Publications by authors named "Mohemmed N Khan"

30 Publications

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High Thyroid Cancer Incidence Rate in a Community near a Landfill: A Descriptive Epidemiological Assessment.

Toxics 2021 Dec 1;9(12). Epub 2021 Dec 1.

Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.

Background: to investigate the high thyroid cancer incidence rate of Staten Island and to disentangle the effects of potential environmental exposure from a landfill from screening.

Methods: age-adjusted thyroid cancer incidence rates obtained from the New York State Public Access Cancer Epidemiology Data for New York State (NYS) excluding New York City (NYC) and the five NYC boroughs, including Staten Island, were mapped over time (1995-2018), investigated per age group and by percentage of localized thyroid cancer. Changes in trends were assessed using joinpoint. Contaminants of concern on Staten Island were assessed for carcinogenic and endocrine disruptive properties.

Results: a more pronounced thyroid cancer incidence rate increase, without a difference in age distribution and similar percentages of localized thyroid cancer, was found in Staten Island compared to its demographic equivalent (NYS excluding NYC). Multiple contaminants of concern with carcinogenic and endocrine disrupting properties (e.g., cadmium, lead) were identified in air, water and sediment samples.

Conclusion: investigations into the effects of increased/sustained environmental exposures are needed in chronically exposed populations to identify potential mechanisms of action of certain pollutants.
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http://dx.doi.org/10.3390/toxics9120325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8705650PMC
December 2021

Out-of-pocket costs associated with head and neck cancer treatment.

Cancer Rep (Hoboken) 2022 Jul 24;5(7):e1528. Epub 2021 Aug 24.

Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre, Toronto, Canada.

Background: Out-of-pocket costs (OOPC) associated with treatment have significant implications on quality of life and survival in cancer patients. Head and neck cancer patients face unique treatment-related challenges, but to date OOPC have been understudied in this population.

Aims: This study aims to identify and measure OOPC for patients with head and neck cancer (HNC) in Ontario.

Methods: HNC patients between 2015 and 2018 at Princess Margaret Cancer Centre in Toronto were recruited. Participants completed OOPC questionnaires and lost income questions during radiation, post-surgery, and 3, 6, 12, and 24 months after completion of treatment. Associations between OOPC and treatment modality and disease site were tested with multivariable hurdle regression.

Results: A total of 1545 questionnaires were completed by 657 patients. Median estimated OOPC for the total duration of treatment for participants undergoing chemoradiation was $1452 [$0-14 616], for surgery with adjuvant radiation or chemoradiation (C/RT) was $1626, for radiation therapy alone was $635, and for surgery alone was $360. The major expenses for participants at the mid-treatment time-point was travel (mean $424, standard error of the mean [SEM] $34) and meals, parking, and accommodations (mean $617, SEM $67). In multivariable analysis, chemoradiation, surgery with C/RT, and radiation were associated with significantly higher OOPC than surgery alone during treatment (791% higher, p < .001; 539% higher, p < .001; 370% higher, p < .001 respectively) among patients with non-zero OOPC. Participants with non-zero OOPC in the laryngeal cancer group paid 49% lower OOPC than those with oropharyngeal cancers in adjusted analysis (p = .025).

Conclusions: Patients undergoing treatment for HNC pay significant OOPC. These costs are highest during treatment and gradually decrease over time. OOPC vary by patient demographics, clinical factors, and, in particular, treatment modality.
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http://dx.doi.org/10.1002/cnr2.1528DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9327650PMC
July 2022

2-Octyl cyanoacrylate to prevent salivary fistula formation following oral cavity microvascular reconstruction: A prospective trial.

Am J Otolaryngol 2020 Sep - Oct;41(5):102552. Epub 2020 May 28.

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

Background: Salivary fistulas remain a significant problem in patients undergoing major head and neck reconstructive surgery. Surgical sealants have become increasingly used in cutaneous and non-cutaneous wound closure, providing a barrier to fluids/gases and promoting healing. The purpose of this study was to determine the efficacy of a common surgical sealant, 2-Octyl Cyanoacrylate (2-OCA, Dermabond®), in the prevention of salivary fistulas following free flap reconstruction of the oral cavity.

Methods: In this non-randomized, single arm prospective trial, patients undergoing free flap reconstruction of gravity-dependent oral cavity defects were recruited. Application of 2-OCA was performed along flap inset suture lines at the time of surgery. Prospectively collected trial data were propensity score matched to a control cohort to compare outcomes. Data collected include demographics, medical co-morbidities, previous treatments, primary tumor site, and subsites reconstructed. The primary outcome measure was rate of salivary fistula formation. Secondary outcomes were time to development of leak and percentage of patients tolerating oral feeding at one month post-operatively.

Results: In the 46 propensity score matched pairs, eight (17.4%) out of 46 patients in the 2-OCA prospective cohort and seven (15.2%) out of 46 patients in the control cohort developed postoperative salivary fistulas within the one-month study interval (p = 1.00). The average time to postoperative leak in the 2-OCA group was 12.5 days versus 7.1 days in the control cohort (p = 0.10). In the 2-OCA group, 30 (65.2%) patients were tolerating regular diet at one month post-operatively compared to 33 (71.7%) in the control cohort (p = 0.65).

Conclusion: Salivary fistula rates after application of a 2-OCA surgical sealant were not improved compared to a control cohort in this single institutional trial. There are several surgical sealants available, each with varying elasticity and adhesiveness. Future studies are needed to identify surgical sealants that are able to provide sufficient strength and adhesion to seal closures and combat corrosive saliva, but elastic enough to handle motion related tension during swallowing and post-operative movements in the head and neck.
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http://dx.doi.org/10.1016/j.amjoto.2020.102552DOI Listing
November 2020

Palatomaxillary Reconstruction: Fibula or Scapula.

Semin Plast Surg 2020 May 6;34(2):86-91. Epub 2020 May 6.

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

Palatomaxillary reconstruction presents a unique challenge for the reconstructive surgeon. The maxillofacial skeleton preserves critical aerodigestive functions-it provides a stable hard palate to support mastication and separate the nasal and oral cavities, and buttress support to provide adequate midface contour. Free tissue transfer has become a routine part of the reconstructive ladder in managing palatomaxillary defects. While there is a wide variety of options for bony reconstruction within the head and neck, the fibula and the scapula, and their variations, have become two of the most commonly used options for midface reconstruction. This review will discuss the advantages and disadvantages of both in specific regard to reconstruction of the palatomaxillary area.
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http://dx.doi.org/10.1055/s-0040-1709431DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202915PMC
May 2020

Lymphatic mapping with SPECT-CT for evaluation of contralateral drainage in lateralized oropharyngeal cancers using an awake injection technique.

