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  1. Artikel ; Online: Selective Neurectomy for Postfacial Paralysis Synkinesis: A Systematic Review.

    Namavarian, Amirpouyan / Cheng, Emily YiQin / Shapiro, Justin / Ziai, Hedyeh / Talei, Benjamin / Pai, Akshat / Enepekides, Danny / Gantous, Andres M

    Facial plastic surgery : FPS

    2024  

    Abstract: Facial synkinesis is characterized by unintentional contractions of facial musculature secondary to aberrant facial nerve healing. The associated impairment in facial functioning results in a significant decrease in patients' quality of life. The ... ...

    Abstract Facial synkinesis is characterized by unintentional contractions of facial musculature secondary to aberrant facial nerve healing. The associated impairment in facial functioning results in a significant decrease in patients' quality of life. The mainstay treatment for postfacial paralysis synkinesis (PFPS) is chemodenervation and physiotherapy, which requires long-term maintenance neurotoxin injections. This can lead to treatment resistance. Selective neurectomy of the distal branches of the facial nerve has been suggested as an effective surgical treatment of PFPS. This study aims to provide a comprehensive systematic review evaluating the efficacy of selective neurectomy for patients presenting with PFPS. Ovid MEDLINE, Ovid Embase, PubMed, Web of Science, and CINAHL were searched from inception until July 2022. Studies that investigated postoperative outcomes of pediatric and/or adult patients who underwent selective neurectomy as a treatment for PFPS were included. The database search identified 1,967 studies, and 11 were ultimately included based on inclusion and exclusion criteria. These 11 studies represented 363 patients. Studies reported on outcomes following selective neurectomy with or without adjuvant therapies for patients with PFPS. The main outcome categories identified were clinician-reported outcomes and patient-reported outcomes. The studies that used clinician-reported outcomes found an improvement in both synkinesis and facial nerve paralysis (FNP) outcomes following selective neurectomy according to their respective grading systems. Three studies looked at patient-reported outcomes and found increased patient-reported quality of life and satisfaction following selective neurectomy. The most reported complications were upper lip contracture, uneven cheek surface, lagophthalmos, and temporary oral incompetence. Selective neurectomy has demonstrated stable or improved synkinesis, FNP, and quality of life outcomes in patients with PFPS. This approach should be considered for patients with PFPS, particularly for patients with refractory symptoms or those who are unable to undergo continued medical management.
    Sprache Englisch
    Erscheinungsdatum 2024-05-28
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ZDB-ID 630090-x
    ISSN 1098-8793 ; 0736-6825
    ISSN (online) 1098-8793
    ISSN 0736-6825
    DOI 10.1055/s-0044-1786824
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  2. Artikel: Endoscopic Removal of a Displaced Tracheoesophageal Voice Prosthesis.

    Li, Suqing / Enepekides, Danny / Cohen, Lawrence

    ACG case reports journal

    2021  Band 8, Heft 11, Seite(n) e00708

    Sprache Englisch
    Erscheinungsdatum 2021-11-18
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ZDB-ID 2814825-3
    ISSN 2326-3253
    ISSN 2326-3253
    DOI 10.14309/crj.0000000000000708
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  3. Artikel ; Online: Facial Nerve Paralysis and COVID-19: A Systematic Review.

    Namavarian, Amirpouyan / Eid, Anas / Ziai, Hedyeh / Cheng, Emily YiQin / Enepekides, Danny

    The Laryngoscope

    2022  Band 133, Heft 5, Seite(n) 1007–1013

    Abstract: Objective: Several cases of facial nerve paralysis (FNP) post-COVID-19 infection have been reported with varying presentations and management. This study aims to identify FNP clinical characteristics and recovery outcomes among patients acutely infected ...

