Tristan Tham

All Publications

• Functional and radiological sinonasal outcomes of CFTR modulators for sinus disease in cystic fibrosis: A meta-analysis. International forum of allergy & rhinology Tham, T., Li, F. A., Schneider, J. R., Saleem, M. I., Werner, M. T., Chaskes, M. B., Tong, C. C., Fastenberg, J. H. 2024

  Abstract

  Cystic fibrosis transmembrane conductance regulator (CFTR) modulators improve pulmonary outcomes in cystic fibrosis (CF) by stabilizing the CFTR protein on respiratory epithelial surfaces. To determine the efficacy of CFTR modulators on sinonasal outcomes in patients with CF, we performed a meta-analysis of clinical trials to date that include functional and radiographic evidence of sinus disease.English full-text articles were searched in PubMed, Embase, and Scopus databases. Two reviewers screened articles and a third reviewer resolved disagreements. Articles were included if they reported functional or radiological sinonasal outcomes in patients with CF before and after CFTR modulator therapies. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the risk of bias in non-randomized studies of interventions tool was used for quality assessment. The generic inverse variance method with random effects model was used for meta-analysis. Standardized mean difference (SMD) and mean difference (MD) were used as effect measurements.Seven prospective and two retrospective studies representing 248 patients were included in this analysis. There was a significant improvement in sinonasal outcome test-22 scores on elexacaftor‒tezacaftor‒ivacaftor (MD = 12.80, [95% confidence interval, CI: 10.46‒15.13], p < 0.001, n = 222), with no heterogeneity detected (I2 = 0%, p = 0.820). There was also a significant improvement in Lund‒Mackay scores (SMD = 1.25, [95% CI: 0.58‒1.91], p < 0.001, n = 88), with heterogeneity detected (I2 = 67%, p = 0.030).CFTR modulators improve functional and radiologic sinonasal outcomes. Given the utility of CFTR modulators, the treatment paradigm for CF-related chronic rhinosinusitis promises to evolve.

  View details for DOI 10.1002/alr.23439

  View details for PubMedID 39212072

• Machine Learning Methods in Classification of Prolonged Radiation Therapy in Oropharyngeal Cancer: National Cancer Database. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Ahn, S., Oh, E. J., Saleem, M. I., Tham, T. 2024

  Abstract

  To investigate the accuracy of machine learning (ML) algorithms in stratifying risk of prolonged radiation treatment duration (RTD), defined as greater than 50 days, for patients with oropharyngeal squamous cell carcinoma (OPSCC).Retrospective cohort study.National Cancer Database (NCDB).The NCDB was queried between 2004 to 2016 for patients with OPSCC treated with radiation therapy (RT) or chemoradiation as primary treatment. To predict risk of prolonged RTD, 8 different ML algorithms were compared against traditional logistic regression using various performance metrics. Data was split into a distribution of 70% for training and 30% for testing.A total of 3152 patients were included (1928 prolonged RT, 1224 not prolonged RT). As a whole, based on performance metrics, random forest (RF) was found to most accurately predict prolonged RTD compared to both other ML methods and traditional logistic regression.Our assessment of various ML techniques showed that RF was superior to traditional logistic regression at classifying OPSCC patients at risk of prolonged RTD. Application of such algorithms may have potential to identify high risk patients and enable early interventions to improve survival.

  View details for DOI 10.1002/ohn.926

  View details for PubMedID 39082895

• Impact of Treatment Parameters on Racial Survival Differences in Oropharyngeal Cancer: National Cancer Database Study. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Zhu, D., Wong, A., Oh, E. J., Ahn, S., Wotman, M., Sahai, T., Bottalico, D., Frank, D., Tham, T. 2022; 166 (6): 1134-1143

