Otolaryngologic Clinics of North America Articles in Press

Article in Press

Genetics of Hearing Loss—Nonsyndromic

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Kay W. Chang, MD

Department of Otolaryngology, Stanford University, 801 Welch Road, Stanford, CA 94305, USA

Otolaryngologic Clinics of North America

Published Online: August 11, 2015

DOI: http://dx.doi.org/10.1016/j.otc.2015.06.005

Publication stage: In Press Corrected Proof

Eighty percent of nonsyndromic hearing losses are caused by autosomal-recessive (AR) inheritance, while most of the other 20% are caused by autosomal-dominant (AD) inheritance. Although AR nonsyndromic SNHL is most commonly caused by GJB2 and SLC26A4, there is no single gene that accounts for any significant proportion of AD SNHL. High-throughput sequencing techniques, also called next-generation sequencing (NGS) or massively parallel sequencing (MPS), may allow for routine definitive diagnosis of all possible genetic causes for hearing loss in the not-too-distant future.

© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.

Article in Press

Medical and Surgical Complications in the Treatment of Chronic Rhinosinusitis

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James A. Stankiewicz, MD

Department of Otolaryngology-Head and Neck Surgery, Loyola University/Trinity Health Center, 2160 South First Avenue, Maywood, IL 60153, USA

Otolaryngologic Clinics of North America

Published Online: July 14, 2015

DOI: http://dx.doi.org/10.1016/j.otc.2015.07.001

Publication stage: In Press Corrected Proof

In 1985, endoscopic diagnosis and surgery for rhinosinusitis were introduced into the United States by Drs David Kennedy and Heinz Stammburger. Surgery for chronic rhinosinusitis prior to this date mainly involved the treatment of nasal polyps or complications of chronic rhinosinusitis with external or nonendoscopic procedures. The endoscopic surgical management of the disease caught the imagination of the world community, and endoscopic sinus surgeons enthusiastically began performing surgery. However, in the initial description of the surgical procedures, minimal discussion was given to the risks and complications associated with the surgery.

© 2015 Published by Elsevier Inc.

Article in Press

Early Practice

External Sinus Surgery and Procedures and Complications

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John S. Schneider, MD, MA

,

 Andrew Day, MD

,

 Matthew Clavena, MD

,

 Paul T. Russell III, MD

,

 James Duncavage, MD

Otolaryngologic Clinics of North America

Published Online: July 02, 2015

DOI: http://dx.doi.org/10.1016/j.otc.2015.05.010

Publication stage: In Press Corrected Proof

External approaches to the paranasal sinuses are rarely used in the endoscopic era. However, their indications for use have not changed, and in every surgeon's career those indications may present themselves. For residents training in the endoscopic era, these procedures are also very rarely seen. In this article, the external approaches to the maxillary, ethmoid, and frontal sinuses are described: their original descriptions, modern use, and potential complications. It is hoped that this article will serve to instruct residents and practitioners alike in these techniques.

© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.

Article in Press

Anatomy and Complications

Safe Sinus

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Muhamad A. Amine, MD, MS

,

 Vijay Anand, MD

Department of Otolaryngology–Head and Neck Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, 772 Park Avenue, New York, NY 10021, USA

Otolaryngologic Clinics of North America

Published Online: July 02, 2015

DOI: http://dx.doi.org/10.1016/j.otc.2015.05.003

Publication stage: In Press Corrected Proof

Safe sinus surgery is predicated on a clear understanding and knowledge of the anatomy. The paranasal sinuses are surrounded by vital vascular and neurologic structures. In every step during the surgical procedure, one should know the regional surrounding anatomy and the potential complications that can be encountered if the procedures traverse these areas. Preoperative assessment of the imaging is important to identify potential hazardous areas.

© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.

