Publications by authors named "Marc W Herr"

15 Publications

  • Page 1 of 1

Radiation Necrosis of the Lateral Skull Base and Temporal Bone.

Semin Plast Surg 2020 Nov 24;34(4):265-271. Epub 2020 Dec 24.

Neurotology, Head and Neck Surgery, Fort Worth, Texas.

Radiation therapy plays a critical role in the treatment of malignancies involving the head and neck. Although the therapeutic effects of ionizing radiation are achieved, normal tissues are also susceptible to injury and significant long-term sequelae. Osteoradionecrosis of the temporal bone (ORNTB) is among the many complications that can arise after therapy. ORNTB is a debilitating and potentially lethal condition that continues to challenge patients and treating physicians. Herein, we review the pathophysiology, presentation, work-up, and management of ORNTB.
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http://dx.doi.org/10.1055/s-0040-1721763DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759429PMC
November 2020

Sterno-omohyoid Free Flap for Dual-Vector Dynamic Facial Reanimation.

Ann Otol Rhinol Laryngol 2020 Feb 3;129(2):195-200. Epub 2019 Oct 3.

Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA, USA.

Background: Dynamic rehabilitation of longstanding facial palsy with damaged, atrophied, or absent facial muscles requires replacement of neural and muscular components. The ideal reconstruction would include a fast-twitch muscle that is small, a reliable donor vessel and nerve, and the potential to provide a natural, synchronous, dentate smile with minimal donor site morbidity. Many flaps have been successfully used historically, but none has produced ideal rehabilitation.

Objective: To evaluate the novel sterno-omohyoid, dual-vector flap in rehabilitation of chronic facial paralysis.

Results: We performed sterno-omohyoid free tissue transfer for smile reanimation in a 39-year-old male with a history of longstanding right facial palsy following resection of a skull base tumor several years previously. We transferred both muscles with the superior thyroid artery, middle thyroid vein, and ansa cervicalis. The patient developed a dynamic smile by 6 months postoperatively, and he had improved objective facial symmetry.

Conclusion: Herein, we demonstrate the first use of the sterno-omohyoid flap for successful facial reanimation. Overall, it is a novel flap in facial reanimation with many advantages over traditional flaps, including the potential to produce a more synchronous, dynamic smile while adding minimal bulk to the face. Future series will better elucidate the potential of the sterno-omohyoid flap.
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http://dx.doi.org/10.1177/0003489419875473DOI Listing
February 2020

Tracheoesophageal voice after total laryngopharyngectomy reconstruction: Jejunum versus radial forearm free flap.

Laryngoscope 2015 Dec 21;125(12):2715-21. Epub 2015 Jul 21.

Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.

Objective/hypothesis: Tracheoesophageal (TE) voice restoration after laryngopharyngectomy with jejunal (Jej) flap and radial forearm flap (RFF) reconstruction has been successfully completed and studied for both techniques, but no direct comparisons exist. We undertook this study to directly compare TE voice in patients with total laryngopharyngectomy (TLP) reconstruction using the Jej and the RFF in a comprehensive and rigorous manner.

Study Design: Retrospective cohort study.

Methods: Forty patients after total laryngectomy or TLP were grouped by pharyngeal closure method: 18 primary closure (STL), 10 jejunal flap (TLP-Jej), and 12 radial forearm flap (TLP-RFF). Voice recordings underwent objective acoustic analysis and blinded subjective assessment by trained and naïve listeners. Quality-of-life (QOL) assessments were obtained in all subjects using general health, disease-specific, and voice-specific survey tools.

Results: All studies groups had similar demographics. Acoustic analysis demonstrated no differences in fundamental frequency or intensity levels. Subjective assessment demonstrated statistically significant inferior voice function of the reconstructed patients (TLP-Jej and TLP-RFF) compared to STL subjects for nearly all parameters tested by both naïve and trained listeners. No differences were noted between TLP-Jej and TLP-RFF subjects for any of the parameters evaluated. Overall, trained listeners assessed TE voice more favorably compared to naïve listeners in a significant manner. The three QOL surveys revealed no significant differences between TLP-Jej and TLP-RFF subjects.

Conclusion: Tracheoesophageal voice in TLP-Jej and TLP-RFF subjects was equivalent but inferior to STL subjects. Reconstructed subjects had no differences in general, disease-specific, and voice-specific quality of life.

Level Of Evidence: 2b.
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http://dx.doi.org/10.1002/lary.25404DOI Listing
December 2015

Supraclavicular artery island flap for reconstruction of complex parotidectomy, lateral skull base, and total auriculectomy defects.

