Publications by authors named "Ramez Nassif"

6 Publications

  • Page 1 of 1

Office-based transnasal esophagoscopy biopsies for histological diagnosis of head and neck patients.

Laryngoscope 2019 12 13;129(12):2721-2726. Epub 2018 Dec 13.

Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom.

Objectives/hypothesis: To present yield of transnasal esophagoscopy (TNE) biopsies of upper aerodigestive tract (UADT) lesions and define the role of TNE as a safe alternative to rigid endoscopy.

Study Design: Retrospective case series.

Methods: All patients who underwent TNE-guided biopsies attempted over a 2-year period were included. Patients were identified using coding records and outpatient diaries. Demographic data were recorded as well as the histological diagnosis and additional histological diagnostic procedures.

Results: During the observation period, 134 TNE-guided procedures were attempted. The procedure could not be completed in 19 patients. There were 102/115 (89%) patients who did not require further interventions for histological diagnosis of the tumor. The most common biopsied area was the larynx (53), followed by the tongue base (29). The most common malignancy was invasive squamous cell carcinoma in 42/115 (36.5%).

Conclusions: The work presented in this article strongly suggests that TNE-guided biopsy is a valuable diagnostic tool for patients suspected of having carcinoma of the UADT.

Level Of Evidence: 4 Laryngoscope, 129:2721-2726, 2019.
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December 2019

A Case of Cutaneous Malakoplakia in the Head and Neck Region and Review of the Literature.

Head Neck Pathol 2016 Dec 6;10(4):444-450. Epub 2016 May 6.

Norfolk and Norwich University Hospital, Colney Lane, Norwich, UK.

Malakoplakia is a rare inflammatory condition that typically occurs in the urinary tract. The cutaneous form is less prevalent, and most commonly occurs in the perianal or genital regions. Here we present a 61 year old lady with cutaneous malakoplakia of the neck, which was successfully treated with surgical excision and a prolonged course of ciprofloxacin. We follow our case report with a discussion and literature review of all seventeen previously reported cutaneous head and neck malakoplakia cases from the literature. A diagnosis of cutaneous malakoplakia should be considered in nodular, ulcerated or discharging lesions that are refractory to treatment. Histology is essential, not only to diagnose malakoplakia, but also to exclude other important differential diagnoses, such as malignancy. Combined surgical excision and prolonged antibiotic courses appear to have the highest success rate. Antibiotics should be culture specific, but quinolones appear to be the best empirical choice.
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December 2016

Conservative or radical surgery for pediatric papillary thyroid carcinoma: A systematic review of the literature.

Int J Pediatr Otorhinolaryngol 2015 Oct 10;79(10):1620-4. Epub 2015 Aug 10.

Department of Otolaryngology, Head and Neck Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.

Background: Pediatric papillary thyroid carcinoma (PTC) is characterized by an aggressive clinical course. Early diagnosis is a challenge and treatment consists principally of partial or total thyroidectomy┬▒neck dissection and radioactive iodine therapy. Due to the rarity of PTC in children, there is no consensus on optimal surgical treatment.

Methods And Results: A literature search was carried out using PubMed, Embase, Medline, Cochrane and Web of Science. Seven studies (489 patients) investigating the outcome of surgically managed pediatric PTC were identified. No clear advantage in survival or recurrence rate was found for total thyroidectomy compared to other surgical approaches.

Conclusion: Despite the aggressive behavior of PTC, prognosis is good, with low mortality. After removal of disease and prevention of recurrence, reduction of iatrogenic complications are a priority in this age group. Due to the paucity of available evidence, this review cannot recommend conservative or radical surgery for pediatric papillary thyroid carcinoma. To answer this question, we recommend the establishment of a randomized controlled trial with adequately matched baseline variables.
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October 2015

Efficacy and safety of central compartment neck dissection for recurrent thyroid carcinoma.

Arch Otolaryngol Head Neck Surg 2012 Jan;138(1):33-7

Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Hospital, Toronto, ON, Canada.

Objective: To explore the safety and efficacy of central compartment neck dissection (CCND) in the treatment of well-differentiated thyroid carcinoma (WDTC) recurrences in the central compartment of the neck.

Design: Retrospective medical chart review.

Setting: Tertiary-care academic hospital.

Patients: Eighty-two consecutively treated patients with recurrent WDTC, with a median follow-up of 28 months.

