Outcomes After Definitive Surgery For Mandibular Osteoradionecrosis, Kevin J Contrera, Steven B Chinn, Randal S Weber, Dianna Roberts, Jeffery N Myers, Stephen Y Lai, Carol M Lewis, Amy C Hessel, Ann M Gillenwater, Collin F Mulcahy, Peirong Yu, Matthew M Hanasono, Clifton D Fuller, Mark S Chambers, Mark E Zafereo

Faculty, Staff and Student Publications

Objectives: To analyze charges, complications, survival, and functional outcomes for definitive surgery of mandibular osteoradionecrosis (ORN).

Materials and methods: Retrospective analysis of 76 patients who underwent segmental mandibulectomy with reconstruction from 2000 to 2009.

Results: Complications occurred in 49 (65%) patients and were associated with preoperative drainage (odds ratio [OR] 4.40, 95% confidence interval [CI] 1.01-19.27). The adjusted median charge was $343 000, and higher charges were associated with double flap reconstruction (OR 8.15, 95% CI 2.19-30.29) and smoking (OR 5.91, 95% CI 1.69-20.72). Improved swallow was associated with age <67 years (OR 3.76, 95% CI 1.16-12.17) and preoperative swallow (OR 3.42, 95% CI 1.23-9.51). Five-year ORN-recurrence-free survival was 93% while overall survival was 63% and associated with pulmonary disease (HR [hazard ratio] 3.57, 95% CI 1.43-8.94).

Conclusions: Although recurrence of ORN is rare, surgical complications are …

Integrative Genomic Analysis Reveals Low T-Cell Infiltration As The Primary Feature Of Tobacco Use In Hpv-Positive Oropharyngeal Cancer, Benjamin M Wahle, Paul Zolkind, Ricardo J Ramirez, Zachary L Skidmore, Sydney R Anderson, Angela Mazul, D Neil Hayes, Vlad C Sandulache, Wade L Thorstad, Douglas Adkins, Obi L Griffith, Malachi Griffith, Jose P Zevallos

Faculty, Staff and Students Publications

Although tobacco use is an independent adverse prognostic feature in HPV(+) oropharyngeal squamous cell carcinoma (OPSCC), the biologic features associated with tobacco use have not been systematically investigated. We characterized genomic and immunologic features associated with tobacco use through whole exome sequencing, mRNA hybridization, and immunohistochemical staining in 47 HPV(+) OPSCC tumors. Low expression of transcripts in a T cell-inflamed gene expression profile (TGEP) was associated with tobacco use at diagnosis and lower overall and disease-free survival. Tobacco use was associated with an increased proportion of T > C substitutions and a lower proportion of expected mutational signatures, but not with …

Outcome Of Newborn Hearing Screening Program In A Tertiary Care Centre, South India., S. Sija, V. K. Gireeshan, V. T. Ajith Kumar Professor And Head Of The Department, T. V. Rajesh Additional Professor

Journal of Early Hearing Detection and Intervention

Objective

To determine the coverage and outcome of Universal Newborn Hearing Screening (UNHS) Program in Government Medical College Manjeri, South India. To study the prevalence of hearing loss (HL) among those children screened, to describe the characteristics of confirmed cases, and the status of speech and language development acquired by them at follow up.

Design

Hospital based retro prospective study.

Methods

Data were collected from all newborns who underwent Universal Newborn Hearing Screening (UNHS) over a four-year period (November 2014 to October 2018). Cases with confirmed hearing loss were studied by pre-structured questionnaire and telephonic interview. Speech and language …

Case Report: How A Vallecular Cyst Could Have Become An Airway Emergency, Adam Kandil, Robin Lahr, Andrew Caravello

Rowan-Virtua Research Day

Vallecular cysts, also known as epiglottic mucous retention cysts are known to be generally self-limiting laryngeal lesion. They can however also be associated with airway obstruction, and dysphagia in infants. In adults, they are usually asymptomatic, and usually incidentally diagnosed. At times they are diagnosed during rapid sequence intubation, as they may contribute to endotracheal intubation difficulty. Moreover, there is question as to the correlation between vallecular cysts and the incidence of acute epiglottitis, as a vallecular cyst may become infected and cause a localized expansion of inflammation and infection. This expansion from the vallecula progresses to epiglottis.

