Otolaryngology -- Head and Neck Surgery

Otolaryngology http://oto.sagepub.com/ -- Head and Neck Surgery

Incidence of Trismus in Head and Neck Cancer Caterina A. Finizia Otolaryngology -- Head and Neck Surgery 2012 147: P137 DOI: 10.1177/0194599812451426a41 The online version of this article can be found at: http://oto.sagepub.com/content/147/2_suppl/P137.3

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appropriate serum levels of IgG4 for monitoring disease activity, a total of 36 serum samples and 8 tissue samples from patients with IgG4-related sialadenitis were studied. Method: The patient group consisted of 6 men and 4 women with an average age of 60 years (range, 47 to 74 years). Serum levels of IgG4 and the density of IgG4-positive plasmacytes in affected tissues were studied. Results: All patients had elevated serum IgG4 levels (>135 mg/ dL), and IgG4-positive plasmacytes (IgG4+ plasma cells/ IgG+ plasma cells >50%) were observed in the involved salivary glands. Six patients with IgG4-related sclerosing sialadenitis with high IgG4/IgG ratios and prominent infiltration of IgG4-positive plasmacytes in the involved salivary glands had systemic complications, including pancreatitis, retroperitoneal fibrosis, and/or inflammatory pseudotumor of the lung after swelling of the salivary glands. All 6 of these patients were successfully treated with systemic corticosteroids. Conclusion: In the 6 patients with systemic complications, treatment with systemic corticosteroids reduced the salivary gland enlargement and lowered serum IgG4 concentrations. These results suggest that IgG4 levels and IgG4/IgG ratios may be used as additional indicators of disease activity and as biomarkers for potential life-threatening complications.

General Otolaryngology Impact of a Yearly Head and Neck Surgery Trip to Rural Kenya Elizabeth C. Pearce, MD (presenter); Rajshri Mainthia; James L. Netterville, MD; Sarah L. Rohde, MD Objective: Surgical specialty trips to third world countries have been both praised and criticized for contributions to lowresource regions. Our objective was to learn the impact of a yearly head and neck surgery trip through initial analysis of 2 years of patient data. Method: Review of a prospectively maintained data repository cataloging surgical patients treated on a yearly head and neck surgical trip to Malindi, Kenya, during 2010 to 2011. Basic demographics, distance traveled for care, access to physicians, preoperative diagnosis, surgical procedure(s), and pathology results were recorded for each patient. Results: In 2 years, 222 surgeries were performed. Age of patients ranged between 6 months and 85 years, and patient sex was evenly split. Half of the patients came from outside the town of Malindi, and a third traveled over 100 km for care. A total of 5.7% were known to be HIV positive. The majority reported access to a local physician, and two-thirds were seen by one for their chief complaint, yet very few patients were offered prior surgical treatment. The most common surgeries performed were adenotonsillectomy, hemithyroidectomy, and biopsy/keloid/ lipoma excision. A wide variety of cases were performed, and there were no immediate surgical complications.

Conclusion: Annual surgical specialty trips to rural, resourcelimited regions are worthwhile and offer procedures not otherwise available. It is important to collect patient, surgical, and pathology data on such trips. By continuing to collect valuable data, surgeons can determine the best procedures to teach local physicians and provide needed resources.

General Otolaryngology Impact of Long-term Diving on Otolaryngology Berk Gurpinar, MD (presenter) Objective: 1) Determine the negative effects of diving in otolaryngology. 2) Review the literature and give a brief description of pathologies related to diving. Method: Between May 2011 and February 2012, 90 male subjects were prospectively examined in Kasimpasa and Golcuk Military Hospitals. The study group consisted of 45 military divers, and the rest, nondivers, were determined as the control group. The data included the age, sex, and experience of diving in terms of years. Detailed otolaryngologic examination, including endoscopy, was performed. Continuous data were displayed as mean ± standard deviation (SD). The MannWhitney U test was used to determine statistically significant variances. Results: In the study group, the mean age was 30.71 ± 5.932 years, and total time in diving was 7.289 ± 6.083 years. In the control group, the mean age was 32.21 ± 4.784 years. In the study group 26 of 45 subjects had exocytosis (57.7%), and 34 had inferior turbinate hypertrophy (75.5%). Correlation of exocytosis and the inferior turbinate hypertrophy between the 2 groups was statistically significant (P < .0001). Age was not statistically correlated between the 2 groups, implying the 2 groups were identical (P = .831) Conclusion: Although the negative effect of cold water on the external ear canal is studied thoroughly, inferior turbinate hypertrophy in long-term divers was not familiar up to now. This study shows that diving has negative effects on external ear anatomy and the nasal cavity.

