to the region are also reviewed.

Methods: A systematic review of the available literature was performed on buccal space tumours from 1980 to 2017. Data was extracted on clinical presentation, investigations and surgical approaches to the buccal space. The pathologies encountered in the buccal space were reviewed and presented.

Results: Forty-nine unique articles were reviewed, with a total 217 patients. The age of the patients ranged from 0 to 83 with a mean age of 45.8. A total of 51 pathologies were reported. The majority of these were vascular and salivary gland pathologies. The majority of salivary gland neoplasms were malignant. However a wide variety of benign and malignant soft tissue tumours were also reported to occur in this region.

Conclusions: The buccal space is a small and complex region with a variety of pathologies occurring within it. This review clarifies the differential diagnosis of a mass which presents in this area and the pathologies which occur within it.
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http://dx.doi.org/10.1016/j.anl.2018.06.011DOI Listing
April 2019

Cervical necrotizing fasciitis: Systematic review and analysis of 1235 reported cases from the literature.

Head Neck 2018 09 22;40(9):2094-2102. Epub 2018 Jun 22.

Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia.

Background: Cervical necrotizing fasciitis is a progressive soft tissue infection with significant morbidity and mortality.

Methods: A case review of cervical necrotizing fasciitis managed at our institution (2007-2017) and a systematic review of PubMed, MEDLINE, and EMBASE databases using the algorithm "(cervical OR neck) AND necrotizing fasciitis."

Results: There were 1235 cases from 207 articles which were included in our clinical review. Mean age for cervical necrotizing fasciitis was 49.1 years (64.23% men). Etiology was odontogenic (47.04%), pharyngolaryngeal (28.34%), or tonsillar/peritonsillar (6.07%). There were 2 ± 0.98 organisms identified per patient; streptococci (61.22%), staphylococci (18.09%), and prevotella (10.87%). There were 2.5 ± 3.22 surgical debridements undertaken. Descending necrotizing mediastinitis occurred in 31.56% of patients. Mean length of stay in the hospital was 29.28 days and overall mortality was 13.36%.

Conclusion: Physicians and surgeons must be vigilant of the diagnosis of cervical necrotizing fasciitis as early clinical findings may be subtle and prompt identification to facilitate aggressive intervention is required to preclude catastrophic local and systemic morbidity and mortality.
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http://dx.doi.org/10.1002/hed.25184DOI Listing
September 2018

Minimally invasive surgery versus radiotherapy/chemoradiotherapy for small-volume primary oropharyngeal carcinoma.

Cochrane Database Syst Rev 2016 12 11;12:CD010963. Epub 2016 Dec 11.

Head and Neck Unit, Royal Marsden Hospital, Fulham Road, London, UK, SW3 6JJ.

Background: More than 400,000 cases of oropharyngeal squamous cell carcinoma (OPSCC) are diagnosed each year worldwide and the incidence is rising, partly as a result of human papillomavirus. Human papillomavirus-associated OPSCC affects younger patients and often presents at a higher stage; however, it is associated with a better prognosis.Until recently, first-line management of OPSCC involved chemoradiotherapy, as research had demonstrated comparable survival outcomes when compared with open surgery, with significantly decreased morbidity. However, interventions have now evolved with computerised planning and intensity-modulated radiotherapy, and the advent of endoscopic head and neck surgery, which provide the potential for decreased treatment-associated morbidity.The oropharynx plays an essential role in swallowing, speech and protecting the airway as it is situated at the bifurcation of the respiratory and digestive tracts. Treatment modality recommendations are based on survival outcomes. Given the younger patient demographic, establishing the safety of modalities that potentially have better functional outcome is becoming increasingly important.

Objectives: To assess the efficacy of endoscopic head and neck surgery (transoral robotic surgery or transoral laser microsurgery) for small-volume, primary (T1-2, N0-2) oropharyngeal squamous cell carcinoma (OPSCC) in comparison to radiotherapy/chemoradiotherapy.

Search Methods: The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2016, Issue 10); PubMed; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 8 November 2016.