  Abstract

  To investigate how differences in treatment parameters account for survival differences between races of patients with oropharyngeal squamous cell carcinoma (OPSCC).Retrospective cohort study.National Cancer Database.Data of patients with OPSCC undergoing radiation therapy (RT) or concurrent chemoradiation therapy as primary treatment were obtained from the National Cancer Database from 2004 to 2016. We analyzed 4 treatment-related time intervals to determine their impact on survival between races when controlling for human papilloma virus (HPV) status. Cox proportional hazards models, stepwise logistic regressions, covariate adjustments, and propensity score matching were performed.A total of 3152 patients were identified (2877 White, 275 Black). In HPV- cases, Black patients with prolonged radiation duration had a significantly worse overall survival as compared with White patients (hazard ratio, 1.77; 95% CI, 1.03-3.05; P = .039). In a logistic regression model, the only covariate that was significantly associated with prolonged RT was facility type. When further adjusted for facility type, the survival difference between Black and White patients with HPV- status and prolonged RT times was no longer significant (hazard ratio, 1.55; 95% CI, 0.90-2.69; P = .116).There is a significant disparity in overall survival between Black and White patients with HPV- OPSCC when RT duration is prolonged. Clinicians should be aware of the negative impact of prolonged RT, especially in Black patients, so that they can attempt to decrease treatment-related time intervals. Facility type was also found to affect the outcomes of patients with OPSCC, and efforts should be made to improve patient access to well-equipped, high-volume facilities.

  View details for DOI 10.1177/01945998211035056

  View details for PubMedID 34399637

• The Prevalence of Olfactory and Gustatory Dysfunction in COVID-19 Patients: A Systematic Review and Meta-analysis. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Tong, J. Y., Wong, A., Zhu, D., Fastenberg, J. H., Tham, T. 2020; 163 (1): 3-11

  Abstract

  To determine the pooled global prevalence of olfactory and gustatory dysfunction in patients with the 2019 novel coronavirus (COVID-19).Literature searches of PubMed, Embase, and Scopus were conducted on April 19, 2020, to include articles written in English that reported the prevalence of olfactory or gustatory dysfunction in COVID-19 patients.Search strategies developed for each database contained keywords such as anosmia, dysgeusia, and COVID-19. Resulting articles were imported into a systematic review software and underwent screening. Data from articles that met inclusion criteria were extracted and analyzed. Meta-analysis using pooled prevalence estimates in a random-effects model were calculated.Ten studies were analyzed for olfactory dysfunction (n = 1627), demonstrating 52.73% (95% CI, 29.64%-75.23%) prevalence among patients with COVID-19. Nine studies were analyzed for gustatory dysfunction (n = 1390), demonstrating 43.93% (95% CI, 20.46%-68.95%) prevalence. Subgroup analyses were conducted for studies evaluating olfactory dysfunction using nonvalidated and validated instruments and demonstrated 36.64% (95% CI, 18.31%-57.24%) and 86.60% (95% CI, 72.95%-95.95%) prevalence, respectively.Olfactory and gustatory dysfunction are common symptoms in patients with COVID-19 and may represent early symptoms in the clinical course of infection. Increased awareness of this fact may encourage earlier diagnosis and treatment, as well as heighten vigilance for viral transmission. To our knowledge, this is the first meta-analysis to report on the prevalence of these symptoms in COVID-19 patients.

  View details for DOI 10.1177/0194599820926473

  View details for PubMedID 32369429

• Outcomes of Chandelier-Assisted Scleral Buckling in Rhegmatogenous Retinal Detachments: Systematic Review and Meta-analysis. Journal of vitreoretinal diseases Zhu, D., Wong, A., Jiao, G., Zhang, C., Yakobashvili, D., Zhu, E., Tham, T., Lieberman, R. 2024; 8 (2): 158-167