Head Neck 2020 03 28;42(3):385-393. Epub 2019 Nov 28.

Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.

Background: Risk of contralateral nodal metastases in oropharyngeal squamous cell carcinoma (OPSCC) is currently based on clinical risk factors. We propose lymphatic mapping with single photon emission computed tomography (SPECT-CT) for tumor-specific delineation of lymphatic drainage to guide treatment.

Methods: Retrospective review of lymphatic drainage patterns in cT1-2 OPSCC and contralateral cN0 neck with a nonoperative, awake injection of 99 m-Tc sulfur colloid and SPECT-CT.

Results: Ten patients were reviewed. Primary sites included tonsil (n = 8, 80%) and tongue base (n = 2, 20%). All patients tolerated awake injections with no complications. Nine patients (90%) demonstrated satisfactory migration of radiotracer to neck node(s) with seven (78%) to the ipsilateral lateral neck, one (11%) to the ipsilateral lateral neck and retropharynx, and one (11%) to bilateral lateral neck nodes.

Conclusions: Characterization of lymphatic drainage in OPSCC is feasible using a nonoperative injection technique and SPECT-CT. Drainage to the contralateral neck is rare, warranting further study to tailor treatment appropriately.
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http://dx.doi.org/10.1002/hed.26011DOI Listing
March 2020

A systematic review of secondary cerebrospinal fluid leaks.

Am J Rhinol Allergy 2017 Nov;31(6):48-56

Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, New York, USA.

Background: Secondary cerebrospinal leaks (CSF) are leaks that recur after an initial endoscopic repair of CSF leaks. Identification of characteristics that could predict secondary leaks may allow surgeons to plan repairs with the knowledge that these defects are more likely to fail.

Objective: To identify characteristics that could predict secondary CSF leaks.

Methods: A search of all studies that reported outcomes after endoscopic repair of CSF leaks was conducted by using medical literature data bases. Studies with the following criteria were included: written in the English language, secondary CSF leaks after primary repair, and assessment of success of fistula repair. Data extracted included the etiology of the leak, site of the leak, reconstructive materials used, and success of the repair.

Results: Ninety-four studies, from 1988 to 2015, with a total of 3149 primary CSF leaks were included. Sixty-three studies (67%) had a success rate of ≥80%; 77 studies (82%) had secondary leak rates of <40%. For 88 of the 94 studies (94%), the success rate after secondary repair improved to 81.0-100%. Of 48 studies that included leaks of more than one site, the sphenoid was the most common site of leak in 26 studies (55%), the ethmoid was the most common site in 16 studies (34%), and the cribriform was the most common site in 11 studies (23%).

Conclusion: The rate of secondary CSF leaks was low due to advances in endoscopic repair techniques. Spontaneous and iatrogenic CSF leaks were more likely to recur, especially without adequate control of underlying factors, such as increased intracranial pressure and obesity. Further studies with consistent reporting are required for more definitive conclusions about secondary CSF leaks.
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http://dx.doi.org/10.2500/ajra.2017.31.4487DOI Listing
November 2017

Association of Body Mass Index With Infectious Complications in Free Tissue Transfer for Head and Neck Reconstructive Surgery.

JAMA Otolaryngol Head Neck Surg 2017 06;143(6):574-579

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

Importance: Elevated body mass index (BMI) has been proposed as a risk factor for morbidity and mortality among patients undergoing surgery. Conversely, an elevated BMI may confer a protective effect on perioperative morbidity.

Objective: To examine whether an elevated BMI is an independent risk factor for perioperative and postoperative infectious complications after free tissue transfer in head and neck reconstructive surgery.

Design, Setting, And Participants: This cohort study included patients undergoing major head and neck surgery requiring free tissue transfer at a tertiary care center. Data were collected for 415 patients treated from January 1, 2007, through December 31, 2014.

Main Outcomes And Measures: The outcome of interest was postoperative infection and complications after head and neck surgery using free flaps. Covariates considered for adjustment in the statistical model included alcohol consumption (defined as >5 drinks per day [eg, 360 mL of beer, 150 mL of wine, or 45 mL of 80-proof spirits]), type 2 diabetes, prior radiotherapy, anesthesia time, hypothyroidism, smoking, American Society of Anesthesiologists classification, antibiotic regimen received (defined as a standard regimen of a first- or second-generation cephalosporin with or without metronidazole hydrochloride vs an alternative antibiotic regimen for patients allergic to penicillin), and primary surgeon. A multiple logistic regression model was developed for the incidence of the infection end point as a function of elevated BMI (>30.0).

Results: Among the 415 patients included in this study (277 men [66.7%] and 138 women [33.2%]; mean [SD] age, 61.5 [13.9] years), type 2 diabetes and use of an alternative antibiotic regimen were found to be independently associated with increased infectious complications after free flap surgery of the head and neck, with estimated odds ratios of 2.78 (95% CI, 1.27-6.09) and 2.67 (95% CI, 1.14-6.25), respectively, in the multiple logistic regression model. However, a high BMI was not found to be statistically significant as an independent risk factor for postoperative infectious complication (estimated odds ratio, 1.19; 95% CI, 0.48-2.92).

Conclusions And Relevance: Elevated BMI does not seem to play a role as an independent risk factor in postoperative complications in free tissue transfer in head and neck surgery.
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http://dx.doi.org/10.1001/jamaoto.2016.4304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5824233PMC
June 2017

The price of free tissue transfer after tongue reconstruction: quantifying the risks.

Laryngoscope 2017 07 20;127(7):1551-1557. Epub 2017 Jan 20.

Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, New York, U.S.A.

Objectives/hypothesis: To evaluate the preoperative variables, mean operative time, morbidity, and mortality associated with reconstruction of partial glossectomy defects.

Study Design: Retrospective data analysis.

Methods: The National Surgical Quality Improvement Program database was queried for patients having undergone glossectomy procedures. The study sample was split into two groups based on the lack or presence of a flap reconstruction. A total of 1,012 glossectomy patients were identified, with 805 undergoing nonflap reconstruction and 207 undergoing free flap reconstruction. Variables evaluated included wound complications, major and minor morbidity, return to the operating room, mortality, and mean operative time.

