Prospective studies of neck dissection specimens support preservation of sublevel IIB for laryngeal squamous carcinoma with clinically negative neck.
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Carcinoma, Squamous Cell↗
Biomedical subjects
Yoav P Talmi
Publications and source records attributed to Yoav P Talmi.
Olfactory function in oncologic hospice patients.
INTRODUCTION: Normal sense of smell is important for well being. Although cancer is reported to be associated with impaired olfactory function, very few studies have directly evaluated this effect. PATIENTS AND METHODS: We performed a quantitative analysis of olfactory status in 42 hospice patients in a hospital-based hospice facility. Olfaction was assessed using the "Sniffin' Sticks" (Burghart Medical Technology, Tinsdaler, Germany) kit. RESULTS: Twenty-five patients (60%) were found to be hyposmic. CONCLUSION: Study results indicate the high incidence of decreased olfactory function among hospice patients.
Adult↗
Cricotracheal resection for airway reconstruction: The Sheba Medical Center experience.
BACKGROUND: Intubation and tracheostomy are the most common causes of benign acquired airway stenosis. Management varies according to different conceptions and techniques. OBJECTIVES: To review our experience with cricotracheal resection and to assess related pitfalls and complications. METHODS: We examined the records of all patients who underwent CTR in a tertiary referral medical center during the period January 1995 to April 2005. RESULTS: The study included 61 patients (16 women and 45 men) aged 15-81 years. In 17 patients previous interventions had failed, mostly dilatation and T-tube insertion. Complete obstruction was noted in 19 patients and stenosis > 70% in 26. Concomitant lesions included impaired vocal cord mobility (n=8) and tracheo-esophageal fistula (n=5). Cricotracheal anastomosis was performed in 42 patients, thyrotracheal in 12 and tracheotracheal in 7. A staged procedure was planned for quadriplegic patients and for three others with bilateral impaired vocal cord mobility. Restenosis occurred in six patients who were immediately revised with T-tube stenting. Decanulation was eventually achieved in 57 patients (93.4%). Complications occurred in 25 patients, the most common being subcutaneous emphysema (n=5). One patient died of acute myocardial infarction on the 14th postoperative day. CONCLUSIONS: CTR is a relatively safe procedure with a high success rate in primary and revised procedures. A staged procedure should be planned in specific situations, namely, quadriplegics and patients with bilateral impaired vocal cord mobility.
Adolescent↗
25-year experience of using a linear stapler in laryngectomy.
BACKGROUND: Stapler application for pharyngeal closure after total laryngectomy allows for rapid watertight closure without field contamination and for potentially reduced fistula rate. METHODS: One thousand four hundred fifteen patients underwent laryngectomy with linear stapler closure. In 98.6%, laryngectomy was performed after radiation failure. RESULTS: A relatively high incidence of pharyngeal fistulae (12%) was seen, although these rates were reduced to 5.5% during the recent decade. Simultaneous creation of tracheoesophageal fistula and myotomy by a novel technique was introduced. Swallowing problems were observed in 11 patients and local recurrences in nine patients (0.6%). CONCLUSION: The advantages of mechanical sutures with the closed stapling technique are simple and rapid application, watertight closure with good hemostasis, prevention of field contamination, good speech and deglutition, no increase in fistula rate, and low local recurrence rates. Operating room expenses may also be significantly reduced, rendering this method cost-effective as well.
Adult↗
Use of mitomycin C for treatment of keloid: a preliminary report.
OBJECTIVES: Mitomycin C (MC) is an anti-neoplastic agent with an anti-proliferative effect on fibroblasts. We set out to evaluate the effect of MC application following keloid excision. STUDY DESIGN AND SETTING: Patients with keloid in a tertiary referral center were enrolled in a prospective study. The scar was excised and prior to skin closure, a pledget with 1 cc of MC 0.4 mg/mL was applied for 5 minutes. Patient satisfaction and keloid thickness were assessed. RESULTS: All patients were satisfied with the results, although complete disappearance of the keloid was evident only in two. Keloid thickness was measured and ranged from 5 to 26 mm. Following surgery and treatment at 2 months thickness ranged from 0 to 8 mm. CONCLUSIONS: MC application following scar resection appears to be effective in treatment of keloid. SIGNIFICANCE: As no specific effective treatment for keloid is currently available, utilization of this readily available therapeutic agent may improve treatment outcome.
