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Article ; Online: Use of a sternocleidomastoid muscle flap to protect the carotid artery during laryngectomy.

Fleming, J C / Fuson, A R / Jeyarajan, H / Thomas, C M / Greene, B

2021 Volume 135, Issue 6, Page(s) 547–550

Abstract: Objectives: This paper describes a simple method of securing tissue coverage of the great vessels at the initial surgery by rotating the divided sternal heads of the sternocleidomastoid muscle, a routine step during laryngectomy, and approximating them ... ...

Abstract	Objectives: This paper describes a simple method of securing tissue coverage of the great vessels at the initial surgery by rotating the divided sternal heads of the sternocleidomastoid muscle, a routine step during laryngectomy, and approximating them to the prevertebral fascia. The paper presents an illustrated case example where this technique in a salvage laryngectomy repair resulted in a protected vascular axis following a salivary leak. Results: Since utilising this technique, there has been a marked reduction in the requirement of subsequent flap procedures to protect vessels, and no episodes of threatened or actual carotid blowout.
MeSH term(s)	Carotid Artery Injuries/prevention & control ; Humans ; Intraoperative Complications/prevention & control ; Laryngeal Neoplasms/surgery ; Laryngectomy/methods ; Male ; Middle Aged ; Neck Muscles/transplantation ; Surgical Flaps
Language	English
Publishing date	2021-05-12
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	218299-3
ISSN	1748-5460 ; 0022-2151
ISSN (online)	1748-5460
ISSN	0022-2151
DOI	10.1017/S0022215121001249
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Article ; Online: Autologous Free Dermal-Fat-Fascial Graft for Parotidectomy Defects: A Case Series.

Mianroodi, Aliasghar A / Mohtashami, Sadaf / Romero, Nahir / Fuson, Andrew / Joshi, Arjun / Sadeghi, Nader

The Annals of otology, rhinology, and laryngology

2021 Volume 130, Issue 10, Page(s) 1171–1180

Abstract: Background: Frey's syndrome and facial asymmetry from loss of parotid tissue are long-term sequelae of parotid surgeries causing significant morbidity. Various techniques have been used to fill the parotidectomy defect, preserve facial contour symmetry, ...

Abstract	Background: Frey's syndrome and facial asymmetry from loss of parotid tissue are long-term sequelae of parotid surgeries causing significant morbidity. Various techniques have been used to fill the parotidectomy defect, preserve facial contour symmetry, and prevent Frey's syndrome. Free dermal-fat-fascial graft (DFFG) is one such technique; however, its use is largely undocumented in the literature. In this case series, we investigate the efficacy of free DFFG in reconstructing parotidectomy defects at 2 tertiary care centers. Materials and methods: Medical records of 54 patients who underwent primary parotidectomy and immediate reconstruction with autologous abdominal free DFFG by 2 surgeons in George Washington University Hospital and McGill University Health Centre between 2007 and 2019 were collected prospectively. Patients responded to 2 questionnaires addressing postoperative outcomes. Results: Fifty-four patients were included; 32 superficial parotidectomies and 22 total parotidectomies were performed for 39 benign and 15 malignant tumors. Thirty-seven patients could be reached. Out of 37 patients who responded to the first questionnaire, 59% (22) reported complete facial symmetry, 27% (10) reported mild hollowness, and 14% (5) reported mild fullness. None declared noticeable hollowness or fullness. While 81% (30) did not experience Frey's syndrome, 5.4% (2) experienced mild symptoms without disability, and 13.5% (5) experienced debilitating symptoms. Out of 37 patients, 8 patients responded to a second questionnaire addressing the outcome of the abdominal graft donor site. In regard to the donor site, 87.5% (7) were satisfied or very satisfied from its cosmetic appearance, 75% (6) were not bothered by its cosmetic appearance, and 87.5% (7) had no discomfort at the graft donor site. Patients did not report any other symptom at the graft donor site. Conclusion: In this large series of total parotidectomies including malignant pathologies, autologous abdominal free DFFG effectively prevented Frey's syndrome and preserved facial cosmesis in most patients.
MeSH term(s)	Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Parotid Gland/surgery ; Parotid Neoplasms/surgery ; Prospective Studies ; Skin Transplantation/methods ; Surgical Flaps ; Transplantation, Autologous ; Young Adult
Language	English
Publishing date	2021-03-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	120642-4
ISSN	1943-572X ; 0003-4894
ISSN (online)	1943-572X
ISSN	0003-4894
DOI	10.1177/0003489421999542
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Article ; Online: Sonolocation during submandibular sialolithotomy.

