Publications by authors named "Robert J DeFatta"

31 Publications

Laryngeal lipotransfer: review of a 14-year experience.

J Voice 2013 Jul 15;27(4):512-5. Epub 2013 May 15.

Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania 19103, USA.

Objective: To determine the efficacy of lipotransfer for treatment of various vocal fold (VF) pathologies.

Study Type: Retrospective review.

Methods: We reviewed retrospectively the indications for and techniques of laryngeal lipotransfer and its effect on glottic closure and mucosal wave. One hundred four patients treated with lipotransfer between 1997 and 2010 were screened for inclusion in this study. Fifteen patients were excluded. Strobovideolaryngoscopic examinations for the 89 included subjects were reviewed to determine the change in glottic closure and mucosal wave. The degree of improvement, if any, was graded as mild, moderate, or substantial. The population was divided into the following four groups for analysis: (1) single lateral lipoinjection, (2) combination of lipoinjection and thyroplasty, (3) multiple lipoinjections with or without other injection medialization procedures, and (4) lipoimplantation for treatment of VF scar.

Results: Lipotransfer was used alone and as an adjunct procedure to treat glottic insufficiency (GI) secondary to VF motion abnormality or vibratory margin pathology. Augmentation was accomplished either by lateral injection or by medial implantation through an access tunnel. Most patients showed a statistically significant improvement in glottic closure because of lipoinjection and in mucosal wave because of lipoimplantation. Few minor and no serious complications occurred.

Conclusion: Laryngeal lipotransfer is safe and effective for treatment of GI and VF scar.
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http://dx.doi.org/10.1016/j.jvoice.2013.03.009DOI Listing
July 2013

Midface lifting: current standards.

Facial Plast Surg 2011 Feb 18;27(1):77-85. Epub 2011 Jan 18.

Facial Plastic and Reconstructive Surgery, Williams Center of Excellence, Latham, New York 12110, USA.

The most significant factor contributing to the overall change in the appearance of an individual's facial features over time is age. This process of gradual structural weakening of the face begins during the third decade and continues to worsen during the remainder of an individual's lifetime. Here, we discuss how the approach to midface rejuvenation has evolved over time owing to our increased understanding of the aging process. In addition, we discuss specific techniques that we use that have helped us achieve more natural and lasting results.
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http://dx.doi.org/10.1055/s-0030-1270417DOI Listing
February 2011

Thread-lift for facial rejuvenation: assessment of long-term results.

Arch Facial Plast Surg 2009 May-Jun;11(3):178-83

Division of Otolaryngology-Head and Neck Surgery, Albany Medical College, 32 Hackett Blvd, Albany, NY 12208, USA.

Objective: To evaluate the long-term success of the thread-lift procedure for facial rejuvenation.

Methods: Thirty-three patients underwent a thread-lift procedure alone or in combination with other facial rejuvenation procedures to the brow, midface, jowl, and neck. Ten patients underwent thread-lifts only, and 23 had thread-lifts with other procedures. Ten additional patients having had non-thread-lift rejuvenation procedures, including lipotransfer, chemical peels, and rhytidectomies, were randomly designated as controls. The mean follow-up period was 21 months (range, 12-31 months). Photodocumentation was obtained at each visit. Long-term aesthetic results were evaluated by 4 independent, blinded, and board-certified facial plastic surgeons. Each result was graded on a scale of 0 to 3, with 0 indicating no change; 1, minimal improvement; 2, moderate improvement; and 3, considerable improvement. The population was divided into 3 groups for comparison. Two-tailed t test (P = .05) was used for statistical analysis of aesthetic outcomes.

Results: Although aesthetic improvement was noted in all groups at 1 month, measurable results persisted to the end of the study for all but the group that underwent the thread-lift procedure only. Aesthetic improvement scores of the non-thread-lift control group were better than the group that underwent thread-lift only. Similarly, when the thread-lift was combined with other procedures, scores were better than when thread-lift was used alone. Statistical significance was demonstrated in both of these comparisons (P < .01).