Adolescent↗
Effects of tracheostomy on well-being and body-image perceptions.
OBJECTIVE: Quality of life after tracheostomy was addressed by measuring its impact on well being and body image perceptions. STUDY DESIGN AND SETTING: A controlled study in a laryngotracheal clinic of a tertiary referral center. Three groups were studied: 24 cannulated, 19 decannulated, and 20 noncannulated patients. They filled up 3 conventional questionnaires. RESULTS: (1) Satisfaction-with-life scale: reduced scores were detected between cannulated and noncannulated patients. (2) Personality traits: neuroticism and extroversion: no differences were noted. (3) Body cathexis scale: both cannulated and decannulated patients scored less than noncannulated. In tracheostomy-specific issues, decannulated patients scored better than cannulated patients. CONCLUSIONS: Reduced scores after tracheostomy indicate an overall diminished quality of life. These changes correlate with personality traits. Decannulated patients exhibited only slight improvement indicating an incomplete psychosocial recovery. SIGNIFICANCE: This is the first report on tracheostomy related quality of life in noncancer patients conducted with specific psychological questionnaires.
Body Image↗
Limited use of complementary and alternative medicine in Israeli head and neck cancer patients.
HYPOTHESIS/OBJECTIVE: The use of complementary or alternative medicine (CAM) is growing among cancer patients. A Medline search failed to reveal any dedicated report of CAM use specifically in patients with head and neck cancer (HNC). STUDY DESIGN: Use of CAM was evaluated in a cohort of treated HNC patients. METHODS: Patients treated for HNC were asked if they had used CAM since their diagnosis. Demographic data and data pertaining to mode of CAM, duration of treatment and effects were obtained. RESULTS: One hundred forty-three patients (mean age 61 years) were included. Only nine patients (6.3%) reported using disease related CAM. This included acupuncture (4), Reiki (2), naturopathy (2), hypnosis (1), shiatsu (1), chiropractic treatment (1), homeopathy (1), and selenium (1). CONCLUSION: Contrary to the reported use, few of our HNC patients used CAM. Although this could be related to good caregiver-patient relationship, further studies in comparable populations are warranted to evaluate if this is a local or a pervading finding in head and neck cancer patients.
Adolescent↗
Seasonal variations in rhino-cerebral Mucor infection.
OBJECTIVES: Rhino-orbito-cerebral mucormycosis (ROCM) is an uncommon, potentially lethal infection that occurs mostly in immunocompromised hosts. The seasonal occurrence of ROCM was studied in two of Israel's largest medical centers. METHODS: A total of 36 patients were seen during a 25-year period in this retrospective bi-institutional cohort study. Meteorologic data were obtained and analyzed for a possible linkage of infection with precipitation and temperature. RESULTS: Twenty-one of the 36 patients (58%) presented between the months of August and October, and 27 patients (75%) presented between the months of August and December. A peak incidence of ROCM was noted in the month of September (13/36 patients; 36%). No association was noted between meteorologic conditions and the incidence of ROCM infection. CONCLUSIONS: A consistent seasonal peak was observed in ROCM. Heightened awareness is important for early recognition and treatment of this disease.
Brain Diseases↗
Coronoidectomy in maxillary swing for reducing the incidence and severity of trismus--a reminder.
PURPOSE: The maxillary swing approach is a proven method for access to the nasopharynx. However, often, trismus is incurred postoperatively, hampering adequate oral care and follow-up and affecting patients' quality of life. CASE REPORTS: Coronoidectomy was performed in four patients undergoing maxillary swing. Minimal trismus was seen in one patient undergoing repeat irradiation and chemotherapy. After a 1-month period no trismus was observed in the other three patients. CONCLUSION: Coronoidectomy, usually performed in maxillectomy for reducing trismus is a useful adjunct in the maxillary swing procedure.
Humans↗
Laser cryptolysis for the treatment of halitosis.