Romero, Nahir J / Fuson, Andrew / Kieliszak, Christopher R / Joshi, Arjun S

The Laryngoscope

2019 Volume 129, Issue 12, Page(s) 2716–2720

Abstract: Objectives/hypothesis: Ultrasound is a proven tool for diagnostic and therapeutic purposes for treatment of salivary gland pathology. It is also useful for localization of calculi during submandibular gland transoral sialolithotomy when calculi cannot ... ...

Abstract	Objectives/hypothesis: Ultrasound is a proven tool for diagnostic and therapeutic purposes for treatment of salivary gland pathology. It is also useful for localization of calculi during submandibular gland transoral sialolithotomy when calculi cannot easily be palpated. Our objective was to determine the efficacy of sialolith localization using ultrasound during submandibular gland sialolithotomy. Study design: Retrospective case series. Methods: A study performed utilizing data compiled from 2009 through 2016 in a tertiary academic center. Treatment was completed in 164 patients with sialadenitis and sialolithiasis by submandibular gland transoral sialolithotomy in either the office (81%) or the operating room (19%). Ultrasound was used for localization of sialoliths during submandibular gland sialolithotomy. Main treatment outcomes studied were success of the procedure, complications, and follow-up. Results: Successful sialolithotomy was performed in (147 patients) 90% of cases. Complications were minimal and included stricture formation, which occurred in 3% (five patients) of cases, followed by ranula formation in 1.8% (three patients) of cases. There were no incidences of lingual nerve injury. Conclusions: Ultrasound can be used effectively for precise sialolith localization intraoperatively. Level of evidence: 4 Laryngoscope, 129:2716-2720, 2019.
MeSH term(s)	Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Otorhinolaryngologic Surgical Procedures/methods ; Reproducibility of Results ; Retrospective Studies ; Salivary Gland Calculi/diagnosis ; Salivary Gland Calculi/surgery ; Submandibular Gland/diagnostic imaging ; Submandibular Gland/surgery ; Surgery, Computer-Assisted ; Ultrasonography/methods
Language	English
Publishing date	2019-02-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	80180-x
ISSN	1531-4995 ; 0023-852X
ISSN (online)	1531-4995
ISSN	0023-852X
DOI	10.1002/lary.27816
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Article ; Online: Unusual presentation of submandibular lingual nerve sheath tumour as sublingual stone.

Straughan, Alexander J / Badger, Christopher / Javan, Ramin / Fuson, Andrew / Joshi, Arjun S

BMJ case reports

2020 Volume 13, Issue 6

Abstract: A 60-year-old woman was referred to the otolaryngologist for 18 months of left-sided tongue pain and taste changes. Surgeon-performed ultrasound of the submandibular region revealed a hyperechoic mass. Wharton's duct was dilated proximally and the ... ...

Abstract	A 60-year-old woman was referred to the otolaryngologist for 18 months of left-sided tongue pain and taste changes. Surgeon-performed ultrasound of the submandibular region revealed a hyperechoic mass. Wharton's duct was dilated proximally and the submandibular gland demonstrated normal vascularity. While these findings were highly suspicious for submandibular gland sialolith, an in-office attempt at sialolithotomy suggested an alternate process or mass. After imaging failed to further elucidate an aetiology, surgical exploration revealed a well-circumscribed submandibular mass associated with the lingual nerve. The mass was removed en-bloc and pathology revealed a schwannoma of the lingual nerve.
MeSH term(s)	Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Nerve Sheath Neoplasms/diagnosis ; Nerve Sheath Neoplasms/pathology ; Nerve Sheath Neoplasms/surgery ; Submandibular Gland/pathology ; Submandibular Gland Neoplasms/diagnosis ; Submandibular Gland Neoplasms/pathology ; Submandibular Gland Neoplasms/surgery
Language	English
Publishing date	2020-06-28
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2019-233759
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Article ; Online: In Vivo Accuracy of Ultrasound for Sizing Salivary Ductal Calculi.

Badger, Christopher D / Patel, Sahil / Romero, Nahir J / Fuson, Andrew / Joshi, Arjun S

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery

2020 Volume 164, Issue 1, Page(s) 124–130

Abstract: Objectives: The present study was developed to evaluate the accuracy of in vivo ultrasound sizing for parotid and submandibular salivary gland calculi, as compared with ex vivo pathology sizing with a standard plastic ruler after extraction.: Study ... ...