Conclusions: The thread-lift provides only limited short-term improvement that may be largely attributed to postprocedural edema and inflammation. Our results objectively demonstrate the poor long-term sustainability of the thread-lift procedure. Given these findings, as well as the measurable risk of adverse events and patient discomfort, we cannot justify further use of this procedure for facial rejuvenation.
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http://dx.doi.org/10.1001/archfacial.2009.10DOI Listing
July 2009

Pulsed-dye laser for treating ecchymoses after facial cosmetic procedures.

Arch Facial Plast Surg 2009 Mar-Apr;11(2):99-103

Williams Center Plastic Surgery Specialists, 1072 Troy Schenectady Rd, Latham, NY 12110, USA.

Objective: To assess the safety and efficacy of a 595-nm pulsed-dye laser in the treatment of ecchymoses after facial cosmetic procedures.

Methods: Twenty consecutive patients with ecchymoses after facial cosmetic procedures underwent treatment with the pulsed-dye laser. A 10-mm spot size was used, with pulse duration of 6 milliseconds, fluence of 6 J/cm(2), and cryogen spray for 30 milliseconds with a 20-millisecond delay. The ecchymotic area was outlined; the lateral half was treated on postoperative day 5 or 6 and the medial half on postoperative day 7 to 10. Clinical photographs were obtained before and after each treatment. Three blinded independent observers evaluated the photographs and graded the ecchymoses on a scale of 0 to 3, with 3 indicating severe ecchymosis.

Results: The most common procedures associated with ecchymoses are cervicofacial rhytidectomy, facial lipocontouring, thread lift, and minimally invasive subperiosteal midface-lift. Pulsed-dye laser treatment resulted in a 63% mean improvement in ecchymosis scores within 48 to 72 hours. The only adverse effects were mild edema and discomfort. Maximal efficacy of the laser treatment was observed when it was performed between 5 and 10 days postoperatively. Patient satisfaction was universally high.

Conclusions: Treatment with the pulsed-dye laser is safe and effective for expeditious resolution of postoperative ecchymoses after facial cosmetic procedures. It has the potential for wider application in treating postoperative ecchymoses on other areas of the body and after trauma.
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http://dx.doi.org/10.1001/archfacial.2008.538DOI Listing
June 2009

Evolution of midface rejuvenation.

Arch Facial Plast Surg 2009 Jan-Feb;11(1):6-12

Department of Facial Plastic and Reconstructive Surgery, Williams Center, Plastic Surgery Specialists, 1072 Troy Schenectady Rd, Latham, NY 12110, USA.

Age is the most significant factor contributing to the overall change in the appearance of an individual's facial features over time. This gradual process of structural weakening of the face begins during the third decade and continues to worsen during the remainder of an individual's lifetime. In this article we discuss how the approach to midface rejuvenation has evolved over time owing to our increased understanding of the aging process. In addition, we discuss specific techniques that we employ that have helped us achieve more natural and lasting results.
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http://dx.doi.org/10.1001/archfaci.11.1.6DOI Listing
April 2009

Comparison of closed reduction alone versus primary open repair of acute nasoseptal fractures.

J Otolaryngol Head Neck Surg 2008 Aug;37(4):502-6

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, USA.

Objective: Nasoseptal injuries have traditionally been treated via closed reduction. Historically, the high incidence of postreduction deformities has led some surgeons to consider alternative approaches to obtain superior results. Here we compare simple closed reduction versus primary open repair of the nasoseptal fracture.

Study Design: This was a prospective study of 40 consecutive patients treated with simple closed reduction of their combined nasal bone and septal fracture versus 40 patients treated with closed reduction of their nasal bone fracture and open treatment of the septum. Group outcomes were then compared.

Results: In the closed reduction group, 60% had significant postoperative septal deviation, whereas only 12.5% suffered from residual septal deformity in the open group. This resulted in a statistically significant reduction (p < .01) of patients requiring a second operation to formally address the septum.

Conclusion: By addressing the septum through an open approach, a statistically significant reduction in the number of patients requiring revision rhinoplasty was achieved.
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August 2008

Fat transfer in conjunction with facial rejuvenation procedures.

Facial Plast Surg Clin North Am 2008 Nov;16(4):383-90, v

Facial Plastic and Reconstructive Surgery, Williams Center for Excellence, 1072 Troy Schenectady Road, Latham, NY 12110, USA.

