SUNDAY, JUNE 19, 2005

POLIQUIN MEDTRONIC-XOMED RESIDENT COMPETITION
BALLROOM A, HOTEL NEWFOUNDLAND, ST. JOHN'S, NF

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08:45 – 08:55
SURGERY VS. RADIOTHERAPY FOR EARLY T1-T2 GLOTTIC CARCINOMA - Mlynarek, A., Kost, K., Gesser, S.L.P., MONTREAL, QC

Objectives: Compare surgery and radiotherapy as treatments for early T1-T2 glottic cancer in terms of local and regional control, complications, cost and voice outcome.

Methods: Retrospective comparative review of 36 patients. 26 patients post radiotherapy (group 1) and 12 patients post endoscopic surgical resection (group 2). The two groups were compared in terms of local control, complications, and treatment-related costs. Cross-Sectional study of 11 patients: 5 patients post surgery, 4 post radiotherapy and 2 post radiotherapy and surgery. The voice quality was compared objectively and subjectively by an otolaryngologist using videostroboscopy, a standardized VHI questionnaire and by a visipitch II computer program.

Results: The recurrence rate following primary treatment was 22% in group 1, and 25% in group 2. In group 1, local complications such as vocal fold scars and erythema were noted in 33%, while systemic complications (mainly hypothyroidism) were found in 22%. In group 2, local complications were noted in 17%, and there were no systemic complications. Vocal fold function as assessed by videostroboscopy was superior in the radiotherapy group. Patients in the surgical group scored higher on the subjective and objective voice assessments.Treatment costs with radiotherapy were five times higher than those associated with surgery

Conclusion: Surgery for early glottic cancer tends to have less complications and better voice outcome than radiotherapy.

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09:00 – 09:10
SECRETS OF THE LENTICULAR PROCESS AND INCUDOSTAPEDIAL JOINT - Alsabah, B.H., Funnell, W.R.J., Daniel, S.J., Zeitouni, A.G., Rappaport, J.M., MONTREAL, QC

The complex anatomy of the lenticular process and incudostapedial joint has been poorly represented in the otolaryngology literature. Our objective is to study the anatomy and mechanics of this area.

Temporal-bone dissection was performed to isolate the human lenticular process and incudostapedial joint. X-ray microscopic CT scans were performed, with voxel sizes as small as 4.2 microns. Locally developed software was used to segment the images and to do 3 dimensional reconstruction.

A preliminary 3-dimensional model of the lenticular process and incudostapedial joint is presented. The potential of finite-element modelling for elucidating the mechanics of incudostapedial coupling is discussed.

The study results lead to further insight into the morphology and mechanics of the lenticular process and incudostapedial joint. The implications for ossicular prosthesis design will be addressed.

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09:15 – 09:25
ELECTRONYSTAGMOGRAPHY (ENG) EVALUATION IN CHILDREN - Dickson, J.M., Moxham, J.P., Mallinson, A., VANCOUVER, BC

Objective: To evaluate the role of electronystagmography (ENG) on pediatric patients presenting with vertigo.

Methods: A retrospective chart review was performed to determine the number of children presenting to a single pediatric otolaryngologist with vertigo over a five year period. All patients had ENG’s performed by a single ENG technician. Adjunctive evaluations included neurology referral, MR Scanning, and CT Scanning where appropriate.

Results: The study group consisted of forty patients. Twenty-six patients had ENG evaluation. There was one positive Dix-Hallpike test consistent with clinical diagnosis of BPPV. The remainder of the ENG evaluation for this patient was normal. ENG testing was normal for all other children. Eight patients were not tested because of age less than five. ENG was not indicated in five patients. One test could not be completed.

Conclusion: ENG did not appear to influence the diagnosis or treatment in patients evaluated with vertigo and therefore should be used sparingly in the pediatric population.

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09:30 – 09:40
PREVENTION OF AMINOGLYCOSIDE INDUCED OTOTOXICITY IN MICE WITH THE FREE RADICAL SCAVENGING AGENT SODIUM THIOSULFATE - Blakley, B., Hochman, J., Wellman, M., Blakley, L., WINNIPEG, MB

Aminoglycoside antibiotics are some of the most commonly utilized agents for treating gram-negative bacterial infections. They are extremely efficacious but can result in ototoxicity. It has been postulated that the mechanisms for damage is the formation of oxygen free radicals. The objective of this study was to determine if the free radical scavenging agent sodium thiosulfate could reduce the amount of hearing loss suffered by C57 mice when provided with intra-peritoneal gentamicin.

