BackgroundIt is crucial to find a balance between functional and oncological outcome when choosing an adequate method for the management of vocal fold leukoplakia. Therefore, a detailed examination is a milestone in the decision-making process.AimTo examine whether narrow-band imaging (NBI) can be helpful in vocal fold assessment in the case of leukoplakia and how to overcome the “umbrella effect”- understood as the submucosal vascular pattern hidden under the plaque.Material and methodsProspective cohort of 41 consecutive patients. Inclusion criteria: vocal fold leukoplakia, no previous procedures (surgery, radiotherapy), and preoperative endoscopy with an optical filter for NBI. Two groups: “suspicious” and “normal”, according to the submucosal microvascular pattern of peripheral regions of the mucosa surrounding the plaque, were distinguished. Patients were qualified for a full-thickness or partial-thickness biopsy, respectively. Criteria defining suspected characters were well-demarcated brownish areas with scattered brown spots corresponding to type IV, Va, Vb, and Vc NI classifications.ResultsIn 22/41 (53.7%) patients with “suspected” microvascular pattern, full-thickness biopsy was performed. Moderate and severe dysplasia was revealed in 15 type IV and 7 type Va NI patients. In 19/41 (46.3%) patients with proper NBI vessel pattern treated by partial-thickness biopsy, hyperkeratosis was diagnosed. There was a strong correlation between the NBI pattern and final histology: Chi2 (2) = 41.0 (p = 0.0000).ConclusionThe results demonstrate that NBI endoscopic assessment of the submucosal microvascular pattern of mucosa surrounding the plaque can be an effective method to categorise the risk in vocal fold leukoplakia prior to treatment.

Laryngeal cancer (LC) patients who meet the age and smoking criteria of the U.S. Preventive Services Task Force (USPSTF) for annual CT lung screening were analysed for pulmonary nodules (PN) detection and secondary lung cancer (SLC) diagnosis. This is a retrospective chart review of LC patients treated at Johns Hopkins Hospital from January 2010 to December 2017. The study population included patients who met USPSTF criteria by age and smoking history for annual chest screening and were followed for at least 3 consecutive years. A total of 998 LC patients' records were reviewed, of which 151 met the inclusion criteria. Inadequate follow-up period (37% of excluded cases) was the most common reason for exclusion, followed by not meeting USPSTF age criteria (27% excluded cases). In seventy-eight patients (n = 78, 52% of analysed patients) PN were reported. Nine individuals (6% of analysed patients) were diagnosed with SLC. Age over 70 (p = 0.003) was an independent predictor of malignancy. White race and smoking history over 40 pack-years were positively associated with a pulmonary nodule detection (p = 0.037 and p = 0.044, respectively). The incidence of PN and SLC in patients with LC is high. Many patients with laryngeal cancer meet the formal guidelines for USPSTF screening, and should be screened annually according to evidence-based medicine for the early detection of secondary lung cancers.Approximately 13,150 new cases of laryngeal cancer (LC) are diagnosed every year in the USA 1 . The most pronounced risk factors remain tobacco smoking and alcohol consumption 2 , and the 5 year overall survival has not changed significantly over the last 20 years and it is currently estimated at approximately 60% 1 . One of the significant reasons for the reduced overall survival is that the incidence of secondary primary lung cancer (SPLC) in patients affected by LC ranges from 5 to 19% 3-6 , which has a significant impact on outcome. The risk of pulmonary nodules is even higher and has been reported to be up to 58% 7 in head and neck cancer (HNC) patients.One of the national attempts to reduce the smoking-related mortality was the introduction of the U.S. Preventive Services Task Force (USPSTF) recommendations for annual lung cancer screening with low-dose CT in a group of high-risk smokers. This screening program has proven to prevent a significant number of lung cancer-related deaths in patients who received three CT scans over the course of two years. The USPSTF recommends annual chest imaging with low-dose CT for adults aged 55-80, with at least 30 pack-years smoking history in current smokers or those who have quit within the past 15 years 8 . However, one of the exclusion criterion of the large clinical trials 9 justifying implementation of screening program was previously known malignancy. Practically, this meant that HNC patients with substantial smoking history and obvious cancer predisposition were excluded.The aim of this study was therefore to assess the frequency of incidental findings on CT screening such as ...

