Machine Learning Based Radiomic HPV Phenotyping of Oropharyngeal SCC: A Feasibility Study Using MRI

xlomafota13 shared this article with you from Inoreader Machine Learning Based Radiomic HPV Phenotyping of Oropharyngeal SCC: A Feasibility Study Using MRI Via The Laryngoscope Objectives To investigate whether a radiomic MRI feature‐based prediction model can differentiate oropharyngeal squamous cell carcinoma (SCC) according to the human papillomavirus (HPV) status. Study Design Retrospective cohort study. Methods Pretreatment MRI data from 62 consecutive patients with oropharyngeal SCC were retrospectively reviewed, and chronologically allocated to training (n = 43) and test sets (n = 19). Enhancing tumors were semi‐automatically segmented on each slice of the postcontrast T1WI to span the entire tumor volume, after registration of T2WI to postcontrast T1WI; 170 radiomic features were extracted from the entire tumor volume. Relevant features were selected and radiomics models were trained using least absolute shrinkage and selection operator (LASSO) logistic regression model with 10‐fold cross‐validation, after subsampling of training sets using synthetic minority over‐sampling technique to mitigate data imbalance. The selected features, weighted by their respective coefficients, were combined linearly to yield a radiomics score. The diagnostic performance of the radiomic score was evaluated using the area under the receiver operating characteristic curve (AUC). Results Six radiomic features, which revealed strong association with HPV status of oropharyngeal SCC, were selected using LASSO. The radiomics model yielded excellent performance on the training set (AUC, 0.982 [95% CI, 0.942–1.000]) and moderate performance on the test set (AUC, 0.744 [95% CI, 0.496–0.991]) for differentiating oropharyngeal SCC according to HPV status. Conclusions Radiomics‐based MRI phenotyping differentiates oropharyngeal SCC according to HPV status, and thus, is a potential imaging biomarker. Level of Evidence 3 Laryngoscope, 131:E851–E856, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Chronic Aspiration Pneumonitis Caused by Spontaneous Cerebrospinal Fluid Fistulae of the Skull Base

xlomafota13 shared this article with you from Inoreader Chronic Aspiration Pneumonitis Caused by Spontaneous Cerebrospinal Fluid Fistulae of the Skull Base Via The Laryngoscope Objectives/Hypothesis Spontaneous cerebrospinal fluid (CSF) leaks of the skull base are associated with obesity, multiparity, and elevated intracranial pressure. Although spontaneous CSF leaks often present with rhinorrhea, they can be an underdiagnosed cause of chronic aspiration pneumonitis, a complication that has not been previously reported in detail. Study Design Retrospective case series. Methods The authors retrospectively reviewed all patients undergoing surgical repair of CSF fistulae at the University of Southern California between 2011 and 2018 to identify those presenting with pulmonary symptoms including dyspnea, aspiration, chronic cough, and shortness of breath caused by chronic noniatrogenic CSF pneumonitis. Results Symptomatic chronic pneumonitis was evident in six of 20 patients with spontaneous CSF rhinorrhea. Five women (mean body mass index = 36) had CSF leaks arising from the fovea ethmoidalis (n = 4) and lateral sphenoid region (n = 1). One man had a middle fossa floor dehiscence draining through the eustachian tube. All patients had bilateral ground‐glass opacities in their lungs on computed tomography imaging that were attributed to spontaneous CSF fistulae arising from noniatrogenic skull base defects, and one patient underwent a biopsy of a lung lesion at another hospital showing chronic bronchiolitis and adjacent peribronchiolar metaplasia. Five patients underwent endoscopic endonasal repair using an autologous fascial graft and pedicled nasoseptal flap, and one underwent craniotomy for repair. All patients underwent successful repair with no complications or evidence of recurrence. Upon repair of the spontaneous CSF leaks, both pneumonitis symptoms and ground‐glass opacities on imaging resolved in all six cases. Conclusions Skull base CSF fistulae should be considered as a reversible cause of chronic pneumonitis that is not alleviated or worsens with standard treatment. Level of Evidence 4 Laryngoscope, 131:462–466, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Management and Outcomes of Sporadic Vestibular Schwannoma: A Longitudinal Study Over 12 Years