Selection Criteria: Randomised controlled trials in patients with carcinoma in the oropharynx subsite (as defined by the World Health Organization classification C09, C10). Cancers included were primary squamous cell carcinomas arising from the oropharyngeal mucosa. The tumours were classified as T1-T2 with or without nodal disease and with no evidence of distant metastatic spread. The intervention was transoral, minimally invasive surgery with or without adjuvant radiotherapy or adjuvant chemoradiotherapy. The comparator was primary radiotherapy with or without induction or concurrent chemotherapy for the tumour. The treatments received and compared were of curative intent and patients had not undergone prior intervention, other than diagnostic biopsy.

Data Collection And Analysis: We used the standard methodological procedures expected by Cochrane. Our primary outcomes were overall survival (disease-related mortality was to be studied where possible), locoregional control, disease-free survival and progression-free survival or time to recurrence. All outcomes were to be measured at two, three and five years after diagnosis. Our secondary outcomes included quality of life, harms associated with treatment, patient satisfaction and xerostomia score.

Main Results: No completed studies met the inclusion criteria for the review. Two ongoing trials fulfilled the selection criteria, however neither are complete.'Early-stage squamous cell carcinoma of the oropharynx: radiotherapy versus trans-oral robotic surgery (ORATOR)' is a phase II randomised controlled trial comparing primary radiation therapy with primary transoral robotic surgery for small-volume primary (T1-2, N0-2) OPSCC. It is currently in progress with an estimated completion date of June 2021.'European Organisation for Research and Treatment of Cancer 1420 (EORTC 1420-HNCG-ROG)' is a phase III, randomised study assessing the "best of" radiotherapy compared to transoral robotic surgery/transoral laser microsurgery in patients with T1-T2, N0 squamous cell carcinoma of the oropharynx and base of tongue. It was due to start accrual mid-2016.

Authors' Conclusions: The role of endoscopic head and neck surgery in the management of OPSCC is clearly expanding as evidenced by its more overt incorporation into the current National Comprehensive Cancer Network guidelines. Data are mounting regarding its outcomes both in terms of survival and lower morbidity. As confidence increases, it is being used in the management of more advanced OPSCC.Based on this review, there is currently no high-quality evidence from randomised controlled trials regarding clinical outcomes for patients with oropharyngeal cancer receiving endoscopic head and neck surgery compared with primary chemoradiotherapy.
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http://dx.doi.org/10.1002/14651858.CD010963.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463943PMC
December 2016

Botulinum Toxin for the Management of Sjögren Syndrome-Associated Recurrent Parotitis.

J Oral Maxillofac Surg 2016 Dec 18;74(12):2428-2430. Epub 2016 Jun 18.

Neurologist, Sydney Medical School and Department of Neurology, Westmead Hospital, Sydney, New South Wales, Australia.

Recurrent parotitis is a rare manifestation of Sjögren syndrome. The management of recurrent parotitis is challenging because conservative methods may be of limited efficacy and invasive approaches carry the risk of complications. Botulinum toxin has been shown to reduce salivary flow, and consequently, the results of its use in the management of recurrent parotitis have been encouraging. A 65-year-old female patient with recurrent parotitis due to Sjögren syndrome was referred to us, complaining of weekly bouts of inflammation. She required a course of antibiotics monthly to control bacterial superinfections. We treated her with onabotulinumtoxinA injections into both parotid glands at regular intervals. After her second injection cycle, she denied further inflammatory bouts, has not required antibiotics in more than 36 months, and denied any side effects. Botulinum toxin may be a safe and effective method of treating Sjögren syndrome-associated recurrent parotitis.
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http://dx.doi.org/10.1016/j.joms.2016.06.169DOI Listing
December 2016

Case of migrated Gore-Tex implant following external thyroplasty.

BMJ Case Rep 2016 Jun 8;2016. Epub 2016 Jun 8.

Westmead Hospital, Westmead, New South Wales, Australia.

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http://dx.doi.org/10.1136/bcr-2016-215277DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4904435PMC
June 2016

Swallowing assessment and management pre and post head and neck cancer treatment.

Curr Opin Otolaryngol Head Neck Surg 2015 Dec;23(6):440-7

aDepartment of Otolaryngology, Head and Neck Surgery bCrown Princess Mary Cancer Centre, Westmead Hospital cUniversity of Sydney dChris O'Brien Lifehouse, Royal Prince Alfred Hospital, Sydney, Australia.