Abstract	Objectives: The present study was developed to evaluate the accuracy of in vivo ultrasound sizing for parotid and submandibular salivary gland calculi, as compared with ex vivo pathology sizing with a standard plastic ruler after extraction. Study design: Retrospective chart review. Setting: Ultrasound is frequently used to size salivary calculi and make treatment decisions, but the accuracy of measurements from this modality has not been validated. Subjects and methods: We evaluated and reviewed the charts and ultrasound examinations of 167 patients who underwent procedures for the treatment of sialolithiasis involving the parotid and submandibular glands. US examinations were performed between 2009 and 2016 in a tertiary-level hospital setting by the senior author. Measurements were collected from ultrasound evaluation before sialolithotomy, and pathology measurements were taken after removal. Ultrasound measurements in millimeters were compared with the measurements collected with a ruler. The differences were calculated and compared. Results: A total of 167 calculi measurements were compared. Good concurrent validity between pathology and ultrasound measurements was suggested by a Pearson correlation of 0.92 (95% CI, 0.887-0.937). On Bland-Altman plot, correlation of the difference between US and pathology measurements showed a mean difference of 0.095 mm (95% CI, -0.19 to 0.38 mm) with a limit of agreement ranging from -3.59 mm (95% CI, -3.84 to -3.34 mm) to +3.78 mm (95% CI, +3.53 to +4.03 mm). Conclusions: Ultrasound is an accurate, relatively precise, and minimally invasive imaging tool for salivary gland sialolithiasis. Preoperative size of calculi can be used to guide management and clinical decision making. Level of evidence: 2C.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Salivary Duct Calculi/diagnostic imaging ; Salivary Duct Calculi/pathology ; Salivary Duct Calculi/surgery ; Ultrasonography/methods
Language	English
Publishing date	2020-06-30
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	392085-9
ISSN	1097-6817 ; 0161-6439 ; 0194-5998
ISSN (online)	1097-6817
ISSN	0161-6439 ; 0194-5998
DOI	10.1177/0194599820937676
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Article ; Online: Perioperative Hypercoagulability in Free Flap Reconstructions Performed for Intracranial Tumors.

Lilly, Gabriela L / Sweeny, Larissa / Santucci, Nicole / Cannady, Steven / Frost, Ariel / Anagnos, Vincent / Curry, Joseph / Sagalow, Emily / Freeman, Cecilia / Puram, Sidharth V / Pipkorn, Patrik / Slijepcevic, Allison / Fuson, Andrew / Bonaventure, Caroline / Wax, Mark K

The Laryngoscope

2022 Volume 133, Issue 5, Page(s) 1103–1109

Abstract: Objective(s): Patients with intracranial tumors have a higher risk of thromboembolic events. This risk increases at the time of surgical intervention. We have noted an anecdotal increase in perioperative flap thrombosis in patients undergoing free ... ...

Abstract	Objective(s): Patients with intracranial tumors have a higher risk of thromboembolic events. This risk increases at the time of surgical intervention. We have noted an anecdotal increase in perioperative flap thrombosis in patients undergoing free tissue transfer for intracranial tumor resection. This study aims to formally evaluate this risk. Methods: A multi-institutional retrospective chart review was performed of patients who underwent free tissue transfer for scalp/cranial reconstruction. Perioperative thrombosis and free flap outcomes were evaluated. Results: The 209 patients who underwent 246 free tissue transfers were included in the study. The 28 free flap scalp reconstructions were associated with intracranial tumors, 19 were performed following composite cranial resections with associated dural resection/reconstruction, and 199 were performed in the absence of intracranial tumors (control group). There was a significantly higher incidence of perioperative flap thrombosis in the intracranial tumor group (11/28, 39%) when compared to controls (38/199, 19%) (p = 0.0287). This was not seen when scalp tumors extended to the dura alone (4/19, 21%, p = 0.83). Therapeutic anticoagulation used for perioperative thrombosis (defined as intraoperative or in the immediate postoperative phase up to 5 days) was associated with a lower risk of flap failure, although this was not statistically significant (p = 0.148). Flap survival rates were equivalent between flaps performed for intracranial pathology (93.3%) and controls (95%). Conclusion: There is an increase in perioperative flap thrombosis in patients with intracranial tumors undergoing free tissue scalp reconstruction. Anticoagulation appears to mitigate this risk. Level of evidence: This recommendation is based on level 3 evidence (retrospective case-control studies, systematic review of retrospective studies, and case reports) Laryngoscope, 133:1103-1109, 2023.
MeSH term(s)	Humans ; Free Tissue Flaps ; Retrospective Studies ; Thrombophilia/complications ; Thrombophilia/drug therapy ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/drug therapy ; Thrombosis/etiology ; Anticoagulants/therapeutic use ; Brain Neoplasms/surgery
Chemical Substances	Anticoagulants
Language	English
Publishing date	2022-10-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	80180-x
ISSN	1531-4995 ; 0023-852X
ISSN (online)	1531-4995
ISSN	0023-852X
DOI	10.1002/lary.30417
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Article ; Online: Hypopharyngeal applications of a new flexible robotic system in otolaryngology.