    Abstract Objective: Several cases of facial nerve paralysis (FNP) post-COVID-19 infection have been reported with varying presentations and management. This study aims to identify FNP clinical characteristics and recovery outcomes among patients acutely infected with COVID-19. We hypothesize that FNP is a potentially unique sequalae associated with COVID-19 infections.
    Methods: A systematic review of PubMed-Medline, OVID Embase, and Web of Science databases from inception to November 2021 was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
    Results: This search identified 630 studies with 53 meeting inclusion criteria. This resulted in 72 patients, of which 30 (42%) were diagnosed with Guillain-Barré Syndrome (GBS). Non-GBS patients were on average younger (36 vs. 53 years) and more likely to present with unilateral FNP (88%) compared to GBS patients who presented predominantly with bilateral FNP (74%). Among non-GBS patients, majority (70%) of FNP presented a median of 8 [IQR 10] days after the onset of initial COVID-19 symptom(s). Treatment for non-GBS patients consisted of steroids (60%), antivirals (29%), antibiotics (21%), and no treatment (21%). Complete FNP recovery in non-GBS patients was achieved in 67% patients within a median of 11 [IQR 24] days.
    Conclusion: FNP is a possible presentation post COVID-19 infections, associated with both GBS and non-GBS patients. Although no causation can be assumed, the clinical course of isolated FNP associated with COVID-19 raises the possibility of a unique presentation differing from Bell's palsy, seen with higher proportion of patients developing bilateral FNP and a shorter duration to complete recovery. Laryngoscope, 133:1007-1013, 2023.
    Mesh-Begriff(e) Humans ; Bell Palsy/drug therapy ; COVID-19/complications ; Facial Nerve ; Facial Paralysis/drug therapy ; Steroids/therapeutic use
    Chemische Substanzen Steroids
    Sprache Englisch
    Erscheinungsdatum 2022-08-08
    Erscheinungsland United States
    Dokumenttyp Journal Article ; Systematic Review
    ZDB-ID 80180-x
    ISSN 1531-4995 ; 0023-852X
    ISSN (online) 1531-4995
    ISSN 0023-852X
    DOI 10.1002/lary.30333
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  4. Artikel: Selective Neurectomy for Postfacial Paralysis Synkinesis: A Systematic Review

    Namavarian, Amirpouyan / Cheng, Emily YiQin / Shapiro, Justin / Ziai, Hedyeh / Talei, Benjamin / Pai, Akshat / Enepekides, Danny / Gantous, Andres M.

    Facial Plastic Surgery

    2024  

    Abstract: Facial synkinesis is characterized by unintentional contractions of facial musculature secondary to aberrant facial nerve healing. The associated impairment in facial functioning results in a significant decrease in patients' quality of life. The ... ...

    Abstract Facial synkinesis is characterized by unintentional contractions of facial musculature secondary to aberrant facial nerve healing. The associated impairment in facial functioning results in a significant decrease in patients' quality of life. The mainstay treatment for postfacial paralysis synkinesis (PFPS) is chemodenervation and physiotherapy, which requires long-term maintenance neurotoxin injections. This can lead to treatment resistance. Selective neurectomy of the distal branches of the facial nerve has been suggested as an effective surgical treatment of PFPS. This study aims to provide a comprehensive systematic review evaluating the efficacy of selective neurectomy for patients presenting with PFPS. Ovid MEDLINE, Ovid Embase, PubMed, Web of Science, and CINAHL were searched from inception until July 2022. Studies that investigated postoperative outcomes of pediatric and/or adult patients who underwent selective neurectomy as a treatment for PFPS were included. The database search identified 1,967 studies, and 11 were ultimately included based on inclusion and exclusion criteria. These 11 studies represented 363 patients. Studies reported on outcomes following selective neurectomy with or without adjuvant therapies for patients with PFPS. The main outcome categories identified were clinician-reported outcomes and patient-reported outcomes. The studies that used clinician-reported outcomes found an improvement in both synkinesis and facial nerve paralysis (FNP) outcomes following selective neurectomy according to their respective grading systems. Three studies looked at patient-reported outcomes and found increased patient-reported quality of life and satisfaction following selective neurectomy. The most reported complications were upper lip contracture, uneven cheek surface, lagophthalmos, and temporary oral incompetence. Selective neurectomy has demonstrated stable or improved synkinesis, FNP, and quality of life outcomes in patients with PFPS. This approach should be considered for patients with PFPS, particularly for patients with refractory symptoms or those who are unable to undergo continued medical management.
    Schlagwörter synkinesis ; selective neurectomy ; facial nerve paralysis
    Sprache Englisch
    Erscheinungsdatum 2024-05-28
    Verlag Thieme Medical Publishers, Inc.
    Erscheinungsort Stuttgart ; New York
    Dokumenttyp Artikel
    ZDB-ID 630090-x
    ISSN 1098-8793 ; 0736-6825
    ISSN (online) 1098-8793
    ISSN 0736-6825
    DOI 10.1055/s-0044-1786824
    Datenquelle Thieme Verlag