JAMA Otolaryngol Head Neck Surg 2014 Sep;140(9):861-6

Division of Head and Neck Surgical Oncology and Reconstruction, Massachusetts Eye and Ear Infirmary, Boston2Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.

Importance: There are limited data on the use of the supraclavicular artery island flap (SCAIF) for parotid and lateral skull base (LSB) surgery. This flap can be an important reconstructive tool for these procedures.

Objective: To describe the use of the SCAIF for parotid and LSB surgery and its success, as well as important technique modifications for successful use of the flap in this setting.

Design, Setting, And Participants: Retrospective single-institution review from July 1, 2011, to September 30, 2013, of patients in a tertiary care referral center. A prospectively collected institutional database was reviewed to identify patients who received SCAIF reconstruction for parotid and/or LSB surgery. Forty-six SCAIF reconstructions were identified; 16 were performed for the indication of parotidectomy or LSB surgery.

Interventions: The SCAIF reconstruction for parotid and/or LSB surgery.

Main Outcomes And Measures: Indication for reconstruction, flap viability, flap size, reconstruction site complication, and donor site complication.

Results: Resection was performed for advanced cutaneous malignant tumor in 10 patients, primary salivary gland malignant tumor in 4 patients, and chronic infection and mastoid cutaneous fistula in 2 patients. All defects were complex, involving multiple subsites; 5 patients underwent facial nerve resection and 4 had previous radiation therapy. No complete flap loss occurred. One partial flap loss occurred. The average flap island size was 7 × 10 cm. No major complications occurred. Two minor reconstruction site complications and 3 donor site seromas occurred.

Conclusions And Relevance: The SCAIF can be successfully and reliably used for complex defects following parotid and LSB surgery. There are 3 important technique modifications to help facilitate rotation and coverage of this region.
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http://dx.doi.org/10.1001/jamaoto.2014.1394DOI Listing
September 2014

Shoulder function following reconstruction with the supraclavicular artery island flap.

Laryngoscope 2014 Nov 10;124(11):2478-83. Epub 2014 Jun 10.

Division of Head and Neck Surgical Oncology and Reconstruction, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.; Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.

Objectives/hypothesis: The supraclavicular artery island flap (SCAIF) is a pedicled fasciocutaneous flap used for head and neck reconstruction. In recent years, its use has significantly increased as a result of several advantageous characteristics, including pliability, an excellent color and texture match, ability to reconstruct a variety of skin and aerodigestive tract defects, and short harvest times. Clinical experience suggests that donor site complications are relatively infrequent and typically self-limiting, and there have been no documented cases of prolonged or permanent shoulder dysfunction. However, formal studies have not been performed to assess this outcome. The goal of this study was to evaluate the effects of SCAIF flap harvest on postoperative shoulder strength and flexibility.

Study Design: Prospective cohort pilot study.

Methods: Data was gathered prospectively during routine follow-up and surveillance. The Penn Shoulder Score and Constant Shoulder Scale were used to measure subjective and objective outcomes. Physical therapists performed testing for strength and flexibility.

Results: Ten patients were evaluated from January to July, 2013. Subjective self-reporting of shoulder function and satisfaction was good to excellent in most patients. The majority of patients demonstrated limitations in range of motion for one or more shoulder movements. Muscle strength was preserved postoperatively.

Conclusion: Harvest of the SCAIF appears to have limited postoperative morbidity. Postoperative shoulder strength and function appears to be very good; however, some limitation of range of motion was observed.

Level Of Evidence: 4
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http://dx.doi.org/10.1002/lary.24761DOI Listing
November 2014

Esthesioneuroblastoma: an update on the massachusetts eye and ear infirmary and massachusetts general hospital experience with craniofacial resection, proton beam radiation, and chemotherapy.

J Neurol Surg B Skull Base 2014 Feb 20;75(1):58-64. Epub 2013 Sep 20.

Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States ; Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts, United States.

Objectives To update the Massachusetts General Hospital (MGH) and Massachusetts Eye and Ear Infirmary (MEEI) experience in the management of esthesioneuroblastoma (ENB) with multimodality therapy and to reassess treatment outcomes and complications in a larger cohort with longer follow-up times. Design A retrospective chart review. Setting A tertiary referral center. Participants All patients presenting with ENB and managed at the MGH and MEEI from 1997 to 2013. Main Outcome Measures Disease-free and overall survival. Results Twenty-two patients were identified with an average follow-up of 73 months. Ten patients presented with Kadish stage B disease and 12 with stage C disease. A total of six patients (27%) developed regional metastases. Treatment for all patients included craniofacial resection (CFR) followed by proton beam irradiation with or without chemotherapy. The 5-year disease-free and overall survival rates were 86.4% and 95.2%, respectively, by Kaplan-Meier analysis. Negative margins were a significant factor in disease-free survival. One patient experienced severe late-radiation toxicity. Conclusions ENB is safely and effectively treated with CFR followed by proton beam irradiation. The high incidence of regional metastases warrants strong consideration for elective neck irradiation. Proton beam radiation is associated with lower rates of severe late-radiation toxicity than conventional radiotherapy.
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http://dx.doi.org/10.1055/s-0033-1356493DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912136PMC
February 2014

Orbital preservation in patients with esthesioneuroblastoma.