This study was accomplished by creating several treatment arms. The animals were either provided with intra-peritoneal injections of gentamicin, sodium thiosulfate, gentamicin plus sodium thiosulfate or simply saline. At approximately weekly intervals the animals were sedated and ABR testing was accomplished.

The results indicate limited protection provided by the addition of sodium thiosulfate to the aminoglycoside.

We have determined that unlike the case of cisplatin, sodium thiosulfate is not an effective agent for prophylaxis against gentamicin induced hearing loss. This may suggest that different mechanisms are resulting in the ototoxicity suffered by some patients taking aminoglycosides. This conclusion is grounded in the fact that this research was conducted in an identical fashion and in the same lab as that which found sodium thiosulfate minimizes the chemotherapeutic medication’s ototoxicity.

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09:45 – 09:50
BACTERIOLOGY OF ASYMPTOMATIC SUBJECTS AFTER ENDOSCOPIC SINUS SURGERY - Al-Shamari, H., Abou-Hamad, W., Libman, M., Desrosiers, M., MONTREAL, QC

Aims: We wished to determine the resident flora and the level of bacterial presence of the healthy post-ESS sinus cavity.

Setting: Academic based prospective trial.

Method: Asymptomatic patients having previously undergone ESS for inflammatory disease greater than twelve weeks previously . Endoscopic cultures of the sinus cavities were performed with swab and a novel lavage technique and processed for identification of bacterial species and level of bacterial presence.

Results: 21 patients were recruited. Bacterial organisms could be recovered in 100% of subjects (mean 1.7 organisms/ pt). Flora was predominantly coagulase-negative staphylococci (CNS) (76%) and diptheroids (29%). S Aureus was recovered in 24% of subjects and P Aeruginosa in 5% only. No subject had semi quantitative growth of more than 1+. All lavage fluid were less than 10 000 organims/ml.

Conclusion: CNS and diptheroids constitute the predominant flora of the healthy post-ESS sinusitis cavity. Colonization is more probable than infection given low levels of presence.

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10:30 – 10:40
3-YEAR IMPACT OF A PROVINCIAL CHOKING PREVENTION PROGRAM - Després, N., Lapointe, A., Quintal, M.-C., Giguère, C.M., Arcand, P., Abela, A., MONTREAL, QC

Objective: To determine the impact of a provincial choking prevention program (CPP) on the incidence of aerodigestive foreign body cases among children.

Method: The CPP including posters, pamphlets, informative video and annual participation to Parents & Kids Fair was launched throughout the Quebec province in October 1999. The incidence rates of aerodigestive foreign body cases prior to implementation (during 1997-98) and subsequently (2000-02) within the province and our tertiary care center were compared by estimating incidence rate ratios (IRR) and associated 95% confidence intervals (95% CI).

Results: No significant changes in the incidence of aerodigestive foreign body cases after program implementation were observed in our hospital (age-adjusted IRR 0.92, CI 0.79 – 1.07). The provincial rates were higher after program implementation (age-adjusted IRR 1.15, CI 1.05-1.25).

Conclusions: In order to impact choking prevention habits, modifications to the campaign are required. Strategies are discussed.

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10:45 – 10:55
KOILOCYCTOSIS IN ORAL SQUAMOUS CELL CARCINOMA: WHAT DOES IT MEAN? - Al-Qahtani, K., Brousseau, V.J., Paczesny, D., Domanowski, G., Hamid, Q., Hier, M., Black, M., Franco, E., Kost, K., MONTREAL, QC

Objectives: 1. Determine the prognosis of patients with squamous cell carcinoma (SCCA) of the oral cavity. 2. Determine whether a relationship exists between koilocytosis and tumor grade, stage, and prognosis in these patients.

Methods: Retrospective study of patients with SCCA of the oral cavity at McGill in the last 5 years followed by pathology review of available cases. Data extracted: age at diagnosis, risk factors, tumor stage, grade, koilocytosis, treatment and outcome.