Article in Press

Neurologic Complications and Treatment

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Kevin C. Welch, MD

Department of Otolaryngology, Northwestern University Feinberg School of Medicine, 676 North St Clair St, Suite 1325, Chicago, IL 60611, USA

Otolaryngologic Clinics of North America

Published Online: July 02, 2015

DOI: http://dx.doi.org/10.1016/j.otc.2015.05.005

Publication stage: In Press Corrected Proof

Risk is inherent with all surgical procedures. Most endoscopic sinus surgery (ESS) is uncomplicated. Among the many complications inherent with ESS are the neurologic complications, which include cerebrospinal fluid rhinorrhea, traumatic soft tissue and vascular injuries, infection, and seizures. Despite intense review of a patient's preoperative scans, use of stereotactic image guidance, and an expert understanding of anatomy, neurologic complications occur. An understanding of these complications and how to manage them can help to reduce long-term patient injury as well as help prevent recurrence.

© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.

Article in Press

Medicolegal Issues in Endoscopic Sinus Surgery and Complications

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James A. Stankiewicz, MD

,

 Jeffrey Hotaling, MD

Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA

Otolaryngologic Clinics of North America

Published Online: June 26, 2015

DOI: http://dx.doi.org/10.1016/j.otc.2015.05.014

Publication stage: In Press Corrected Proof

Complications occur during and after endoscopic sinus surgery. Complications leading to temporary or most commonly permanent injury often are involved in litigation for malpractice. This article concentrates on areas of importance that are considered during medicolegal deliberations.

© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.

Article in Press

Does Image-Guided Surgery Reduce Complications?

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Vijay R. Ramakrishnan, MD

,

 Todd T. Kingdom, MD

Department of Otolaryngology-Head and Neck Surgery, University of Colorado, 12631 East 17th Avenue, B205, Aurora, CO 80045, USA

Otolaryngologic Clinics of North America

Published Online: June 26, 2015

DOI: http://dx.doi.org/10.1016/j.otc.2015.05.011

Publication stage: In Press Corrected Proof

Image-guided surgery (IGS) is progressively used in endoscopic sinus surgery (ESS), and surgeon comfort with the technology has increased. It remains a challenge to determine if the use of IGS in ESS leads to a reduction in surgical complications and improved outcomes. Current literature does not show a clear reduction in surgical complications. The routine use of IGS in ESS as a deterrent to medicolegal liability is not substantiated by recent reported data. There are particular situations in which IGS may be helpful, but its use is likely not required for routine ESS and seems best left to surgeon discretion.

© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.

Article in Press

Imaging of the Paranasal Sinuses

Mitigation, Identification, and Workup of Functional Endoscopic Surgery Complications

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Salvatore V. Labruzzo, DO

,

 Nafi Aygun, MD

,

 S. James Zinreich, MD

Russell H. Morgan Department of Radiology and Radiologic Sciences, Johns Hopkins Hospital, 601 North Caroline Street, Room 4210, Baltimore, MD 21287-0006, USA

Otolaryngologic Clinics of North America

Published Online: June 24, 2015

DOI: http://dx.doi.org/10.1016/j.otc.2015.05.008

Publication stage: In Press Corrected Proof

The purpose of this article is to identify and define the appropriate imaging techniques in the evaluation of post–functional endoscopic surgery (FESS) complications. Although most complications encountered during FESS are identified readily during surgery, some are less conspicuous and require postoperative imaging. As illustrated in this article, these include cerebrospinal fluid leak, vascular injury, brain injury, orbital injury, and infectious complications of the brain and meninges. Some of the common anatomic variants of the paranasal sinuses are identified, and how these may predispose to surgical complications is discussed.

Published by Elsevier Inc.

