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Now showing items 1 - 16 of 2399

  • Incidental Findings on FDG PET/CT in Head and Neck Cancer

    Britt, Christopher J.   Maas, Austin M.   Kennedy, Tabassum A.   Hartig, Gregory K.  

    Objective 18F-fluoro-deoxy-glucose positron emission tomography/computed tomography (FDG PET/CT) imaging is common in head and neck cancer and often identifies incidental findings that necessitate additional patient evaluations. Our goal was to assess the frequency and nature of these incidental imaging findings on FDG-PET/CT. Study Design Retrospective cohort study. Setting Tertiary medical center. Subjects and Methods All patients with head and neck cancer who had undergone FDG-PET/CT imaging between January 2014 and June 2015 at our institution were evaluated for incidental findings. Results A total of 293 patients met criteria; more than one-third (n =3D 103) had at least 1 finding unrelated to their head and neck cancer, for a total of 134 incidental findings. Incidental findings within the head and neck (33.5% of all) excluding the thyroid were most common: 35% incidental findings were concerning for malignancy; of these, 25.5% were malignant with further workup. Recommendations were given by the head and neck radiologist on 72 (53.7%) findings: 74.5% of potentially malignant findings and 42.5% of benign findings had recommendations for follow-up. Significantly more patients with findings described as malignant were given recommendations for follow-up (P =3D .0004). Conclusion Incidental findings on FDG-PET/CT are present in more than one-third of patients with head and neck cancer. More than one-third of incidental findings were concerning for malignancy. This study illustrates how the incidental findings discovered on FDG PET/CT frequently necessitate additional evaluations unrelated to the index head and neck cancer. The impact of these additional assessments on the cost and quality of health care warrants future evaluation.
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  • A Review of and Algorithmic Approach to Soft Palate Reconstruction

    Britt, Christopher J.   Hwang, Michelle S.   Day, Andrew T.   Boahene, Kofi   Byrne, Patrick   Haughey, Bruce H.   Desai, Shaun C.  

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  • Contemporary management of advanced laryngeal cancer

    Britt, Christopher J.   Gourin, Christine G.  

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  • Energy-Based Facial Rejuvenation

    Britt, Christopher J.   Marcus, Benjamin  

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  • Incidental Findings on FDG PET/CT in Head and Neck Cancer

    Britt, Christopher J.   Maas, Austin M.   Kennedy, Tabassum A.   Hartig, Gregory K.  

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  • Metastatic synovial sarcoma of the scalp: Case report

    Lippert, Dylan C.   Britt, Christopher J.   Pflum, Zachary E.   Rush, Patrick S.   Hartig, Gregory K.  

    BackgroundSynovial sarcoma is a malignant tumor of soft tissue that is rarely found in the head and neck. Even less common are metastasis within the head and neck. MethodsWe describe a case of a delayed metastatic synovial sarcoma to the scalp. A man who had been diagnosed and treated 16 years previously for monophasic synovial sarcoma of the groin, presented with a new scalp lesion confirmed to be metastatic monophasic synovial sarcoma. Wide local excision and sentinel lymph node biopsy (SLNB) were performed and adjuvant radiation therapy was deferred. ResultsA positron emission tomography (PET)/CT was obtained 3 months after surgery and showed no evidence of local recurrence or metastatic disease. ConclusionThis case report describes a rare case of synovial sarcoma metastasizing to the scalp. The genetic, histopathologic, and clinical features of synovial sarcoma are reviewed with a focus on their manifestation and management within the head and neck. (c) 2015 Wiley Periodicals, Inc. Head Neck 38: E45-E48, 2016
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  • Tracheal exposure: Anticipatory management of the difficult airway

    Britt, Christopher J.   Rohrbach, Marc R.   McCulloch, Timothy M.  

    Background. When a patient cannot be intubated or ventilated, cricothyrotomy is indicated. Risks associated with emergent cricothyrotomy are significant, and this procedure typically requires revision. Additional options for establishing an emergent airway are limited. Thus, elective tracheotomy to ensure a safe airway after procedures involving the upper aerodigestive tract is common. Although safe and effective overall, this procedure is not without additional risks, added resources, complex cares, and extended hospitalizations. Methods. We present a case in which exposure of the anterior trachea was performed without tracheotomy in a patient with a high-risk airway undergoing an open partial laryngectomy. Results. The patient did not develop respiratory distress postoperatively and was able to avoid a tracheostomy and its associated cares. Conclusion. Pretracheotomy with tracheal exposure simplifies emergent surgical access to the airway. We believe tracheal exposure in the appropriately selected patient is a safe and cost-effective alternative to elective tracheotomy. (C) 2016 Wiley Periodicals, Inc.
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  • Tyrosine Kinase Inhibitor Use and Wound Healing in Tracheoesophageal Punctures

    Britt, Christopher J.   Russell, Jonathon O.  

