JAMA otolaryngology-- head & neck surgery
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JAMA Otolaryngol Head Neck Surg · Jun 2014
Case ReportsRight Aortic Arch With Kommerell Diverticulum: A Rare Cause of Dysphagia.
Dysphagia is a common condition with multiple causes. Fortunately, a thorough evaluation will often lead to a correct diagnosis, even when the cause is a rare entity. A right aortic arch with associated aberrant left subclavian artery is an uncommon anatomical variant. Physicians involved in the management of dysphagia should be aware of vascular anomalies that can cause dysphagia. ⋯ Kommerell diverticulum, a remnant of the left dorsal arch, is a rare cause of dysphagia. However, vascular causes should be considered in the algorithm when evaluating patients who present with dysphagia, especially when there is compression of the esophagus noted on imaging or examination.
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JAMA Otolaryngol Head Neck Surg · Feb 2014
Comparative StudyQuality of life among long-term survivors of head and neck cancer treated by intensity-modulated radiotherapy.
Radiation therapy to the head and neck has traditionally been associated with adverse effects that can affect oral health and physical functioning. Although intensity-modulated radiotherapy (IMRT) has been widely adopted as a means of decreasing toxic effects, limited clinical data exist on its potential effect on long-term quality of life. ⋯ Our findings add to the body of literature that supports the acceptance of IMRT as standard treatment for head and neck cancer. The fact that most 5-year survivors were satisfied with their quality of lives points to the ability of IMRT to preserve long-term functioning.
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JAMA Otolaryngol Head Neck Surg · Aug 2013
Sentinel node biopsy in lieu of neck dissection for staging oral cancer.
Neck dissection is the standard staging procedure to ascertain the pathologic status of cervical lymph nodes in patients with oral cavity squamous cell carcinoma (OSCC), but it results in multiple morbidities. ⋯ The majority of patients with positive results on SNB had additional positive nodes on neck dissection. A low rate of isolated neck recurrence was found in patients with negative results on SNB. Individuals with negative results on SNB exhibited better overall and disease-specific survival than those with positive results.
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JAMA Otolaryngol Head Neck Surg · Feb 2015
Inpatient observation for elective decannulation of pediatric patients with tracheostomy.
The incidence and timing patterns of decannulation failure in children are unknown. There is substantial variability in the duration of inpatient hospitalization for patients undergoing decannulation, which represents an opportunity for improved resource use. ⋯ Elective decannulation failure occurred in 9% of this population and may be more common in younger patients and those with a diagnosis of vocal fold paralysis. Patients who are symptomatic during predecannulation capping are at high risk for decannulation failure. Inpatient observation for a 24-hour asymptomatic interval after decannulation may be sufficient because late failures were not observed in this sample.