Article in Press

Orbital Complications Associated with the Treatment of Chronic Rhinosinusitis

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Alpen B. Patel, MD

,

 Joseph M. Hoxworth, MD

,

 Devyani Lal, MD

Otolaryngologic Clinics of North America

Published Online: June 24, 2015

DOI: http://dx.doi.org/10.1016/j.otc.2015.05.004

Publication stage: In Press Corrected Proof

Orbital injuries from endoscopic sinus surgery are rare but potentially catastrophic. The most feared complications from sinus surgery include blindness and diplopia. Recent publications note that the rate of orbital complications has decreased when compared with the past, reflecting the use of endoscopes, better technology, and improved training. The sinus surgeon must have mastery over the procedure she or he plans to undertake and be aware of the specific potential for orbital injury given the patient's anatomy and disease. The sinus surgeon must also have expert knowledge of the appropriate and immediate medical and surgical management of orbital complications.

© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.

Article in Press

Rare and Other Notable Complications in Endoscopic Sinus Surgery

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James R. Martin, MD

,

 Monica O. Patadia, MD

Department of Otolaryngology – Head and Neck Surgery, 2160 South First Avenue, Building 105, Room 1870, Maywood, IL 60153, USA

Otolaryngologic Clinics of North America

Published Online: June 24, 2015

DOI: http://dx.doi.org/10.1016/j.otc.2015.05.012

Publication stage: In Press Corrected Proof

This article focuses on the rare and obscure complications of endoscopic sinus surgery. The majority of surgeons will not encounter these complications in their practice, but should be aware of their possibility. With knowledge of these rare complications, the surgeon can understand the possible avoidance as well as urgent management of these problems.

Published by Elsevier Inc.

Article in Press

Pitfalls in Sinus Surgery

An Overview of Complications

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Peter F. Svider, MD

,

 Soly Baredes, MD

,

 Jean Anderson Eloy, MD

Otolaryngologic Clinics of North America

Published Online: June 24, 2015

DOI: http://dx.doi.org/10.1016/j.otc.2015.05.002

Publication stage: In Press Corrected Proof

There is a potential for significant complications from the medical and surgical treatment of rhinosinusitis because of the intimate relationship between the paranasal sinuses and surrounding vital structures. Familiarity with the complex anatomic relationships between the skull base and other critical structures and knowledge of pharmacologic properties of commonly used medical therapies are essential for preventing serious and harmful seqsuelae. The authors hope that this review represents a valuable addition to the otolaryngologist-in-training's therapeutic armamentarium, and also serves as a reminder of the potential pitfalls for the experienced sinus surgeon.

© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.

Article in Press

Olfaction in Endoscopic Sinus and Skull Base Surgery

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Christopher F. Thompson, MD

,

 Robert C. Kern, MD

,

 David B. Conley, MD

Department of Otolaryngology, Northwestern University, Chicago, IL, USA

Otolaryngologic Clinics of North America

Published Online: June 24, 2015

DOI: http://dx.doi.org/10.1016/j.otc.2015.05.007

Publication stage: In Press Corrected Proof

Olfactory dysfunction is a common complaint for patients with chronic rhinosinusitis, because smell loss decreases a patient's quality of life. Smell loss is caused by obstruction from polyps, nasal discharge, and mucosal edema, as well as inflammatory changes within the olfactory epithelium. Addressing olfaction before endoscopic sinus and skull base surgery is important in order to set postoperative expectations, because an improvement in smell is difficult to predict. Several commercially available olfactory testing measures are available and can easily be administered in clinic. During surgery, careful dissection within the olfactory cleft is recommended in order to optimize postoperative olfactory function.

© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.

Article in Press

Medicolegal Implications of Common Rhinologic Medications

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David M. Poetker, MD, MA

,

 Timothy L. Smith, MD, MPH

Otolaryngologic Clinics of North America

Published Online: June 24, 2015

DOI: http://dx.doi.org/10.1016/j.otc.2015.05.009

Publication stage: In Press Corrected Proof

As otolaryngologists, we prescribe many medications to our patients. The objective of this article is to review the potential side effects and medicolegal risks of the common medications used to treat chronic rhinosinusitis. The authors evaluate some of the common side effects as well as the published literature on the lawsuits associated with those medications. Finally, the authors review the informed consent discussion and opportunities to improve patient care and decrease the risk of litigation.