The purpose of the study was to assess the role of laser-assisted posterior cordectomy in the management of patients with bilateral vocal cord paralysis. We aimed an analysis of 132 consecutive patients treated by CO2 laser posterior cordectomy, aged 38–91, 31% tracheotomized on admission. Cordectomy was performed under microlaryngoscopy using CO2 laser (Lumenis AcuPulse 40 CO2 laser, wavelength 10.6 μm, Lumenis Ltd., Yokneam, Israel). We looked at the number of laser glottic procedures necessary to achieve decannulation in tracheotomized patients and to achieve respiratory comfort in non-tracheotomized subjects and we evaluated the two groups for differences in patient characteristics. In tracheotomized patients, we also assessed factors affecting the success of decannulation and we evaluated the impact of tracheotomy on patients’ lives. Decannulation was performed in 63% of tracheotomized patients. In terms of the number of procedures, 54% (14), 19% (5), and 27% (7) tracheotomized vs. 74% (61), 24% (20), and 2% (2) non-tracheotomized subjects underwent one, two, or three procedures, respectively. In the group of tracheotomized patients who were successfully decannulated, the number of multiple laser-assisted procedures was significantly higher than in the group of non-tracheotomized subjects with respiratory comfort after treatment (p = 0.04). Advanced age (> 66 years), comorbidities (diabetes, gastroesophageal reflux disease (GERD)), multiple thyroid surgeries, and tracheotomy below the cricoid cartilage were found to decrease the likelihood of successful decannulation. Posterior cordectomy is a simple method allowing for airway improvement and decannulation in patients with bilateral vocal cord paralysis. It is less effective in tracheotomized subjects with diabetes or GERD, older than 66 years old, after two or more thyroidectomies.

Background: Occult metastases are common in patients with oral squamous cell carcinoma (OSCC) which is why elective neck dissection, adjuvant radiotherapy or watchful waiting have been treatment options after surgical removal of the primary tumour. Sentinel lymph node biopsy (SLNB), has lately emerged as a novel possibility in treatment planning. Even though the SLNB technique is constantly improving, it has not yet been firmly established in the assessment of head and neck cancer. Objectives: To establish a reliable and clinically useful protocol for SLNB in staging/elective neck dissection in oral cancer. Methods: 14 consecutive patients with T1-T2 N0 oral cancer were enrolled when scheduled for elective neck dissection. Results: This study outlines various techniques improving SLNB in head and neck cancer. After evaluation, a combination of techniques was found to constitute a reliable, clinically adaptable work concept. The suggested procedure starts with the pre-surgical injection of radioactive technetium 99Tcm carried on tilmanocept (Lymphoseek®) at the tumour site. The radioactivity in the lymph node is then visualized preoperatively with Single Photon Emission Computed Tomography (SPECT/CT). Intraoperatively, indocyanine green (ICG) is injected and a sentinel node is visualized with near infrared light. To support the sentinel node detection, the surgeon uses a hand held gamma detection probe. This approach results in a reproducible and reliable detection of sentinel nodes. Conclusion: This paper presents a novel protocol for identification of sentinel node in the head and neck region. The protocol additionally enables the use of flow cytometry analysis of resected lymph nodes.

Objectives/Hypothesis: The purpose of this study is to develop consensus on key points that would support the use of systemic bevacizumab for the treatment of recurrent respiratory papillomatosis (RRP), and to provide preliminary guidance surrounding the use of this treatment modality.Study Design: Delphi method-based survey series. Methods: A multidisciplinary, multi-institutional panel of physicians with experience using systemic bevacizumab for the treatment of RRP was established. The Delphi method was used to identify and obtain consensus on characteristics associated with systemic bevacizumab use across five domains: 1) patient characteristics; 2) disease characteristics; 3) treating center characteristics; 4) prior treatment characteristics; and 5) prior work-up.Results: The international panel was composed of 70 experts from 12 countries, representing pediatric and adult otolaryngology, hematology/oncology, infectious diseases, pediatric surgery, family medicine, and epidemiology. A total of 189 items were identified, of which consensus was achieved on Patient Characteristics (9), Disease Characteristics (10), Treatment Center Characteristics ( 22), and Prior Workup Characteristics (18).Conclusion: This consensus statement provides a useful starting point for clinicians and centers hoping to offer systemic bevacizumab for RRP and may serve as a framework to assess the components of practices and centers currently using this therapy. We hope to provide a strategy to offer the treatment and also to provide a springboard for bevacizumab's use in combination with other RRP treatment protocols. Standardized delivery systems may facilitate research efforts and provide dosing regimens to help shape best-practice applications of systemic bevacizumab for patients with early-onset or less-severe disease phenotypes.