General Otolaryngology Incidence of Trismus in Head and Neck Cancer Caterina A. Finizia, MD (presenter) Objective: To investigate the incidence of trismus and to analyze the impact on health-related quality of life (HRQL) in patients with trismus undergoing treatment for head and neck (H&N) cancer. Method: This prospective study assesses the incidence of trismus (≤35 mm) and HRQL in H&N cancer patients during 2007 in a university hospital setting. Maximum interincisal opening was measured in 127 patients during the study year,


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Otolaryngology–Head and Neck Surgery 147(2S)

and the EORTC HRQL questionnaires and Gothenburg Trismus Questionnaire (GTQ) were used.

evaluation and interventions, and review other common clinical manifestations of the disease.

Results: In the present study the incidence of trismus was 9% pre-treatment, and the highest incidence (38%) was found 6 months posttreatment. Patients with tumors of the tonsils were the most prone to develop trismus. The trismus patients reported negatively affected HRQL in terms of ability to work and affected social and family life than those without trismus. Furthermore, all patients with H&N malignancies had severe problems with deteriorated HRQL parameters, especially at 3 months posttreatment.

Method: We performed a retrospective review of all patients from the Southwestern United States referred to our HHT Center of Excellence from its inception in May 2010 through February 2012. Clinical presentation, radiographic imaging, genetic testing, otolaryngologic treatments, and other operative interventions were analyzed.

Conclusion: The incidence of trismus in patients with H&N cancer is non-negligible. Trismus severely impairs HRQL and daily life activities in H&N cancer patients.

General Otolaryngology Irrigation Device for Duct Dilatation during Sialoendoscopy Andrea Gallo, MD, PhD (presenter); Salvatore Martellucci, MD; Marco De Vincentiis, MD; Camilla Gallipoli, MD; Antonio Greco, MD; Massimo Fusconi, MD; Giulio Pagliuca, MD Objective: During sialendoscopic procedures a constant irrigation of saline is required to achieve an effective dilatation of the ducts. The aim of this study is to evaluate the efficacy and safety of a technique to dilate the duct using a cost-effective device that allows a continuous irrigation at a constant pressure. Method: In this prospective study 18 consecutive patients with submandibular or parotid sialadenitis were included. In Group A, 9 patients underwent dilatation of the duct using a balloon inflation device, while in Group B dilatations were performed using a manual irrigation. After each procedure, the surgical team expressed an overall evaluation. Results: Sialoliths, strictures, and mucous plugs were visualized and managed in all patients. Any kind of complication was recorded. The technique of irrigation adopted in Group A obtained a subjective assessment higher than that used in Group B. Conclusion: This irrigation device allows a simple, safe, and cost-effective dilation ensuring good visualization of the salivary duct lumen during sialoendoscopy.

General Otolaryngology Key Role for Otolaryngology in a Hereditary Hemorrhagic Telangectasia Center of Excellence Christopher F. Thompson, MD (presenter); Brandon Kim; Jeffrey D. Suh, MD; Gary Duckwiler, MD; Justin McWilliams, MD; Marilene B. Wang, MD Objective: 1) Learn about the initial experiences of a Hereditary Hemorrhagic Telangectasia (HHT) Center of Excellence. 2) Understand which HHT patients require otolaryngologic

Results: In 2010 a dedicated center was started at our tertiary medical center to manage patients with HHT, an autosomal dominant disease with a prevalence of 1:5000. Of the 159 patients referred, 86 have HHT based on genetic testing or Curacao clinical criteria. Seventy-three do not have HHT or are undergoing further workup. Fourteen patients have sought otolaryngologic evaluation for relentless epistaxis or oral bleeding, with 50% of these requiring KTP laser ablation for symptomatic nasal and oral telangectasias. Additionally, 21 patients have required embolization, neurosurgical clipping, or radiation for enlarging or symptomatic arteriovenous malformations in the lung, brain, and abdomen. Conclusion: An HHT Center of Excellence is important in providing comprehensive care for patients with this rare disease with significant clinical sequelae. Otolaryngologists are critical members of this multidisciplinary team performing interventions in the clinic and operating room to improve quality of life for these patients.

General Otolaryngology Manual Dexterity Aptitude Testing: A Soap Study Christopher G. Tang, MD (presenter); Raymond L. Hilsinger Jr, MD; Raul M. Cruz, MD; Luke J. Schloegel, MD; Frederick M. Byl Jr, MD; Barry M. Rasgon, MD Objective: To determine whether or not manual dexterity aptitude testing in the form of soap carving during otolaryngology residency interviews at Kaiser Permanente Oakland Medical Center predicts surgical skill at the time of graduation from otolaryngology residency programs. Methods: Over the past 25 years, applicants to the residency program at Kaiser Permanente Oakland were required to carve soap. This study was conducted to determine how applicants with the best and worst soaps compared at the time of graduation with respect to various metrics including visiospatial ability and manual dexterity. Results: The best and worst soaps from 1990 to 2006 were determined. Sixty-two individuals qualified for the study and matriculated into otolaryngology residency programs. Surveys were sent to their residency programs to evaluate those individuals on a 5-point Likert scale in various categories. There was no difference between individuals with the “best soaps” and those with the “worst soaps” in all categories: cognitive knowledge, visiospatial ability, manual dexterity, decision making, and overall score (P > .1 for all categories). There