Published by Elsevier Inc.

Article in Press

Avoiding Complications in Endoscopic Sinus Surgery

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Ian M. Humphreys, DO

,

 Peter H. Hwang, MD

Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology – Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA

Otolaryngologic Clinics of North America

Published Online: June 24, 2015

DOI: http://dx.doi.org/10.1016/j.otc.2015.05.013

Publication stage: In Press Corrected Proof

Complications of endoscopic sinus surgery (ESS) can range from the mundane to the catastrophic, with nasal hemorrhage being the most common. Intraorbital and intracranial complications are much less common. Despite the rarity of complications, they are often avoidable. Certain identifiable risk factors can be appreciated during the preoperative, intraoperative, and postoperative evaluations of the sinus patient. With awareness of these risk factors the rhinologist can develop a strategic plan of risk factor mitigation. This article identifies areas of increased risk that are amenable to preventive strategies before complications become realized.

© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.

Otolaryngologic Clinics of North America

• Genetics of Hearing Loss—Nonsyndromic

  Kay W. Chang, 2015-08-17 08:57:12 AM

  Eighty percent of nonsyndromic hearing losses are caused by autosomal-recessive (AR) inheritance, while most of the other 20% are caused by autosomal-dominant (AD) inheritance. Although AR nonsyndromic SNHL is most commonly caused by GJB2 and SLC26A4, there is no single gene that accounts for any significant proportion of AD SNHL. High-throughput sequencing techniques, also called next-generation sequencing (NGS) or massively parallel sequencing (MPS), may allow for routine definitive diagnosis of all possible genetic causes for hearing loss in the not-too-distant future.
  Read moreTop

• Medical and Surgical Complications in the Treatment of Chronic Rhinosinusitis

  James A. Stankiewicz, 2015-08-17 08:57:12 AM

  In 1985, endoscopic diagnosis and surgery for rhinosinusitis were introduced into the United States by Drs David Kennedy and Heinz Stammburger. Surgery for chronic rhinosinusitis prior to this date mainly involved the treatment of nasal polyps or complications of chronic rhinosinusitis with external or nonendoscopic procedures. The endoscopic surgical management of the disease caught the imagination of the world community, and endoscopic sinus surgeons enthusiastically began performing surgery. However, in the initial description of the surgical procedures, minimal discussion was given to the risks and complications associated with the surgery.
  Read moreTop

• Early Practice

  John S. Schneider, Andrew Day, Matthew Clavena, Paul T. Russell, James Duncavage, 2015-08-17 08:57:12 AM

  External approaches to the paranasal sinuses are rarely used in the endoscopic era. However, their indications for use have not changed, and in every surgeon's career those indications may present themselves. For residents training in the endoscopic era, these procedures are also very rarely seen. In this article, the external approaches to the maxillary, ethmoid, and frontal sinuses are described: their original descriptions, modern use, and potential complications. It is hoped that this article will serve to instruct residents and practitioners alike in these techniques.
  Read moreTop

• Neurologic Complications and Treatment

  Kevin C. Welch, 2015-08-17 08:57:12 AM

  Risk is inherent with all surgical procedures. Most endoscopic sinus surgery (ESS) is uncomplicated. Among the many complications inherent with ESS are the neurologic complications, which include cerebrospinal fluid rhinorrhea, traumatic soft tissue and vascular injuries, infection, and seizures. Despite intense review of a patient's preoperative scans, use of stereotactic image guidance, and an expert understanding of anatomy, neurologic complications occur. An understanding of these complications and how to manage them can help to reduce long-term patient injury as well as help prevent recurrence.
  Read moreTop

• Anatomy and Complications

  Muhamad A. Amine, Vijay Anand, 2015-08-17 08:57:12 AM

  Safe sinus surgery is predicated on a clear understanding and knowledge of the anatomy. The paranasal sinuses are surrounded by vital vascular and neurologic structures. In every step during the surgical procedure, one should know the regional surrounding anatomy and the potential complications that can be encountered if the procedures traverse these areas. Preoperative assessment of the imaging is important to identify potential hazardous areas.
  Read moreTop