Age is the most significant factor contributing to the overall change in the appearance of an individual's facial features over time. The purpose of any cosmetic procedure is to reverse the aging process that has occurred in an individual. During the last 5 years, volume restoration through lipotransfer combined with lifting procedures has been instrumental in elevating these procedures to a new level of excellence in comprehensive facial rejuvenation. The authors believe that restoration of facial volume can be achieved safely, precisely and reliably by lipotransfer. In this article they describe their techniques of lipotransfer.
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http://dx.doi.org/10.1016/j.fsc.2008.05.006DOI Listing
November 2008

The decision process in choosing costal cartilage for use in revision rhinoplasty.

Facial Plast Surg 2008 Aug 24;24(3):365-71. Epub 2008 Oct 24.

Williams Center Plastic Surgery Specialists, Latham, New York 12110, USA.

The aims of rhinoplasty reconstruction include maintaining or augmenting long-term tip projection, restoring rigid dorsal stability, and restoring optimum respiratory function. The methods set forth to obtain these objectives are inherently based on the intrinsic nasal principles at the time of the rhinoplasty. Because of the excellent and consistent results autologous costal cartilage grafts provide when faced with problems such as the traumatic saddle deformity, defects after neoplastic resection, congenital nasal deformities, severe tip weakness or underprojection, rhinoplasty in the ethnic patient, and revision rhinoplasty, they are an invaluable resource to the rhinoplasty surgeon. Once the surgeon becomes comfortable and proficient at harvesting this graft, it inevitably will become the graft of choice when substantial amounts of cartilage are required.
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http://dx.doi.org/10.1055/s-0028-1083090DOI Listing
August 2008

Current concepts in the postoperative care of the rhinoplasty patient.

South Med J 2008 Sep;101(9):935-9

University of Texas Southwestern Medical Center, Dallas, Texas, USA.

This is a systematic review of the available literature and our own personal experience regarding the optimal management of the rhinoplasty patient. The routine utilization of nasal splinting, casting and perioperative antibiotics is supported. The management of a number of common early complications is also discussed. Meticulous technique based on sound structural principles and coupled with preoperative planning and attention to wound care will result in a favorable outcome in most individuals undergoing rhinoplasty.
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http://dx.doi.org/10.1097/SMJ.0b013e3181807a79DOI Listing
September 2008

Objective assessment of the accuracy of computer-simulated imaging in rhinoplasty.

Am J Otolaryngol 2008 May-Jun;29(3):151-5. Epub 2008 Mar 19.

Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, University of Florida School of Medicine, Gainesville, FL 32606, USA.

Objective: The objective of the study was to evaluate the accuracy by which computer-simulated rhinoplasty images reflect surgical results in 6-month postoperative photographs.

Methods: We performed a retrospective, objective evaluation of 5 features of the facial profile in the computer-simulated images and in the 6-month postoperative photographs of 36 rhinoplasty patients. Data recorded for the nasolabial angle, nasofrontal angle, columella tip angle, columella/infratip lobule ratio, and an established method of assessing tip projection were subjected to statistical analysis by 2-tailed t test and analysis of variance testing.

Results: Simulated and actual measurements of columella tip angle were found to be significantly different (P = .021). The set of measurements taken from computer-simulated images at the nasolabial angle (P = .301), nasofrontal angle (P = .471), columellar/infratip lobule ratio (P = .402), and tip projection ratio (P = .547) were not statistically different from the respective measurements recorded from the 6-month follow-up images.

Conclusions: No significant difference was found between the measurements recorded from computer-simulated images and those recorded from 6-month postoperative photographs in 4 of the 5 features of the facial profile studied. The accuracy and predictive value of computer-simulated images is demonstrated and quantified for the first time.
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http://dx.doi.org/10.1016/j.amjoto.2007.04.008DOI Listing
December 2008

Free tissue transfer reconstruction of the head and neck at a Veterans Affairs hospital.

Head Neck 2008 Aug;30(8):1007-11

Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Background: The Veterans Affairs (VA) population is considered to have generally poorer health than its non-VA counterpart.