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  5. Artikel ; Online: Lymph node yield: Impact on oncologic outcomes in oral cavity cancer.

    Khalil, Carlos / Khoury, Mark / Higgins, Kevin / Enepekides, Danny / Karam, Irene / Husain, Zain Ali / Bayley, Andrew / Poon, Ian / Truong, Tra / Chan, Kelvin K W / Smoragiewicz, Martin / Fu, Rui / Eskander, Antoine

    Head & neck

    2024  

    Abstract: Background: Lymph node metastases are associated with poor prognosis in oral cavity squamous cell carcinoma (OCSCC). In other cancers, clinical guidelines on the number of lymph nodes removed during primary surgery, lymph node yield (LNY), exist. Here, ... ...

    Abstract Background: Lymph node metastases are associated with poor prognosis in oral cavity squamous cell carcinoma (OCSCC). In other cancers, clinical guidelines on the number of lymph nodes removed during primary surgery, lymph node yield (LNY), exist. Here, we evaluated the prognostic capacity of LNY on regional failure, locoregional recurrence, and disease-free survival (DFS) in patients with OCSCC treated by primary neck surgery.
    Methods: This retrospective cohort study took place at Sunnybrook Health Sciences Centre in Toronto, Canada and involved a chart review of all adult patients with treatment-naive OCSCC undergoing primary neck dissection. For each outcome, we first used the maximally selected rank statistics and an optimism-corrected concordance to identify an optimal threshold of LNY. We then used a multivariable Cox proportional hazards model to assess the association between high LNY (>threshold) and each outcome.
    Results: Among the 579 patients with OCSCC receiving primary neck dissection, 61.7% (n = 357) were male with a mean age of 62.9 years (standard deviation: 13.1) at cancer diagnosis. When adjusting for sociodemographic and clinical factors, LNY >15 was significantly associated with improved DFS (adjusted HR [aHR]: 0.73, 95% CI: 0.54-0.98), locoregional recurrence (aHR: 0.68, 95% CI: 0.49-0.95), and regional failure (aHR: 0.61, 95% CI: 0.39-0.93).
    Conclusions: Our study findings suggested high LNY to be a strong independent predictor of various patient-level quality of surgical care metrics. The optimal LNY we found (15) was lower than the conventionally recommended (18), which calls for further research to establish validity in practice.
    Sprache Englisch
    Erscheinungsdatum 2024-02-12
    Erscheinungsland United States
    Dokumenttyp 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.27656
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  6. Artikel ; Online: Stereotactic body radiotherapy for distant metastases to the head and neck.

    Mutsaers, Adam / Abugharib, Ahmed / Poon, Ian / Loblaw, Joshua / Bayley, Andrew / Zhang, Liying / Chin, Lee / Galapin, Madette / Erler, Darby / Sahgal, Arjun / Higgins, Kevin / Enepekides, Danny / Eskander, Antoine / Karam, Irene

    Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

    2024  Band 32, Heft 4, Seite(n) 230

    Abstract: Purpose: To report clinical outcomes for patients with metastatic disease to the head and neck (HN) treated with stereotactic body radiation therapy (SBRT).: Methods: A retrospective review of patients treated with SBRT to HN sites from 2012 to 2020 ... ...