  Abstract

  Purpose: To examine the outcomes of chandelier endoillumination-assisted scleral buckling (chandelier scleral buckling) for rhegmatogenous retinal detachments (RRDs) and compare them with those of standard scleral buckling using indirect ophthalmoscopy. Methods: A literature search was performed on April 15, 2023. Outcomes analyzed included the primary anatomic success rates, surgical duration, and complication rates. A meta-analysis of proportions estimated the pooled success rate of chandelier scleral buckling. In addition, meta-analyses compared the success rates between pseudophakic eyes and phakic eyes having chandelier scleral buckling and compared success rates and surgical duration between standard scleral buckling and chandelier scleral buckling. Results: Thirty studies with 1133 eyes were included. The pooled primary anatomic success rate of chandelier scleral buckling was 91.7% (95% CI, 89.6%-93.6%). In studies comparing success rates between the 2 techniques, there was no significant difference (risk ratio, 1.01; 95% CI, 0.94-1.08; P = .80). The surgical times were significantly shorter with chandelier scleral buckling than with standard scleral buckling (mean difference, -18.83; 95% CI, -30.88 to -6.79; P = .002). There was no significant difference in the success rate between pseudophakic eyes and phakic eyes (risk ratio, 0.99; 95% CI, 0.91-1.08; P = .89). No cases of endophthalmitis were reported. Conclusions: Chandelier endoillumination-assisted scleral buckling may be a promising technique given its high rate of primary anatomic success for RRDs and success rates similar to those of standard scleral buckling. There was no significant difference in the efficacy of chandelier scleral buckling between pseudophakic eyes and phakic eyes.

  View details for DOI 10.1177/24741264231224956

  View details for PubMedID 38465358

  View details for PubMedCentralID PMC10924592

• Management of Extruded Porous High-density Polyethylene Implant in the Internal Nasal Valve. Plastic and reconstructive surgery. Global open Diaz, A. M., Tham, T., Saleem, M. I., Ponder, B., Georgolios, A. 2022; 10 (11): e4647

  Abstract

  Porous high-density polyethylene (PHDPE) has been used since the 1990s as an alternative to autologous grafts. Implant extrusion is a rare but well-known complication of PHDPE and other alloplastic implants. This article discusses the case of PHDPE implant extrusion in a 69-year-old man with unsuccessful previous alar batten graft placement for internal nasal valve insufficiency. We detail the surgical techniques engaged in removing the implant from the internal nasal valve, postoperative results, and care, and present a histologic study of the removed implants.

  View details for DOI 10.1097/GOX.0000000000004647

  View details for PubMedID 36438463

  View details for PubMedCentralID PMC9682612

• The jaw-dropping costs of oral cavity cancer malpractice. Head & neck Wong, A., Zhu, D., Tong, J. Y., Ko, A., Tham, T., Kraus, D. 2021; 43 (10): 2869-2875

  Abstract

  Medical litigation is different than it was 20 years ago due to changes in health care. This study provides an updated analysis of oral cavity malpractice litigation from the past two decades (2000-2010 and 2011-2019).Verdict reviews from the Westlaw database were analyzed from January 2000 to August 2019. Data were collected and analyzed with the Statistical Package for the Social Sciences.Sixty-five lawsuits were evaluated across 24 states. Failure to diagnose was the most common allegation in both decades. Adjusting for inflation, the average amount awarded from 2000 to 2010 was $1 721 068 and $3 925 504 from 2011 to 2019.There has been a significant rise in allegations of failure to biopsy and failure to refer (p < 0.05). In addition, while award amounts appear different between decades, the difference is not statistically significant (p = 0.248). Education should focus on early diagnosis, biopsy, and referral to physicians who routinely care for this patient population.

  View details for DOI 10.1002/hed.26764

  View details for PubMedID 34050580

• The impact of the COVID-19 pandemic on otolaryngologic emergency department visits at two major NYC hospital systems AMERICAN JOURNAL OF OTOLARYNGOLOGY Patel, V. M., Kominsky, E., Tham, T., Bottalico, D., Setzen, M., Ferastraoaru, D., Akbar, N., Fastenberg, J. H. 2021; 42 (5): 103123