Methods: We reviewed our experience with 55 consecutive patients undergoing free tissue transfers for head and neck reconstruction at the Dallas VA Hospital between July 2000 and September 2006, with 6 months' follow-up.

Results: The overall success rate was 93% (51 of 55 flaps). Factors affecting flap survival were fasciocutaneous flap versus others (p = .01) and minimal versus excessive intraoperative crystalloid administration (p = .03). Nine different flaps were used. Major and minor complications occurred in 33% (n = 18) and 31% (n = 17) patients, respectively. Average intensive care unit and hospital stays were 7.4 and 16.0 days, respectively.

Conclusions: Free flaps for head and neck reconstructions in the VA population can be performed with excellent success rates. Complication rates and hospital days in this population are similar to those of the non-VA populations. Flap selection and administration of minimal intraoperative fluids are important.
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http://dx.doi.org/10.1002/hed.20817DOI Listing
August 2008

Tragal cartilage grafts in rhinoplasty: a viable alternative in the graft-depleted patient.

Otolaryngol Head Neck Surg 2008 Feb;138(2):166-9

Gunter Center for Aesthetics & Cosmetic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75231, USA.

Objective: To describe a simple technique for harvesting tragal cartilage and describe its use in rhinoplasty.

Study Design: Retrospective review.

Subjects And Methods: Rhinoplasties performed between January 2005 and June 2007 in which tragal cartilage grafts were utilized by the senior author (CSC) were reviewed to assess type of graft, preservation of tragal contour, and donor-site morbidity.

Results: Tragal cartilage grafts were used in three primary and three secondary rhinoplasty patients. Postoperative follow-up ranged from six months to 12 months. Tragal cartilage was used as five alar contour grafts, one lateral crural onlay graft, one dorsal onlay graft, and one infratip lobule graft. Tragal cartilage was used to close the septal perforation of one patient. Tragal contour was preserved in all patients, and there were no complications noted with this procedure.

Conclusion: The tragus provides a simple, convenient alternative source of cartilage for rhinoplasty in graft-depleted patients.
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http://dx.doi.org/10.1016/j.otohns.2007.10.007DOI Listing
February 2008

External auditory canal hemangioma: case report.

Skull Base 2007 Mar;17(2):141-3

Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

A patient with a hemangioma completely within the external auditory canal is reported.
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http://dx.doi.org/10.1055/s-2006-953512DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1876154PMC
March 2007

Restorative rhinoplasty in the aging patient.

Laryngoscope 2007 May;117(5):803-7

Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.

Objective: The objective of this study is to review our favorable experience in performing rhinoplasty in aging patients.

Methods: All patients aged 65 years or greater who underwent rhinoplasty, either esthetic or functional, by the senior author (Y.D.) from August 1997 to July 2005 with a minimum follow up of 1 year were retrospectively reviewed.

Results: A total of 51 patients met the inclusion criteria and had complete records available for review. The average age was 69.5 years (range, 65-82 years) with 24 female and 27 male patients. All but two patients underwent open rhinoplasty. Eighteen procedures represented secondary rhinoplasties. Seven patients required auricular cartilage grafts, and 11 patients required costal cartilage grafts. One costal cartilage graft was aborted as a result of excessive calcification. All patients underwent columellar strut placement, 92% underwent internal valve grafts, and 80.4% underwent grafting of the external nasal valves. Nasal osteotomies were performed in only 23.5% of patients, all with the percutaneous technique. Revision surgery was necessary in only three (5.8%) patients, all of whom required grafting of the external valve (not performed primarily). In each of these cases, no significant external valve collapse was noted preoperatively. Premaxillary augmentation with diced or crushed cartilage grafts was performed in 81.8% (n = 18) of patients with an edentulous maxillary arch.

Conclusions: Aging patients present unique technical challenges in rhinoplasty that warrant a comprehensive approach to restore internal and external valve competency and tip support. Consideration of prophylactic external valve grafts in addition to the routine use of internal valve grafts and columellar struts may help decrease the need for revision surgery in this patient population. Reasonable functional and esthetic outcomes can be expected in the aging patient.
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http://dx.doi.org/10.1097/01.mlg.0000248240.72296.b9DOI Listing
May 2007

Integrity of craniofacial plating systems after multiple sterilization procedures.

