Radiation therapy is an important and commonly used treatment modality for head and neck cancers. Osteoradionecrosis (ORN) is a potential debilitating complication of treatment, which most commonly affects the mandible. Management strategies are tailored to the severity of disease. Medical management including oral rinses, irrigations, antibiotics, and pharmacological treatments is viable for mild-to-moderate ORN. More severe disease is best addressed with a combination of medical management and surgical intervention aimed at aggressively removing devitalized tissue until bleeding bone is encountered and reconstructing the soft tissue and bone defect. Reconstruction with either regional vascularized flaps or vascularized osteocutaneous free flaps in case of larger full-thickness bone defects (greater than 6 cm) or anterior mandible (medial to mental foramen) is most appropriate. Maxillary ORN complications can present with a wide range of functional problems and facial disfigurement. Life-threatening and time-sensitive problems should be treated first, such as skull base bone coverage or correction of severe ectropion, to avoid blindness from exposure keratopathy. Then, less time-sensitive issues can be addressed next, such as nasal obstruction, velopharyngeal insufficiency, and chronic tearing. It may require a combination of specialists from different disciplines to address various issues that can arise from maxillary ORN.
Objective: Determine whether social media platforms can influence article impact as measured by citations. Methods: Cross-sectional study that analyzed articles published in the top 10 otolaryngology journals by Eigenfactor score in January 2015. Total accumulated Twitter mentions and citations were recorded in 2021. The main outcomes examined the difference in citations, tweets, article types, and author counts accumulated over a 5-year period for all articles that were either tweeted or nontweeted. Results: A total of 3094 articles were included for analysis. The average article was cited 11.2 ± 13.2 times and tweeted 2.10 ± 4.0 times. Sixty-four percent of the articles had at least one tweet. Over the study period, there was a statistically significant difference in mean number of citations between tweeted articles (12.1 ± 15.0) versus nontweeted articles (9.6 ± 10.5) citations, representing a 26% difference ( P < .001). Review articles had the highest mean citations (19.4 ± 23.4) while editorials had the lowest mean citations (2.8 ± 6.9). Tweets peaked in the year of publication, but citations continued to rise in the subsequent years. Tweeted articles’ peak citation rate change was +1.27 mean citations per year, compared to +0.99 mean citations per year in nontweeted articles. The mean author count in tweeted articles (5.40 ± 3.1) was not significantly different than the mean author count in nontweeted articles (5.19 ± 2.65, P = .0794). Conclusion: These data suggest a moderate correlation between tweets and article citations, but a clear difference in the number of citations in articles tweeted versus those with no tweets. Thus, dissemination of knowledge may be impacted by social medial platforms such as Twitter.
Posterior glottic stenosis (PGS) is a process that results in partial or total fixation of the vocal folds. Type I PGS (PGS-1) is an uncommon clinical entity that results from an interarytenoid adhesion/scar band that is separate from the posterior interarytenoid mucosa. We present a case series of patients with PGS-1 treated at our institution to contribute to the understanding of this complex clinical entity.
Introduction: Epithelioid sarcoma is a rare soft tissue malignancy that usually presents in the distal extremities along fascial planes, aponeuroses or tendon sheaths. Very rarely, it presents as a primary or metastatic lesion of the head neck. Methods: Chart review and comprehensive literature review using PubMed and Google Scholar. Results: A 17-year-old non-smoker was referred for evaluation of an ulcerative lesion of the right anterior-lateral tongue, progressing over several months. Incisional biopsy was concerning for squamous cell carcinoma. He underwent partial glossectomy and bilateral selective neck dissections, with reconstruction using a radial forearm free flap. Final pathology was consistent with epithelioid sarcoma, proximal type, demonstrating perineural invasion and close margins. Post-operative PET scan showed no persistent nor metastatic disease. He underwent post-operative radiation therapy to a total dose of 56 Gy to the primary site. Conclusion: Epithelioid sarcoma is a rare malignancy usually presenting in the extremities of young adults, which uncommonly presents in the head and neck as a primary or metastatic lesion. The infrequency of these lesions has prevented development of evidence-based treatment recommendations. As with most sarcomas, surgery is the mainstay of therapy for epithelioid sarcoma, while radiation has been used in an adjunctive role. Although a rare lesion, epithelioid sarcoma should be considered in the differential diagnosis for atypical epithelioid lesions of the tongue and oral cavity when patient demographics, gross lesion characteristics, or histopathology are not entirely consistent with more common lesions, such as squamous cell carcinoma.
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