Chao, Janet Ren / Goodman, Joseph / Fuson, Andrew / Romero, Nahir J / Joshi, Arjun

Journal of robotic surgery

2017 Volume 12, Issue 3, Page(s) 571–574

Abstract: This case report describes the use a new flexible robotic system in otolaryngology, the ... ...

Abstract	This case report describes the use a new flexible robotic system in otolaryngology, the FlexRobot
MeSH term(s)	Aged ; Female ; Humans ; Hypopharynx/surgery ; Laryngeal Neoplasms/surgery ; Otorhinolaryngologic Surgical Procedures/methods ; Robotic Surgical Procedures/methods
Language	English
Publishing date	2017-09-27
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2268283-1
ISSN	1863-2491 ; 1863-2483
ISSN (online)	1863-2491
ISSN	1863-2483
DOI	10.1007/s11701-017-0756-3
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Article ; Online: Neoadjuvant chemotherapy followed by surgery for HPV-associated locoregionally advanced oropharynx cancer.

Sadeghi, Nader / Mascarella, Marco A / Khalife, Sarah / Ramanakumar, Agnihotram V / Richardson, Keith / Joshi, Arjun S / Taheri, Reza / Fuson, Andrew / Bouganim, Nathaniel / Siegel, Robert

Head & neck

2020 Volume 42, Issue 8, Page(s) 2145–2154

Abstract: Background: Neoadjuvant chemotherapy followed by surgery (NAC + S), a paradigm based on systemic escalation coupled with surgery-based de-escalation, is under investigation for treatment of HPV-associated oropharynx cancer (OPC).: Methods: ... ...

Abstract	Background: Neoadjuvant chemotherapy followed by surgery (NAC + S), a paradigm based on systemic escalation coupled with surgery-based de-escalation, is under investigation for treatment of HPV-associated oropharynx cancer (OPC). Methods: Prospective cohort of patients with non-metastatic, p16 positive OPC enrolled in a clinical trial of NAC + S was compared to a historic cohort of patients undergoing concurrent chemoradiation (CCRT) to compare disease-free survival (DFS). Results: Fifty-five patients were treated with NAC + S and 142 with CCRT. Stage-matched patients undergoing CCRT had higher frequency of smoking and alcohol consumption. 5-year DFS in the NAC + S group was 96.1% (95% CI 90.8-100) compared to 67.6% (95% CI 50.7-84.5) for CCRT (P = .01). At 12 months from treatment, 24.5% of patients undergoing CCRT and none of the patients in the NAC + S were feeding tube dependent (P < .0001). Conclusion: NAC + S may be a novel approach for HPV-associated OPC as it provides lower feeding tube dependence and improved survival compared to stage-matched patients undergoing CCRT.
MeSH term(s)	Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Chemoradiotherapy ; Humans ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms/drug therapy ; Neoadjuvant Therapy ; Oropharyngeal Neoplasms/therapy ; Papillomavirus Infections/complications ; Papillomavirus Infections/therapy ; Prospective Studies
Language	English
Publishing date	2020-03-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	645165-2
ISSN	1097-0347 ; 0148-6403 ; 1043-3074
ISSN (online)	1097-0347
ISSN	0148-6403 ; 1043-3074
DOI	10.1002/hed.26147
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Article ; Online: Pathologic response to neoadjuvant chemotherapy in HPV-associated oropharynx cancer.

Sadeghi, Nader / Khalife, Sarah / Mascarella, Marco A / Ramanakumar, Agnihotram V / Richardson, Keith / Joshi, Arjun S / Bouganim, Nathaniel / Taheri, Reza / Fuson, Andrew / Siegel, Robert

Head & neck

2019 Volume 42, Issue 3, Page(s) 417–425

Abstract: Background: A paradigm shift has led to de-escalation trials for the treatment of HPV-positive oropharynx cancer (OPC). The objective of this study was to assess the ability of tumor volume reduction on imaging to predict pathological response to ... ...