    Tyrosine kinase inhibitors (TKIs) aid in prolonging life in patients with advanced locoregional thyroid malignancy. Such patients may undergo total laryngectomy for local disease control and tracheoesophageal puncture (TEP) for speech rehabilitation. Enlargement of TEP fistulas is usually attributed to wound healing issues and leads to major complications. Four laryngectomies with TEP were performed between 2015 and 2016 and subsequently placed on a TKI. Three patients developed a complication after TKI treatment, and 2 patients had a tracheoesophageal fistula. Patients should be counseled about possible wound healing risks associated with TKIs.
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  • Quality indicators of laryngeal cancer care in commercially insured patients

    Britt, Christopher J.   Chang, Hsien-Yen   Quon, Harry   Kang, Hyunseok   Kiess, Ana P.   Eisele, David W.   Frick, Kevin D.   Gourin, Christine G.  

    ObjectiveTo examine associations between quality, complications, and costs in commercially insured patients treated for laryngeal cancer. Study DesignRetrospective cross-sectional analysis of MarketScan Commercial Claim and Encounters data (Truven Health Analytics, Ann Arbor, Michigan, U.S.A.). MethodsWe evaluated 10,969 patients diagnosed with laryngeal cancer from 2010 to 2012 using cross-tabulations and multivariate regression. Using quality indicators derived from guidelines for recommended care, summary measures of quality were calculated for diagnosis, initial treatment, surveillance, treatment for recurrence, performance, and an overall summary measure of quality. ResultsHigher-quality care in the initial treatment period was associated with lower odds of 30-day mortality (odds ratio [OR] =3D 0.21, 95% confidence interval [CI] [0.04-0.98]), surgical complications (OR =3D 0.39 [0.17-0.88]), and medical complications (OR =3D 0.68 [0.49-0.96]). Mean incremental 1-year costs were higher for higher-quality diagnosis ($20,126 [$14,785-$25,466]), initial treatment ($17,918 [$10,481-$25,355]), and surveillance ($25,424 [$20,014-$30,834]) quality indicators, whereas costs were lower for higher-quality performance measures (-$45,723 [-$56,246--$35,199]) after controlling for all other variables. Higher-quality care was associated with significant differences in mean incremental costs for initial treatment in surgical patients ($-37,303 [-$68,832--$5,775]), and for the overall summary measure of quality in patients treated nonoperatively ($10,473 [$1,121-$19,825]). After controlling for the overall summary measure of quality, costs were significantly lower for patients receiving high-volume surgical care (mean -$18,953 [-$28,381--$9,426]). ConclusionHigher-quality larynx cancer care in commercially insured patients was associated with lower 30-day mortality and morbidity. High-volume surgical care was associated with lower 1-year costs, even after controlling for quality. These data have implications for discussions of value and quality in an era of healthcare reform. Level of Evidence2c. Laryngoscope, 127:2805-2812, 2017
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  • Tracheal exposure: Anticipatory management of the difficult airway

    Britt, Christopher J.   Rohrbach, Marc R.   McCulloch, Timothy M.   Irish, Jonathan  

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  • Quality indicators of laryngeal cancer care in commercially insured patients

    Britt, Christopher J.   Chang, Hsien-Yen   Quon, Harry   Kang, Hyunseok   Kiess, Ana P.   Eisele, David W.   Frick, Kevin D.   Gourin, Christine G.  

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  • Factors influencing sialocele or salivary fistula formation postparotidectomy

    Britt, Christopher J.   Stein, Andrew P.   Gessert, Thomas   Pflum, Zach   Saha, Sandeep   Hartig, Gregory K.   Eisele, David W.  

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  • Bone-anchored hearing aid and skin graft removal with subsequent cochlear implantation

    Britt, Christopher J.   Coughlin, Adam R.   Gubbels, Samuel P.  

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  • Preliminary Evaluation of Functional Swallow After Total Laryngectomy Using High-Resolution Manometry

    Lippert, Dylan   Hoffman, Matthew R.   Britt, Christopher J.   Jones, Corinne A.   Hernandez, Jodi   Ciucci, Michelle R.  

    Introduction: Understanding of swallowing pressures after total laryngectomy (TL) and what constitutes a "functional" swallow are limited. Mobile structures are altered or removed after TL, with consequent effects on pressure profiles. High-resolution manometry (HRM) can characterize these pressures.Methods: Six TL subjects without dysphagia and 6 controls underwent pharyngeal HRM. Timing and pressure variables for the velopharynx, mesopharynx, and upper esophageal sphincter (UES) were compared. Changes in variables due to bolus volume were evaluated in TL subjects.Results: The TL subjects had increased duration of velopharyngeal pressure (P =3D .012). Maximum mesopharyngeal pressure was lower versus controls (P =3D .003). Maximal and total pre-opening (P =3D .002, P =3D .002) and post-closure (P =3D .001, P =3D .002) UES pressures were lower. Maximum mesopharyngeal pressure (P =3D .032) decreased with increasing bolus volume.Conclusions: Increased velopharyngeal pressure duration and total swallow duration reflect separation of the pharynx into distinct conduits for air and food, thus ensuring successful bolus passage without the need for respiration. Decreased UES pressure highlights the effects of disrupting the cricopharyngeal and rostral esophageal muscle fibers from their attachments to the larynx and performing a cricopharyngeal myotomy. Additional studies including subjects with dysphagia could further characterize the functional TL swallow and identify aspects susceptible to dysfunction.
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  • Christopher J. Gostout, MD

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  • Christopher J. Tucker, M.D., Podcast Editor

    Lubowitz, James H.  

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