Results: Patients undergoing free flap reconstruction experienced significantly longer mean operative times (482.1 vs. 183.0 minutes, P < .001), were more likely to return to the operating room (odds ratio [OR] = 2.39, 95% confidence interval [CI] = 1.33-4.29, P = .003), and had higher likelihood of wound complications (OR = 5.78, 95% CI = 2.72-12.26, P < .001), major morbidity (OR = 12.39, 95% CI = 7.02-21.85, P < .001), and minor morbidity (OR = 4.20, 95% CI = 2.12-8.33, P < .001). There was no difference in mortality between groups (OR = 8.62, 95% CI = 0.53-141.7, P = .131).

Conclusions: Free flap reconstruction of glossectomy defects involving up to half of the tongue is associated with increased morbidity and operative time when compared with nonflap reconstruction. Currently available functional outcomes data for tongue reconstruction are poor. Possible functional impairment must be weighed against the associated morbidity when deciding which defects require reconstruction, and the decision to reconstruct should not be taken lightly.

Level Of Evidence: 4. Laryngoscope, 127:1551-1557, 2017.
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http://dx.doi.org/10.1002/lary.26461DOI Listing
July 2017

Improved delivery of sinus irrigations after middle turbinate resection during endoscopic sinus surgery.

Int Forum Allergy Rhinol 2017 04 9;7(4):338-342. Epub 2016 Dec 9.

Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, NY.

Background: Improvement in topical delivery to nasal mucosa is a fundamental goal of endoscopic sinus surgery (ESS). This study compares the penetration of irrigation before and after middle turbinate resection (MTR) to assess the efficacy of topical delivery.

Methods: ESS was performed on 4 cadaver heads, followed by MTR. Each head was irrigated with fluorescein-dyed water using a squeeze bottle both before and after MTR. Videos were recorded by rigid nasal endoscopy. Four blinded raters reviewed videos and scored the extent of staining (0 to 3) for each site.

Results: The mean score for the extent of staining of all anatomical sites before and after MTR was 1.30 and 1.92, respectively (p = 0.035). The mean score for extent of staining before and after MTR was 2.56 and 2.81 (p = 0.134) for the maxillary sinus, 1.66 and 2.25 (p = 0.022) for the ethmoid sinus, 1.03 and 1.94 (p = 0.263) for the sphenoid sinus, 0.16 and 0.94 (p = 0.055) for the frontal sinus, and 1.09 and 1.66 (p = 0.340) for the olfactory cleft, respectively. When evaluating interrater reliability, Cronbach's alpha was 0.92, which is acceptable. When evaluating intrarater reliability, the Fleiss kappa statistic for each rater was excellent or good.

Conclusion: Overall, MTR results in significant improvement in the penetration of nasal irrigations in the cadaver model. Each individual sinus displays a trend toward improvement; however, only the ethmoid sinus displays a statistically significant improvement. Further in vivo studies are needed to elucidate the role of MTR.
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http://dx.doi.org/10.1002/alr.21894DOI Listing
April 2017

Treatment modalities in sinonasal undifferentiated carcinoma: an analysis from the national cancer database.

Int Forum Allergy Rhinol 2017 02 7;7(2):205-210. Epub 2016 Oct 7.

Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, New York.

Background: Sinonasal undifferentiated carcinoma (SNUC) is a rare, aggressive malignancy of unknown etiology with a poor overall prognosis. Its relative rarity has made it difficult to determine the impact of different treatment modalities on survival.

Methods: Retrospective study of cases in the National Cancer Data Base (NCDB). NCDB cases that were diagnosed as having SNUC between January 1, 2004, and December 31, 2013 were included in the analysis. Outcomes of patients treated with surgery followed adjuvant chemoradiotherapy were compared with definitive chemoradiotherapy.

Results: A 5-year survival rate of 42.2% was observed in the 460 patients in the analysis. American Joint Committee on Cancer (AJCC) clinical staging data were available for 304 patients. Of these patients, 60.2% had advanced tumors (AJCC stage 3 or 4). Surgery followed by adjuvant chemoradiotherapy was associated with better survival than definitive chemoradiotherapy (55.8% vs 42.6%, p = 0.007) in the study population. However, in late-stage tumors, there was no difference in survival between the 2 treatment groups (p = 0.22). For late-stage tumors, the time to initiation of adjuvant therapy was 49.2 ± 5.1 days for the surgery plus adjuvant therapy group as compared with 25.9 ± 2.6 days in the definitive chemoradiotherapy group (p < 0.0001), yet this did not appear to affect outcomes. No differences in age, gender, race, Charlson-Deyo score, facility type (academic vs nonacademic), or radiation dose were found between the 2 treatment groups (p > 0.05). Margin status played a critical role in the success of surgical resection, as no patients with positive margin status receiving adjuvant therapy survived to 5 years.

Conclusion: Surgery may play a role in a multimodality approach to treatment of late-stage SNUC if the tumor is amenable to surgical resection and negative margins can be reliably obtained. However, in cases where there may be difficulty obtaining negative margins, or this is considered unlikely preoperatively, surgical resection does not appear to provide any additional survival benefit.
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http://dx.doi.org/10.1002/alr.21861DOI Listing
February 2017

The presentation and outcomes of mucosal melanoma in 695 patients.

Int Forum Allergy Rhinol 2017 01 14;7(1):99-105. Epub 2016 Sep 14.

Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, NY.

Background: Most data on sinonasal mucosal melanoma come from small institutional studies, and therefore optimal treatment methods are not well understood. The purpose of this study was to analyze the association between treatment and survival in sinonasal mucosal melanoma.

Methods: Six hundred ninety-five patients diagnosed with sinonasal mucosal melanoma between 2004 and 2010 were identified from the National Cancer Data Base. Treatment modalities and overall survival rates were determined.

Results: The 5-year overall survival was 21.7%, with a mean survival of 38.4 ± 1.7 months. The majority of patients were treated with surgery alone (31.5%) or surgery with adjuvant radiotherapy (41.4%). There was no statistical difference between survival with surgery alone and surgery with adjuvant radiation therapy (25.1% vs 25.1%, p = 0.93). Between the surgery and surgery-with-adjuvant-therapy groups, there was no difference in the number of patients with positive margins (p = 0.54), regional lymph node metastases at diagnosis (p = 0.55), morbidity scores (p = 0.58), insurance status (p = 0.13), age > 60 years (p = 0.24), or treatment at academic centers (p = 0.12).

Conclusions: Based on this large review of patients with sinonasal mucosal melanoma, adjuvant radiation therapy may not provide a survival benefit as patients tended to do poorly regardless of adjuvant radiation status.
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http://dx.doi.org/10.1002/alr.21831DOI Listing
January 2017

Successful repair of intraoperative cerebrospinal fluid leaks improves outcomes in endoscopic skull base surgery.