Results: A total of 198 patients were identified. There was an overall 13% mortality rate over the follow-up period. Pathology material was available for 97 patients. Koilocytosis was identified in 65 samples (67%); 82% of tumors with koilocytosis were graded as either well or moderately differentiated squamous cell. Koilocytosis was evenly distributed amongst tumor stages (I: 60%, II: 79%, III:59%, IV: 68%). Of 11 patients deceased, 8 (73%) demonstrated koilocytosis.

Conclusion: Our mortality rates are similar to those published in the literature. There is a high prevalence of koilocytosis in SCCA of the oral cavity, which appears to be associated with better tumor differentiation and worse outcome but does not seem to be associated with staging.

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11:00 – 11:10
THE USE OF EXTERNAL JUGULAR VEIN AS THE SOLE RECIPIENT VEIN IN HEAD AND NECK FREE FLAP RECONSTRUCTION - Hong, P., Hart, R., Trites, J., Taylor, M., HALIFAX, NS

Objective: To ascertain whether the use of the external jugular vein as the sole recipient vein increases the risk of free flap failure in head and neck reconstructive surgery.

Method: A retrospective review of all free flaps performed at an academic center using the external jugular vein as the sole recipient vein was performed. The same two surgeons completed all free flap microvascular anastomoses. Outcome measures were free flap survival or free flap failure rate.

Results: 95% of the flaps survived (38 of 40). These numbers are well within published flap survival acceptability.

Conclusions: Use of the external jugular vein as the sole recipient vein in head and neck reconstruction does not increase the risk of free flap failure as compared to published free flap survival data.

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11:15 – 11:25
CENTRAL LABORATORY VS. POINT OF CARE TESTING IN INTRAOPERATIVE MONITORING OF PARATHYROID HORMONE LEVELS: A COST COMPARISON - O’Connell, D.A., Harris, J.R., Seikaly, H.R., EDMONTON, AB

Objectives: To examine the cost of central laboratory based intraoperative parathyroid hormone (PTH) during parathyroid surgery compared to a point of care based PTH testing system.

Methods: Based on a retrospective analysis of intraoperative PTH testing in the 50 most recent parathyroid surgeries. A cost comparison between the current testing system at the University of Alberta Hospital (Elecsys 2010, Roche Diagnostics) and a theoretical model utilizing the QuiCK-Pak Automated System (Nichols Institute Diagnostics) was generated. Results: The cost per surgery of central lab based PTH testing was approximately $75 compared to $260 for the point of care based system.

Conclusions: In recent years intra-operative PTH testing has become widely utilized to improve outcomes in the surgical management of hyperparathyroidism. Some studies have shown that point of care PTH testing has an economic benefit over central lab based systems, we provide evidence that the converse is true with central lab based PTH testing have the cost effective advantage.

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11:30 - 11:40
DEVELOPMENT OF A CLINICALLY RELEVANT MOUSE MODEL OF ORAL CANCER FOR USE IN SERUM PROTEOMICS - Balys, R., Alaoui-Jamali, M., Hier, M., Black, M., MONTREAL, QC

Introduction: Serum proteomics has enormous potential in the identification of biomarkers and the development of new therapies for oral cancer. Current efforts are limited by the lack of a control subject. The human/mouse chimeric model offers a solution. Objectives: To develop and test two orthotopic xenograft mouse models of human oral squamous cell carcinoma for research in serum proteomics.

Methods: Advanced human oral cancer from 2 patients was implanted orthotopically into the tongues of 15 SCID and 6 RAG2/?(c) mice. The mouse models were compared for tumor growth, presence of metastasis, histological invasiveness and by immunohistochemistry. Mouse serum was preserved for studies in serum proteomics.

Results: Tumor tissue was successfully implanted into 100% of SCID and RAG2/?(c) mice. There was no evidence of macroscopic metastasis in either mouse model. The human origin of these tumors was confirmed pathologically. The RAG2/?(c) mice demonstrated faster growth and increased invasiveness as compared to the SCID mouse.

Conclusions: The RAG2/?(c) mouse is superior to the SCID for use in serum proteomics.

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13:00 - 13:10
QUALITY OF LIFE IN PATIENTS UNDERGOING THYROID SURGERY - Shah, M., Witterick, I., Pinto, R., Spiro, E., Freeman, J., TORONTO, ON

OBJECTIVE: The extent of thyroidectomy in the management of low risk well-differentiated thyroid carcinoma (WDTC) has been debated extensively. Our objective was to determine if hemithyroidectomy has a less detrimental effect upon quality of life (QOL) than total thyroidectomy.