J Oral Maxillofac Surg 2007 May;65(5):940-4

Department of Otolaryngology, Division Chief, Facial Plastic and Reconstructive Surgery, University of Florida, Gainesville, FL, USA.

Purpose: To determine the effect of multiple autoclave sterilization cycles on the integrity of titanium plates and screws used in craniofacial reconstruction.

Materials And Methods: Torque to fracture was evaluated for 36 titanium 6AL-4V (Ti 6/4) screws divided evenly into 3 groups and tested as machined (control), after 10 cycles of autoclaving or after 50 cycles of autoclaving. Sterilization was carried out by autoclaving for 15 minutes followed by 8 minutes of drying at 270 degrees to 272 degrees F. The maximum torque attained before fracture was recorded. Rotating beam specimens were crafted from single lots of Ti 6/4, commercially pure titanium grade 4 (CP4) and commercially pure titanium grade 2 (CP2), and then subjected to testing in a standard rotating beam device as machined (control), after 10 cycles of autoclaving or after 50 cycles of autoclaving. The cycles required to fracture the specimen at a given applied stress were recorded for each material and for the number of autoclavings carried out before testing.

Results: Although there was a trend toward decreased strength and increased ability to fracture with increased number of autoclave cycles, this did not reach statistical significance. Torque to fracture testing for 7 mm Ti 6/4 screws showed no significant difference in the maximum torque reached before fracture between controls, those screws that had been autoclaved 10 times (P < .500 +/- 5.70) and those that had been autoclaved 50 times (P < .398 +/- 4.08). Rotating beam specimens of Ti 6/4, CP4, and CP2 showed no significant difference in cycles to fracture regardless of the number of sterilization cycles to which the material was subjected.

Conclusions: Repeated cycles of autoclaving had no significant effect on the integrity of titanium plates and screws routinely used in craniofacial surgery.
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http://dx.doi.org/10.1016/j.joms.2005.12.059DOI Listing
May 2007

Rethinking nasal osteotomies: an anatomic approach.

Laryngoscope 2007 Apr;117(4):662-7

Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.

Objectives: To review our experience with our anatomic (medial, transverse, and lateral) nasal osteotomy technique for correcting the asymmetric bony nasal vault in esthetic and functional rhinoplasty.

Methods: All patients undergoing anatomic nasal osteotomy technique by the senior author (y.d.) from August 1997 to August 2005 with a minimum follow-up of 6 months were reviewed. Preoperative and postoperative photographs and clinical examination were analyzed to determine restoration of a symmetric bony nasal vault configuration.

Results: A total of 322 patients met the inclusion criteria. Percent of patients who had favorable results with restoration of a symmetric bony nasal vault configuration was 98.1%. Six (1.9%) patients required revision surgery at the level of the nasal bones with repeat osteotomies or dorsal rasping. All six of these patients had favorable outcomes after revision surgery.

Conclusions: The anatomic nasal osteotomy technique represents an effective, simple, and logical approach for correcting asymmetric bony nasal vault.
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http://dx.doi.org/10.1097/MLG.0b013e318030e3ffDOI Listing
April 2007

T-cell lymphoma of the upper eyelid: a case report and review of the literature.

Surg Oncol 2006 Nov 19;15(3):135-9. Epub 2006 Dec 19.

Department of Otolaryngology Head & Neck Surgery, Division of Facial Plasctic & Reconstructive Surgery, University of Missouri-Columbia, USA.

We present the case report of a 95-year-old white female with a cutaneous T-cell lymphoma (CTCL) of the upper eyelid. Due to her comorbid medical problems, multidisciplinary tumor board recommendation for treatment was surgical excision. She underwent excision with frontalis muscle flap and contralateral eyelid full thickness skin graft reconstruction. The patient has been symptom free for 3.5 years. A literature review of cutaneous CTCL isolated to the eyelid is included.
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http://dx.doi.org/10.1016/j.suronc.2006.11.001DOI Listing
November 2006

Liposarcoma of the tongue: case report and review of the literature.