The Utility Of An Inpatient Consult For Paradoxical Vocal Fold Motion, Pankti P. Acharya, Jason Cohn

Rowan-Virtua Research Day

Paradoxical vocal fold motion (PVFM) is vocal fold adduction during inspiration

Patients often present with dyspnea, throat tightness, and cough

Common risk factors that predispose patients to PVFM include gastroesophageal reflux disease, psychiatric disease, chronic cough, airway irritation, and female gender

This study was conducted to identify possible risk factors and associated conditions for PVFM; additionally, a novel scoring system was developed to aid in diagnosis of PVFM

Cpap And Epistaxis: Is There A Connection In Osa Patients?, Aesha Patel

Rowan-Virtua Research Day

Nasal continuous positive airway pressure (CPAP) has become a standard form of therapy for patients with obstructive sleep apnea (OSA). There are reports of patients suffering from episodes of epistaxis within the initial few weeks of starting CPAP therapy, believed to be due to the high flow rate of air during use, nasal CPAP purportedly dries the nasal mucosa, leading to an increased risk of scabbing, ulceration, and ultimately epistaxis. This study seeks to analyze whether epistaxis is common in patients following CPAP initiation and then compare this rate of epistaxis amongst OSA patients that received upper airway stimulation (UAS) …

Nasal Chondromesenchymal Hamartoma: A Case Report And Review Of The Literature, Jana Ghulmiyyah

Research Days

Background: Nasal chondromesenchymal hamartoma (NCMH) is a rare benign tumor of the sinonasal cavity. It commonly presents in infancy, however there are reported cases of adult tumors. As of August 2021, there have been 56 reported cases in the literature. This is the first description of a solely endoscopically resected NCMH in a neonate in addition to a review of the literature.

Case Presentation: A 5-day old male patient born at term presented to our institution for stridor and cyanosis since birth. The patient was reported to have desaturations while feeding at the outside hospital. On bedside examination, the patient …

Hearing Durability And Trajectory After Radiosurgery For Vestibular Schwannoma, Christian G. Fritz, Dennis I. Bojrab Ii, Nathan C. Tu, Christopher A. Schutt, Dennis I. Bojrab, Seilesh C. Babu

Posters

INTRODUCTION
Vestibular schwannomas (VS) are benign skull base tumors arising from the eighth cranial nerve. Stereotactic radiosurgery (SRS) is emerging as treatment for smaller sized tumors with the intent being to prevent further tumor growth, thus avoiding mass-effect symptoms. Hearing outcomes are commonly presented as preservation of class A/B hearing (defined as Pure Tone Average (PTA) ≤50 dB with Word Recognition Score (WRS) ≥50 dB). Long-term follow-up data on hearing outcomes and hearing trajectory trends are limited.

Manual Therapy For Patients With Radiation-Associated Trismus After Head And Neck Cancer, Holly Mcmillan, Carly E A Barbon, Richard Cardoso, Abigail Sedory, Sheila Buoy, Christine Porsche, Kiara Savage, Lauren Mayo, Katherine A Hutcheson

Faculty, Staff and Student Publications

IMPORTANCE: Trismus is highly prevalent in head and neck cancer (HNC) survivorship. Current standards for trismus treatment include various stretch-based exercise protocols as a primary and single treatment modality with limited evidence regarding the role of manual therapy (MT) for this indication.

OBJECTIVE: To assess the effect size and associations of response to MT to increase oral opening in the setting of radiation-associated trismus.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective case series was conducted at the University of Texas MD Anderson Cancer Center between 2016 and March 2020 (before COVID-19 interruption) and included 49 disease-free survivors of HNC who were …

Use Of Mandibular Distraction Osteogenesis To Correct Micrognathia And Airway Obstruction In Newborn Female With Pierre Robin Sequence And Neonatal Abstinence Syndrome In Rural Appalachia, Seneca Williams, Adam Van Horn Md

Marshall Journal of Medicine

We present a case of Pierre Robin sequence and Neonatal Abstinence Syndrome (NAS) in a newborn female patient to highlight the surgical technique of mandibular distraction osteogenesis to correct airway obstruction due to micrognathia. The patient presented as a transport after delivery due to respiratory distress. She was noted to have a cleft palate and micrognathia. The absence of other dysmorphic features diagnosed her with non-syndromic Pierre Robin sequence. To solve her upper airway obstruction, mandibular distraction osteogenesis was performed. This procedure allowed the patient to be weaned from all respiratory support and nasogastric tube feeds by the end of …

Conversations In Cochlear Implantation: The Inner Ear Therapy Of Today, Grant Rauterkus, Anne K. Maxwell, Jacob B. Kahane, Jennifer J. Lentz, Moises A. Arriaga

School of Medicine Faculty Publications

As biomolecular approaches for hearing restoration in profound sensorineural hearing loss evolve, they will be applied in conjunction with or instead of cochlear implants. An understanding of the current state-of-the-art of this technology, including its advantages, disadvantages, and its potential for delivering and interacting with biomolecular hearing restoration approaches, is helpful for designing modern hearing-restoration strategies. Cochlear implants (CI) have evolved over the last four decades to restore hearing more effectively, in more people, with diverse indications. This evolution has been driven by advances in technology, surgery, and healthcare delivery. Here, we offer a practical treatise on the state of …