  Abstract

  Since the COVID-19 pandemic began, emergency departments (ED) across the country have seen a significant decrease in patient visits. We aim to evaluate the impact of COVID-19 on ED visits for acute otolaryngologic complaints in New York City, one of the first epicenters of the pandemic in the US.We conducted a retrospective study of patients who presented to the ED with a primary diagnosis of an acute otolaryngologic complaint between March 1 and May 31 in 2019 and 2020. This was a multicenter study, including two tertiary care hospital systems encompassing Manhattan, Bronx, Queens, and Long Island.A total of 10,162 patients were identified. Significantly fewer patients presented to the ED for acute otolaryngologic complaints in 2020 (7332 vs 2830, p < 0.001). The rate of total otolaryngology-related ED visits was decreased by a factor of 0.635 (95% CI 0.6079 to 0.6634). In a subgroup analysis of each individual diagnosis, there was a significant decrease in rate of ED visits for 13 out of 18 diagnoses, including for life-threatening conditions, such as anaphylaxis. There was no significant difference based on which borough in New York City. Pediatric patients (age 0-17) were more significantly impacted by the pandemic compared to other age groups.The COVID-19 pandemic has led to a reduction in the utilization of ED for acute otolaryngologic complaints, including those requiring emergent management, and an even more significant reduction in the pediatric population. Healthcare providers should encourage patients to seek appropriate care, particularly for those illnesses with significant associated morbidity and mortality.

  View details for DOI 10.1016/j.amjoto.2021.103123

  View details for Web of Science ID 000690739600001

  View details for PubMedID 34186437

  View details for PubMedCentralID PMC8214322

• The paralyzing legal costs of facial nerve injury in head and neck tumors. American journal of otolaryngology Zhu, D., Wong, A., Tham, T., Kraus, D. 2020; 41 (6): 102693

  Abstract

  Facial nerve paralysis from head and neck tumors can result from disease progression or iatrogenic causes, leading to litigation. The aim of this study was to investigate lawsuits regarding facial paralysis as a consequence of these tumors to understand and better educate physicians behind the reasons for litigation.Jury verdict reviews were obtained from the Westlaw database from 1985 to 2018. Gathered data, including verdicts, litigation reasons, defendant specialties, and amounts awarded, were analyzed via Statistical Package for the Social Sciences.Of the 26 lawsuits analyzed, the leading reason for litigation was failure to diagnose (53.8%), followed by iatrogenic injury (34.6%). The average award was $2,704,470. Otolaryngologists were the most common defendants. Defendants that included an otolaryngologist had shorter delays of diagnosis compared to those that did not (p < 0.05).Failure to diagnose parotid injury was the leading cause of litigation. In instances where the jury found for the plaintiff, the amount was material. There were equivalent incidences of cases in favor of plaintiffs and defendants.

  View details for DOI 10.1016/j.amjoto.2020.102693

  View details for PubMedID 32866849

• MLKL-dependent epithelial-to-mesenchymal transition in nasopharyngeal carcinoma: a novel finding and avenues for future research. Annals of translational medicine Tham, T. 2020; 8 (5): 153

  View details for DOI 10.21037/atm.2020.01.83

  View details for PubMedID 32309302

  View details for PubMedCentralID PMC7154460

• Systemic immune response in squamous cell carcinoma of the head and neck: a comparative concordance index analysis. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Tham, T., Wotman, M., Chung, C., Ahn, S., Dupuis, H., Gliagias, V., Movsesova, T., Kraus, D., Costantino, P. 2019; 276 (10): 2913-2922