J Neurol Surg B Skull Base 2013 Jun 13;74(3):142-5. Epub 2013 Mar 13.

Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts, USA.

Objectives Surgical resection in addition to adjuvant radiation with or without chemotherapy is the mainstay of treatment for esthesioneuroblastoma (ENB). However, management of patients with orbital involvement remains controversial. Historically, orbital exenteration has been advocated when there is evidence of periorbital invasion. Recently, the indications for orbital exenteration have become more selective and orbital preservation has been advocated. We report our experience with anterior craniofacial resection and orbital preservation in patients with ENB. Design Retrospective review of all patients diagnosed with esthesioneuroblastoma who underwent traditional open anterior craniofacial resection at the Massachusetts General Hospital/Massachusetts Eye and Ear Infirmary Cranial Base Center from 1997 to 2008. Results Sixteen patients were identified with a mean follow-up of 76 months. All patients underwent anterior craniofacial resection via an open approach and adjuvant proton beam radiation. Six of the 16 patients had evidence of either periorbital or lacrimal sac involvement at the time of surgery. All of these patients underwent periorbital resection to negative histologic margins with preservation of the orbit. Conclusion In our study, patients with ENB and periorbital invasion-who were treated with anterior craniofacial resection and periorbital resection with orbital preservation-had no evidence of decreased survival. In all patients, negative histologic margins of the periorbital resection were achieved.
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http://dx.doi.org/10.1055/s-0033-1338259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709964PMC
June 2013

Treatment outcomes and prognostic factors, including human papillomavirus, for sinonasal undifferentiated carcinoma: a retrospective review.

Head Neck 2015 Mar 30;37(3):366-74. Epub 2014 Apr 30.

Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts; Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts.

Background: Sinonasal undifferentiated carcinoma (SNUC) is a high-grade, aggressive neoplasm. Low incidence and poor outcomes make identification of prognostic factors and treatment standardization difficult. Similarly, little is known regarding the association of human papillomavirus (HPV) with SNUC.

Methods: A retrospective review was conducted. Extracted information included treatment received, tumor recurrence, patient survival, p16 expression, and HPV status. The Kaplan-Meier method was used to estimate overall survival (OS) and disease-free survival (DFS). Survival trends were compared using the log-rank test.

Results: Nineteen patients received multimodality treatment for SNUC. Five-year OS and DFS rates were 45.2% and 50.7%, respectively, with no significant difference between treatment types. Tumors from 11 patients were p16-positive and 9 of these were also HPV-positive. Kaplan-Meier analysis demonstrated improved survival.

Conclusion: Our series demonstrates a higher prevalence of HPV in SNUC than previously reported. HPV-positive SNUCs may benefit from improved survival and should be investigated further in future studies.
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http://dx.doi.org/10.1002/hed.23606DOI Listing
March 2015

The supraclavicular artery flap for head and neck reconstruction.

JAMA Facial Plast Surg 2014 Mar-Apr;16(2):127-32

Division of Head and Neck Surgery, Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Boston.

IMPORTANCE This study demonstrates the versatility of the supraclavicular artery (SCA) flap in head and neck reconstruction and offers technical highlights to improve the efficiency of flap harvest. OBJECTIVES To report our series of diverse reconstructions utilizing the SCA flap and to highlight several technical aspects of flap harvest that make the procedure more safe, reliable, and efficient. DESIGN, SETTING, AND PARTICIPANTS A retrospective review was conducted from July 2011 to December 2012 on all patients who had undergone SCA flap reconstruction of a head and neck defect at a tertiary referral center. The average follow-up time was 8 months. INTERVENTION OR EXPOSURE Supraclavicular artery flap reconstruction of defects at various head and neck subsites. MAIN OUTCOME AND MEASURE Reconstructive outcomes and complications were assessed and cases were reviewed to identify key aspects of flap harvest. RESULTS Twenty-four SCA flaps were performed on defects at multiple head and neck subsites. Several technical modifications were developed to increase the safety and efficiency of flap harvest. Complications were typically self-limited and were successfully managed nonsurgically. CONCLUSIONS AND RELEVANCE The SCA flap is a versatile and reliable reconstructive option for head and neck defects. There are 4 key steps to making the harvest of this flap safe, reliable, and efficient. LEVEL OF EVIDENCE 4.
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http://dx.doi.org/10.1001/jamafacial.2013.2170DOI Listing
November 2014

Malignant head and neck paragangliomas: treatment efficacy and prognostic indicators.