Genetic Susceptibility To Patient-Reported Xerostomia Among Long-Term Oropharyngeal Cancer Survivors, Puja Aggarwal, Katherine A Hutcheson, Robert Yu, Jian Wang, Clifton D Fuller, Adam S Garden, Ryan P Goepfert, Jillian Rigert, Frank E Mott, Charles Lu, Stephen Y Lai, G Brandon Gunn, Mark S Chambers, Guojun Li, Chih-Chieh Wu, Ehab Y Hanna, Erich M Sturgis, Sanjay Shete

Faculty, Staff and Students Publications

Genetic susceptibility for xerostomia, a common sequela of radiotherapy and chemoradiotherapy for head and neck cancer, is unknown. Therefore, to identify genetic variants associated with moderate to severe xerostomia, we conducted a GWAS of 359 long-term oropharyngeal cancer (OPC) survivors using 579,956 autosomal SNPs. Patient-reported cancer treatment-related xerostomia was assessed using the MD Anderson Symptom Inventory. Patient response was dichotomized as moderate to severe or none to mild symptoms. In our study, 39.2% of OPC survivors reported moderate to severe xerostomia. Our GWAS identified eight SNPs suggestively associated with higher risk of moderate to severe xerostomia in six genomic regions …

Communities Helping The Hearing Of Infants By Reaching Parents (Chhirp) Through Patient Navigation: A Hybrid Implementation Effectiveness Stepped Wedge Trial Protocol, Matthew Bush, Miranda Hatfield, Marissa Schuh, Beverly K. Balasuriya, Anthony Mahairas, Julie Jacobs, Christina R. Studts, Philip M. Westgate, Nancy E. Schoenberg, Jennifer Shinn, Liza Creel

Otolaryngology--Head & Neck Surgery Faculty Publications

Introduction As the most common neonatal sensory disorder in the USA, infant hearing loss has an incidence of 1.7 per 1000 births. The consequences of delayed diagnosis and failure to obtain timely intervention include significant communication impairment and negative socioeconomic effects. Early Hearing Detection and Intervention (EHDI) national standards dictate that all infants should be screened and diagnosed by 3 months of age and there is a need for interventions that promote adherence to timely diagnosis. Patient navigation (PN) has been shown to be efficacious to decrease non-adherence with infant hearing diagnostic care; however, PN has yet to be tested …

An Imaging Biomarker Of Tumor-Infiltrating Lymphocytes To Risk-Stratify Patients With Hpv-Associated Oropharyngeal Cancer, Germán Corredor, Paula Toro, Can Koyuncu, Cheng Lu, Christina Buzzy, Kaustav Bera, Pingfu Fu, Mitra Mehrad, Kim A Ely, Mojgan Mokhtari, Kailin Yang, Deborah Chute, David J Adelstein, Lester D R Thompson, Justin A Bishop, Farhoud Faraji, Wade Thorstad, Patricia Castro, Vlad Sandulache, Shlomo A Koyfman, James S Lewis, Anant Madabhushi

Faculty, Staff and Students Publications

BACKGROUND: Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) has excellent control rates compared to nonvirally associated OPSCC. Multiple trials are actively testing whether de-escalation of treatment intensity for these patients can maintain oncologic equipoise while reducing treatment-related toxicity. We have developed OP-TIL, a biomarker that characterizes the spatial interplay between tumor-infiltrating lymphocytes (TILs) and surrounding cells in histology images. Herein, we sought to test whether OP-TIL can segregate stage I HPV-associated OPSCC patients into low-risk and high-risk groups and aid in patient selection for de-escalation clinical trials.

METHODS: Association between OP-TIL and patient outcome was explored on whole slide …

Risk Factors Associated With Patient-Reported Fatigue Among Long-Term Oropharyngeal Carcinoma Survivors, Puja Aggarwal, Katherine A Hutcheson, Ryan P Goepfert, Adam S Garden, Naveen Garg, Frank E Mott, Clifton D Fuller, Stephen Y Lai, Gary Brandon Gunn, Mark S Chambers, Ehab Y Hanna, Erich M Sturgis, Sanjay Shete

Faculty, Staff and Students Publications

BACKGROUND: The study objective is to identify risk factors associated with fatigue among long-term OPC survivors.

METHODS: This cross-sectional study included disease-free OPC survivors treated curatively between 2000 and 2013 who were surveyed from September 2015 to July 2016. The outcome variable was patient-reported fatigue. Multivariable logistic regression was used to identify factors associated with moderate to severe fatigue.

