ORCID Profile
0000-0003-0294-5203
Current Organisation
Vanderbilt University Medical Center
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Publisher: Elsevier BV
Date: 06-2022
DOI: 10.1016/J.NANO.2022.102546
Abstract: Sentinel lymph node biopsy in cancers of the head and neck offers demonstrated clinical and diagnostic value, but adoption is limited by concerns about the detrimental consequence to survival of false negative results in a highly curable setting. The aim of this study was to demonstrate potential to overcome this via application of a novel mannose-labeled magnetic iron oxide tracer. In a large animal model, preoperative imaging and intraoperative magnetometer detection were used to identify magnetic lymph nodes. Iron quantification mapped the distribution of tracer within lymphatic levels. Over a 4-week test period, uptake of magnetic tracer in lymph nodes increased in a linear-like fashion, with a substantial percentage of accumulated iron (83%) being retained in the sentinel node. This result indicates a high affinity of mannose-labeled particles to the sentinel node, while providing a means for the magnetometer probe to indicate node status based on intraoperative signal.
Publisher: American Medical Association (AMA)
Date: 11-2009
Abstract: To compare toxic effects and functional outcomes of reirradiation with and without salvage surgery for nonnasopharyngeal mucosal head and neck squamous cell carcinoma. Retrospective review. Academic tertiary referral hospital. Between December 1992 and March 2007, a total of 87 patients underwent reirradiation (64 for cure and 23 for palliation). Patients underwent reirradiation with (n = 38) or without salvage surgery (n = 49). After January 2000 there was increased use of concurrent platinum-based chemotherapy (80% vs 5%) and intensity-modulated radiation therapy (82% vs 0%). Early and late toxic effects of treatment by Radiation Therapy Oncology Group criteria, tracheostomy retention, gastrostomy tube dependence, and survival. The median follow-up among patients alive at last contact was 5.0 years. Compared with reirradiation without surgery, postoperative reirradiation was associated with increased early grade 3 to grade 5 toxic effects (50% [19 of 38] vs 29% [14 of 49], P = .04) and with longer median survival (17.3 vs 8.9 months, P < .001). Free-flap reconstruction decreased early toxic effects in the surgical cohort by 16% (from 60% [9 of 15] to 43% [10 of 23], P = .32). Gastrostomy tube dependence (P = .05) and tracheostomy retention (P = .04) have increased since 2000. The median survival for curative patients was 12.5 months. The estimated 2-year survival was 25%, and the estimated 5-year survival was 8%. Reirradiation represents the only chance for cure in patients with unresectable disease. After surgery, reirradiation is performed in patients at high risk of locoregional recurrence and may increase acute toxic effects. However, free-flap reconstruction may reduce toxic effects. Functional outcomes have declined since 2000 likely because of the addition of concurrent platinum-based chemotherapy. Future research may define the subpopulation of postoperative patients for whom survival benefits most outweigh reirradiation toxic effects.
Publisher: Wiley
Date: 08-04-2009
DOI: 10.1002/LARY.20200
Abstract: To evaluate head and neck patients undergoing secondary (delayed) free flap reconstructions. Retrospective chart review. Of the 523 free flaps between October 2004 and May 2008, 70 patients underwent 71 secondary free flaps. Outcomes include: hospital stay, complications, flap operative time, enterogastric tube, and tracheostomy requirement. Variables assessed include donor site, indication, prior radiation, and extra-cervical vascular anastomosis. Radial forearm (40.8%) and fibula free flaps (29.6%) were most commonly used. Mean hospital stay was 7.9 days, follow-up 23.5 months, and operative time 323 minutes. Complications occurred in 39.4% in hospital (early) and 31.4% after discharge (late). Many required further surgery (33.8%), tracheostomy at discharge (26.8%), and prolonged enterogastric tube feeding (31%). In-hospital mortality was 1.4%, total flap failure 1.4%, and partial failure 5.6%. The radial forearm required the least operative time (P = .002), and had least tracheostomies at discharge (P = .040). Osteocutaneous fibula took longest (P = .0001), and had the highest tracheostomy rate (P = .047). Early complications were highest with anterolateral thigh flaps (P = .001). Osteoradionecrosis resulted in higher tracheostomy rates at discharge (P = .0001). Osteocutaneous flaps took 111 minutes longer (P = .001), and required more tracheostomies on discharge (P = .031), but with lower fistula rates (P = .046). Previous irradiation and extra-cervical vessels did not significantly impact outcomes. Secondary free flaps are technically feasible for head and neck reconstruction with low mortality and flap failure rates. The extra-cervical and external carotid vessels were equally effective. Patients considering semi-elective free flap reconstruction for osteoradionecrosis should be cautioned about complication rates and tracheostomy retention.
Publisher: Elsevier BV
Date: 05-2009
DOI: 10.1016/J.FSC.2009.01.005
Abstract: Large periauricular and temporal bone defects most commonly follow resection of advanced nonmelanoma skin cancers. Reconstruction aims to cover the cutaneous defect and adjacent vital structures with the ability to heal in an irradiated field and withstand further treatment. Preferred reconstructions are class I, cervicofacial rotation or radial forearm free flap class II, anterolateral thigh and class II, rectus abominis free flap. Ancillary procedures, especially for associated facial paralysis, often are required. Although free flap reconstruction provides rapid wound healing, local and regional flaps are alternatives for patients unable to tolerate prolonged anesthesia and for use after recurrence or complications.
