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Cannady S.B.,Head and Neck Center | Dean N.,University of Alabama at Birmingham | Kroeker A.,Oregon Health And Science University | Albert T.A.,Oregon Health And Science University | And 2 more authors.
Head and Neck | Year: 2011

Background. The purpose of this study was to determine factors to predict the success of free flap surgery in the treatment of osteoradionecrosis (ORN). Methods. Univariate analysis of overall and flap complications was performed. The effect of time to ORN, and the time interval between ORN to reconstruction was evaluated. Results. Fifty-five flaps on 53 patients for ORN were done with a 90% resolution rate. Univariate parameter analysis was significant for infield mandibulotomy. An increased time interval from radiation therapy (XRT) to ORN development significantly predicted for flap-specific complications and flap loss (p <.05). Increased time from ORN diagnosis to flap surgery resulted in greater length of bone involvement (p =.01). Anastomotic complications occurred in 13 cases resulting in 7 complete flap losses. Conclusion. An increased risk of complication was encountered with greater time from XRT to ORN. Thus, in patients developing ORN long after treatment, surgery should be accordingly more aggressive. Copyright © 2009 Wiley Periodicals, Inc. Source

Gould J.,St Louis Sinus Center | Alexander I.,New Mexico Sinus Institute | Tomkin E.,Head and Neck Center | Brodner D.,Center for Sinus
American Journal of Rhinology and Allergy | Year: 2014

Background: The objective of this prospective, multicenter study was to assess 1-year changes in sinonasal symptoms and health care use after office-based multisinus balloon dilation. Methods: Adults diagnosed with chronic or recurrent acute rhinosinusitis per the 2007 adult sinusitis guidelines were enrolled in this Institutional Review Board-approved study. Balloon dilation of the maxillary sinuses/ethmoid infundibula with or without frontal or sphenoid ostial dilation was performed in the physician's office under local anesthesia. Intraoperative procedure technical success and subject procedure tolerance were recorded. Efficacy was assessed using the patient-reported 20-item Sino-Nasal Outcome Test (SNOT-20) and Rhinosinusitis Symptom Inventory (RSI). Complications and revision surgeries were also recorded. Results: A total of 313 ostial dilations were attempted and 307 were successfully completed (98.1%) in 81 subjects. Mean procedure tolerance was 2.8 ± 2.2 (0 = no pain; 10 = severe pain). Clinically meaningful and statistically significant (p < 0.0001) mean SNOT-20 symptom improvement was observed at 1 and 6 months and sustained through 1 year. The RSI treatment effect for all major rhinosinusitis symptoms was "large" and improvement in each was significant (p < 0.0001). Compared with the previous 1-year period, patients reported an average of 2.3 fewer acute sinus infections (p < 0.0001), 2.4 fewer antibiotic courses taken (p < 0.0001), and 3.0 fewer sinus-related physician visits (p < 0.0001) after balloon dilation. No serious device or procedure-related adverse events occurred. One subject (1.3%) underwent revision surgery. Conclusion: In-office, multisinus balloon dilation is safe, effective, and well tolerated. Patients reported significant reductions in both sinonasal symptoms and health care use after balloon dilation. Efficacy observed at 1 and 6 month follow-up was sustained through 1 year with a very low rate of revision surgery. This study was a part of the clinical trial NCT01612780 registered at www.clinicaltrials.gov Copyright © 2014, OceanSide Publications, Inc. Source

Howe D.J.,Head and Neck Center | Skinner D.W.,Head and Neck Center
Ear, Nose and Throat Journal | Year: 2012

Epistaxis is a common emergency seen by the otolaryngologist. A minority of cases require surgical intervention. Multiple surgical procedures have been tried in the past, including endoscopic ligation of the sphenopalatine artery (ELSPA), which is considered an effective surgical modality in the management of epistaxis. This study examines the outcome of 33 ELSPA procedures over a 5-year period. Three of 4 cases that were not controlled with ELSPA were successfully managed with subsequent anterior ethmoidal ligation. Failed ELSPA procedures may represent an incorrect choice of procedure rather than a failure of the procedure. High-resolution computed tomography can identify the position of the anterior ethmoidal artery; it may be possible to infer vulnerability to hemorrhage from this artery and hence target procedure selection.© 2011, Vendome Group, LLC. Source

Jerjes W.,University of Baghdad | Jerjes W.,University College London | Jerjes W.,Leeds Institute of Molecular Medicine | Hamdoon Z.,University of Baghdad | And 4 more authors.
Head and Neck Oncology | Year: 2012

Photodynamic therapy (PDT) is a minimally-invasive surgical tool successfully targeting premalignant and malignant disorders in the head and neck, gastrointestinal tract, lungs and skin with greatly reduced morbidity and disfigurement. The technique is simple, can commonly be carried out in outpatient clinics, and is highly acceptable to patients. The role of photodynamic therapy in the management of oral potentially malignant disorders and early oral cancer is being discussed. © 2012 Jerjes et al.; licensee BioMed Central Ltd. Source

Abbas S.,Head and Neck Center | Jerjes W.,University College London | Jerjes W.,University of Leeds | Upile T.,Head and Neck Center | And 3 more authors.
Photodiagnosis and Photodynamic Therapy | Year: 2012

We report on the application of photodynamic therapy (PDT) in the management of Kimura disease. A 58-year-old Asian male was offered this modality to assess the possibility to control disease progression. The patient was managed with surgery and the disease recurred and caused facial disfigurement. PDT was offered after careful discussion at UCLH multidiscipline meeting. The photosensitiser "mTHPC" was introduced intravenously 96. h prior to delivering the light under ultrasound guidance. Magnetic resonance images showed moderate-significant reduction of the disease volume. Fourteen months post-PDT, the disease started re-growing and the patient subsequently underwent one further round of PDT which was as successful as the first round in reducing the facial disfigurement. Photodynamic therapy was very effective in controlling disease progression in this patient who suffers from Kimura disease. © 2011 Elsevier B.V. Source

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