We present two cases of removal of an orbital apex cavernous venous malformation using an endoscopic endonasal trans-septal approach and a CT-guided navigation system. The apex was accessed through endoscopic medial wall orbitotomy. The periorbita was then opened, and the inferior and medial rectus muscles were isolated to enable an approach to the lesion. These surgeries were performed jointly by Oculoplastics and ENT endoscopy teams.

To explore the association between intraoperative surgical margin sampling by the frozen sections and recurrence in inverted papilloma surgery. A multicenter, retrospective study of patients who underwent attachment-oriented IP resection in four tertiary care medical centers with a minimal follow-up of 36 months. The study included 220 surgeries with a mean follow-up period of 49 months (range 36–204). The endoscopic approach was used in all but 4 cases; 73% of procedures were primary. Overall recurrence was 10.45% (n = 23). Squamous cell carcinoma was found in 5 cases (2.2%). Intraoperative margin sampling was obtained in 145 cases. There was no difference in the recurrence rate between frozen section and no-frozen section groups (p = 0.44). Furthermore, margin sampling in various sites of tumor origin, in cases with concomitant nasal polyps (p = 0.53) and in revision cases (p = 0.08) showed no correlation with recurrence. In 26 cases when the surgery was extended following a positive frozen section, there was a significantly higher recurrence rate (OR = 6.94). According to our results, intraoperative margin sampling did not affect the recurrence rate of IP, and therefore, its routine use should be questioned.

Objective To evaluate the correlation between the ability to predict the attachment site of sinonasal inverted papilloma by computed tomography and the long-term surgical outcome. Study Design Retrospective cohort study. Setting Five tertiary medical centers. Methods Study patients underwent attachment-oriented resection of inverted papilloma. The primary outcome was tumor recurrence. Results Among 195 patients eligible for the study, focal hyperostosis was recognized on computed tomography in 65% (n = 127), in 71% of primary cases (n = 101), and in 50% of revision procedures (n = 26). There was a trend for a higher incidence of squamous cell carcinoma among the patients without detectable hyperostosis (P = .051). Location of hyperostosis coincided with the actual tumor attachment site in 114 patients (90%). Discordance between these parameters did not differ significantly (P = .463) between 11 primary and 2 revision cases. The overall rate of recurrence was 9.7% (n = 19), with a mean time to recurrence of 20 months (range, 7-96 months). The rate of recurrence did not correlate with any of the following: tumor stage, surgical approach, presence of squamous cell carcinoma, whether the surgery was primary or revision, and the presence or location of focal hyperostosis on computed tomography. Inverted papilloma recurred significantly more often (38.5%) when the intraoperative findings of the tumor attachment site did not match the location of hyperostosis observed on computed tomography (odds ratio, 6.5; 95% CI, 1.78-23.66). Conclusion Detectability of focal hyperostosis on preoperative computed tomography does not affect the long-term outcome of inverted papilloma resection.

Abstract Objective: To examine the incidence of late presentation of patients with recurrent pleomorphic adenoma (RPA) of the parotid gland. Methods: This is a retrospective analysis of patients treated in our center. We examined patients demographics, disease characteristics, treatment, and outcome and as well as the time period length from the first discovery of a recurrent mass until seeking treatment at our clinic and its effect on morbidity. Results: A total of 30 patients were included. 26% underwent initial enucleation in other institutions. In eight patients (26%), the recurrence of the mass was second or higher. The patients average time period length until seeking treatment was 2.48 years, with 33% of patients showing a time period length of over three years. Multifocal tumor, tumor diameter larger than 2 cm and facial nerve involvement were found in 15 (50%),16 (53.3%) and seven (25%) patients respectively. Patient's delay of presentation by ≥3 years was associated with a tumor size of ≥2 cm (Relative Risk [RR] = 2, p = .02). Patient's delay of presentation by ≥2 years was also associated with a trend towards a higher rate of post-operative facial nerve palsy (RR = 3.37, p = .07, CI = 0.88–12.85). Conclusion: Most patients with RPA were presented late, thus affecting disease extent and surgical morbidity.