• Medicolegal Issues in Endoscopic Sinus Surgery and Complications

  James A. Stankiewicz, Jeffrey Hotaling, 2015-08-17 08:57:12 AM

  Complications occur during and after endoscopic sinus surgery. Complications leading to temporary or most commonly permanent injury often are involved in litigation for malpractice. This article concentrates on areas of importance that are considered during medicolegal deliberations.
  Read moreTop

• Does Image-Guided Surgery Reduce Complications?

  Vijay R. Ramakrishnan, Todd T. Kingdom, 2015-08-17 08:57:12 AM

  Image-guided surgery (IGS) is progressively used in endoscopic sinus surgery (ESS), and surgeon comfort with the technology has increased. It remains a challenge to determine if the use of IGS in ESS leads to a reduction in surgical complications and improved outcomes. Current literature does not show a clear reduction in surgical complications. The routine use of IGS in ESS as a deterrent to medicolegal liability is not substantiated by recent reported data. There are particular situations in which IGS may be helpful, but its use is likely not required for routine ESS and seems best left to surgeon discretion.
  Read moreTop

• Avoiding Complications in Endoscopic Sinus Surgery

  Ian M. Humphreys, Peter H. Hwang, 2015-08-17 08:57:12 AM

  Complications of endoscopic sinus surgery (ESS) can range from the mundane to the catastrophic, with nasal hemorrhage being the most common. Intraorbital and intracranial complications are much less common. Despite the rarity of complications, they are often avoidable. Certain identifiable risk factors can be appreciated during the preoperative, intraoperative, and postoperative evaluations of the sinus patient. With awareness of these risk factors the rhinologist can develop a strategic plan of risk factor mitigation. This article identifies areas of increased risk that are amenable to preventive strategies before complications become realized.
  Read moreTop

• Rare and Other Notable Complications in Endoscopic Sinus Surgery

  James R. Martin, Monica O. Patadia, 2015-08-17 08:57:12 AM

  This article focuses on the rare and obscure complications of endoscopic sinus surgery. The majority of surgeons will not encounter these complications in their practice, but should be aware of their possibility. With knowledge of these rare complications, the surgeon can understand the possible avoidance as well as urgent management of these problems.
  Read moreTop

• Medicolegal Implications of Common Rhinologic Medications

  David M. Poetker, Timothy L. Smith, 2015-08-17 08:57:12 AM

  As otolaryngologists, we prescribe many medications to our patients. The objective of this article is to review the potential side effects and medicolegal risks of the common medications used to treat chronic rhinosinusitis. The authors evaluate some of the common side effects as well as the published literature on the lawsuits associated with those medications. Finally, the authors review the informed consent discussion and opportunities to improve patient care and decrease the risk of litigation.
  Read moreTop

• Imaging of the Paranasal Sinuses

  Salvatore V. Labruzzo, Nafi Aygun, S. James Zinreich, 2015-08-17 08:57:12 AM

  The purpose of this article is to identify and define the appropriate imaging techniques in the evaluation of post–functional endoscopic surgery (FESS) complications. Although most complications encountered during FESS are identified readily during surgery, some are less conspicuous and require postoperative imaging. As illustrated in this article, these include cerebrospinal fluid leak, vascular injury, brain injury, orbital injury, and infectious complications of the brain and meninges. Some of the common anatomic variants of the paranasal sinuses are identified, and how these may predispose to surgical complications is discussed.
  Read moreTop