Ear Nose Throat J 2006 Nov;85(11):749-51

Department of Otolaryngology, University of Florida College of Medicine, Gainesville, FL 32610, USA.

Liposarcoma is the most common soft-tissue malignancy in adults, but the appearance of a liposarcoma in the head and neck region is distinctly unusual. Intraoral liposarcomas represent a particularly interesting subset of this tumor in that (1) they are exceedingly rare and (2) affected patients tend to have a better prognosis than do patients with a similar lesion located elsewhere in the head and neck. An understanding of the histologic subtypes and corresponding clinical behavior of liposarcomas will assist physicians in appropriately managing these patients. Most of these tumors can be effectively treated with conservative surgery. We report the rare case of a well-differentiated liposarcoma arising in the tongue of a 55-year-old man. We also discuss the typical pathologic findings in these malignancies and review the diagnosis, associated controversies, management, and prognosis.
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November 2006

Nodular hidradenocarcinoma over the parotid gland: a pathologic presentation.

Head Neck 2007 Feb;29(2):193-7

The University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.

Background: Nodular hidradenocarcinoma (NHAC), an eccrine carcinoma, has been reported in the dermatology and pathology literature, but few references have been made in the otolaryngology literature even though the head and neck is a common site of occurrence.

Methods: A case report of a 37-year-old Hispanic man with a right-sided neck mass diagnosed preoperatively as a parotid mass by imaging and fine-needle aspiration is presented. After presentation at our multidisciplinary tumor board, excision of the mass was undertaken.

Results: Final pathology revealed a NHAC, which is presented in our report.

Conclusion: NHAC is an aggressive malignant tumor that is often misdiagnosed preoperatively and that must be treated with aggressive multimodality therapy for increased survival.
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http://dx.doi.org/10.1002/hed.20498DOI Listing
February 2007

Sialoblastoma: a rare submandibular gland neoplasm.

Ear Nose Throat J 2006 Jul;85(7):440-2

Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center at Dallas, USA.

A sialoblastoma is a rare congenital epithelial tumor that arises in a major salivary gland. To our knowledge, only 24 cases of sialoblastoma have been previously reported in the English-language literature. We report a new case, that of a 15-month-old boy who presented with a submandibular mass. Surgical excision of the mass was undertaken. Intraoperatively, the mass appeared to be adjacent to the submandibular gland, but it had not invaded it. The mass was excised, and the submandibular gland was left in place. Pathology identified the tumor as a sialoblastoma. However, pathology also revealed that residual tumor was present at the surgical margin. The patient was returned to the operating room for excision of the left submandibular gland and the level I lymph nodes. Following revision surgery, the surgical margins were negative. The patient remained disease-free at the 1-year follow-up. Despite the need for revision surgery, this case provides support for the idea that surgery alone is sufficient for curative treatment.
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July 2006

Asymmetric sensorineural hearing loss evaluation with T2 FSE-MRI in a public hospital.

Acta Otolaryngol 2006 Jul;126(7):705-7

Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.

Conclusions: T2-weighted fast-spin echo magnetic resonance imaging (MRI) can be an economically beneficial protocol for screening patients with asymmetric sensorineural hearing loss without other neurologic findings in a public hospital population.

Objective: The goal of this study was to determine if fast spin echo T2 MRI is similar to gadolinium-enhanced MRI in evaluating asymmetric sensorineural hearing loss in a county hospital population.

Patients And Methods: This was a retrospective chart review of all outpatients seen at a public hospital, comprising patients with no other cranial nerve findings who underwent gadolinium-enhanced MRI of the internal auditory canal and brain between January 2002 and September 2003. Patients with >15 dB difference in hearing at one frequency or 10 dB hearing difference at two frequencies underwent gadolinium-enhanced MRI scan with FSE T2 sequence as part of the examination protocol.

Results: A total of 146 patients were identified who met all the inclusion criteria for the study. Of the 146 MRI scans performed, abnormalities were seen on 71 of them, the majority of which were inconsequential. No acoustic neuromas were identified in our study population. Cost savings of over 100,000 dollars would have been realized if only T2 FSE protocols had been used.
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http://dx.doi.org/10.1080/00016480500504184DOI Listing
July 2006

Giant myxomas of the maxillofacial skeleton and skull base.