  Abstract

  The objective of this study was to investigate the prognostic role of three inflammatory markers: the neutrophil to lymphocyte ratio (NLR), the lymphocyte to monocyte ratio (LMR), and the platelet to lymphocyte ratio (PLR) as prognostic indicators in squamous cell carcinoma of the head and neck (HNSCC).Patients with HNSCC treated with primary surgery, with or without adjuvant radiochemotherapy were enrolled. The preoperative NLR, LMR, and PLR were recorded. Confounding variables were also recorded: age, sex, BMI, comorbidities, performance status, AJCC T and N stage and HPV status. Endpoints were overall survival (OS) and event-free survival (EFS). Survival analysis was performed using Kaplan-Meier analysis, and multivariable analysis was performed using Cox proportional hazards regression. Survival models were evaluated using Harrell's concordance index (c-index).NLR (p = 0.2413), PLR (p = 0.1593), and LMR (p = 0.0552) were not significantly associated with OS in the multivariable analysis. With regard to EFS, low LMR (HR = 2.95, 95% CI 1.54-5.65, p = 0.001), high PLR (HR = 2.68, 95% CI 1.42-5.09, p = 0.003), and high NLR (HR = 3.37, 95% CI 1.7-6.69, p < 0.001) were associated with EFS. The multivariable c-index was highest for LMR (0.762), followed by NLR (0.761) and PLR (0.739).The LMR, PLR, and NLR were not associated with OS, but were associated with EFS in HNSCC. These markers are easily obtainable, and in the age of individualized patient care and precision medicine, they might represent further risk stratification tools for HNSCC patients.

  View details for DOI 10.1007/s00405-019-05554-x

  View details for PubMedID 31312922

• Platelet-Lymphocyte Ratio as a Predictor of Prognosis in Head and Neck Cancer: A Systematic Review and Meta-Analysis. Oncology research and treatment Bardash, Y., Olson, C., Herman, W., Khaymovich, J., Costantino, P., Tham, T. 2019; 42 (12): 665-677

  Abstract

  The aim of this systematic review and meta-analysis was to investigate the prognostic utility of the platelet-to-lymphocyte ratio (PLR) in head and neck cancer. Medline (via PubMed), EMBASE, Scopus, and the Cochrane Library databases were searched from their inception to May 2017 for relevant literature. A systematic review and meta-analysis were performed to generate the pooled hazard ratios (HR) for overall survival (OS) and disease-specific survival (DSS). The study was conducted in accordance with the Cochrane Handbook and PRISMA guidelines. Risk of bias was assessed using the QUIPS tool. The logarithm of the HR with standard error was used as the primary summary statistic. Heterogeneity was assessed using Cochran's Q and Higgins' I2. A total of 13 studies were included in the final analysis, combining data from 4,541 patients. The results demonstrated that an elevated PLR was significantly associated with poorer OS [HR 1.85, 95% CI 1.35-2.52, p < 0.00001] and DSS [HR 1.57, 95% CI 1.25-1.97, p < 0.0001]. Significant heterogeneity was detected for the pooled end points. Subgroup analysis demonstrated reduction of heterogeneity by controlling for sample size and cutoff value. 95% prediction intervals showed wide ranges crossing the null threshold.

  View details for DOI 10.1159/000502750

  View details for PubMedID 31550732

• Anaphylactoid hypersensitivity reaction from intra-arterial cetuximab: Clinical considerations and management. SAGE open medical case reports Bardash, Y., Tham, T., Olson, C., Khaymovich, J., Costantino, P. 2019; 7: 2050313X18823447

  Abstract

  Intra-arterial infusion of drugs shows promising results in terms of safety and efficacy. Intra-arterial cetuximab, a monoclonal antibody treatment, is currently being tested for its use in head and neck cancers. We present the case of a 45-year-old Asian male who developed an anaphylactoid hypersensitivity reaction, manifesting itself in the form of bronchospasm, tachycardia, and hypotension, during intra-arterial infusion of cetuximab. The symptoms were quickly diagnosed, and the patient was treated accordingly. Despite the safety profile of cetuximab and the decreased risk of systemic effects with intra-arterial infusion versus intravenous infusion, severe hypersensitivity reactions are still a risk in intra-arterial cetuximab infusions. Consequently, proper planning and care must be taken to prophylactically prevent and in the case of a reaction, treat the reaction accordingly. The case presented herein is, to the best of our knowledge, the first recorded moderate-to-severe infusion reaction in a patient receiving intra-arterial cetuximab treatment for head and neck cancer.