Background: More than 90% of all thyroid cancers are differentiated thyroid carcinomas (DTC) with a 10 year survival rate greater than 90%. The commonly used risk stratification systems for DTC include: European Organization for Research and Treatment of Cancer (EORTC), AGES (Age, histologic Grade, Extent of tumor, Size), AMES (Metastasis) and MACIS (Completeness of resection, local Invasion). Other systems are also utilized. Several new factors that may be involved in DTC risk stratification have emerged in recent studies, with other "traditional" factors being challenged.Objectives: To present recent updates in the literature on new potential prognostic factors for DTC.Methods: We conducted a literature review and analysis of publications regarding DTC prognostic factors or risk stratification published in the last 10 years.Results: Several new, factors with potential prognostic implications for DTC were noted, including family history, lymph node involvement parameters, positive PET-CT findings, multifocal disease, thyroglobulin level and Several molecular markers including BRAF. Increasing age is associated with poorer outcome in DTC; however, recent studies suggest that the cutoff point of 46 years may be contested. Furthermore, several studies have shown contradictory results regarding male gender as a negative prognostic factor, thus questioning its prognostic significance.Conclusions: A number of new factors with potential prognostic implications for DTC have emerged and should be addressed. However, their role and possible inclusion in new staging systems has yet to be determined.

The incidence of acute invasive fungal rhinosinusitis (AIFR) is rising due to more aggressive chemotherapy and longer survival of immunosuppressed patients. Early diagnosis and appropriate but nonmutilating surgical treatment are particularly problematic in the pediatric population. This study aimed to evaluate the outcome of surgery for pediatric AIFR. Medical records of children surgically treated for AIFR between 1998 and 2014 were reviewed. Diagnosis was based on both histopathological and microbiological confirmation. Surgery was performed with curative intent and repeated for any resectable extension. The children underwent endoscopy and magnetic resonance imaging every 2 and 6 months, respectively, during the first postoperative year. Thirteen patients (2-18 years old) met the EORTC/MSG criteria for proven invasive fungal sinusitis; fungal invasion was diagnosed by preoperative biopsy and confirmed in the surgical specimen. All patients underwent an average of two endoscopic procedures (range 1-3), and four of them also underwent an open surgery. The local control rate was at least 79%. There was no facial disfiguration during follow-up (average 41 months). Although AIFR is still associated with high mortality, aggressive medical and surgical treatment provides local control in most cases. Fair outcome should encourage a maximal joint effort of pediatric hemato-oncologists and otorhinolaryngologists in the management of AIFR.

Objective The article aims to present different forms of lateral sphenoid sinus wall defects.Study Design Case series and literature review.Methods A comparison between two patients who presented with spontaneous CSF rhinorrhea, defects in the lateral wall of the sphenoid sinus, and meningeal contents in the sphenoid sinus based on MRI is discussed. Both patients were operated endoscopically, through a trans-nasal-ethmoid-pterygoid approach.Results In the first patient, a meningoencephalocele, protruding through a defect in the lateral sphenoid sinus wall and pterygoid base, occupied the inferior part of the sphenoid sinus. In the second patient, there were no exposed meningeal contents inside the sphenoid sinus. Instead, the lateral sphenoid sinus wall was thin and bulging medially into the inferior part of the sinus, with the dura and temporal lobe covered with thin bony cap.Conclusion Complete dehiscence of the lateral wall of the sphenoid sinus results in exposed meningeal contents inside the sphenoid sinus. In partial dehiscence, the thin and weakened lateral wall of the sphenoid sinus yields to the pressure of the temporal lobe and bulges into the sphenoid sinus cavity. There are no other descriptions of partially dehiscent lateral sphenoid sinus walls in the literature.

OBJECTIVE:There are only sporadic reports of delayed sino-nasal complications associated with nasopharyngeal carcinoma (NPC) treated with radiotherapy. These include choanal stenosis, osteoradionecrosis, chronic sinusitis, and intranasal synechiae. Most likely, these complications are underestimated as in many institutions nasal endoscopies in NPC patients are not performed routinely. The aim of this study was to identify the onset and incidence of delayed sino-nasal complications in NPC patients and their effect on quality of life (QOL).STUDY DESIGN:Case series with chart review.SETTING:Tertiary medical center.SUBJECTS AND METHODS:A retrospective chart review was performed on all patients treated for NPC in our institution between 1988 through 2009. The inclusion criteria required at least a 3-year follow-up without recurrence. Included patients were contacted prospectively and asked to fill a SNOT-16 questionnaire.RESULTS:Sixty-two patients were included in our review. There were 42 males and 20 females. The average age at onset was 42 years. The AJCC staging for T1, T2, T3, and T4 tumors was 22 (35%), 11 (18%), 18 (29%), and 11 (18%), respectively. Eleven patients (18%) suffered from chronic sinusitis. Nine patients (15%) developed choanal stenosis. Five patients (8%) developed osteoradionecrosis. Two patients suffered from nasal synechiae. Forty-eight patients completed the SNOT-16 questionnaire. Patients with choanal stenosis had the lowest QOL scores out of the cohort.CONCLUSION:The incidence of delayed sino-nasal complications after radiation treatment for NPC is not negligible and should be kept in mind when addressing the quality of life of NPC survivors.