Abstract	Background: A paradigm shift has led to de-escalation trials for the treatment of HPV-positive oropharynx cancer (OPC). The objective of this study was to assess the ability of tumor volume reduction on imaging to predict pathological response to neoadjuvant chemotherapy in patients with HPV-positive OPC. Methods: A prospective observational study of 54 patients with HPV-positive OPC enrolled in a clinical trial of neoadjuvant chemotherapy followed by surgery was performed. Patients underwent three cycles of induction chemotherapy (cisplatin/docetaxel); prechemotherapy and postchemotherapy imaging were obtained. Receiver operating characteristic curves and logistic regression analyses were used. Results: The complete pathologic response (pCR) rate at primary and nodal sites were 72% and 57%, respectively. Tumor volume reduction of ≥90% following induction chemotherapy predicted pCR of the primary tumor. Conclusions: Neoadjuvant chemotherapy followed by definitive transoral surgery is a new paradigm worthy of further investigation and MRI is a reliable modality to assess preoperative response.
MeSH term(s)	Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Breast Neoplasms ; Docetaxel ; Female ; Humans ; Neoadjuvant Therapy ; Oropharyngeal Neoplasms/therapy ; Papillomavirus Infections ; Treatment Outcome
Chemical Substances	Docetaxel (15H5577CQD)
Language	English
Publishing date	2019-11-27
Publishing country	United States
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	645165-2
ISSN	1097-0347 ; 0148-6403 ; 1043-3074
ISSN (online)	1097-0347
ISSN	0148-6403 ; 1043-3074
DOI	10.1002/hed.26022
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Article ; Online: Repair of Tympanic Membrane Perforations with Customized Bioprinted Ear Grafts Using Chinchilla Models.

Kuo, Che-Ying / Wilson, Emmanuel / Fuson, Andrew / Gandhi, Nidhi / Monfaredi, Reza / Jenkins, Audrey / Romero, Maria / Santoro, Marco / Fisher, John P / Cleary, Kevin / Reilly, Brian

Tissue engineering. Part A

2017 Volume 24, Issue 5-6, Page(s) 527–535

Abstract: The goal of this work is to develop an innovative method that combines bioprinting and endoscopic imaging to repair tympanic membrane perforations (TMPs). TMPs are a serious health issue because they can lead to both conductive hearing loss and repeated ... ...

Abstract	The goal of this work is to develop an innovative method that combines bioprinting and endoscopic imaging to repair tympanic membrane perforations (TMPs). TMPs are a serious health issue because they can lead to both conductive hearing loss and repeated otitis media. TMPs occur in 3-5% of cases after ear tube placement, as well as in cases of acute otitis media (the second most common infection in pediatrics), chronic otitis media with or without cholesteatoma, or as a result of barotrauma to the ear. About 55,000 tympanoplasties, the surgery performed to reconstruct TMPs, are performed every year, and the commonly used cartilage grafting technique has a success rate between 43% and 100%. This wide variability in successful tympanoplasty indicates that the current approach relies heavily on the skill of the surgeon to carve the shield graft into the shape of the TMP, which can be extremely difficult because of the perforation's irregular shape. To this end, we hypothesized that patient specific acellular grafts can be bioprinted to repair TMPs. In vitro data demonstrated that our approach resulted in excellent wound healing responses (e.g., cell invasion and proliferations) using our bioprinted gelatin methacrylate constructs. Based on these results, we then bioprinted customized acellular grafts to treat TMP based on endoscopic imaging of the perforation and demonstrated improved TMP healing in a chinchilla study. These ear graft techniques could transform clinical practice by eliminating the need for hand-carved grafts. To our knowledge, this is the first proof of concept of using bioprinting and endoscopic imaging to fabricate customized grafts to treat tissue perforations. This technology could be transferred to other medical pathologies and be used to rapidly scan internal organs such as intestines for microperforations, brain covering (Dura mater) for determination of sites of potential cerebrospinal fluid leaks, and vascular systems to determine arterial wall damage before aneurysm rupture in strokes.
MeSH term(s)	Animals ; Bioprinting ; Disease Models, Animal ; Female ; Gelatin/chemistry ; Implants, Experimental ; Mice ; NIH 3T3 Cells ; Tympanic Membrane/metabolism ; Tympanic Membrane/pathology ; Tympanic Membrane Perforation/metabolism ; Tympanic Membrane Perforation/pathology ; Tympanic Membrane Perforation/therapy
Chemical Substances	Gelatin (9000-70-8)
Language	English
Publishing date	2017-09-01
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2420582-5
ISSN	1937-335X ; 1937-3341
ISSN (online)	1937-335X
ISSN	1937-3341
DOI	10.1089/ten.TEA.2017.0246
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