Publisher: Wiley
Date: 09-12-2009
DOI: 10.1002/LARY.20743
Publisher: Wiley
Date: 03-2010
DOI: 10.1002/LARY.20789
Abstract: Determine outcomes associated with nerve grafting versus static repair following facial nerve resection. Retrospective chart review. Charts from 105 patients who underwent facial nerve reconstruction between January 1999 and January 2009 were reviewed. The majority had parotid malignancy (78.1%), most commonly squamous cell carcinoma (50.5%). Patients underwent static (n = 72) or dynamic (n = 33) reconstruction with nerve grafting. Facial nerve function was measured using the House-Brackmann (H-B) scale. Patients receiving static reconstruction were on average 10.3 years older (P = .002). Mean overall survival for tumor cases was 61.9 months parotid squamous cell carcinoma was associated with worse prognosis (P = .10). Median follow-up was 16.1 months (range, 4-96.1 months). Most (97%) patients receiving a nerve graft had some return of function at a median of 6.2 months postoperatively (range, 4-9 months) and the majority (63.6%) had good function (H-B score 6 cm), and prolonged preoperative dysfunction.
Publisher: Wiley
Date: 08-2009
DOI: 10.1016/J.OTOHNS.2009.05.014
Abstract: To evaluate functional outcomes following transoral robotic surgery for head and neck cancer. Case series with planned data collection. Academic hospital. Between March 2007 and December 2008, 54 of 62 candidate patients underwent transoral robotic tumor resection. Outcomes include airway management, swallowing (MD Anderson Dysphagia Inventory), and enterogastric feeding. Tumors were most commonly oropharynx (61%) or larynx (22%) and T1 (35%) or T2 (44%). Many received radiotherapy (22% preoperatively, 41% postoperatively) and chemotherapy (31%). Endotracheal intubation was retained (22%) for up to 48 hours, tracheostomy less frequently (9%), and all were decannulated by 14 days. Most commenced oral intake prior to discharge (69%) or within two weeks (83%). A worse postoperative Dysphagia Inventory score was associated with retained feeding tube ( P = 0.020), age ( P = 0.017), higher T stage ( P = 0.009), laryngeal site ( P = 0.017), and complications ( P = 0.035). At a mean 12 months' follow‐up, 17 percent retained a feeding tube (9.5% among primary cases). Retained feeding tube was associated with preoperative tube requirement ( P = 0.017), higher T stage ( P = 0.043), oropharyngeal/laryngeal site ( P = 0.034), and recurrent/second primary tumor ( P = 0.008). Complications including airway edema (9%), aspiration (6%), bleeding (6%), and salivary fistula (2%) were managed without major sequelae. Transoral robotic surgery provides an emerging alternative for selected primary and salvage head and neck tumors with low morbidity and acceptable functional outcomes. Patients with advanced T stage, laryngeal or oropharyngeal site, and preoperative enterogastric feeding may be at increased risk of enterogastric feeding and poor swallowing outcomes.
Publisher: Wiley
Date: 22-03-2010
DOI: 10.1002/LARY.20791
Abstract: To demonstrate that the osteocutaneous radial forearm free flap provides equivalent functional outcomes and improved morbidity compared to the fibular free flap in mandibular reconstruction. Retrospective review. There were 168 patients requiring free flap reconstruction of segmental mandibular defects between January 2001 and December 2008. Mean follow-up was 31 months for fibula free flap (FFF) (n = 117) and 20 months for osteocutaneous radial forearm free flaps (OCRFFF) (n = 51), reflecting an increasing use of forearms. OCRFFF were more commonly used in older patients (mean 63.7 years vs. 59 years, P = .03). The majority (96.2%) of reconstruction was for malignant pathology. Flap failure was 3.4% for the fibula group and 3.9% in the forearm group. Malunion was infrequent (2.0% OCRFFF, 6.0% FFF, P = .26). Donor site complications were higher in the FFF group (4.3%) versus none in the OCRFF group (P = .13). Despite a high rate of long-term survival in this patient population (75% at 5 years for carcinoma), dental implants were rarely placed (2.3% of patients) and were more common in forearm than fibula free flaps. Functional outcomes demonstrated no significant difference between groups with respect to oral diet (FFF 72.6% vs. OCRFFF 79.1%, P = .49) or retained enterogastric feeding tube (20.9% OCRFFF vs. 27.4% FFF, P = .49). Osteocutaneous radial forearm flaps provide comparable functional outcomes with less morbidity compared to fibula free flaps for selected segmental mandibulectomy defects. The overall dental implantation rate was low and more commonly performed in osteocutaneous radial forearm flaps compared to fibula flaps.
Location: United States of America
Location: United States of America
Location: United States of America
No related grants have been discovered for Eben Rosenthal.