METHODS: Using both disease specific and global QOL instruments, patients treated with either hemi or total thyroidectomy were prospectively followed. QOL was assessed pre-operatively and for 12 months post-operatively.

RESULTS: Patients with cancer experienced a greater drop in QOL during the first 6 months following surgery when compared to patients with benign disease (p < 0.03). Additionally, patients treated with total thyroidectomy did not have a significantly different QOL than patients treated with hemithyroidectomy (p > 0.2).

CONCLUSION: These results suggest that QOL is not significantly impacted by the extent of surgery and that this should not be a factor in the decision making process for the treatment of low risk WDTC.

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13:15 - 13:25
FACTORS AFFECTING UNANTICIPATED HOSPITAL ADMISSION FOLLOWING OUTPATIENT SURGICAL PROCEDURES IN OTOLARYNGOLOGY - Tewfik, M.A., Frenkiel, S., Gasparrini, R., Zeitouni, A., Kost, K., Samaha, M., Sweet, R., Novick, W., MONTREAL, QC

Outpatient surgery constitutes an important part of modern otolaryngology practice. However, significant rates of unplanned admissions remain an issue.

Objectives: To determine the incidence, reasons, and predictive factors for unanticipated admission after ambulatory otolaryngology surgical procedures.

Methods: A retrospective review of all cases of unplanned admission following otolaryngology day surgery at a tertiary care center, over a four-year period from 2000 to 2004. Data relating to patient demographics, comorbidities, surgical procedure, perioperative complications and reasons for hospital admission were recorded.

Results: During the above period, a total of 1,215 patients underwent otolaryngological day surgery, of which 75 (6.2%) required admission. The 3 most common procedures with unplanned admission were open neck biopsy (24.6%), panendoscopy (23.2%), and FESS (20.3%). The reasons for admission could be divided into airway monitoring (37.7%), postoperative bleeding (26.1%), need for supportive/pain management (21.8%), anesthetic complication (5.8%), cardiovascular complication (4.3%), and booking error (2.9%).

Conclusions: This study suggests strategies to reduce the unplanned admission rate by means of careful pre-operative assessment, patient selection and education, follow-up with nursing care and postoperative analgesia. This is important both for cost-effectiveness, and for quality assurance purposes.

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13:30 - 13:40
A RETROSPECTIVE REVIEW OF THE PECTORALIS MAJOR MYOFASCIAL FLAP (PMMF): INDICATIONS AND OUTCOMES - Ethier, J.-L., Taylor, S.M., Trites, J., HALIFAX, NS

Objective: Review the PMMF in head and neck reconstruction.

Methods: Twenty-seven consecutive patients who underwent a PMMF reconstruction between March 1st 2001 and Oct 1st 2004 were retrospectively reviewed and have generated the largest series in the world literature to date. Data acquisition centered on indications for use, tumor staging, defect location, type of wound, and complications (major and minor).

Results: Thirteen patients had resections of primary tumor, while 13 others had recurrent disease. Stages varied from T0 to rTxN3. A variety of defects were filled, but the majority of defects were oral cavity 14(52%). Indication ranged from pure soft tissue filling to salvage of previously failed reconstructions. The outcomes have been evaluated at 24(89%) success, 6(22%) major complications and 5(19%) minor complications.

Conclusions: The PMMF remains a successful reconstructive option, however when used in the context of previously failed reconstructive efforts, the morbidity of the PMMF is much higher.

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13:45 - 13:55
DONOR SITE MORBIDITY FOLLOWING RADIAL FOREARM FREE TISSUE TRANSFER IN HEAD AND NECK SURGERY - Sardesai, M.G., Fung, K., Yoo, J.H., LONDON, ON

Radial forearm free tissue transfer is frequently used in head and neck reconstruction. The donor site morbidity associated with the radial forearm flap is a pertinent quality of life issue in patients undergoing major ablative and reconstructive surgery. Long-term hand function following surgery has been reported, but has not been comprehensively studied. A single-centre retrospective cohort study was undertaken in order to quantitate donor site morbidity in this patient population. Outcome measures were (i) subjective hand function using the Michigan Hand Outcomes Questionnaire, (ii) objective hand function compared with normative data and contralateral-hand controls, and (iii) aesthetics.