edically unexplained symptoms are a classification commonly encountered in clinical medicine but are not yet known to have an organic origin. 1,2 Medically unexplained symptoms occur in chronic symptom complexes, which are grouped into different diagnoses such as fibromyalgia syndrome (FMS), irritable bowel syndrome (IBS), and chronic fatigue syndrome (CFS). As a group and individually, these 3 diseases are common, with an estimated prevalence ranging from 230 to 20 000 per 100 000 persons worldwide. [3][4][5][6] Ascertaining the number of patients with medically unexplained symptoms is challenging because of physicians' lack of awareness and the reluctance of most patients with these conditions to seek help in the health care system or receive medical treatment. [7][8][9] Because all of these diseases are defined by their physical symptoms, given that no testing is performed to confirm an underlying organic disease, 10 they are a cost burden to the health care system; these conditions can be diagnosed only by definitively excluding the organic disease. 11 Furthermore, it is uncertain whether treatment itself is effective. 9,12 Commonly encountered chronic pain syndromes (CPSs), such as FMS, IBS, and CFS, are traditionally considered as distinct entities. However, they may exist on a spectrum with a shared pathophysiology, and all of them may be grouped under CPS spectrum disorders. 10 Supporting this hypothesis is that these disorders share a set of multiple symptoms, coexisting psychiatric diagnoses such as anxiety or depressive disorders, and treatment involving antidepressants. 13 Voice and airway symptoms are not part of the formal diagnostic criteria for FMS, IBS, and CFS, but our clinical obser-IMPORTANCE Fibromyalgia syndrome (FMS), irritable bowel syndrome (IBS), and chronic fatigue syndrome (CFS) are traditionally considered as distinct entities grouped under chronic pain syndrome (CPS) of an unknown origin. However, these 3 disorders may exist on a spectrum with a shared pathophysiology. OBJECTIVE To investigate whether the clinical presentation of FMS, IBS, and CFS is similar in a population presenting with voice and laryngeal disorders. DESIGN, SETTING, AND PARTICIPANTSThis case series was a retrospective review of the medical records and clinical notes of patients treated between January 1, 2016, and December 31, 2017, at the Johns Hopkins Voice Center in Baltimore, Maryland. Patients with at least 1 CPS of interest (FMS, IBS, or CFS) were included (n = 215), along with patients without such diagnoses (n = 4034). Diagnoses, demographic, and comorbidity data were reviewed. Diagnoses related to voice and laryngeal disorders were subdivided into 5 main categories (laryngeal pathology, functional voice disorders, airway problems, swallowing problems, and other diagnoses).MAIN OUTCOMES AND MEASURES Prevalence and odds ratios of 45 voice and laryngeal disorders were reviewed. Odds ratios (ORs) were calculated by comparing patients with CPS with control patients. RESULTSIn total, 4249 individuals were ...

SUMMARY A parotid abscess is a dangerous complication of parotitis. In this study, we aimed to define current treatment concepts for parotid abscess, focusing on different management options. The authors performed a PRISMA-compliant systematic review across multiple databases including all original studies published until January 2021 focusing on treatment of parotid abscess. Studies specifying treatment modalities and treatment success rates were included based on abstract and full-text selection. The authors assessed study quality, demographics, success rates, management modalities and adverse events. Among 1,318 citations, 18 studies met our inclusion criteria. Twelve studies relied only on incision and drainage with antibiotic therapy; the remaining 6 compared different treatment modalities (incision and drainage versus exclusive medical therapy or ultrasound-guided drainage). Heterogeneity between studies precluded meta-analysis of data. The review showed that antibiotics remain the mainstay of treatment for parotid abscess. Conversely, the role of incision and drainage, and aspiration should be studied further. The higher rate of complications following incision and drainage suggests a more conservative approach is needed. Incision and drainage remain the main salvage option for conservative treatment failures.

Introduction: Treatment planning in T2, T3 laryngeal carcinoma is based on clinical assessment and radiological imaging. However, to delineate precise mucosal margins for transoral laser microsurgery (TLM), a high class, sophisticated endoscopy is indispensable. Narrowband imaging (NBI) which is an optical filter technology, seems to be a useful adjunctive tool in marking superficial margins. Materials and Methods: A total of 98 patients diagnosed with HNSCC underwent cordectomies and were enrolled in the evaluation. T2 and T3 stage cancer were diagnosed in 90 and 8 patients, respectively. Intraoperatively, prior to the first laser shot, all anatomical sites were endoscopically evaluated by WL and NBI. Results: In 10/98 patients (10.2%), 10 samples were taken based only on NBI findings to guarantee better delineation of superficial margins. The result of histology revealed moderate dysplasia in 4 cases (40%), severe dysplasia in 2 (20%), carcinoma in situ in 3 (30%) and hyperkeratosis in 1 (10%). Based on presented results, combined NBI/WL endoscopy reached the sensitivity of 100%, specificity 98.88%, positive predictive value 90%, negative predictive value 100% and accuracy 98.98%. All patients had clear margins according to definitive histology results. Discussion: In this paper, we aimed to assess the usefulness of NBI in intraoperative imaging of laryngeal mucosa and delineation of superficial margins in patients with selected T2 and T3 laryngeal cancer treated with TLM. We proved in our study that with the support of NBI endoscopy, it is possible to increase the accuracy of superficial resection margins in patients with moderately advanced laryngeal cancer (T2, T3).