Mace, Jess C.

AbstractObjectiveThe primary goal of this study was to measure health‐state utility values (HUVs) in patients with facial paralysis before and after treatment. A secondary objective was to compare these values with those of other chronic diseases and currently available treatments.Study DesignA retrospective chart review.SettingA tertiary medical center.MethodsAdults with flaccid and non‐flaccid facial paralysis were included. Baseline demographics, medical comorbidities, facial paralysis history, treatment details, and disease‐specific quality‐of‐life scores were collected. Utility values were derived using the Short‐Form 6D health index at baseline and after treatment.ResultsThe mean baseline Short‐Form 6D utility value for patients with facial paralysis (n = 134) was 0.73 (± 0.14) (95% confidence interval [CI]: 0.71‐0.75). Baseline utility values significantly correlated with disease‐specific quality of life as measured by the Facial Clinimetric Evaluation Scale (r = 0.400; P < .001), but not with Sunnybrook Facial Grading Scale or Synkinesis Assessment Questionnaire scores. Post‐treatment utility values showed a mean improvement of 0.03 (95% CI: −0.01 to 0.08; P = .14) in the overall cohort. The flaccid group showed a greater average improvement compared to the non‐flaccid group (0.05 [± 0.17] vs 0.02 [± 0.17]; P = .62).ConclusionPatients with flaccid and non‐flaccid facial paralysis reported HUVs that were significantly lower than the US population norm. Treatment improved utility values in both groups. These findings provide initial data for future cost‐effectiveness analyses of surgical and non‐surgical treatment options for facial paralysis.

AbstractBackgroundWith modern treatment paradigms, olfactory neuroblastoma (ONB) has favorable overall survival (OS); however, the incidence of recurrence remains high. The primary aims of this study were to delineate the prognosis of recurrence of ONB and explore how recurrence subsites are associated with OS, disease‐specific survival (DSS), and further recurrence.MethodsA retrospective chart review of ONB cases from nine academic centers between 2005 and 2021 was completed. Tumor characteristics, recurrence subsites, timelines to recurrence, additional recurrences, and survival estimates were determined using descriptive and time‐to‐event analyses.ResultsA final cohort of 233 patients was identified, with 70 (30.0%) patients recurring within 50.4 (standard deviation ±40.9) months of diagnosis on average, consisting of local (50%), neck (36%), intracranial (9%), and distant (6%) recurrence. Compared with subjects without recurrence, patients with recurrence had significantly different primary American Joint Committee on Cancer T stage (p < 0.001), overall stage (p < 0.001), and modified Kadish scores (p < 0.001). Histopathology identified that dural involvement and positive margins were significantly greater in recurrent cases. First recurrence was significantly associated with worse 5‐year DSS (hazard ratio = 5.62; p = 0.003), and subjects with neck or local recurrence had a significantly better DSS compared to intracranial or distant recurrence.ConclusionsRecurrent cases of ONB have significantly different stages and preoperative imaging factors. Patients with local or neck recurrence, however, have better DSS than those with intracranial or distant recurrence, independent of initial tumor stage or Hyams grade. Identifying specific factors that confer an increased risk of recurrence and DSS is important for patient counseling in addition to surveillance planning.

AbstractObjectiveTo evaluate recurrence patterns and survival after recurrence among patients with sinonasal mucosal melanoma (SNMM).MethodsThis was a multi‐institutional retrospective review from seven U.S. institutions of patients with SNMM from 1991 to 2022. Recurrence was categorized as local, regional, distant, or multifocal. Kaplan‐Meier tests were used to evaluate disease‐free survival (DFS), overall survival (OS), and post‐recurrence survival (PRS) reported with standard errors (SE) and log‐rank testing used for comparison. Cox‐regression was further used, with hazard ratios (HR) and 95% confidence intervals (CI) reported.ResultsAmong 196 patients with SNMM, there were 146 patients with recurrence (74.5%). Among all patients, 60‐month DFS (SE) was 15.5% (2.9%), 60‐month OS (SE) was 44.7% (3.7%), mean age ± standard deviation at diagnosis was 69.7 ± 12.5 years, and 54.6% were female. In 26 patients who underwent primary treatment of the neck, 60‐month DFS did not differ from no treatment (p > 0.05). Isolated distant recurrence was most common (42.8%), followed by local (28.3%), multifocal (20.7%), and regional recurrence (8.3%). Among patients with regional recurrence in the neck, there was no 60‐month PRS benefit for patients undergoing salvage neck dissection or radiation (p > 0.05). Among patients with distant recurrence, only immunotherapy was associated with improved 12‐month PRS (HR = 0.32, 95% CI = 0.11–0.92, p = 0.034), and no treatment group was associated with improved 24‐ or 60‐month PRS (p > 0.05).ConclusionSNMM is associated with a high recurrence rate and poor survival. Primary treatment of the neck was not associated with reduced recurrence, and immunotherapy for treatment of distant recurrence was associated with increased 12‐month PRS.

BackgroundCommonly used computed tomography (CT) staging systems for chronic rhinosinusitis (CRS) focus on the sinuses and do not quantify disease in the olfactory cleft. The goal of the current study was to determine whether precise measurements of olfactory cleft opacification better correlate with olfaction in patients with CRS.MethodsOlfaction was assessed using the 40‐item Smell Identification Test (SIT‐40) before and after sinus surgery in adult patients. Olfactory cleft opacification was quantified precisely using three‐dimensional (3D), computerized volumetric analysis, as well as via semiquantitative Likert scale estimations at predetermined anatomic sites. Sinus opacification was also quantified using the Lund‐Mackay staging system.ResultsThe overall cohort (n = 199) included 89 (44.7%) patients with CRS with nasal polyposis (CRSwNP) and 110 (55.3%) with CRS without nasal polyposis (CRSsNP). The olfactory cleft opacified volume correlated with objective olfaction as determined by the SIT‐40 (Spearman's rank correlation coefficient [Rs] = −0.461; p < 0.001). The correlation was significantly stronger in the CRSwNP subgroup (Rs = −0.573; p < 0.001), whereas no appreciable correlation was found in the CRSsNP group (Rs = −0.141; p = 0.141). Correlations between sinus‐specific Lund‐Mackay CT scoring and SIT‐40 scores were weaker in the CRSwNP (Rs = −0.377; p < 0.001) subgroup but stronger in the CRSsNP (Rs = −0.225; p = 0.018) group when compared to olfactory cleft correlations. Greater intraclass correlations (ICCs) were found between quantitative volumetric measures of olfactory cleft opacification (ICC = 0.844; p < 0.001) as compared with semiquantitative Likert grading (ICC = 0.627; p < 0.001).ConclusionQuantitative measures of olfactory cleft opacification correlate with objective olfaction, with the strongest correlations seen in patients with nasal polyps.