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14:00 - 14:10
MOBILE C-ARM CONE-BEAM CT: A NOVEL IMAGE-GUIDANCE TECHNOLOGY FOR HEAD AND NECK SURGERY - Chan, Y., Siewerdsen, J.H., Rafferty, M., Moseley, D., Jaffray, D.A., Irish, J.C., TORONTO, ON

Objectives: A conventional approach to image-guided surgery relies on positional tracking relative to preoperative images. We investigate the performance of intraoperative cone-beam CT (CBCT) on a mobile C-arm for real-time guidance of head and neck surgery. Objectives include: (1) to quantify improvements in surgical performance achieved with intraoperative CBCT; and (2) to demonstrate the utility of CBCT in skull base surgery.

Methods: Surgical performance was evaluated using a phantom in which a simulated skull base lesion was excised under open and endoscopic approaches with and without intraoperative CBCT. Performance was quantified by means of statistical decision theory analysis for conservative and aggressive excision tasks. Cadaveric specimens were employed to demonstrate the utility of CBCT guidance in skull base surgery.

Results: Performance under CBCT guidance was significantly increased for aggressive excision tasks and marginally improved for conservative tasks. Cadaver studies demonstrated that CBCT-guided procedures yielded higher quality surgical product and higher conformity to surgical margins with dramatically increased surgical confidence.

Conclusions: Intraoperative CBCT quantifiably improved surgical performance in all excision tasks, and dramatically increased surgical confidence. CBCT offers near real-time visualization that should be of great benefit in delicate procedures where excision must be executed in close proximity to critical structures.

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14:45 – 14:55
ORBITAL DECOMPRESSION: A CADAVER STUDY - Forest, V.I., Boulos, P., Hardy, I., Ahmarani, C., MONTREAL, QC

OBJECTIFS : À l’aide d’une étude cadavérique, mesurer la diminution de la proptose selon le ou les parois orbitaires décomprimées. Améliorer la prédiction de la réduction de la proptose.

MÉTHODE : 12 orbites sont utilisées. Une proptose est créée et une décompression des parois médiane, inférieure, latérale, suivie d’une combinaison des différentes parois est réalisée.

RÉSULTATS : La décompression d’un mur n’entraîne pas une réduction statistiquement significative de la proptose. L’association des parois médiane et latérale diminue la proptose de 4,2 mm. Lorsque les parois médiane, inférieure et latérale sont décomprimées, une diminution de 6,6 mm est mesurée. Ajouter l’avancement du mur latéral à la décompression de ces 3 parois permet de réduire la proptose de 12,6 mm.

CONCLUSION : Pour une diminution de 5 mm et plus de l’exophtalmie, nous suggérons une décompression des 3 parois de l’orbite. L’avancement de la paroi latérale double cette réduction. Pour une réduction de moins de 5 mm, une décompression des parois médiane et latérale serait suffisante.

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15:00 – 15:10
PRE-OPERATIVE CHARACTERISTICS AND POST-OPERATIVE OUTCOMES FOLLOWING ADENOIDECTOMY IN CHILDREN Lee, J., Cohen-Kerem, R., Crysdale, W., TORONTO, ON

Objective: (1) To describe the pre-operative characteristics of children undergoing adenoidectomy; (2) To evaluate objective and quality of life outcomes following adenoidectomy in children.

Methods: This was a cross-sectional observational study. Patients who were candidates for adenoidectomy at The Hospital for Sick Children were evaluated with respect to pre-operative symptoms, flexible nasal endoscopy findings, and nasal airflow studies. Following surgery, a quality of life questionnaire was administered to all available patients and an attempt was made to repeat the nasal airflow study.

Results: 57 patients were included in the study with 31 females and 26 males. The average age of the patient at surgery was 10.1 years. 30 patients (52.6%) had a significant nasal airflow (NAF) study while flexible nasal endoscopy revealed an average nasopharyngeal obstruction of 73.2%. We did not find any correlation between pre-operative symptoms, flexible nasal endoscopy findings, or NAF study results. The degree of symptom reduction was the only predictor of how satisfied a patient would be in the post-operative period (p < 0.05).