Int Forum Allergy Rhinol 2017 01 31;7(1):80-86. Epub 2016 Aug 31.

Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC.

Background: The impact of failed cerebrospinal fluid leak (CSF) leak repair in endoscopic skull base surgery has not been adequately studied.

Methods: In this investigation we reviewed patients who had undergone endoscopic skull base surgery between 2002 and 2014 at 7 international centers. Demographic variables, comorbidities, tumor characteristics, and repair techniques were evaluated to determine association with successful repair of CSF leak. Postoperative complications and length of stay were compared among groups.

Results: Data were collected on 2097 patients who were divided into 3 groups: (1) those with no intraoperative leak (n = 1533); (2) those with successful repair of their intraoperative leak (n = 452); and (3) those with failed repair (n = 112). Compared with successful repair, failed repair was associated with an increased risk of intracranial infection (odds ratio [OR], 5.6; 95% confidence interval [CI], 5.3-13.15), pneumocephalus (OR, 16; 95% CI, 5.8-44.4), 30-day readmission (OR, 8.4; 95% CI, 5.3-13.5), reoperation (OR, 115.4; 95% CI, 56.3-236.8), and prolonged hospital stay (14.9 vs 7.0 days, p < 0.01). Outcomes in patients who had successful repairs of intraoperative leaks were similar to those who never had leakage. Intraoperative use of pedicled nasoseptal flaps was associated with successful repair (OR, 0.60; 95% CI, 0.34-0.92).

Conclusion: Intraoperative CSF leaks are a frequent and expected occurrence during endoscopic skull base surgery. Failed CSF leak repair has a significant impact on patient outcomes, with increased rates of postoperative pneumocephalus, intracranial infections, reoperation, deep vein thrombosis, readmission, and prolonged hospital stay. Recognition and repair of intraoperative CSF leaks reduces postoperative complications. Use of pedicled nasoseptal flaps improves outcomes in reconstructing defects at higher risk for postoperative leak.
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http://dx.doi.org/10.1002/alr.21845DOI Listing
January 2017

The versatility of the serratus anterior free flap in head and neck reconstruction.

Laryngoscope 2017 03 9;127(3):568-573. Epub 2016 Jun 9.

Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, New York.

Objectives/hypothesis: Review the literature on the use of the serratus anterior free flap in the head and neck reconstruction and describe new applications of the serratus anterior free flap.

Study Design: Case series with retrospective chart review and literature review.

Methods: A PubMed literature review was performed using the search terms "serratus free flap," "serratus skull base," "serratus scalp," and "serratus free tissue transfer." One hundred and seventy-six articles were identified, 22 of which included at least one head and neck reconstructive case utilizing the serratus free flap. Twenty-two articles were identified since 1982 that discussed the use of the serratus anterior free flap for reconstruction in the head and neck. However, most of these were harvested in conjunction with latissimus muscle.

Results: We present a case series of 15 patients in whom the serratus anterior muscle free flap was used alone for head and neck reconstruction. In seven of these patients, we used the serratus for coverage of the newly created pharynx after total laryngectomy, which has not previously been reported.

Conclusion: The serratus anterior free muscle flap has great versatility in reconstruction of the head and neck. Because of its low donor site morbidity, thinness, and pliability, as well as its ease of harvest, it is ideal for reconstruction of the skull base and scalp. We have also found that it is ideal for muscle coverage of the newly reconstructed pharynx after total laryngectomy.

Level Of Evidence: 4. Laryngoscope, 127:568-573, 2017.
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http://dx.doi.org/10.1002/lary.26116DOI Listing
March 2017

Retrosternal Goiter: 30-Day Morbidity and Mortality in the Transcervical and Transthoracic Approaches.

Otolaryngol Head Neck Surg 2016 10 24;155(4):568-74. Epub 2016 May 24.

Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, New York, USA.

Objective: Retrosternal goiters pose a significant challenge in determining the indications and appropriate approach for surgical removal while limiting postoperative morbidity and mortality. The objective of this study is to use the National Surgical Quality Improvement Program (NSQIP) database to compare outcomes of transcervical and transthoracic approaches for retrosternal goiter removal and to review the literature regarding the varying indications for the 2 surgical approaches.

Study Design: Administrative database analysis.

Setting: NSQIP database.

Subjects And Methods: The NSQIP database was queried for all cases of retrosternal thyroid: 2716 patients were included, which represents one of the largest data reviews of patients with retrosternal thyroid pathology who underwent surgery. Data were analyzed to examine morbidity and mortality of the cervical and transthoracic approaches.

Results: Patient demographics and preoperative comorbidities were similar between groups. Patients undergoing a transthoracic approach experienced increased rates of unplanned intubations and need for transfusion and length of stay postoperatively.

Conclusions: A transthoracic approach is associated with increased rates of several critical postoperative morbidities, and the data indicate the potential of increased overall mortality. Given equivalent retrosternal extension, a transcervical approach should be attempted whenever anatomically possible, regardless of pathology.
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http://dx.doi.org/10.1177/0194599816649583DOI Listing
October 2016

Endoscopic graduated multiangle, multicorridor resection of juvenile nasopharyngeal angiofibroma: an individualized, tailored, multicorridor skull base approach.

J Neurosurg 2016 May 13;124(5):1328-38. Epub 2015 Nov 13.

Departments of 1 Neurological Surgery and.

OBJECT Juvenile nasopharyngeal angiofibromas (JNAs) are formidable tumors because of their hypervascularity and difficult location in the skull base. Traditional transfacial procedures do not always afford optimal visualization and illumination, resulting in significant morbidity and poor cosmesis. The advent of endoscopic procedures has allowed for resection of JNAs with greater surgical freedom and decreased incidence of facial deformity and scarring. METHODS This report describes a graduated multiangle, multicorridor, endoscopic approach to JNAs that is illustrated in 4 patients, each with a different tumor location and extent. Four different surgical corridors in varying combinations were used to resect JNAs, based on tumor size and location, including an ipsilateral endonasal approach (uninostril); a contralateral, transseptal approach (binostril); a sublabial, transmaxillary Caldwell-Luc approach; and an orbitozygomatic, extradural, transcavernous, infratemporal fossa approach (transcranial). One patient underwent resection via an ipsilateral endonasal uninostril approach (Corridor 1) only. One patient underwent a binostril approach that included an additional contralateral transseptal approach (Corridors 1 and 2). One patient underwent a binostril approach with an additional sublabial Caldwell-Luc approach for lateral extension in the infratemporal fossa (Corridors 1-3). One patient underwent a combined transcranial and endoscopic endonasal/sublabial Caldwell-Luc approach (Corridors 1-4) for an extensive JNA involving both the lateral infratemporal fossa and cavernous sinus. RESULTS A graduated multiangle, multicorridor approach was used in a stepwise fashion to allow for maximal surgical exposure and maneuverability for resection of JNAs. Gross-total resection was achieved in all 4 patients. One patient had a postoperative CSF leak that was successfully repaired endoscopically. One patient had a delayed local recurrence that was successfully resected endoscopically. There were no vascular complications. CONCLUSIONS An individualized, multiangle, multicorridor approach allows for safe and effective surgical customization of access for resection of JNAs depending on the size and exact location of the tumor. Combining the endoscopic endonasal approach with a transcranial approach via an orbitozygomatic, extradural, transcavernous approach may be considered in giant extensive JNAs that have intracranial extension and intimate involvement of the cavernous sinus.
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http://dx.doi.org/10.3171/2014.12.JNS141696DOI Listing
May 2016