    Abstract Purpose: To report clinical outcomes for patients with metastatic disease to the head and neck (HN) treated with stereotactic body radiation therapy (SBRT).
    Methods: A retrospective review of patients treated with SBRT to HN sites from 2012 to 2020 was conducted. Treatment indications included the following: oligometastases, oligoprogression, and control a dominant area of progression (DAP). Kaplan-Meier method was used to estimate local control (LC), regional control (RC), overall survival (OS), and progression-free survival (PFS). Univariable (UVA) and multivariable analyses (MVA) were performed. Grade 3-4 acute and late toxicities were reported by the Common Terminology Criteria for Adverse Events v5.0.
    Results: Fifty-six patients (58 lesions) were analysed with a median follow-up of 16 months. Primary sites included lung (25.0%), kidney (19.6%), breast (19.6%) and other (35.8%). SBRT indications were as follows: oligometastases (42.9%), oligoprogression (19.6%) and local control of a dominant area of progression (37.5%). Most patients received SBRT to a single neck node (n = 47, 81.0%). Median SBRT dose was 40 Gy (range 25-50 Gy) in five fractions, with a median biologically effective dose (BED
    Conclusion: The use of SBRT for metastatic disease to the HN provided excellent LC rates with low rates of regional failure and an acceptable toxicity profile, highlighting its utility in these patients. Patients with oligometastatic disease had better OS and PFS than others.
    Mesh-Begriff(e) Humans ; Radiosurgery/adverse effects ; Radiosurgery/methods ; Lung Neoplasms/pathology ; Progression-Free Survival ; Lung/pathology ; Neck ; Retrospective Studies
    Sprache Englisch
    Erscheinungsdatum 2024-03-15
    Erscheinungsland Germany
    Dokumenttyp Journal Article
    ZDB-ID 1134446-5
    ISSN 1433-7339 ; 0941-4355
    ISSN (online) 1433-7339
    ISSN 0941-4355
    DOI 10.1007/s00520-024-08419-0
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  7. Artikel ; Online: Patient satisfaction with different types of craniofacial prostheses.

    Higgins, Kevin M / Gressmann, Kassandra / Yan, Bernie / Eskander, Antoine / Enepekides, Danny J / Blanas, Nick / Somogyi-Ganss, Eszter

    The Journal of prosthetic dentistry

    2022  

    Abstract: Statement of problem: A maxillofacial prosthesis represents an effective method of giving maxillofacial defects a positive esthetic appearance with minimal risk. However, studies of complications among prosthesis wearers are lacking.: Purpose: The ... ...

    Abstract Statement of problem: A maxillofacial prosthesis represents an effective method of giving maxillofacial defects a positive esthetic appearance with minimal risk. However, studies of complications among prosthesis wearers are lacking.
    Purpose: The purpose of this cross-sectional study was to determine levels of patient satisfaction with various maxillofacial prostheses and retention types, as measured through a survey questionnaire package.
    Material and methods: Patients treated at the Sunnybrook Health Sciences Center Craniofacial Prosthetics Unit (CPU) since 2015 were included. They had been treated according to a standardized protocol and answered a survey questionnaire package with the following sections: demographics, frequency of prosthesis usage, and the Toronto Outcome Measure for Craniofacial Prosthetics (TOMCP-27) survey addressing patient satisfaction. To be eligible for this study, patients must have been more than 18 years of age, in possession of a maxillofacial prosthesis, and received treatment at the Sunnybrook Health Sciences Center CPU since 2015.
    Results: A total of 157 patients were eligible and contacted, of whom 51 agreed to participate in the survey. The study population was overall extremely satisfied with their maxillofacial prostheses. In 77.8% of the TOMCP-27 questions, the largest group of patients chose the answer demonstrating the highest level of satisfaction. Of all prosthesis types surveyed, patients with auricular prostheses reported the greatest rates of satisfaction, with the entire group having selected answers corresponding to the highest levels of overall satisfaction. However, patients with orbital prostheses were more likely to experience varying degrees of dissatisfaction, with 72% of the highest reported levels of dissatisfaction being from this prosthesis group. In addition, patients with osseointegrated implant-retained prostheses reported higher satisfaction levels with other retention methods, with the bar clasp group outperforming the magnetic coupling retention group.
    Conclusions: Patients experienced an excellent overall rate of satisfaction with their maxillofacial prostheses. Future development should focus on the continued development of osseointegrated methods, improved magnetic coupling, and improved prosthesis technology, especially for orbital prostheses.
    Sprache Englisch
    Erscheinungsdatum 2022-09-24
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ZDB-ID 218157-5
    ISSN 1097-6841 ; 0022-3913
    ISSN (online) 1097-6841
    ISSN 0022-3913
    DOI 10.1016/j.prosdent.2022.08.019
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  8. Artikel ; Online: Length of Stay Prediction Models for Oral Cancer Surgery: Machine Learning, Statistical and ACS-NSQIP.