Main Outcome Measures: Postoperative complications, disease control posttreatment, and normalization of serum thyroglobulin (Tg) level.

Results: Eighty-two patients underwent 86 central compartment procedures. Only CCND was performed in 36 patients (42%), while a lateral neck dissection was also required in the remainder. Postoperative hypoparathyroidism was temporary in 17 patients (20%) and permanent in 6 patients (7%). Postoperative intact serum parathyroid hormone level was greater than 15.0 pg/mL (to convert to nanograms per liter, multiply by 1.0) in 81% of patients, accurately predicting eucalcemia postoperatively. Unilateral recurrent laryngeal nerve injury was transient in 3 patients (2% of nerves at risk) and permanent in 3 patients (2%). Seventeen patients (21%) experienced subsequent recurrences after their CCND-2 patients (2%) had recurrence in the central neck, 8 (9%) in the lateral neck, 2 (2%) in the central and lateral neck, and 7 (8%) at distant sites. Twenty-seven patients underwent a CCND alone and were deemed appropriate for efficacy analysis. The Tg level was normalized in 15 patients (56%) in the group overall. Normalization occurred in 10 of the 20 patients (50%) who received sodium iodide I 131 ablation and in 5 of the 7 patients (71%) who did not.

Conclusion: Central compartment neck dissection is a safe and efficacious procedure for the management of central neck recurrences in WDTC.
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January 2012

Surgical instrument force exerted during endoscopic sinus surgery: differences within the ethmoid sinus complex.

Am J Rhinol Allergy 2010 Jan-Feb;24(1):76-80

Department of Otolaryngology, Head and Neck Surgery, University of Dundee, Ninewells Hospital, Dundee, United Kingdom.

Background: Endoscopic sinus surgery (ESS) has been the most important technical advance in surgical rhinology in the last 25 years. The technique is now used beyond its initial sinus confines but knowledge of the forces required to perform ESS is limited. Greater understanding of these forces will lead to improved surgical training and safety. The aim of this study was to quantify the magnitude of the forces exerted during punch osteotomy of the bony lamella of the paranasal sinuses and surrounding bony structures during ESS.

Methods: Fifteen formalin-fixed cadaveric heads underwent simulated ESS. Peak axial forces were measured using a pair of modified Blakesley forceps. Measurements were recorded during osteotomy of the paranasal sinus complex, skull base, and crests of the optic nerve and internal carotid artery. Statistical comparison between the mean forces was performed.

Results: A mean force of 6.06 N was required to breach the lamellae of the ethmoid sinus complex. This was significantly less than the mean force required to breach the skull base, excluding the olfactory cleft (17.80 N; p < 0.0001), crests of the optic nerve (15.43 N; p < 0.001), and internal carotid artery (13.15 N; p < 0.001). There was no significant difference between the ethmoid lamella and the lamina papyracea (6.13; p = 0.67).

Conclusion: Significantly greater force was required to breach the skull base and other safety critical areas encountered in ESS, than the bony lamellae of the ethmoid sinus complex. Although this result is reassuring, in vivo studies are now required to validate this relationship in the operative patient.
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June 2010

Pilot study of a device for measuring instrument forces during endoscopic sinus surgery.

Acta Otolaryngol 2004 Mar;124(2):176-8

University Department of Otolaryngology, Ninewells Hospital and Medical School, Dundee, UK.

ESS is a form of minimal access surgery that includes different tasks and manoeuvres requiring sophisticated psychomotor coordination with varying levels of force application. The avoidance of complications is partially dependent upon reducing surgical force application when operating against vital barriers such as the skull base and the medial orbital wall. The study of the surgical forces in endoscopic sinus surgery offers the potential for surgeons to identify the appropriate application of the instrument forces and torques necessary to conduct safe surgery. We have developed Sinoforce, a sinus surgery force-measuring instrument, which comprises modified Blakesley forceps fitted with specialized force sensors The instrument produces a real-time visual display of the various forces applied by the surgeon to the forceps during endoscopic ethmoidectomy. A pilot study was conducted using four cadaveric head specimens. We measured the force needed to break through the different parts of the ethmoidal bony labyrinth and skull base. Comparable forces were needed to break through the ethmoidal bulla and uncinate process. However, a force of > 2 kg, exceeding the forceps calibration, was needed to break through the different parts of the skull base. In this article we describe the new forceps, present our preliminary results and explore the potential benefits of this new instrument.
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March 2004