Multi-institutional study of risk factors for perioperative morbidity following transnasal endoscopic pituitary adenoma surgery.

Int Forum Allergy Rhinol 2016 Jan 6;6(1):101-7. Epub 2015 Aug 6.

Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.

Background: The goal of this study was to identify preoperative risk factors associated with increased perioperative morbidity after endoscopic pituitary surgery.

Methods: A retrospective review of patients undergoing endoscopic pituitary adenoma surgery between 2002 and 2014 at 6 international centers was performed. Standard demographic and comorbidity data, as well as information regarding tumor extent and treatment were collected. Logistic regression was used to examine risk factors for the following 30-day outcomes: systemic complications, intracranial complications, postoperative cerebrospinal fluid (CSF) leaks, length of hospital stay, readmission, and reoperation.

Results: Data was collected on 982 patients with a mean age of 52 years. The median body mass index (BMI) for all patients was 30.9 kg/m(2) with 56% female. The median hospital stay was 5 days and 23.8% of patients suffered a postoperative adverse event. Systemic complications occurred in 3.2% of patients and intraventricular extension was a risk factor (odds ratio [OR] 8.9). Intracranial complications occurred in 7.3% of patients and risk factors included previous radiation (OR 8.6) and intraventricular extension (OR 7.9). Reoperation occurred in 6.5% of patients and intraventricular extension (OR 7.3) and age (<40 years, OR 3.5; 40 to 64 years, OR 3.2) were risk factors. Postoperative CSF leaks occurred in 5.5% of patients and risk factors included female gender (OR 2.4), BMI ≥ 30 (OR 2.1), age (<40 years, OR 5.3; 40 to 64 years, OR, 7.9), and intraventricular extension (OR, 9.5).

Conclusion: Postoperative endoscopic pituitary adenoma surgery complications are associated with tumors with intraventricular extension, preoperative radiation, as well as common patient comorbidities. Identification of these factors may permit implementation of strategies to reduce postoperative complications.
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http://dx.doi.org/10.1002/alr.21622DOI Listing
January 2016

Sinonasal squamous cell carcinoma and the prognostic implications of its histologic variants: a population-based study.

Int Forum Allergy Rhinol 2015 Jan 2;5(1):85-91. Epub 2014 Oct 2.

Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.

Background: Variants of squamous cell carcinoma (SCC) make up 15% of all cases of SCC of the upper aerodigestive tract. There are 5 main histologic variants of SCC in the head and neck region: verrucous (VSCC), papillary (PSCC), spindle cell (sarcomatoid) (SCSC), basaloid (BSCC), and adenosquamous (ASC). Conventional sinonasal SCC has been studied extensively, but far less is known about its major variants.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to extract frequency and survival data from 1973 to 2009. A total of 4382 cases of conventional sinonasal SCC and 328 cases of its major variants were found. Statistical comparisons of data for sinonasal SCC and its variants were carried out with respect to varying demographic and disease specific parameters, such as gender, race, age at diagnosis, and specific anatomic site affected.

Results: Sinonasal BSCC was diagnosed at a significantly lower mean age than sinonasal SCC. Sinonasal SCSC significantly affected the maxillary sinus more commonly than SCC. In the setting of advanced stage disease, sinonasal VSCC, PSCC, and BSCC appear to be associated with a better prognosis than conventional sinonasal SCC, whereas the impact of histologic subtype on prognosis in early stage disease appears to be more limited. Survival for SCSC and ASC, both regarded as more lethal variants, was statistically similar to conventional SCC.

Conclusion: Our study supports the practice of distinguishing between conventional sinonasal SCC and its major histologic variants, because histologic subtype appears to carry important prognostic implications.
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http://dx.doi.org/10.1002/alr.21418DOI Listing
January 2015

Demographics and survival trends of sinonasal adenocarcinoma from 1973 to 2009.

Int Forum Allergy Rhinol 2014 Sep 21;4(9):771-6. Epub 2014 May 21.

Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.

Background: The purpose of this work was to study the demographics and survival of patients diagnosed with sinonasal adenocarcinoma (SNAC) within the time period of 1973 to 2009 using the Surveillance, Epidemiology, and End Result (SEER) database.

Methods: A retrospective cohort study using the U.S. National Cancer Institute's SEER registry was performed to study the demographics and survival for SNAC from 1973 to 2009. Analysis was conducted based on race, gender, and stage.

Results: In total, 1270 cases of SNAC were analyzed for demographics and survival. Males accounted for 51.6% of cases, while females accounted for 48.4% of cases, amounting to a male to female ratio of 1.06:1.00. Disease specific survival at 5, 10, 15, and 20 years was 65.2%, 50.9%, 40.9%, and 36.5%, respectively. When analyzed by gender, females had higher survival than males, although this difference was not statistically significant. When analyzed by race, the category of other, which encompasses American Indian, Asian, Hispanic, and unknown or unspecified race, was shown to have the best survival, followed by whites and blacks, respectively.

Conclusion: SNAC is a rare tumor classically associated with occupational exposure and carries a variable prognosis. This is the first dedicated large-scale, retrospective analysis of a North American SNAC population. SNAC appears to affect both males and females equally and predominantly affects whites. Patients categorized as other had significantly better survival outcomes, while gender appeared to have no significant effect on survival.
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http://dx.doi.org/10.1002/alr.21342DOI Listing
September 2014

Squamous cell carcinoma of the parotid gland: a population-based analysis of 2545 cases.

Am J Otolaryngol 2014 Jul-Aug;35(4):469-75. Epub 2014 Mar 5.

Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA. Electronic address:

Purpose: Squamous cell carcinoma (SCC) of the parotid gland is an uncommon tumor, which generally affects older patients. In this study, we explore various aspects of this entity using a national population-based database.

Methods: The Surveillance, Epidemiology, and End Results (SEER) registry was used to extract data on frequency, incidence, and disease-specific survival (DSS) from 1973 to 2009. Variables analyzed included age, gender, race, histologic grade, stage and treatment. Cox proportional hazards analysis was conducted.

Results: A total of 2545 cases were identified. Parotid SCC was most common in males (79.8%), whites (92.9%), and patients aged ≥75 years (51.4%). Incidence increased slightly over the past three decades (annual percent change 1.90%, p<0.05). Overall 5-year DSS was 54.4%. Statistically significant poor prognostic factors included black race, age ≥75 years, tumor T3 or greater, and higher clinical stage at diagnosis. Elective neck dissection (END) in patients staged N0 was associated with higher DSS (78.3% versus 51.1%, p<0.0001). The omission of END was associated with a three-fold greater hazard of death (hazard ratio 3.19, 95% confidence interval 1.53-7.26, p=0.0016), regardless of whether or not radiotherapy was given.

Conclusion: Parotid SCC is uncommon, and data on treatment decisions are limited. Our study profiles the demographic, clinicopathologic, incidence, and survival features of this entity. Perhaps most notably, our results support the practice of END of the N0 neck.
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http://dx.doi.org/10.1016/j.amjoto.2014.03.003DOI Listing
February 2015

Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue of the salivary glands: a population-based study from 1994 to 2009.

Head Neck 2015 Jan 15;37(1):18-22. Epub 2014 Apr 15.

Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.

Background: Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) arising from the salivary glands is rare.

Methods: Five hundred seven cases were available for frequency/incidence analysis, and 712 for relative survival and regression analysis in the Surveillance Epidemiology and End Results (SEER) database.

Results: Of the total patients, 72.98% were women, 80.47% were white, and 74.75% were ≥50 years old. The parotid gland was involved in 80.87% of cases. Ann Arbor stage at diagnosis was 53.85% IE, 18.54% IIE, and 10.06% IIIE/IV. Overall, 15-year relative survival was 78.40%. Relative survival was worst among blacks and those with advanced-stage disease. No difference was noted between those treated with surgery, radiation, or both. Statistically significant poor prognosticators included black race (hazard ratio [HR], 2.3961; 95% confidence interval [CI], 1.54-3.72; p = .0001) and stage IIIE/IV (HR, 2.3677; 95%CI, 1.36-4.11; p = .0022).

Conclusion: Early-stage salivary gland MALT lymphoma disease may be amenable to unimodality treatment. Even patients with advanced disease have relatively high survivals.
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http://dx.doi.org/10.1002/hed.23543DOI Listing
January 2015

Nasopharyngeal squamous cell carcinoma: a comparative analysis of keratinizing and nonkeratinizing subtypes.

Int Forum Allergy Rhinol 2014 Aug 14;4(8):675-83. Epub 2014 Apr 14.

Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.

Background: Nasopharyngeal squamous cell carcinoma (NPSCC) is uncommon in non-endemic regions. Two major histologic subtypes are recognized: keratinizing (K-NPSCC) and nonkeratinizing (NK-NPSCC). We hypothesize that significant differences exist between the 2 in terms of demographic, clinicopathologic, survival, and prognostic features. We aim to show that differentiating between the 2 subtypes is perhaps the most important first step at the time of diagnosis.

Methods: Using a retrospective cohort design, the U.S. National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry was used to extract data on the 2 major subtypes of NPSCC. Frequency, incidence, and relative survival (RS) were analyzed comparatively. Regression analysis was conducted and hazard ratios (HRs) calculated.

Results: A total of 1624 cases were identified: 1234 (76.0%) cases of NK-NPSCC and 390 (24.0%) cases of K-NPSCC. Five-year RS was 60.6% for NK-NPSCC and 40.5% for K-NPSCC. Regression analysis revealed K-NPSCC to be a poor prognostic factor (HR 2.1; 95% confidence interval, 1.8-2.6; p < 0.0001). Other factors associated with a poor prognosis included female gender in K-NPSCC, age greater than 44 years in both groups, and advanced-stage disease at diagnosis. Favorable prognostic factors included Asian/Pacific Islander race, and treatment with radiation therapy. Higher histologic grade did not portend a worse prognosis for either group.

Conclusion: NPSCC remains an uncommon malignancy in the United States. K-NPSCC and NK-NPSCC represent 2 different histologic entities with important clinical differences. K-NPSCC carries a worse overall prognosis when compared to NK-NPSCC.
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http://dx.doi.org/10.1002/alr.21332DOI Listing
August 2014

Diffuse large B-cell lymphoma of the sinonasal tract: analysis of survival in 852 cases.

Am J Otolaryngol 2014 Mar-Apr;35(2):154-8. Epub 2013 Sep 28.

Department of Otolaryngology-Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ. Electronic address:

Purpose: Diffuse large B-cell lymphomas (DLBCLs) are rare tumors of the head and neck that often have non-specific presentations and significant morbidity and mortality. In this analysis we use a large cohort to compare the demographic and disease-specific parameters affecting survival and incidence of DLBCLs.

Methods: The United States National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry was utilized to extract data regarding sinonasal diffuse large B-cell lymphoma between 1973 and 2009. A total of 852 cases of sinonasal DLBCLs were found. Presenting symptoms, demographics, disease specific survival, relative survival and survival by treatment modality were described for this rare tumor.

Results: Overall disease specific survival (DSS) at 1-year was 84.7% and at 5 years was 68.0%. DSS was significantly lower for those not treated with radiation therapy, with 1- and 5-year survival rates of 77.3% and 62.5%, versus those treated with radiation therapy, with 1- and 5-year rates of 89.2% and 71.5% (p<0.05). Prognosis was significantly better for patients treated with radiation therapy (HR 0.6, p<0.05) while it was poorer for patients with involvement of multiple sinuses (HR 1.5, 1.8, p<0.05).

Conclusions: DLBCLs of the sinonasal tract are rare tumors of the head and neck. Survival is significantly improved for those treated with radiation therapy while the involvement of multiple sinuses is a negative prognostic indicator.
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http://dx.doi.org/10.1016/j.amjoto.2013.09.003DOI Listing
November 2014

Sinonasal melanoma: survival and prognostic implications based on site of involvement.

Int Forum Allergy Rhinol 2014 Feb 4;4(2):151-5. Epub 2013 Nov 4.

Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ; Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine, New York, NY.

