The Laryngoscope
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In 2% to 3% of patients with cancer metastatic to cervical lymph nodes, a primary tumor will not be found despite exhaustive diagnostic efforts. The treatment for these patients includes cervical lymphadenectomy followed by radiation to areas with increased risk of harboring a mucosal primary. Wide-field radiation therapy increases the incidence of xerostomia and dysphagia. Localizing a primary tumor has thus both therapeutic and quality-of-life implications, allowing possible complete surgical excision, concentrated radiation therapy, and potential deintensification of adjuvant therapy. With improved visualization and freedom of motion, transoral robotic surgery (TORS) is an innovative surgical modality that allows resection of oropharyngeal subsites with minimal morbidity. ⋯ Unknown primary SCCA presents a diagnostic challenge to the head and neck surgeon. We present a small series of tumors that would have been treated as unknown primaries under traditional diagnostic and therapeutic algorithms. TORS base of tongue resection identified primary tumors in 90% patients with minimal morbidity.
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Laryngeal cleft is a rare congenital anomaly that is recently being diagnosed with increased frequency. The objective of this report is to present a comprehensive description of endoscopic laser repair of a laryngeal cleft, using both the carbon dioxide (CO(2)) laser via a micromanipulator (Carl Zeiss Microimaging Inc., Thornwood, NY) and the flexible CO(2) laser fiber (OmniGuide, Inc.; Cambridge, MA), from both an anesthesia and surgical perspective. Laryngoscope, 2013.
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Develop a standardized letter of recommendation (SLOR) for otolaryngology residency application that investigates the qualities desired in residents and the letter writer's experience. Compare this SLOR to narrative letters of recommendation (NLORs). ⋯ SLORs require little writing time, save reviewing time, and are easier to review compared to NLORs. Our SLOR had higher inter-rater reliability in four of seven categories and was correlated with our rank list. This tool conveys standardized information in an efficient manner.
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To examine the changing microbiology of pediatric neck abscesses over a 10-year period with particular interest in methicillin-resistant Staphylococcus aureus (MRSA) infections and their associated antibacterial-resistance patterns, including resistance to clindamycin, a frequently used antibiotic for Staphylococcus aureus. ⋯ These findings demonstrate a statistically significant rise in the proportion of MRSA neck infections in pediatric patients in Iowa. Resistance to clindamycin was highest among MSSA isolates. Clindamycin-resistant S. aureus and Streptococcus pyogenes are established pathogens in neck infections. In communities with similar microbiology patterns, empiric treatment with combination therapy of a beta lactam and vancomycin or trimethoprim/sulfamethoxazole should be initiated until culture results are available.
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Bacterial biofilms are prevalent in pediatric tracheostomy tubes (TTs) and are not completely cleared by standard cleaning with gauze and household detergents. We aimed to examine the effectiveness of different disinfecting solutions to remove Staphylococcus aureus (SA) and Pseudomonas aerginosa (PA) biofilms from TTs. ⋯ Disinfection with sodium hypochlorite or chlorhexidine solutions significantly reduces SA and PA biofilms on PVC TTs. Standard home care of reusable pediatric TTs may be improved by use of these readily available solutions.