Otolaryngol Head Neck Surg 2006 Jun;134(6):931-5

Department of Otolaryngology-Head and Neck Surgery at the University of Texas Southwestern Medical Center, Dallas, TX 76104, USA.

Objectives: To review our experience with patients diagnosed with giant myxomas of the maxillofacial skeleton.

Study Design: All patients undergoing excision of myxomas of the head and neck from September 1998 through September 2003 with a minimum follow-up of 1 year by the senior author (YD) were included in the study.

Methods: A retrospective chart review was conducted to select all patients who met the inclusion criteria. Clinical presentation, preoperative radiology findings, excisions performed, reconstruction, and follow-up were recorded and reported.

Results: Four patients were identified who met the inclusion criteria. All underwent wide en bloc excision of the tumor with various reconstructions. Complete resection was achieved in each case, and no patients have had evidence of recurrence.

Conclusions: Giant myxomas of the maxillofacial skeleton have been reported to have significant rates of recurrence. Wide en bloc resection with appropriate reconstruction can result in excellent quality of life postoperatively and minimize the risk of recurrence. Lesser resections may not be appropriate especially in giant myxomas because of the potential morbidity that would be associated with a multifocal recurrence.

Ebm Rating: C-4.
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http://dx.doi.org/10.1016/j.otohns.2006.02.008DOI Listing
June 2006

An innovative method of facilitating ranula excision with methylene blue injection.

Ear Nose Throat J 2006 Mar;85(3):159, 163

Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center at Dallas, USA.

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March 2006

Congenital midline cervical cleft: a practical approach to Z-plasty closure.

Int J Pediatr Otorhinolaryngol 2006 Mar 18;70(3):553-9. Epub 2006 Jan 18.

Department of Otolaryngology - Head & Neck Surgery, The University of Texas Southwestern Medical Center at Dallas, TX 75390-9035, USA.

A congenital midline cervical cleft (CMCC) is a rare developmental abnormality with several common features of variable severity: a midline defect of anterior neck skin, a superior nipple-like skin projection, and a subcutaneous fibrous cord. Congenital midline cervical clefts have important functional and cosmetic implications as cicatrical contracture with subsequent deformity may result without early surgical intervention. Treatment involves excision of all abnormal tissue, and reconstruction with Z-plasty techniques is favored because linear closure results in hypertrophic scarring and recurrent contracture. Z-plasty allows broken-line closure, reorientation of the defect in the horizontal plane with re-creation of a cervicomental angle, and most importantly, a lengthening of the anterior neck skin that aids in preventing recurrent contracture. We present our experience managing a congenital cervical midline cleft in a 3-month-old patient and describe a simple technique for planning the ideal Z-plasty closure. No simple description for planning the ideal closure for this defect could be found in the otolaryngology literature.
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http://dx.doi.org/10.1016/j.ijporl.2005.07.024DOI Listing
March 2006

Kaposiform hemangioendothelioma: case report and literature review.

Laryngoscope 2005 Oct;115(10):1789-92

Department of Otolaryngology--Head and Neck Surgery, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, 75390, USA.

We report the identification of a kaposiform hemangioendothelioma (KH) in the oropharynx of a 3-year-old boy. This is a rare endothelial-derived spindle cell neoplasm affecting children and early adolescents with features common to capillary hemangioma and Kaposi sarcoma. Nine cases of head and neck KH have been reported, this being the first in the otolaryngology literature. Our patient underwent wide local excision and has remained tumor free for over 1 year. KH should be considered in the differential diagnosis of a vascular lesion demonstrating unexpected behavior from that of a hemangioma.
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http://dx.doi.org/10.1097/01.mlg.0000176539.94515.75DOI Listing
October 2005

Metastatic breast cancer of the oral cavity.

Am J Otolaryngol 2005 Jul-Aug;26(4):279-81

Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, USA.

Objective: To present a rare case of breast carcinoma initially presenting as an oral cavity mass.

Study Design: Case report with review of the literature.