    Namavarian, Amirpouyan / Gabinet-Equihua, Alexander / Deng, Yangqing / Khalid, Shuja / Ziai, Hedyeh / Deutsch, Konrado / Huang, Jingyue / Gilbert, Ralph W / Goldstein, David P / Yao, Christopher M K L / Irish, Jonathan C / Enepekides, Danny J / Higgins, Kevin M / Rudzicz, Frank / Eskander, Antoine / Xu, Wei / de Almeida, John R

    The Laryngoscope

    2024  

    Abstract: Objective: Accurate prediction of hospital length of stay (LOS) following surgical management of oral cavity cancer (OCC) may be associated with improved patient counseling, hospital resource utilization and cost. The objective of this study was to ... ...

    Abstract Objective: Accurate prediction of hospital length of stay (LOS) following surgical management of oral cavity cancer (OCC) may be associated with improved patient counseling, hospital resource utilization and cost. The objective of this study was to compare the performance of statistical models, a machine learning (ML) model, and The American College of Surgeons National Surgical Quality Improvement Program's (ACS-NSQIP) calculator in predicting LOS following surgery for OCC.
    Materials and methods: A retrospective multicenter database study was performed at two major academic head and neck cancer centers. Patients with OCC who underwent major free flap reconstructive surgery between January 2008 and June 2019 surgery were selected. Data were pooled and split into training and validation datasets. Statistical and ML models were developed, and performance was evaluated by comparing predicted and actual LOS using correlation coefficient values and percent accuracy.
    Results: Totally 837 patients were selected with mean patient age being 62.5 ± 11.7 [SD] years and 67% being male. The ML model demonstrated the best accuracy (validation correlation 0.48, 4-day accuracy 70%), compared with the statistical models: multivariate analysis (0.45, 67%) and least absolute shrinkage and selection operator (0.42, 70%). All were superior to the ACS-NSQIP calculator's performance (0.23, 59%).
    Conclusion: We developed statistical and ML models that predicted LOS following major free flap reconstructive surgery for OCC. Our models demonstrated superior predictive performance to the ACS-NSQIP calculator. The ML model identified several novel predictors of LOS. These models must be validated in other institutions before being used in clinical practice.
    Level of evidence: Level 3 Laryngoscope, 2024.
    Sprache Englisch
    Erscheinungsdatum 2024-04-23
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ZDB-ID 80180-x
    ISSN 1531-4995 ; 0023-852X
    ISSN (online) 1531-4995
    ISSN 0023-852X
    DOI 10.1002/lary.31443
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  9. Artikel ; Online: Innovative insertion of the palmaris major tendon after lower lip reconstruction.