xlomafota13 shared this article with you from Inoreader Management and Outcomes of Sporadic Vestibular Schwannoma: A Longitudinal Study Over 12 Years Via The Laryngoscope Objectives To evaluate the management of sporadic vestibular schwannomas (VS) with a 12‐year follow‐up. Study Design Retrospective study of all VS patients initially treated in 2005 in a tertiary referent center. Methods Initial decision making for microsurgical resection (MSR) or wait‐and‐scan (WaS) was according to VS size and hearing; subsequently, MSR or stereotactic radiosurgery (SRS) was proposed dependent on VS growth and size, hearing, and patient's age or willingness. Results Two hundred and one sporadic VS were included. The first management apportionment was 120 WaS (61.5%), 72 MSR (37%), three SRS (1.5%), and six others refused MSR and were lost to follow‐up (LFU). Within 1 year, 95 (47%) VS were surgically removed; 17 (8.5%) were treated by SRS; and 35 (17.5%) were LFU. The proportions for SRS and LFU were virtually unchanged for the following years, and the proportion under MSR increased slightly within 3 years and then remained stable. Finally, at 12 years, 104 (51.5%) cases had been operated on, 21 (10.5%) treated by SRS, 23 (11.5%) still under WaS, and 53 (26.5%) LFU, which were mainly intracanalicular. The initially and subsequently operated cases presented similar hearing preservation rates and good facial nerve function outcomes. Conclusion This longitudinal study of a large number of VS, which were diagnosed over a short period of time and followed for 12 years, provides new information on both the natural history of these benign tumors and individual patient concerns. This study recommends use of the WaS policy for small and mid‐sized VS before active therapeutic decision making. Level of Evidence 3 Laryngoscope, 131:E970–E976, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Retropharyngeal Internal Carotid Artery Management in TORS Using Microvascular Reconstruction

xlomafota13 shared this article with you from Inoreader Retropharyngeal Internal Carotid Artery Management in TORS Using Microvascular Reconstruction Via The Laryngoscope Objectives Guidelines for transoral robotic surgery (TORS) have generally regarded patients with retropharyngeal carotid arteries as contraindicated for surgery due to a theoretical risk of intraoperative vascular injury and/or perioperative cerebrovascular accident. We aimed to demonstrate that careful TORS‐assisted resection and free flap coverage could not only avoid intraoperative injury and provide a physical barrier for vessel coverage but also achieve adequate margin control. Study Design: Retrospective cohort analysis. Methods Retrospective review of patients with oropharyngeal malignancies and radiologically confirmed retropharyngeal carotid arteries who underwent TORS, concurrent neck dissection, and free flap reconstruction between 2015 and 2019. Results Twenty patients were included, 19 (95.0%) with tonsillar tumors and one (5.0%) with a tongue base tumor with significant tonsillar extension. Eighteen patients (90.0%) received a radial artery forearm flap, one (5.0%) an ulnar artery forearm flap, and one (5.0%) an anteromedial thigh flap. All 20 (100%) flaps were inset through combined transcervical and transoral approaches without mandibulotomy. There were no perioperative mortalities, carotid injuries, oropharyngeal bleeds, cervical hematomas, or cerebrovascular accidents. One patient (5.0%) had a free flap failure requiring explant. All patients underwent decannulation and resumed a full oral diet. The mean length of hospitalization was 6.8 (standard deviation 1.2) days. One (5.0%) patient had a positive margin. Conclusion In this analysis, 20 patients with oropharyngeal malignancy and retropharyngeal carotid arteries underwent TORS, neck dissection, and microvascular reconstruction without serious complication (perioperative mortality, vascular injury, or neurologic sequalae) with an acceptable negative margin rate. These results may lead to a reconsideration of a commonly held contraindication to TORS. Level of Evidence 3 Laryngoscope, 131:E821–E827, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Relevance of and Surgical Approach to the Suprahyoid Region in Thyroglossal Duct Surgery