Purpose Of Review: Head and neck cancer (HNC) imposes significant structural, functional, and cosmetic burdens upon those affected. Although advances in multimodality organ preservation therapy have assisted in ameliorating a number of previous treatment-related sequelae, dysphagia remains a foremost concern for members of the multidisciplinary team. Given its acute and long-term impact on physical and psychological wellbeing, and subsequent bearing on delivery of treatment, treatment-related morbidity and overall mortality, prompt recognition, and accurate assessment and optimization of management are pivotal.

Recent Findings: Qualitative research has provided greater insight into the psychosocial burdens dysphagia imposes on HNC patients and carers, highlighting the need for holistic strategies of management. There is a growing body of evidence to support dietary alterations and preventive swallowing exercise regimens for maintenance of oral intake throughout and following HNC therapy. The role of prophylactic enteral feeding, however, remains uncertain, with conflicting institutional data and lack of high-quality prospective studies for meaningful systematic literature assessment. Endoscopic surgical techniques hold promise in relieving stricture-related dysphagia; however, multiple treatments are required and recurrence is common.

Summary: Swallowing rehabilitation encompassing education, dietary modification, and swallowing exercises comprise the mainstay of current evidence-based dysphagia management in HNC patients.
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http://dx.doi.org/10.1097/MOO.0000000000000205DOI Listing
December 2015

Complications after CO2 laser surgery for early glottic cancer: An institutional experience.

Head Neck 2016 04 4;38 Suppl 1:E987-90. Epub 2015 Sep 4.

Department of Otolaryngology/Head and Neck Surgery, Westmead Hospital, Westmead, Sydney, Australia.

Background: Transoral laser microsurgery (TLM) of the glottis is increasingly utilized in the current management of early glottic cancer, its advantages being administrative ease, potential to be repeated, ability to keep radiotherapy and open laryngeal surgery available as salvage options, and low complication rates.

Methods: A retrospective chart review of prospectively gathered data on all patients over a 10-year period who had undergone TLM for Tis or early (T1-2) glottic squamous cell carcinomas (SCCs) was analyzed to examine the complications experienced.

Results: Of 132 patients undergoing TLM, complications were: edema requiring tracheostomy (n = 1), surgical emphysema (n = 1), pharyngeal bruising (n = 1), endotracheal tube cuff perforation (n = 1), anterior glottic web (n = 14), vocal cord granuloma (n = 14), laryngocele (n = 1), and none of airway fire or intraoperative or postoperative hemorrhage.

Conclusion: Our results suggest that for early glottic cancers, and in skilled hands, with appropriate anesthetic and theater staff support, TLM is a safe and repeatable procedure. © 2015 Wiley Periodicals, Inc. Head Neck 38: E987-E990, 2016.
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http://dx.doi.org/10.1002/hed.24142DOI Listing
April 2016

Relationship between CO2 laser-induced artifact and glottic cancer surgical margins at variable power doses.

Head Neck 2016 04 15;38 Suppl 1:E712-6. Epub 2015 Jul 15.

Department of Otolaryngology/Head and Neck Surgery, Westmead Hospital, University of Sydney, Westmead, New South Wales, Australia.

Background: The carbon dioxide laser can induce thermal cytologic artifacts at the margin of early glottic squamous cell carcinoma histologic specimens, which makes assessment of the margin difficult. This study assesses and correlates the depth of laser-induced thermal artifact with laser power rating.

Methods: The surgical margins of 30 patients with early glottic squamous cell carcinomas who underwent laser resection were reanalyzed retrospectively.

Results: Thermal damage consisted of collagen denaturation within the vocal cord lamina propria and vocalis muscle, and epithelial structural changes. There was a decrease in depth of tissue artifact with increased power rating (p > .05). The average depth of thermal damage was 380.83 ± 178.79 μm.