Am J Otolaryngol 2013 Sep-Oct;34(5):431-8. Epub 2013 May 1.

Harvard Medical School, Boston, MA, USA.

Purpose: Malignant head and neck paragangliomas (MHNPs) are rare and occur in 6%-19% of all HNPs. We sought to identify predictors of survival and compare efficacy of treatment modalities to inform management of this rare disease.

Materials And Methods: We performed a retrospective cohort study of MHNP cases in the National Cancer Institute Surveillance Epidemiology and End Results database (SEER) from 1973 to 2009. We identified 86 patients with MHNP who had documented regional or distant tumor spread with a median follow-up of 74 months. We used Cox proportional hazard models to assess the significance of demographic factors and treatment on five-year overall survival.

Results: The most common treatment was surgery alone (36.0 %), followed by surgery with adjuvant radiation (33.7%). Five-year overall survival was 88.1% for surgery alone and 66.5% for adjuvant radiation (p = 0.2251). In univariate analysis, regional (vs. distant) spread (HR 0.23, p < 0.0001), surgery alone (HR 0.29, p < 0.0001) and primary site in the carotid body (HR 0.32, p = 0.006) conferred significant survival advantage whereas age > 50 (HR 4.04, p < 0.0001) worsened survival. Regional (vs. distant) spread (HR 0.42, p = 0.046) and age > 50 (HR 2.98, p = 0.005) remained significant in multivariate analysis. In patients with regional-only disease, five-year overall survival was 95.4% for surgery alone compared to 75.6% for surgery with radiation (p = 0.1055).

Conclusions: This is the largest and most contemporary series of MHNP patients. Age and tumor stage are significant factors in predicting survival. Surgical resection significantly improves survival outcomes. From this analysis, the value of adjuvant radiation is not clear.
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http://dx.doi.org/10.1016/j.amjoto.2013.03.010DOI Listing
April 2014

Microvascular free flaps in skull base reconstruction.

Adv Otorhinolaryngol 2013 18;74:81-91. Epub 2012 Dec 18.

Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.

The anatomical challenges of skull base surgery are well known. Furthermore, ablative and traumatic defects in this region produce complex reconstructive problems with a high risk of significant postoperative morbidity and mortality. Over the past two decades, microvascular free tissue reconstruction following open resection has been shown to improve outcomes and reduce complication rates when compared to the traditional use of pedicled flaps. The increasing use of free tissue transfer has been further strengthened by improved technical expertise and high flap success rates. Since the size and type of free tissue to be utilized must be individualized to each defect, the accomplished reconstructive surgeon should be extremely versatile and, by extension, facile with a several types of free flaps. Thus, four of the most commonly used flaps--the rectus abdominis, radial forearm, latissimus dorsi and anterolateral thigh flaps--are discussed.
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http://dx.doi.org/10.1159/000342283DOI Listing
June 2013

Pathology quiz case 2. Adenocarcinoma of the colon with metastasis to the thyroid gland (TM).

Arch Otolaryngol Head Neck Surg 2011 May;137(5):527, 529

Tripler Army Medical Center, Honolulu, Hawaii, USA.

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http://dx.doi.org/10.1001/archoto.2011.58-aDOI Listing
May 2011

Pathology quiz case 1. Salivary gland anlage tumor (SGAT).

Arch Otolaryngol Head Neck Surg 2009 Mar;135(3):320, 322

Tripler Army Medical Center, Honolulu, Hawaii, USA.

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http://dx.doi.org/10.1001/archoto.2008.547-aDOI Listing
March 2009

Historical perspective and current management of traumatic injury to the extraperitoneal rectum and anus.

Curr Surg 2005 Nov-Dec;62(6):625-32

Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859-5000, USA.

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http://dx.doi.org/10.1016/j.cursur.2005.03.017DOI Listing
March 2006

Historical perspective and current management of colonic and intraperitoneal rectal trauma.

Curr Surg 2005 Mar-Apr;62(2):187-92

Department of Surgery, Tripler Army Medical Center, Honolulu, HI 96859, USA.

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http://dx.doi.org/10.1016/j.cursur.2004.09.004DOI Listing
August 2005