Injury to the nasofrontal outflow tract is important in the treatment of fractures of the frontal sinus. In 2008 preoperative computed tomographic (CT) criteria or signs of such injuries were proposed and stated to be reliable. The aim of this study was to evaluate the validity of these criteria by comparing the radiological evidence with the operative findings. Thirty-nine patients for whom the data from preoperative CT could be compared with operative findings were eligible for the study, all but 4 of whom had at least one indicator of injury to the outflow tract. Patients whose tracts were found to be obstructed at operation had at least 2 preoperative CT signs of obstruction of the tract. If the outflow tract was obstructed all 3 criteria were significantly more likely to be present than if it was intact (p=0.02). Two criteria or fewer did not correlate significantly with obstruction. Fractures were managed by reconstruction (n=18), obliteration (n=11), or cranialisation (n=10). This study is the first to our knowledge to examine the correlation between preoperative CT criteria and operative findings, and there was a significant difference in the number of criteria present depending on whether the outflow tract was intact or injured. Our findings allow for more accurate planning of management of fractures of the frontal sinus.

Background The purpose of this study was to show a novel technique for secondary tracheoesophageal puncture (TEP) and myotomy in patients who previously underwent total laryngectomy.Methods. Fifteen patients underwent secondary TEP and 3 patients underwent myotomy. In 1 patient, both myotomy and TEP were done concurrently. A Foley catheter is nasally inserted into the esophagus with the patient under local anesthesia and the catheter balloon is inflated at the site of the planned procedure. The myotomy is performed over the inflated balloon for esophageal posterior wall protection and a voice prosthesis is inserted in a small incision made by the physician. When only myotomy is performed, the muscles over the mucosa are incised. A voice test is performed immediately.Results. All patients exhibited good voice rehabilitation. One patient who had a myotomy had a penetration of the pharyngeal mucosa with immediate closure and no sequelae.Conclusion. Outpatient Foley catheter-guided myotomy and secondary TEP are simple, safe, time saving, and costeffective procedures. (C) 2011 Wiley Periodicals, Inc. Head Neck 34: 717-720, 2012

To apply the Brandwein-Gensler et al.’s histopathologic risk score (RS) system and to evaluate its impact on locoregional recurrence and overall survival in a series of cases of oral tongue cancer, along with variables of patient age and margin status.

Free accessAbstractFirst published online August 2010Ophthalmic Manifestation: A Presentation of Sinus MucoceleElad Dagan, MD, presenter, Lev Bedrin, MD, PhD, […], Lela Migirov, MD, and Yoav Talmi, MD+1-1View all authors and affiliationsVolume 143, Issue 2_supplhttps://doi.org/10.1016/j.otohns.2010.06.796

OBJECTIVE:To present our experience with endoscopically managed medial orbital subperiosteal abscess (MOSA) in children and to compare the results with external drainage of the abscess.METHODS:A retrospective record review was conducted on 22 children with MOSA, of whom 6 underwent drainage by endoscopic sinus surgery (group 1) and 16 underwent external ethmoidectomy (group 2). MOSA was diagnosed by computed tomography of the orbits.RESULTS:There were no postoperative sequelae in children treated endoscopically, in contrast to facial scarring, delayed healing, stitch abscess, unresolved diplopia, or recurrent periorbital cellulitis with or without subperiosteal abscess following external drainage. Streptococcus pneumoniae and Haemophilus influenzae were isolated in three children and one child in group 1, respectively, whereas the cultures were negative in the other two group 1 children who received antibiotics prior to admission. Streptococcus species were also the most common isolates in group 2 (50%), followed by H. influenzae (19%). The mean duration of postoperative healing was 4.2 +/- 1.9 days (range 2-7 days) in group 1 and 8.6 +/- 4.2 days (range 5-17) in group 2 (p = .005). The mean respective hospital stay was 6.0 +/- 2.0 days (range 4-9 days) and 9.9 +/- 4.2 days (range 5-18 days) (p = .02). One group 2 child with residual disease underwent revision external ethmoidectomy 5 weeks after the initial procedure. Recurrent periorbital cellulitis was successfully managed conservatively in two group 2 children, 3 and 10 months postoperatively in one child, and 3 months and 6 years postoperatively in the other.CONCLUSION:We recommend exclusive use of an endoscopic approach for treating MOSA and saving external ethmoidectomy for drainage of superior orbital abscesses.