Background: Sinonasal melanoma (SNM) is a rare malignancy that commonly presents at an advanced age and has a slight male predominance. Local recurrence has been implicated as a major reason for treatment failure, and there are poor reported 5-year survival rates. We analyzed the impact of specific location within the sinonasal region on the survival of this rare malignancy.

Methods: The U.S. National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry was used to extract data on SNM between 1973 and 2009. Survival trends and hazard ratios (HRs) were calculated to compare the prognostic implications of involvement of varying areas of the sinonasal tract.

Results: A total of 567 cases were identified. Females constituted 56.44% patient. Disease-specific survival (DSS) at 5 years was 36.66% for patients diagnosed with nasal cavity disease, 23.80% for patients with maxillary sinus tumors, and 18.20% for patients with ethmoid sinus disease. Patients showing evidence of overlapping sinus involvement had approximate 1-year survival of 54.45% and none survived beyond 49 months. HRs for maxillary sinus, ethmoid sinus, and overlapping sinus disease were 1.34, 1.60, and 2.30, respectively. All DSSs and HRs were statistically significant (p < 0.05). There was a higher proportion of earlier-stage disease in the nasal cavity compared to the most common paranasal sinus region (p < 0.05).

Conclusion: Prognosis in SNM is dependent on the anatomic subsite. Paranasal sinus involvement indicates a poorer prognosis when compared to nasal cavity disease. Patients presenting with overlapping sinus involvement have the poorest prognosis.
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http://dx.doi.org/10.1002/alr.21243DOI Listing
February 2014

Epistaxis: the factors involved in determining medicolegal liability.

Int Forum Allergy Rhinol 2014 Jan 10;4(1):76-81. Epub 2013 Oct 10.

Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.

Background: The purpose of this study was to examine litigation involving epistaxis and analyze factors that determine liability.

Methods: Jury verdicts and settlements regarding cases involving epistaxis were gathered utilizing the Westlaw database. Factors involved in litigation gathered included demographics, defendant specialty, procedure, alleged cause of malpractice, outcome, monetary award, and other variables.

Results: A total of 26 cases were analyzed. The majority of cases (57.7%) were decided in favor of the plaintiff or settled out of court. Total awards amounted to $24,501,252. Average awards for cases decided in favor of the plaintiff were $2,260,893 and ranged from $499,845 to $9,022,643. Settlements averaged $1,084,375 and ranged from $300,000 to $3,800,000. Common causes of malpractice encountered included delay in diagnosis, complications from medical procedures, and failure to recognize complications in a timely manner.

Conclusion: Contrary to previous reports analyzing malpractice for varying medical procedures and complications, litigation in epistaxis is more commonly resolved in favor of the plaintiff or resolved through out-of-court settlements. Substantial financial awards and therapeutic complications from blindness to death make epistaxis a candidate for litigation. Of importance from a medicolegal stand is the fact that 30.8% (8) of the patients involved in epistaxis litigation died, either from complications of therapy or from experiencing epistaxis as a complication of another procedure/pathology. Using necessary diagnostic imaging, ensuring proper management techniques, and recognizing complications in a timely manner can serve to limit legal liability and enhance patient safety.
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http://dx.doi.org/10.1002/alr.21229DOI Listing
January 2014

Clival keloid after nasopharyngeal radium irradiation masquerading as skull base malignancy.

Laryngoscope 2014 Aug 13;124(8):1767-70. Epub 2013 Nov 13.

Department of Otolaryngology-Head and Neck Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Objectives/hypothesis: Nonchordomatous lesions of the clivus are rare entities. Nasopharyngeal radium irradiation (NRI) treatment consists of application of radium to the posterior nasopharynx near the orifice of the Eustachian tubes, an area adjacent to the clivus. Here we present a unique case of a patient with a history of NRI 70 years prior to presentation with a space-occupying clival lesion suspicion for a skull-based malignancy. This lesion was resected using an endoscopic endonasal approach. Histopathological analysis revealed a clival keloid, an entity not previously reported in the literature.
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http://dx.doi.org/10.1002/lary.24449DOI Listing
August 2014

Extranodal natural killer/T-Cell lymphoma: A population-based comparison of sinonasal and extranasal disease.

Laryngoscope 2014 Apr 7;124(4):888-95. Epub 2013 Oct 7.

Department of Otolaryngology-Head and Neck Surgery, Newark, New Jersey, U.S.A.

Objectives/hypothesis: Extranodal natural killer/T-cell Lymphoma (ENKTL) is a rare, aggressive malignancy that preferentially affects the paranasal region. This study analyzes the demographic, clinicopathologic, incidence, and survival characteristics of sinonasal ENKTL (SN-ENKTL) and extranasal ENKTL (EN-ENKTL) in a comparative fashion.

Study Design: Retrospective analysis.

Methods: The Surveillance, Epidemiology, and End Results database was queried; 528 cases were available for frequency and incidence analysis, and 473 for survival analysis. Data were examined according to age, gender, race, histology, the presence of systemic (or B) symptoms, treatment, and Ann Arbor stage.

Results: Extranasal disease was a poor prognostic factor (hazard ratio [HR] = 1.69, 95% confidence interval [CI] = 1.30-2.19, P < .05). Patients with EN-ENKTL were older (mean 53.8 vs. 49.9 years, P < .05), most were male (72.5% vs. 59.8%, P < .05), and they were more likely to present with stage IIIE/IV disease (38.33% vs. 18.26%, P < .05). B symptoms were present in 38.41% of the EN-ENKTL group (vs. 22.86%, P < .05), and were a poor prognostic factor in this group only (HR = 1.6593, 95% CI = 1.05-2.62, P < .05). Radiation therapy demonstrated a survival advantage among both groups, especially in early stage disease.

Conclusions: SN-ENKTL carries a significantly better prognosis than EN-ENKTL, which presents at more advanced stages. Radiation therapy was associated with increased survival in both groups, especially in cases of localized disease.

Level Of Evidence: 2b.
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http://dx.doi.org/10.1002/lary.24371DOI Listing
April 2014

Epidemiology of sinonasal squamous cell carcinoma: a comprehensive analysis of 4994 patients.

Laryngoscope 2014 Jan 1;124(1):76-83. Epub 2013 Jul 1.

Department of Otolaryngology-Head and Neck Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey, U.S.A.

Objectives/hypothesis: To examine the incidence and survival of patients with sinonasal squamous cell carcinoma (SNSCC) between the years of 1973 and 2009 using the Surveillance, Epidemiology, and End Result (SEER) database.

Study Design: Retrospective cohort study using a national database.