  View details for DOI 10.1177/2050313X18823447

  View details for PubMedID 30728973

  View details for PubMedCentralID PMC6350015

• Neuroradiological and Neuropathological Changes After 177Lu-Octreotate Peptide Receptor Radionuclide Therapy of Refractory Esthesioneuroblastoma. Operative neurosurgery (Hagerstown, Md.) Schneider, J. R., Shatzkes, D. R., Scharf, S. C., Tham, T. M., Kulason, K. O., Buteau, F. A., Del Prete, M., Chakraborty, S., Anderson, T. A., Asiry, S., Beauregard, J. M., Langer, D. J., Costantino, P. D., Boockvar, J. A. 2018; 15 (6): 100-109

  Abstract

  Olfactory neuroblastoma, also known as esthesioneuroblastoma (ENB), is a malignant neoplasm with an unpredictable behavior. Currently, the widely accepted treatment is inductive chemotherapy, with or without surgery, followed by radiotherapy. Since data on genetics and molecular alterations of ENB are lacking, there is no standard molecularly targeted therapy. However, ENB commonly expresses the somatostatin receptor (SSTR) that is also expressed by neuroendocrine tumors. Peptide receptor radionuclide therapy (PRRT) using radiolabeled somatostatin analogues, such as 177Lu-octreotate, is an effective treatment for the latter. We present the complex neuroradiological and neuropathological changes associated with 177Lu-octreotate treatment of a patient with a highly treatment-resistant ENB.A 60-yr-old male presented with an ENB that recurred after chemotherapy, surgery, stereotactic radiosurgery, and immunotherapy. Pathology revealed a Hyams grade 3 ENB and the tumor had metastasized to lymph nodes. Tumor SSTR expression was seen on 68Ga-octreotate positron emission tomography (PET)/computed tomography (CT), suggesting that PRRT may be an option. He received 4 cycles of 177Lu-octreotate over 6 mo, with a partial response of all lesions and symptomatic improvement. Four months after the last PRRT cycle, 2 of the lesions rapidly relapsed and were successfully resected. Three months later, 68Ga-octreotate PET/CT and magnetic resonance imaging indicate no progression of the disease.We describe imaging changes associated with 177Lu-octreotate PRRT of relapsing ENB. To our knowledge, this is the first report describing neuropathological changes associated with this treatment. PRRT is a promising therapeutic option to improve the disease control, and potentially, the survival of patients with refractory ENB.

  View details for DOI 10.1093/ons/opy028

  View details for PubMedID 29554305

• Neutrophil-to-lymphocyte ratio as a prognostic indicator in head and neck cancer: A systematic review and meta-analysis. Head & neck Tham, T., Bardash, Y., Herman, S. W., Costantino, P. D. 2018; 40 (11): 2546-2557

  Abstract

  The purposes of this systematic review and meta-analysis were to investigate the relationship between the neutrophil-to-lymphocyte ratio (NLR) and prognosis in head and neck cancer.A systematic review and meta-analysis were done to investigate the role of NLR in overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), and progression-free survival (PFS).For qualitative analysis, 33 cohorts with over 10 072 patients were included. For quantitative analysis, 15 studies were included with 5562 patients. The pooled data demonstrated that an elevated NLR significantly predicted poorer OS and DSS.An elevated pretreatment NLR is a prognostic marker for head and neck cancer. It represents a simple and easily obtained marker that could be used to stratify groups of high-risk patients who might benefit from adjuvant therapy.

  View details for DOI 10.1002/hed.25324

  View details for PubMedID 29761587

• Analysis of bone healing with a novel bone wax substitute compared with bone wax in a porcine bone defect model. Future science OA Tham, T., Roberts, K., Shanahan, J., Burban, J., Costantino, P. 2018; 4 (8): FSO326

  Abstract

  This pilot study describes a novel composite of hydroxyapatite and biodegradable polylactic acid with wax-like handling properties (BoneSeal®). The goal was to compare quantitative measures of bone healing between BoneSeal versus Bone wax.BoneSeal and Bone wax were introduced into separate defects of a single porcine specimen. After 6 weeks, the defect sites were harvested for analysis.Both groups had similar hemostatic action. The amount of new bone was significantly greater at 6 weeks in the BoneSeal group (38.05%) versus the Bone wax group (11.88%), p = 0.028.In this pilot study, BoneSeal had higher amounts of new bone formation compared with Bone wax.