Results: A case is presented of a postmenopausal woman with a remote history of treated breast carcinoma who was declared disease-free 2 years before presentation. She presented with an enlarging vestibule mass consistent with metastatic breast carcinoma. Subsequent investigations revealed widely metastatic disease for which the patient was referred for palliative chemotherapy.

Conclusions: Metastatic disease to the oral cavity represents only 1% of all oral cavity malignancies. A high index of clinical suspicion is necessary when evaluating patients with a history of non-head and neck carcinoma.
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http://dx.doi.org/10.1016/j.amjoto.2005.01.008DOI Listing
December 2005

Extracranial internal carotid artery pseudoaneurysm.

Int J Pediatr Otorhinolaryngol 2005 Aug;69(8):1135-9

Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Extracranial internal carotid artery aneurysms are very uncommon entities. We present the case of a young girl who was transferred to our institution after development of a neck mass after Quincy tonsillectomy. The literature on extracranial carotid artery aneurysms is reviewed and reported.
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http://dx.doi.org/10.1016/j.ijporl.2005.03.001DOI Listing
August 2005

Combined laryngocele.

Ann Otol Rhinol Laryngol 2004 Jul;113(7):594-6

Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

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http://dx.doi.org/10.1177/000348940411300715DOI Listing
July 2004

Translational upregulation of yes accompanies eIF4E-mediated oncogenic transformation.

Int J Oncol 2003 Dec;23(6):1709-13

Department of Biochemistry and Molecular Biology and the Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, LA 71130-3932, USA.

Overexpression of the translation initiation factor eIF4E results in transformation of normal fibroblasts as a single-hit oncogene. This implies that eIF4E must affect several pathways leading to transformation. The oncogenic potential of eIF4E is probably realized by elevating the translational efficiency of some oncogene and growth-promotion transcripts that are normally repressed by their 5'UTR (untranslated region). To address this possibility, we have cloned mRNAs whose polysomal representation increases upon overexpression of eIF4E. Among these mRNAs, we now report the isolation of a clone corresponding to the src-like kinase yes. The yes mRNA contains a long 5'UTR with characteristic features of a typical translationally repressed transcript. This was confirmed by analysis of the distribution of yes mRNA after sedimentation in sucrose gradients. Increased utilization of yes mRNA resulted in elevated expression of the protein product in cells transformed with eIF4E, and suggested that overexpression of Yes could contribute to eIF4E-mediated transformation. To test this, we monitored the malignant properties of MM3MG-4E cells after treatment with PP2, a specific inhibitor of src kinases. Growth in soft agar and saturation densities were significantly reduced after treatment with PP2, but treatment of mice harboring MM3MG-4E tumors with PP2 did not affect tumor growth. However, transformation of yes-null fibroblasts by eIF4E was significantly impaired.
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December 2003

Translational upregulation of yes accompanies eIF4E-mediated oncogenic transformation.

Int J Oncol 2003 Dec;23(6):1709-13

Department of Biochemistry and Molecular Biology and the Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, LA 71130-3932, USA.

Overexpression of the translation initiation factor eIF4E results in transformation of normal fibroblasts as a single-hit oncogene. This implies that eIF4E must affect several pathways leading to transformation. The oncogenic potential of eIF4E is probably realized by elevating the translational efficiency of some oncogene and growth-promotion transcripts that are normally repressed by their 5'UTR (untranslated region). To address this possibility, we have cloned mRNAs whose polysomal representation increases upon overexpression of eIF4E. Among these mRNAs, we now report the isolation of a clone corresponding to the src-like kinase yes. The yes mRNA contains a long 5'UTR with characteristic features of a typical translationally repressed transcript. This was confirmed by analysis of the distribution of yes mRNA after sedimentation in sucrose gradients. Increased utilization of yes mRNA resulted in elevated expression of the protein product in cells transformed with eIF4E, and suggested that overexpression of Yes could contribute to eIF4E-mediated transformation. To test this, we monitored the malignant properties of MM3MG-4E cells after treatment with PP2, a specific inhibitor of src kinases. Growth in soft agar and saturation densities were significantly reduced after treatment with PP2, but treatment of mice harboring MM3MG-4E tumors with PP2 did not affect tumor growth. However, transformation of yes-null fibroblasts by eIF4E was significantly impaired.
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December 2003
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