Methods: The SEER registry was utilized to calculate incidence and survival trends for patients with SNSCC between 1973 and 2009. Patient data were then analyzed according to age, sex, and race.

Results: A total of 4,994 cases of SNSCC were identified, composed of 64.44% males and 35.56% females. Incidence trend analysis revealed a significant decrease in yearly rates from 1973 to 2009 for the overall population, females, whites, blacks, and "others" (P < .05). Overall 5-, 10-, and 20-year survival for SNSCC was 52.95%, 44.67%, and 29.37%, respectively. No significant differences (P > .05) were found when comparing survival between the last three decades. Differences in long-term survival were noted between whites, blacks, and "others," with whites displaying the highest 20-year survival. Males and females were found to have similar long-term survival curves, with 20-year survival of 30.68% and 26.35%, respectively.

Conclusions: The overall incidence of SNSCC is declining. However, survival has not significantly improved in the last 3 decades. Race seems to influence the overall survival of this tumor. Future studies need to be conducted to investigate these dynamic trends related to SNSCC.
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http://dx.doi.org/10.1002/lary.24264DOI Listing
January 2014

Demographic trends and disease-specific survival in salivary acinic cell carcinoma: an analysis of 1129 cases.

Laryngoscope 2014 Jan 12;124(1):172-8. Epub 2013 Jul 12.

Department of Otolaryngology-Head & Neck Surgery, Neurological Institute of New Jersey, Newark, New Jersey, U.S.A.

Objective/hypothesis: Acinic cell carcinoma (AciCC) is a rare salivary gland malignancy that most commonly arises in the parotid gland. Characteristics of AciCC are slow growth and a long clinical course. As a rare tumor, population-based studies are limited. We analyzed the incidence and survival for AciCC using a national population-based database.

Study Design: Retrospective analysis.

Methods: The United States National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry was utilized to calculate incidence and disease-specific survival trends for AciCC between 1973 and 2009. Patient data were stratified according to age, gender, race, grade, and extent of disease. Incidence trends were studied across the last 30 years and long-term disease-specific survival outcomes were compared across the different demographic parameters.

Results: A total of 1,129 cases of AciCC were identified, comprising of 672 (59.52%) females. Incidence trend analysis revealed significant changes in yearly incidence rates from 1973 to 2009 for male gender and white and "others" races. Overall 5-year survival was 97.15%, 10-year survival was 93.81%, and 20-year survival was 89.74%. Significant differences in survival outcomes were noted for extent of disease. Patients exhibiting distant metastasis displayed the worse long-term prognosis at 21.99% 20-year disease-specific survival. Hazard ratios demonstrated a significant increase in mortality in patients with poorly differentiated, undifferentiated, and metastatic disease.

Conclusion: Trends in incidence of AciCC are influenced by gender, race and age. Long-term survival of this rare malignant tumor is influenced by gender, grade, race, and extent of disease. Future studies need to be conducted to investigate these dynamic trends related to AciCC.
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http://dx.doi.org/10.1002/lary.24231DOI Listing
January 2014

Management of sinonasal chondrosarcoma: a systematic review of 161 patients.

Int Forum Allergy Rhinol 2013 Aug 20;3(8):670-7. Epub 2013 Mar 20.

Department of Otolaryngology-Head and Neck Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ 07103, USA.

Background: This study reviews the published literature related to management of sinonasal chondrosarcoma. Clinical presentation, demographics, radiographic diagnosis, treatment, and management outcomes of this uncommon disease are reported.

Methods: A systematic review of studies for sinonasal chondrosarcoma from 1950 to 2012 was conducted. A PubMed search for articles related to this condition, along with bibliographies of the selected articles was performed. Articles were examined for patient data that reported survivability. Demographic data, disease site, treatment strategies, follow-up, outcome, and survival were analyzed.

Results: A total of 63 journal articles were included, comprising a total of 161 cases of sinonasal chondrosarcoma. The average follow-up was 77.4 months (range, 1 to 325.2 months). Surgical resection was the most common treatment modality, used in 72.0% of cases. A combination of surgery and radiation therapy was the second most commonly used treatment modality, used in 21.7% of cases.

Conclusion: This review contains the largest pool of sinonasal chondrosarcoma patients to date and suggests aggressive surgical resection is the most common treatment modality for this condition. The use of adjuvant radiotherapy for prevention of local recurrence after subtotal or total resection has not been proven effective. However, the use of radiotherapy in addition to surgical resection has shown benefit in some studies in terms of survival.
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http://dx.doi.org/10.1002/alr.21162DOI Listing
August 2013

Juvenile nasopharyngeal angiofibroma: a systematic review and comparison of endoscopic, endoscopic-assisted, and open resection in 1047 cases.

Laryngoscope 2013 Apr 11;123(4):859-69. Epub 2013 Mar 11.

Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey 07103, USA.

Objectives/hypothesis: This study is a review of the treatment outcomes of juvenile nasopharyngeal angiofibroma (JNA) specifically comparing endoscopic, endoscopic-assisted, and open surgical approaches.

Study Design: Systematic review of studies using the MEDLINE database.

Methods: A systematic review of studies on JNA from 1990 to 2012 was conducted. A search for articles related to JNA, along with bibliographies of those articles, was performed. Articles were examined for individual patient data (IPD) and aggregate patient data (APD). Demographics, presenting symptoms, surgical approach, follow-up, and outcome were analyzed.

Results: Eighty-five articles were included, with IPD reported in 57 articles (345 cases) and APD in 28 articles (702 cases). For the IPD cohort, average follow-up was 33.4 months (range, 0.5-264 months). Average blood loss was 544.0 mL, 490.0 mL, and 1579.5 mL for endoscopic, endoscopic-assisted, and open surgical cases, respectively (P < .05). Recurrence rate following endoscopic surgery and open surgery were significantly less than endoscopic-assisted surgery (P < .05). In the APD cohort, the recurrence rate following endoscopic surgery was 4.7% compared to 20.6% in the endoscopic-assisted group and 22.6% in the open surgery group (P < .05). Among studies that reported Radkowski/Sessions grading, there was no significant difference in recurrence rates for both the IPD and APD cohorts across each stage between open and endoscopic surgery (P > .05).

Conclusions: In this study, endoscopic resection had a significantly lower intraoperative blood loss and lower recurrence rate when compared to open resection. However, there was no difference in recurrence rate when analyzing the IPD and controlling for Radkowski/Sessions grading. Therefore, further large-scale studies may be required to fully elucidate treatment options.
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http://dx.doi.org/10.1002/lary.23843DOI Listing
April 2013
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