  View details for DOI 10.4155/fsoa-2018-0004

  View details for PubMedID 30271614

  View details for PubMedCentralID PMC6153452

• Erratum: The Laparoscopically Harvested Omental Free Flap: A Compelling Option for Craniofacial and Cranial Base Reconstruction. Journal of neurological surgery. Part B, Skull base Costantino, P. D., Shamouelian, D., Tham, T., Andrews, R., Dec, W. 2017; 78 (2): e5

  Abstract

  [This corrects the article DOI: 10.1055/s-0036-1597138.].

  View details for DOI 10.1055/s-0037-1604035

  View details for PubMedID 30464880

  View details for PubMedCentralID PMC6246108

• The Laparoscopically Harvested Omental Free Flap: A Compelling Option for Craniofacial and Cranial Base Reconstruction (vol 78, pg 191, 2017) JOURNAL OF NEUROLOGICAL SURGERY PART B-SKULL BASE Costantino, P. D., Shamouelian, D., Tham, T., Andrews, R., Dec, W. 2017; 78 (2): E5

  View details for DOI 10.1055/s-0037-1604035

  View details for Web of Science ID 000450746500003

• The Laparoscopically Harvested Omental Free Flap: A Compelling Option for Craniofacial and Cranial Base Reconstruction. Journal of neurological surgery. Part B, Skull base Costantino, P. D., Shamouelian, D., Tham, T., Andrews, R., Dec, W. 2017; 78 (2): 191-196

  Abstract

  Background Management of craniofacial and cranial base tumors is a challenge due to the anatomic intricacies associated with the calvarium, the pathological diversity of lesions that present, and the potential complications. Clinical outcomes in laparoscopically harvested omentum free flaps for cranial base and craniofacial reconstruction are presented in this paper, in the largest case series to date. Methods A retrospective single-center experience for over 10 years with laparoscopically harvested omentum flaps used to reconstruct craniofacial and cranial base defects. Results A total of 13 patients underwent craniofacial or cranial base reconstruction using laparoscopically harvested omentum free flaps. The mean patient age was 48 years. The anterior skull base represented the most common site of reconstruction. A total of 12 of the flaps survived (92%), with one flap failure due to infection. All patients demonstrated satisfactory aesthetic and functional outcomes. There were no perioperative or intra-abdominal complications. Conclusions The laparoscopically harvested omentum free flap is a safe and effective tool in the armamentarium of the reconstructive surgeon. It is the ideal option to treat complex, three-dimensional subcutaneous defects, such as those encountered in craniofacial and cranial base reconstruction. Its unique angiogenic and immunologic capacity makes it an excellent flap for the previously irradiated and/or infected wound bed.

  View details for DOI 10.1055/s-0036-1597138

  View details for PubMedID 28321385

  View details for PubMedCentralID PMC5357238

• Intra-arterial cetuximab for the treatment of recurrent unresectable head and neck squamous cell carcinoma†. Journal of experimental therapeutics & oncology Tham, T., White, T. G., Chakraborty, S., Lall, R. R., Ortiz, R., Langer, D. J., Shatzkes, D., Filippi, C. G., Kraus, D., Boockvar, J. A., Costantino, P. D. 2016; 11 (4): 293-301