OBJECTIVE: To evaluate the tonsils as a source of halitosis and to assess the efficacy of laser CO(2) cryptolysis for the treatment of oral bad breath caused by chronic fetid tonsillitis. METHODS: Fifty-three patients with halitosis originating from chronic fetid tonsillitis, who completed laser cryptolysis were enrolled in the study. The origin of halitosis was demonstrated by Finkelstein's tonsil smelling test, which included massaging the tonsils and smelling the squeezed discharge. All patients were treated by laser cryptolysis, an office procedure done under topical anesthesia. Subjective and objective postoperative assessment was based on self-and-family report and clinical assessment. Patients were reexamined 4 to 6 weeks post-treatment, and when the need for further laser treatment was determined. RESULTS: Complete elimination of halitosis required one session in 28 patients (52.8%), 2 sessions in 18 patients (34%), and 3 sessions in 5 patients (9.4%). Follow-up period ranged from 3 to 36 months (mean, 20.8 +/- 8.5 months). No adverse effects or complications were encountered. CONCLUSIONS: After excluding dental or periodontal, sinonasal, oral, pulmonary, or gastroenterological diseases as the origin of halitosis, chronic fetid tonsillitis remains a common cause of halitosis. Patients suffering from halitosis should be treated relying on their examination including Finkelstein's tonsil smelling test. Laser CO(2) cryptolysis is an effective, safe, and well-tolerated procedure for the treatment of halitosis.
Adolescent↗
Primary non-Hodgkin's lymphoma of the sinonasal tract.
OBJECTIVES: We sought to review the records of patients seen at the Chaim Sheba Medical Center (Tel Hashomer, Israel) during a 10-year period with respect to the presenting features, management, and outcome of extranodal non-Hodgkin's lymphoma (NHL) of the sinonasal region. STUDY DESIGN: Eight patients were diagnosed with NHL of the paranasal sinuses from 1993 to 2003. The data were reviewed, and we noted the patient's age, sex, the presenting signs and symptoms, staging, histology, treatment, and outcome of NHL. RESULTS: The mean age was 61.75 years (range, 24-83 years), with a 1:1 male-to-female ratio. All cases involved the paranasal sinuses, and the most common symptom was nasal obstruction (6 patients). All the patients had large B-cell lymphoma, and all were treated with combined chemotherapy and radiation. Three patients died from the disease, 3 were free of disease after 12 to 36 months of follow-up, and 1 had a recurrence after 60 months. CONCLUSIONS: NHLs of the paranasal sinuses are uncommon. Early diagnosis and combined treatment are essential for achieving an optimal outcome.
Adult↗
Quality of life following parotidectomy for malignant and benign disease.
Parotidectomy is performed for benign or malignant tumors and for selected benign inflammatory and autoimmune conditions. Possible associated complications include facial nerve paralysis, pain, loss of sensation, gustatory sweating, and facial scarring. Global quality of life in patients undergoing parotidectomy has not been reported. The implications of facial surgery with the catastrophic potential of facial nerve paralysis may severely affect quality of life. A quality-of-life study was conducted in patients undergoing parotidectomy for benign and malignant diseases to define the significance of associated morbidity and its impact on quality of life. A quality-of-life instrument was specifically created, based on the principles of the University of Washington Quality of Life questionnaire, and mailed to the patients. Questions addressed recognized complications of parotidectomy. Patient group results were compared for age above and below 45 years, sex, benign versus malignant disease, presence or absence of Frey syndrome, and presence or absence of benign pleomorphic adenoma. Forty-six percent of 125 patients meeting the study criteria fully replied to the questionnaire. The global health score was 3.5, corresponding with "good" to "very good." Except for local sensation, which had a score of 50, all other domains scored above 76. Change in appearance, gustatory sweating, and pain were reported by 70 percent, 57 percent, and 30 percent, respectively. Importance attributed to all domains except facial function was low. Pain was encountered significantly less in patients younger than 45 years of age, and scores for appearance were also highly significant in this age group. Postoperative sequelae were noted in the majority of patients. The dominant sequelae were altered sensation, change in appearance, Frey syndrome, and pain. A degree of permanent postoperative facial nerve impairment was reported by 10 patients. Nevertheless, overall, parotidectomy does not seem to severely affect quality of life.
Adult↗
Why promote an educational process for separating level II into level IIA and level IIB in neck dissection?
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Head and Neck Neoplasms↗
Quality of life of well-differentiated thyroid carcinoma patients.