xlomafota13 shared this article with you from Inoreader The Relevance of and Surgical Approach to the Suprahyoid Region in Thyroglossal Duct Surgery Via The Laryngoscope Objectives Persistent or recurrent disease following excision of a thyroglossal duct cyst/sinus (TGDC) is often found in the suprahyoid region. Cadaver dissections were performed to identify and name important surgical landmarks in the suprahyoid area; a histopathologic analysis of surgical specimens was completed to determine the incidence and extent of microscopic disease; and clinical outcomes were compared to determine the efficacy of a specific anatomic dissection. Study Design Retrospective case series. Methods Standardized dissections of four adult cadavers were performed. Consecutive surgical specimens were examined for evidence of microscopic TDGC disease in the suprahyoid region, measuring the greatest width and length of disease. A retrospective review of all consecutive TGDC procedures was completed. Results The important surgical landmarks in the suprahyoid area were identified in all cadavers. Microscopic disease in the suprahyoid area was found in 79% (37 of 47) of surgical specimens. The mean greatest length and width of microscopic disease was 12.4 mm and 1.4 mm, respectively. Following identification of these landmarks, the incidence of recurrent or persistent disease decreased (P = .02) from 5% (8 of 159) to 0% (0 of 112). Conclusion The majority of pediatric patients with a TGDC will have microscopic disease in the suprahyoid area. The surgical landmark of the fascial plane between the geniohyoid and genioglossus muscles demarcates the anterior and lateral borders of resection in the suprahyoid area. This approach can be used as a reliable and easily reproducible technique in TGDC surgery to increase confidence of achieving complete removal of disease in the suprahyoid area, avoiding persistent or recurrent disease and a revision procedure. Level of Evidence 4 Laryngoscope, 131:553–558, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Management of the Acute Loss of a Free Flap to the Head and Neck—A Multi‐institutional Review

xlomafota13 shared this article with you from Inoreader Management of the Acute Loss of a Free Flap to the Head and Neck—A Multi‐institutional Review Via The Laryngoscope Objectives/Hypothesis To review the management of failed free tissue transfers among four large institutions over a 13‐year period to provide data and analysis for a logical, algorithmic, experience‐based approach to the management of failed free flaps. Study Design Retrospective case series. Methods A multi‐institutional retrospective chart review of free tissue transfers to the head and neck region between 2006 and 2019 was performed. Patients with a failed free flap during their hospitalization after surgery to the head and neck were identified and reviewed. Patient age, co‐morbidities, risk factors, flap characteristics, tumor specifics, and length of hospital stay were reviewed, collected, and analyzed. Results One hundred eighteen flap failures met criteria. The most common failed flap in this review was the osteocutaneous flap 52/118 (44%). The recipient site of the initial free flap (P < .001) was the only statistically significant parameter strongly correlated with management. Osteocutaneous flap failures, fasciocutaneous, bowel, and muscle‐only flaps tended to be managed most commonly with a second free flap. Myocutaneous flap failures were managed equally with either a second free flap or a regional flap. Conclusions The most important factor in management of a failed free flap is the recipient site. A second free flap is often the preferred treatment, but in the acute setting, local or regional flaps may be viable options depending on the recipient site, circumstances of flap loss, and patient‐ specific comorbidities. An algorithm for management of the acute flap loss is presented in this review. Level of Evidence 4 Laryngoscope, 131:518–524, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

What Is the Extent of Neck Dissection in Medullary Thyroid Carcinoma?

xlomafota13 shared this article with you from Inoreader What Is the Extent of Neck Dissection in Medullary Thyroid Carcinoma? Via The Laryngoscope View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.