Conclusion: The laser causes less thermal damage at higher power, presumably because of the increased speed of cutting and reduced contact time with surrounding cells. Knowledge of the depth of thermal artifact is important surgically when ensuring the cancer is excised with sufficient oncologic margin. © 2015 Wiley Periodicals, Inc. Head Neck 38: E712-E716, 2016.
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http://dx.doi.org/10.1002/hed.24076DOI Listing
April 2016

Inverted papilloma of lacrimal sac invading into the orbit: case report and review of literature.

J Cancer Res Ther 2015 Jan-Mar;11(1):238-40

Department of Otolaryngology, Head and Neck Surgery, Addenbrookes Hospital, Cambridge, United Kingdom.

Inverted papilloma (IP) is a sinonasal tumor of benign etiology with local invasion and malignant potential. IP arising in lacrimal sac invading the orbit is extremely rare with only one case reported so far. The presented case appears to be the second such case reported in the literature. A 60-year-old Caucasian male presented with a medial canthal mass and epiphora. Incisional biopsy confirmed a transitional neoplasm. The lesion was completely excised enbloc with clear margins by using a Weber-Ferguson incision; orbital clearance and nasolacrimalfossa clearance was achieved via a medial maxillectomy. Enbloc resection of orbital and nasolacrimal parts of the tumor with clear margins is recommended.
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http://dx.doi.org/10.4103/0973-1482.155111DOI Listing
January 2016

Voice outcomes after transoral laser microsurgery for early glottic cancer-considering signal type and smoothed cepstral peak prominence.

J Voice 2015 May 7;29(3):370-81. Epub 2014 Oct 7.

Voice Research Laboratory, Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia.

Objectives/hypotheses: This study proposed the use of signal typing and acoustic measures experimentally validated for aperiodic voices to investigate voice outcomes after transoral laser microsurgery (TLM) for early glottic carcinoma. It was of interest whether signal type and pitch-tracking indicators would reveal unreliable perturbation and noise measures. As an alternative, smoothed cepstral peak prominence (CPPS) was used for the first time in this population.

Study Design: A descriptive study of patients treated with TLM for early glottic carcinoma.

Methods: All participants (n=14) performed a series of vocal tasks. Narrowband spectrograms were generated from voice recordings and classified into one of four signal types. The perturbation and noise measures of periodic or near-periodic signals only were reported. The CPPS for sustained vowel (CPPS-/a/) and connected speech (CPPS-s) were calculated for all participants. The relationship between voice outcomes and tumor and TLM factors was investigated.

Results: Nine of 14 participants had an aperiodic type 3 signal. Three of 14 participants had voices considered reliable for perturbation analysis. Absolute jitter, %jitter, %shimmer, and signal-to-noise ratio were all low; however, CPPS-/a/ and CPPS-s amplitudes were below the normal range for most participants. Involvement of the anterior commissure, number of TLM episodes, and time post-surgery were associated with worse voice outcomes. There were strong correlations between signal type, CPPS-/a/, and pitch-tracking indicators.

Conclusions: The limitations of perturbation analysis should be considered when analyzing the voice after TLM. Signal type should be considered before conducting perturbation analysis. The CPPS-/a/ and CPPS-s may be more reliable acoustic outcome measures for this population.
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http://dx.doi.org/10.1016/j.jvoice.2014.08.018DOI Listing
May 2015

Intraoperative ultrasound to facilitate removal of a submucosal foreign body.

J Clin Ultrasound 2014 Nov-Dec;42(9):565-8. Epub 2014 Aug 22.

Department of ENT Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, United Kingdom, CB2 0QQ.

A 61-year-old man with a history of fish bone ingestion and poorly localized symptoms was seen. His clinical examination was unremarkable, but CT demonstrated a foreign body deeply embedded within his tongue. Intraoperative ultrasound (US) guidance facilitated identification of a bone, allowing a needle to be placed as a guide to dissection. Repeat US scanning through the incision permitted precisely targeted surgery. CT and US are the most effective imaging techniques for localizing fish bones. Intraoperative US can be used to accurately locate a submucosal fish bone in mobile tissue such as the tongue, and focused, image-guided dissection can reduce surgical tissue trauma.
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http://dx.doi.org/10.1002/jcu.22226DOI Listing
June 2015

Kaposiform hemangioendothelioma of paranasal sinus.