The thyroid gland is the second most common site for malignancy in the head and neck region. Quality of life (QOL) of thyroid cancer patients has not been studied directly. The QOL of long-term thyroid carcinoma patients was investigated. A standardized set of questions based on the University of Washington QOL questionnaire for head and neck cancer with specific domains associated with thyroid disease was created. This questionnaire was mailed to patients who underwent total thyroidectomy for well-differentiated cancer in the department of Otolaryngology--Head and Neck surgery at the Chaim Sheba Medical Centre in Israel between the years 1994-2000. Seventy-eight patients undergoing total thyroidectomy were identified. Forty-eight patients were excluded and 20 out of the 30 remaining patients responded to the questionnaires. Six were male and 14 female, 12 were under the age of 45 (these 12 patients were staged as stage 1). Eleven patients underwent neck dissection. General health and QOL were significantly better for the younger age group and so was the calcium balance score. General health and QOL were significantly better for patients undergoing neck dissection. The overall QOL score was 3.8 conforming with 'good' in the questionnaire. Surgery and initial radioiodine treatment scored 6.75 and 6.9 respectively in the distressing scale (0-10 range: 10 = most distressing). The highest distress was encountered during withdrawal from thyroid hormone. Women rated the importance of proper replacement therapy significantly higher than men. Global low scores were found for employment and for effective L-thyroxine replacement therapy. Overall, QOL in these patients was good although lower than expected when compared with other forms of cancer. Age and gender-related differences were noted. Better QOL in neck dissection patients is probably associated with age under 45 years. High distress scores for hormone withdrawal during periodical imaging correspond with former reports and supports use of Thyrogen. Better hormone balance is warranted for this group.
Adolescent↗
[Thyroid surgery without drains].
Wound drainage after thyroidectomy was considered to be a routine procedure. However, it has recently been noted that there is a rising trend in the literature to limit wound drainage to selected cases, or even obviate the need for drains altogether. This article presents 100 cases of patients undergoing hemi or total thyroidectomy without drains over a 5 year period. Only two cases of hemorrhage were observed and the overall hospital stay was shortened. Drains after thyroidectomy can be avoided in most cases and should be used sparingly when indicated.
Adolescent↗
Preservation of the facial artery in excision of the submandibular salivary gland.
BACKGROUND: The accepted method for submandibular gland excision traditionally includes ligation of the facial artery (FA) as suggested by a host of surgical atlases. Preservation of the FA may be significant in reconstructive procedures of the head and neck and its ligation may altogether be obviated. OBJECTIVE: Prospective feasibility study of FA preservation in submandibular gland excision. MATERIALS AND METHODS: Patients undergoing excision of the submandibular salivary glands from September 1999 through August 2001 were prospectively included. The FA was dissected and only its glandular branches ligated. Exclusion criteria were primary benign or malignant tumors of the submandibular salivary gland or metastatic disease involving the gland or level I of the neck. In cases where the primary tumor involved the floor of mouth, anterior tongue or mandible, resection of level I contents included the FA even in N0 necks. RESULTS AND CONCLUSIONS: 104 patients (116 procedures) were included in the study. 81 patients underwent resection of the gland with preservation of the FA. The vessel was sacrificed in 35 necks because of metastases or primary tumor and in two cases of chronic sialadenitis. One patient had a postoperative hematoma following neck dissection requiring re-exploration. The source of bleeding was not found to be related to the FA. Contrary to accepted methodology, the FA may readily be preserved in surgery of the submandibular salivary glands. We suggest preservation of the FA in all cases of procedures for benign disease and in selected cases of malignancy.
Aged↗
Amputation neuromas after neck dissection.
OBJECTIVE: We sought to define the incidence of neuroma formation after neck dissection in a large series of patients. METHODS: One hundred fifty-three patients who were seen during a 2-year period (followed for 3 months to 10 years; mean, 52 months) were evaluated for neuroma formation after neck dissection (185 procedures). Cut nerve edges were not routinely ligated or cauterized. RESULTS: Operative records indicated that except for 4 cases, the stumps of the great auricular nerve and cervical branches were left intact after resection. No cases of palpable neuromas were found. In one case of a revised neck, a small macroscopically indiscernible nodule was histologically defined as neuroma. CONCLUSION: No neuromas were discovered in our series of neck dissection cases. If found, it is imperative these lesions be differentiated from recurrent cancer. Our results do not support any interference with cut nerve edges.
Adult↗
Complications of neck dissection.
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Humans↗