Conclusion: In our study of adenoidectomy patients, clinical signs and symptoms appear to be more predictable than the objective tests of NAF and flexible nasal endoscopy. As such, following these symptoms in the post-operative period is important in determining a patient’s satisfaction following surgery.

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15:15 – 15:25
SUBMANDIBULAR INTRA-DUCTAL ADMINISTRATION OF SCLEROSING AGENTS: A PORCINE MODEL FOR THE NOVEL TREATMENT OF CHRONIC SIALORRHEA - Janjua, A.S., Cohen-Kerem, R., Taylor, G., Forte, V., TORONTO, ON

BACKGROUND: Chronic drooling is a troublesome and frustrating problem in children with neurological and muscular disabilities. Currently, surgical modification of the salivary ductal system is utilized as the primary therapeutic modality.

OBJECTIVE: Determination of a simplistic, non-surgical technique that produces effective salivary gland ablation would serve to: a) minimize the morbidity associated with the surgical treatment of chronic sialorrhea, and b) decrease the significant resource utilization and cost associated with surgical treatment and post-operative care.

METHODS: Various sclerosing agents were delivered to the submandibular ducts of our porcine subjects via simple intra-oral cannulation. The submandibular glands were then excised at interval and histologically analyzed to determine the degree of fibrosis and parenchymal atrophy achieved with each agent.

RESULTS: Intra-ductal administration of a well-known vacular sclerosing agent, Sodium Tetra-decyl Sulfate, reproducibly yielded near-total fibrosis and parenchymal atrophy without any local destructive effects on the intra-oral mucosa or post-operative complications in our pig subjects.

CONCLUSIONS: In our porcine model, intra-ductal administration of Sodium Tetra-decyl Sulfate was safe and effective in ablating salivary gland tissue, and may provide a significantly less invasive alternative to the surgical treatment of chronic sialorrhea in children.

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15:30 – 15:40
FIRST MYRINGOTOMY WITH INSERTION OF MODIFIED GOODE T-TUBE: A REVOLUTIONARY PRACTICE - Carignan, M., Dorion, D., SHERBROOKE, QC

Background: Goode T-tube suffer from a bad reputation regarding their residual tympanic perforation rate. However, these long-term tubes are mostly used in patients at high risks of chronic middle ear problems.

Objective: To demonstrate that modified Goode T-tubes inserted at first myringotomy in normal children leave a perforation rate comparable to the rate reported in the literature for short-term tubes and may be extracted safely in the clinic when the ear is “ready”.

Methodology: This prospective study followed 61 children (106 ears) that had their modified Goode T-tubes electively removed at the clinic.

Results: We found a 2% perforation rate at the third follow-up visit (meantime = 5,1 months). Tubes had been in place for an average of 2,9 years. Perforation healing rate was related to intubation duration. Adenoidectomy and/or adenotonsillectomy seemed to influence speed of healing. Age and gender were not significantly related to persistent perforation. Perforations were fewer when tubes were inserted for chronic middle ear effusion compared to reccurent AOM.

Conclusion: Modified Goode T-tubes inserted at first myringotomy and electively withdrawn, allow a longer drainage and have a perforation rate comparable to short-term tubes.

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15:45 – 16:00
PIGMENT RE-ACTIVATION FOR HYPOPIGMENTED SCARS OF THE FACE, HEAD AND NECK - Eljallah, K., Moore, C., LONDON, ON

Objective: to develop a technique for improving the appearance of hypopigmented scars of the face, head and neck using post -inflammatory photo reactivation of melanocytes.

Methods: Thiry patients presenting to a facial plastic outpatient clinic for hypopigmented facial scars were assessed for treatment. One half of the scar in question was treated and other half of the scar was used as a control. Treatment consisted of a novel technique creating an intense inflammation of the scar using a motorized hypodermic 50 gauge needle. Numerous passes over the scar were performed. The scar was then treated conservatively for 7 days using vaseline ointment to prevent dessication. On day 7 the scar was then exposed to an 800Watt UVA light source for 10 minutes. Irritating agents such as chlorine were then avoided for a further 7 days. Scars were evaluated at 7, 30 and 60 days post treatment using a photonumeric scale.

Results: All treated half scars improved color match with the surrounding skin using this treatment with no complications.

Conclusions: Photoreactivation of hypopigmented scars in the face, head and neck appears to be a safe and effective alternative treatment for scar camouflage.

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