• Olfaction in Endoscopic Sinus and Skull Base Surgery

  Christopher F. Thompson, Robert C. Kern, David B. Conley, 2015-08-17 08:57:12 AM

  Olfactory dysfunction is a common complaint for patients with chronic rhinosinusitis, because smell loss decreases a patient's quality of life. Smell loss is caused by obstruction from polyps, nasal discharge, and mucosal edema, as well as inflammatory changes within the olfactory epithelium. Addressing olfaction before endoscopic sinus and skull base surgery is important in order to set postoperative expectations, because an improvement in smell is difficult to predict. Several commercially available olfactory testing measures are available and can easily be administered in clinic. During surgery, careful dissection within the olfactory cleft is recommended in order to optimize postoperative olfactory function.
  Read moreTop

• Orbital Complications Associated with the Treatment of Chronic Rhinosinusitis

  Alpen B. Patel, Joseph M. Hoxworth, Devyani Lal, 2015-08-17 08:57:12 AM

  Orbital injuries from endoscopic sinus surgery are rare but potentially catastrophic. The most feared complications from sinus surgery include blindness and diplopia. Recent publications note that the rate of orbital complications has decreased when compared with the past, reflecting the use of endoscopes, better technology, and improved training. The sinus surgeon must have mastery over the procedure she or he plans to undertake and be aware of the specific potential for orbital injury given the patient's anatomy and disease. The sinus surgeon must also have expert knowledge of the appropriate and immediate medical and surgical management of orbital complications.
  Read moreTop

• Pitfalls in Sinus Surgery

  Peter F. Svider, Soly Baredes, Jean Anderson Eloy, 2015-08-17 08:57:12 AM

  There is a potential for significant complications from the medical and surgical treatment of rhinosinusitis because of the intimate relationship between the paranasal sinuses and surrounding vital structures. Familiarity with the complex anatomic relationships between the skull base and other critical structures and knowledge of pharmacologic properties of commonly used medical therapies are essential for preventing serious and harmful seqsuelae. The authors hope that this review represents a valuable addition to the otolaryngologist-in-training's therapeutic armamentarium, and also serves as a reminder of the potential pitfalls for the experienced sinus surgeon.
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• Functional Anatomy and Oncologic Barriers of the Larynx

  Niv Mor, Andrew Blitzer, 2015-08-17 08:57:12 AM

  Laryngeal barriers to tumor spread are a product of laryngeal development, anatomic barriers, and enzymatic activity. Supraglottic and glottic/subglottic development is distinct and partially explains the metastatic behavior of laryngeal carcinoma. Dense connective tissues and elastic fibers provide anatomic barriers within the larynx. Laryngeal cartilage contains dense cartilage, enzyme inhibitors, and an intact perichondrium making it relatively resistant to tumor invasion; however, focal areas of vulnerability are created by ossified cartilage and natural interruptions in the perichondrium. Local inflammation and the enzymatic interplay between tumor and host are important factors in the spread of laryngeal tumor.
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• Voice Rehabilitation After Transoral Laser Microsurgery of the Larynx

  Vyas M.N. Prasad, Marc Remacle, 2015-08-17 08:57:12 AM

  Voice rehabilitation after transoral laser microsurgery to the larynx is challenging. We wait at least 6 months before surgical intervention. Only a few patients after total or extended cordectomy requested voice restoration. Subjective perception of voice using the Voice Handicap Index in medialization thyroplasty was significantly better. Medialization thyroplasty with elevation of the fibrous tissue from the inner surface of the thyroid cartilage is critical in achieving success. We preferred the Montgomery Thyroplasty Implant System. Transoral larynx anterior commissure stent placement after laser-assisted sectioning of anterior synechiae with application of mitomycin C is an effective procedure for anterior synechiae.
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• Voice Restoration After Total Laryngectomy

  Christopher G. Tang, Catherine F. Sinclair, 2015-08-17 08:57:12 AM

  The ability to speak and communicate vocally is a unique human characteristic that is often taken for granted but is fundamental to many activities of daily living. Loss of voice after total laryngectomy can lead to a serious decrease in quality of life and can precipitate significant frustration over the inability to communicate effectively. There are 3 main methods of voice restoration: esophageal speech, usage of the electrolarynx, and tracheal-esophageal puncture for tracheal-esophageal speech, which can be performed primarily or secondarily. Although all 3 methods have potential benefits, the gold standard is tracheal-esophageal speech.
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• Voice Outcomes of Transoral Laser Microsurgery of the Larynx