    Sahovaler, Axel / Higgins, Kevin / Deutsch, Konrado / Eskander, Antoine / Enepekides, Danny

    The Laryngoscope

    2019  Band 129, Heft 11, Seite(n) 2479–2481

    Mesh-Begriff(e) Aged ; Carcinoma, Squamous Cell/surgery ; Humans ; Lip/surgery ; Lip Neoplasms/surgery ; Male ; Mouth Neoplasms/surgery ; Reconstructive Surgical Procedures/methods ; Tendons/surgery
    Sprache Englisch
    Erscheinungsdatum 2019-02-06
    Erscheinungsland United States
    Dokumenttyp Case Reports ; Journal Article
    ZDB-ID 80180-x
    ISSN 1531-4995 ; 0023-852X
    ISSN (online) 1531-4995
    ISSN 0023-852X
    DOI 10.1002/lary.27825
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  10. Artikel ; Online: Oropharyngeal Cancer Staging Health Record Extraction Using Artificial Intelligence.

    Baran, Elif / Lee, Melissa / Aviv, Steven / Weiss, Jessica / Pettengell, Chris / Karam, Irene / Bayley, Andrew / Poon, Ian / Chan, Kelvin K W / Parmar, Ambica / Smoragiewicz, Martin / Klieb, Hagen / Truong, Tra / Maralani, Pejman / Enepekides, Danny J / Higgins, Kevin M / Eskander, Antoine

    JAMA otolaryngology-- head & neck surgery

    2024  

    Abstract: Importance: Accurate, timely, and cost-effective methods for staging oropharyngeal cancers are crucial for patient prognosis and treatment decisions, but staging documentation is often inaccurate or incomplete. With the emergence of artificial ... ...

    Abstract Importance: Accurate, timely, and cost-effective methods for staging oropharyngeal cancers are crucial for patient prognosis and treatment decisions, but staging documentation is often inaccurate or incomplete. With the emergence of artificial intelligence in medicine, data abstraction may be associated with reduced costs but increased efficiency and accuracy of cancer staging.
    Objective: To evaluate an algorithm using an artificial intelligence engine capable of extracting essential information from medical records of patients with oropharyngeal cancer and assigning tumor, nodal, and metastatic stages according to American Joint Committee on Cancer eighth edition guidelines.
    Design, setting, and participants: This retrospective diagnostic study was conducted among a convenience sample of 806 patients with oropharyngeal squamous cell carcinoma. Medical records of patients with staged oropharyngeal squamous cell carcinomas who presented to a single tertiary care center between January 1, 2010, and August 1, 2020, were reviewed. A ground truth cancer stage dataset and comprehensive staging rule book consisting of 135 rules encompassing p16 status, tumor, and nodal and metastatic stage were developed. Subsequently, 4 distinct models were trained: model T (entity relationship extraction) for anatomical location and invasion state, model S (numerical extraction) for lesion size, model M (sequential classification) for metastasis detection, and a p16 model for p16 status. For validation, results were compared against ground truth established by expert reviewers, and accuracy was reported. Data were analyzed from March to November 2023.
    Main outcomes and measures: The accuracy of algorithm cancer stages was compared with ground truth.
    Results: Among 806 patients with oropharyngeal cancer (mean [SD] age, 63.6 [10.6] years; 651 males [80.8%]), 421 patients (52.2%) were positive for human papillomavirus. The artificial intelligence engine achieved accuracies of 55.9% (95% CI, 52.5%-59.3%) for tumor, 56.0% (95% CI, 52.5%-59.4%) for nodal, and 87.6% (95% CI, 85.1%-89.7%) for metastatic stages and 92.1% (95% CI, 88.5%-94.6%) for p16 status. Differentiation between localized (stages 1-2) and advanced (stages 3-4) cancers achieved 80.7% (95% CI, 77.8%-83.2%) accuracy.
    Conclusion and relevance: This study found that tumor and nodal staging accuracies were fair to good and excellent for metastatic stage and p16 status, with clinical relevance in assigning optimal treatment and reducing toxic effect exposures. Further model refinement and external validation with electronic health records at different institutions are necessary to improve algorithm accuracy and clinical applicability.
    Sprache Englisch
    Erscheinungsdatum 2024-05-16
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ZDB-ID 2701825-8
    ISSN 2168-619X ; 2168-6181
    ISSN (online) 2168-619X
    ISSN 2168-6181
    DOI 10.1001/jamaoto.2024.1201
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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