OBJECTIVE:The worldwide interest in the use of complementary and alternative medicine (CAM) has been established in multiple surveys. Chronic rhinosinusitis (CRS) is often an unremitting disease with frequent troubling relapses, and despite wide use of endoscopic sinus surgery, conventional medicine may have a smaller contribution than expected. Because of prevalent use of CAM among patients, it is important that physicians acquire basic knowledge of this subject. We studied the prevalence of CAM use among CRS patients in Israel.DESIGN:Use of CAM was evaluated in a cohort of consecutive adult patients with CRS.SETTING:An outpatient clinic in a tertiary medical centre.METHODS:Patients were asked to fill out an anonymous questionnaire containing demographic data and data pertaining to allergy, traditional medical and surgical treatment use of CAM, and modalities used.RESULTS:Ninety patients were included. Nineteen of them (21%) reported CAM use. This included herbal medicine, vitamins, homeopathy, acupuncture, massage, reflexology, yoga, and chiropractics. There was a tendency, although not statistically significant, for patients with allergy and a history of sinus surgery to use CAM.CONCLUSIONS:The prevalence of CAM use among patients with CRS in Israel is high and may correlate with the presence of allergies and a history of sinus surgery.

Margin status, a major prognostic parameter in oral cancer, was analyzed vis‐à‐vis the histopathologic parameters of risk scores and stromal myofibroblasts. Specimens of tongue carcinoma (n = 50) were submitted to a risk score assignment consisting of the worst pattern of invasion, lymphocytic infiltration, and perineural invasion. Frequency of stromal myofibroblasts (alpha‐smooth muscle actin stain) was assessed. A triple immunostaining assay with E‐cadherin, Ki‐67 and alpha‐smooth muscle actin was used to identify carcinoma cells undergoing epithelial–mesenchymal transition. Margins were considered ‘clean’ if the tumor was ≥5 mm away from them. Patients ≤60 years were considered as ‘young’. Kaplan–Meier survival analysis with univariate and Cox multivariate regression model with stepwise forward selection, and Fisher’s exact tests were used. Abundant myofibroblasts were found in 27 (54%) cases. Carcinoma cells devoid of E‐cadherin but amalgamated with the stromal myofibroblasts were identified in 18 (36%) cases. Local recurrence and overall survival were negatively influenced by abundance of stromal myofibroblasts (P = 0.004 and P = 0.008, respectively). High‐risk scores (P = 0.011), positive margins, and ‘young’ age (P = 0.027, each) had an unfavorable impact on recurrence. Multivariate analysis revealed that only abundance of stromal myofibroblasts had an independent adverse effect on local recurrence (hazard ratio [HR] 4.369; P = 0.014; 95% confidence interval [CI], 1.356–14.074). It seems that abundant stromal myofibroblasts (camouflaging some malignant cells) and high‐risk scores have an unfavorable impact on the risk of recurrence in particular in ‘young’ patients. Therefore, the treatment concept should be adjusted accordingly and target concomitantly the epithelial malignancy and its allied stroma. (Cancer Sci 2009)

Chronic lymphocytic leukemia (CLL) is the most common lymphoid malignancy among adults in the Western world. Small lymphocytic lymphoma (SLL) represents the lymphomatous presentation of CLL. We describe a case in which a diagnosis of laryngeal CLL/SLL was made in an 82-year-old man who had undergone laryngectomy and neck dissection for the treatment of squamous cell carcinoma of the larynx. We also discuss the implications of simultaneous malignancies of the larynx.

A protocol was created for prospective margin status evaluation of patients with Oral SCC. Margins are evaluated intra- and post-operatively during three stages. Patients were divided into three groups: group 1 in which one margins were sampled randomly, group 2 with frozen sections taken from the surgical bed and 3 in which they were taken from the tumor specimen itself. Patients in group 3 showed the best correlation with final margin status and survival.

OBJECTIVE: We sought to study the clinical behavior and treatment outcome of isolated sphenoid sinusitis (ISS).STUDY DESIGN AND SETTING: We conducted a retrospective study of patients diagnosed with ISS in a tertiary medical center over 20 years.RESULTS: Of 72 patients with ISS, 79 percent had acute symptoms, 15 percent had chronic symptoms, and 6 percent had incidental radiological findings. Fifteen percent were children. Most patients were diagnosed between January and April (P < 0.01), and increasing incidence was noted over the years (P < 0.001). Headache was the most common presenting symptom (85%). Chronic patients complained also of nasal symptoms (82%). Six patients had a major complication of sinusitis (none of them were children), and two patients died. Immunocompromised patients had more major complications (P <= 0.001) and increased mortality (P <= 0.01).CONCLUSION: Most patients need conservative treatment alone. However, life-threatening complications are not infrequent. Close observation and early surgical intervention, if needed, provide the mainstay of treatment.SIGNIFICANCE: This is the first large series that focuses on the clinical behavior, complications, and treatment of ISS. (C) 2007 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.