  Dana M. Hartl, Samia Laoufi, Daniel F. Brasnu, 2015-08-17 08:57:12 AM

  Transoral laser microsurgery (TLM) is the mainstay in the treatment of early (TisT1T2) glottic cancer. Current knowledge concerning voice quality and voice-related quality of life in patients treated using TLM is based on small cohort studies using various instruments to evaluate these functional results. The bulk of the literature indicates that subjective and objective measurements of voice quality can return to normal or almost normal values after TLM, generally after 6 to 12 months and particularly after cordectomy types I, II, and III.
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• Role of Advanced Laryngeal Imaging in Glottic Cancer

  Kathleen M. Tibbetts, Melin Tan, 2015-08-17 08:57:12 AM

  Laryngeal cancer accounts for approximately 2.4% of new malignancies worldwide each year. Early identification of laryngeal neoplasms results in improved prognosis and functional outcomes. Imaging plays an integral role in the diagnosis, staging, and long-term follow-up of laryngeal cancer. This article highlights advanced laryngeal imaging techniques and their application to early glottic neoplasms.
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• Evaluation of the Dysphonic Patient (in: Function Preservation in Laryngeal Cancer)

  Chad W. Whited, Seth H. Dailey, 2015-08-17 08:57:12 AM

  The evaluation of the dysphonic patient begins with a complete understanding of the laryngeal anatomy and physiology of voice production. A thorough history must be taken regarding the dysphonia qualities, alarming symptoms, and confounding factors. The complete head and neck examination culminates in a detailed visualization of the vocal folds using image-capturing laryngoscopy as well as stroboscopy or high-speed digital imaging to fully evaluate the viscoelastic properties of the vocal fold cover-body structure and function. Finally, the evaluation leads to the biopsy of any concerning lesions either under magnification in the operating room or topical anesthesia in the office.
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• Quality of Life After Conservation Surgery for Laryngeal Cancer

  Babak Sadoughi, 2015-08-17 08:57:12 AM

  Quality of life preservation has become an essential goal of treatment in the management of laryngeal carcinoma. Although established treatments of reference such as total laryngectomy and chemoradiation protocols have focused on survival and anatomic preservation of the larynx, they still generate considerable functional morbidity with detrimental effects on quality of life. Transoral and transcervical partial laryngectomy techniques can offer significant advantages when used prudently after proper patient selection. The growing relevance of those techniques in the management of advanced and recurrent laryngeal carcinoma deserves particular attention, with potential for improved quality of life without compromising oncologic outcomes.
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• Management of Dysphonia After Radiation Therapy

  Craig R. Villari, Mark S. Courey, 2015-08-17 08:57:12 AM

  Radiation-induced dysphonia can develop after radiation for primary laryngeal cancer or when the larynx is in the radiation field for nonlaryngeal malignancy. The effects are dose dependent and lead to variable degrees of dysphonia in both short- and long-term follow-up. Rehabilitation of the irradiated larynx can prove frustrating but can be facilitated through behavioral, pharmacologic, or surgical interventions.
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• Laryngeal Function After Radiation Therapy

  Mauricio Gamez, Kenneth Hu, Louis B. Harrison, 2015-08-17 08:57:12 AM

  Laryngeal function after oncologic treatment is a key aspect and focus of interest in the contemporary management of head and neck cancers. Although historically the treatment of most locally advanced laryngeal cancers has been total laryngectomy, recent innovations in radiation therapy and combined chemotherapy and radiation therapy have shown that organ and function preservation can be achieved with good oncologic outcomes. Technical improvements, along with better understanding of tumor biology and dose tolerance of critical organs involved in speech and swallowing function, have paved the way for better outcomes. This article reviews in comprehensive detail the recent data of laryngeal function after radiotherapy.
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• CME Accreditation Page