  Abstract

  Management of recurrent head and neck squamous cell carcinoma is a common and challenging clinical problem in head and neck oncology.Here we present the first reported case of super-selective intra-arterial (SSIA) microcatheter based local delivery of cetuximab for head and neck cancer. This technical report describes the techniques used to deliver the SSIA dose of cetuximab, as well as the patient outcome.This technical report is part of an ongoing Phase I Clinical Trial.The New York Head and Neck Institute (NYHNI) is a full-service otolaryngology and neurosurgery department at Lenox Hill Hospital, part of the Northwell Health System. The NYHNI serves a diverse patient population with a wide range of head and neck diseases in a tertiary hospital setting.SSIA Cetuximab.A patient presents to our clinic with recurrent unresectable squamous cell carcinoma of the nasopharynx. He is recruited into the first cohort of a phase I clinical trial to assess the safety of SSIA cetuximab, dose starting at 100mg/m2. Adjuvant chemo-radiation therapy is also given.Safety, as measured by toxicity of SSIA cetuximab.SSIA Cetuximab has been demonstrated to be a safe and feasible procedure in this technical report.This case illustrates technical feasibility and a very preliminary assessment of the safety of a novel delivery of a biologic agent for squamous cell carcinoma of the head and neck, which is part of an ongoing phase I clinical trial.NCT02438995.

  View details for PubMedID 27849340

• Multiportal Combined Transorbital and Transnasal Endoscopic Resection of Fibrous Dysplasia. Journal of neurological surgery reports Tham, T., Costantino, P., Bruni, M., Langer, D., Boockvar, J., Singh, P. 2015; 76 (2): e291-6

  Abstract

  Introduction Historically, access to the anterior skull base was achieved with open procedures. The paradigms to this approach were challenged with the advent of minimally disruptive endoscopic surgical techniques and supporting technology. The next step in the evolution of minimally disruptive surgery was the combination of multiportal endoscopic surgery. Results The patient was an 18-year-old man who presented with right-sided proptosis. Further diagnostic tests revealed a fibrous dysplasia (FD) occupying the skull base and orbit. The lesion was successfully resected. Conclusions The location of the tumor in this case was challenging, in which surgeons at some centers would have opted to have performed as an open procedure instead of endoscopically. The combined transnasal/transorbital approach is an uncommonly used technique that we have used to remove this tumor successfully. The patient also had a unique disease (FD) in a unique location that was treated without complications. This case report highlights how surgeons may use an expanded armamentarium in dealing with complex pathologies.

  View details for DOI 10.1055/s-0035-1566126

  View details for PubMedID 26623245

  View details for PubMedCentralID PMC4648726

• Probable Immunoglobulin Subtype-G4-Related Disease in the Head and Neck from Foreign Body Injection: A Case Report. Journal of neurological surgery reports Highstein, M. J., Mallen, J., Tham, T., Brennan, T., Boubour, A., Opher, E., Wolf, V., Singh, P., Costantino, P. 2015; 76 (2): e265-9

  Abstract

  Introduction Immunoglobulin subtype G4-related disease (IgG4-RD) is a fibroinflammatory disease of unknown etiology, with manifestations involving nearly every organ system. Its association with foreign bodies is not established. Here, we present a novel case of IgG4-RD in response to foreign body injection. Case Description A 58-year-old woman presented with history of persistent left facial pain, xerophthalmia, blurred vision, and trismus. The patient's medical history was significant for left-sided temporomandibular joint (TMJ) reconstruction with silicone injection into the joint. Magnetic resonance imaging revealed a lesion in the left skull base. Biopsies demonstrated the cardinal histopathological features of IgG4-RD. The patient was treated with a tapering dose of prednisolone followed by rituximab, resulting in tumor shrinkage and resolution of her symptoms. Discussion This is the first reported case of IgG4-RD potentially precipitated by a foreign body, in this case injected silicone into the TMJ. The pathogenesis and etiology of IgG4-RD is still not fully elucidated, but allergic and reactive inflammatory reactions have been implicated in the disease process. This case report should raise the idea of reactive foreign bodies as a causative agent for IgG4-RD.

  View details for DOI 10.1055/s-0035-1564602

  View details for PubMedID 26623239

  View details for PubMedCentralID PMC4648737