Laryngoscope 2014 Sep 29;124(9):2103-6. Epub 2014 Apr 29.

Department of Otolaryngology, Head and Neck Surgery, Addenbrookes Hospital, Cambridge, United Kingdom.

Kapossiform hemangioendothelioma (KHE) of the paranasal sins (PNS) is a rare cause of recurrent epistaxis. To date, only two cases of PNS KHE have been reported in the literature, both occurring in the pediatric population. The case presented here appears to be the first case of PNS KHE occurring in an adult. A 46-year-old white female presented with progressively worsening unilateral recurrent epistaxis. Diagnostic histopathology confirmed it to be KHE. After a detailed workup, the tumor was completely excised en bloc (medial maxillectomy; anterior and posterior ethmoidectomy) via a lateral-rhinotomy approach. Complete excision of the tumor with clear margins offers the best results.
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http://dx.doi.org/10.1002/lary.24669DOI Listing
September 2014

A systematic review of 1143 parapharyngeal space tumors reported over 20 years.

Oral Oncol 2014 May 28;50(5):421-30. Epub 2014 Feb 28.

Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals, University of Cambridge School of Clinical Medicine, Cambridge CB2 0QQ, UK. Electronic address:

Parapharyngeal space tumours are rare and most clinicians will only see a small number during their career. We performed a systematic review of 1143 parapharyngeal space tumors published in the past 20 years to increase cumulative experience. A systematic literature review was performed and data on histological diagnosis, presentation, surgical approach and postoperative complications of cases published between 1989 and 2009 were compiled and reviewed. The systematic review identified a total of 1143 parapharyngeal space tumors presented in 17 studies. A majority (82%) were benign and 18% were malignant. The most common presentation was a cervical mass (50%) or an intraoral mass (47%). Approximately 70 different histologic subtypes of parapharyngeal space tumors were reported in the cumulative series. The most common primary lesion was a pleomorphic adenoma (34%). Ninety-five percent of patients underwent surgery. The most frequent approach and used to excise the lesions was the cervical approach (48%) and the commonest complication was the vagus nerve injury seen in 14% of the cases.
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http://dx.doi.org/10.1016/j.oraloncology.2014.02.007DOI Listing
May 2014

Parapharyngeal pleomorphic adenoma as a cause of severe obstructive sleep apnoea.

ANZ J Surg 2014 Nov 31;84(11):883-4. Epub 2013 Oct 31.

Department of Otolaryngology, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia.

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http://dx.doi.org/10.1111/ans.12330DOI Listing
November 2014

Intracranial and internal jugular vein thrombosis secondary to ENT infections: a report of 3 cases.

Ear Nose Throat J 2013 Oct-Nov;92(10-11):E25

Department of Surgery, Westmead Hospital, PO Box 533, Wentworthville 2145, NSW, Australia.

We report 3 cases of rare, life-threatening intracranial and internal jugular vein (IJV) thrombosis that were caused by common ENT infections. These infections included otitis media in a 6-year-old girl, tonsillitis in a 21-year-old woman, and odontogenic sepsis in a 56-year-old woman. All 3 patients were treated with culture-directed systemic antibiotics; 2 of them also required surgical drainage (the child and the older adult). The 2 adults also received therapeutic anticoagulation, which was continued until venous recanalization was documented; the duration of combined antibiotic and anticoagulation treatment was 6 weeks. All 3 patients made uneventful recoveries. Significant morbidities associated with intracranial and IJV thrombosis were avoided as a result of prompt diagnosis and judicious treatment.
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June 2014

A unique case of pneumatised styloid process with cholesteatoma.

Case Rep Otolaryngol 2013 4;2013:964725. Epub 2013 Jun 4.

Department of Otolaryngology, Head and Neck Surgery, Addenbrookes Hospital, Cambridge University Teaching Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK.

Pneumatisation of styloid process is a very rare finding and has never been reported previously. We present a unique case of a pneumatised styloid process with a cholesteatoma arising within the cavity. We describe the clinical features, associated radiological findings, and management of this lesion.
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http://dx.doi.org/10.1155/2013/964725DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3687720PMC
July 2013