  2015-08-17 08:57:12 AM

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• Index

  2015-08-17 08:57:12 AM

  Note: Page numbers of article titles are in boldface type.
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• Forthcoming Issues

  2015-08-17 08:57:12 AM

  Medical and Surgical Complications in the Treatment of Chronic Rhinosinusitis
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• Contents

  2015-08-17 08:57:12 AM

  Babak Sadoughi
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• Contributors

  2015-08-17 08:57:12 AM

  BABAK SADOUGHI, MD
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• Copyright

  2015-08-17 08:57:12 AM

  Elsevier
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• Function Preservation in Laryngeal Cancer

  Babak Sadoughi, 2015-08-17 08:57:12 AM

  OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA
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• Function Preservation in Laryngeal Cancer

  Babak Sadoughi, 2015-08-17 08:57:12 AM

  Treating laryngeal cancer entails a rare set of challenges. The larynx is not only complex in structure and function, but also essential to some of the most fundamental attributes defining us as human beings. In addition, laryngeal malignancy follows peculiar patterns of progression, making it a somewhat atypical entity within the realm of head and neck oncology, and rendering its global comprehension singularly difficult.
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• Transcervical Conservation Laryngeal Surgery

  Moustafa Mourad, Babak Sadoughi, 2015-08-17 08:57:12 AM

  The goal of this review is to facilitate an improved understanding of the indications and contraindications to transcervical conservation laryngeal surgery in the treatment of glottic and supraglottic carcinoma. An overview of seminal anatomic principles is presented to provide guidance for clinicians contemplating open partial laryngectomy options.
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• Transoral and Transcervical Surgical Innovations in the Treatment of Glottic Cancer

  Steven M. Zeitels, 2015-08-17 08:57:12 AM

  Transoral and transcervical surgery to treat glottic cancer has advanced substantially over the past decade. There have been considerable innovations that enhance vocal function for early disease and airway function for advanced disease. The fiber-based angiolytic 532 nm potassium titanyl phosphate laser has provided a new foundational strategy to maintain high cure rates with enhanced vocal outcomes for the treatment of early glottic disease. For advanced glottic cancer, transplanting cryopreserved aortic homograft to reconstruct wide-field laryngotracheal airway defects can provide an adequate airway caliber such that a long-term tracheotomy can frequently be avoided.
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• Salvage Conservation Laryngeal Surgery After Radiation Therapy Failure

  Michelle Mizhi Chen, F. Christopher Holsinger, Ollivier Laccourreye, 2015-08-17 08:57:12 AM

  Conservation laryngeal surgery (CLS) includes time-honored approaches such as the vertical partial laryngectomy and the open horizontal supraglottic laryngectomy, as well as the supracricoid partial laryngectomy and transoral laser microsurgery. Carefully selected patients can undergo transoral endoscopic or open CLS for early to intermediate stage recurrent tumors of the glottic and supraglottic larynx. Patient factors, such as comorbid pulmonary disease, are essential in selecting patients for CLS, especially after previous radiation therapy. This article reviews the preoperative indications and postoperative management of salvage CLS after radiation therapy for laryngeal cancer.
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• Contemporary Surgical Management of Early Glottic Cancer

  Dana M. Hartl, Daniel F. Brasnu, 2015-08-17 08:57:12 AM

  For early-stage T1-T2 glottic squamous cell carcinoma, transoral laser microsurgery (TLM) is the main surgical modality, with rates of local control and laryngeal preservation ranging from 85% to 100% and low morbidity. For extensive lesions, open conservation laryngeal surgery may enable wider resections than TLM but at costs of longer hospital stay and higher postoperative morbidity. Surgery provides results that are comparable to nonsurgical treatment options while reserving radiation therapy for recurrences or second primary cancers, particularly in younger patients. In the future, transoral robot-assisted surgery may enable more extensive transoral resections than laser alone, decreasing further the indications for open surgery.
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