RESULTS: Among 863 OPC survivors, 17.4% reported moderate to severe fatigue. Self-reported thyroid problems (OR: 2.01; p = 0.003), current cigarette smoking at time of survey (OR: 3.85; p = 0.001), late lower cranial neuropathy (OR: 3.44; p = 0.002), and …

Survey Of Pediatric Critical Care Fellows On Postresuscitation Debriefing, Nicholas A Rossi, Mia Benavidez, Harold S Pine, Shiva Daram, Wasyl Szeremeta

Faculty, Staff and Student Publications

Choanal atresia is a rare congenital airway malformation that presents a unique surgical challenge for pediatric otolaryngologists. Here we report two classic cases of choanal atresia and examine the surgical approaches to this entity. The first case was a four-day-old female with a history of CHARGE syndrome and bilateral mixed membranous and bony choanal atresia confirmed by a CT scan. After undergoing transnasal endoscopic repair, choanal stents were placed for four weeks, and the patient was seen three months postoperatively and found to be doing well with no respiratory concerns. The second case involved a healthy three-year-old female presenting with …

A Multi-Disciplinary Approach To Chronic Cough In Children, Shraddha S Mukerji, Naga Jaya Smitha Yenduri, Eric Chiou, Siby P Moonnumakal, Joshua R Bedwell

Faculty, Staff and Students Publications

OBJECTIVES: (1) To highlight the important causes of chronic and recurrent cough in children. (2) To discuss multidisciplinary approach to management of chronic/recurrent pediatric cough.

METHODS: Review of scholarly articles, guidelines, expert panels via PubMed and Google Scholar.

CONCLUSION: Chronic cough (CC) in children is mainly attributed to persistent bacterial bronchitis, asthma, nonspecific cough, and gastroesophageal reflux disease (GERD) symptoms. A multi-disciplinary approach is cost-effective and aids with earlier diagnosis and appropriate treatment. Congenital or acquired narrowing of the subglottis is the leading ENT cause for recurrent croup (RC) in children. Laryngeal cleft-type 1 is commonly seen in children with …

Otolaryngology Subspecialty Surgical Rescheduling Rates During The Covid-19 Pandemic, Emily S Sagalow, Alexander Duffy, Priyanga Selvakumar, David Cognetti

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Objective: In the beginning of the COVID-19 pandemic in spring 2020, elective and oncologic surgical cases were cancelled. After adequate safety protocols were established, each subspecialty within otolaryngology faced unique challenges in reengaging patients for surgical scheduling.

Study design: Retrospective review from March to May 2020.

Setting: Single academic institution.

Methods: Patients whose otolaryngology surgery was cancelled due to COVID-19 hospital precautions were identified. Rescheduling rates were analyzed by subspecialty. Case completion was determined as the percentage of initially cancelled cases that were completed within 6 months of their original planned dates.

Results: Of 833 otolaryngology cases scheduled between March …

A Unique Case Of Metastatic Prostate Carcinoma To The Subglottis, Samuel Bosco, Kristen Prijs, Jordan Licata, Sandra A Schwartz, Raymond Lesser

Otolaryngology (ENT) Resident Research

An 85-year-old male presented to an otolaryngology office with hoarseness, stridor, and shortness of breath. He had been evaluated by 2 outside otolaryngologists for a 4-year history of hoarseness. He was referred for consideration for speech therapy regarding hoarseness, vocal fold edema, and a questionable right vocal fold polyp. The patient reported that his symptoms had worsened progressively over the prior 6-12 months. He had no history of head and neck cancer, recent intubation, autoimmune conditions, head and neck trauma, or smoking. The patient had a history of prostate carcinoma treated with radical prostatectomy, radiation therapy, and hormone therapy 18 …

Anatomic Considerations Of Perinasal Musculature For Improved Dental Show During Smile In Facial Synkinesis, Laura T. Hetzler, Marcus Hershey, Todd Lambert, Jason Mussell, Lee Mcdaniel, Sara Macdowell

School of Medicine Faculty Publications

Introduction: There is an anatomic explanation for upper lip and midfacial tethering resulting in lack of motion in facial synkinesis. Objective: To measure the effect of perinasal chemodenervation on dental show in the synkinetic population and clarify the anatomic relationship of perinasal musculature. Methods: Literature search was performed on anatomy of the perinasal modiolus, and anatomic evaluation was performed through human anatomic specimen dissection. Photographic outcomes were observed in synkinetic patients receiving chemodenervation to smile antagonists with and without perinasal muscle injections and assessed through naive observer survey. Retrospective outcomes for all patients receiving perinasal chemodenervation was collected utilizing Facial …