Faculty Bibliography

OBJECTIVE: To evaluate the role of tension on the genioglossus muscle in the performance of genioglossus advancement on sleep-disordered breathing in patients undergoing multilevel obstructive sleep apnea (OSA) surgery. STUDY DESIGN: Prospective study. SETTING: Academic practice. SUBJECTS AND METHODS: Twenty-three subjects underwent genioglossus advancement with uvulopalatopharyngoplasty for OSA. Subjects underwent pre- and postoperative polysomnography, cephalometry, and subjective assessment questionnaires. Eighteen subjects completed the study. The tension force of the mandible and the bicortical width of the genial tubercle were measured and surgical response determined. RESULTS: Improvement in apnea-hypopnea index (AHI) was seen in 15 of 18 subjects (83.3%). Eleven subjects were classified as responders and 7 as nonresponders (61.1% success), with responders exhibiting a statistically significant reduction in mean delta AHI as compared with nonresponders: 28.3 +/- 26.2 versus 2.0 +/- 22.0 events per hour (95% confidence interval, 1.8-50.8; P = .037). The Epworth Sleepiness Scale improved from 13.2 +/- 4.5 to 7.6 +/- 3.4 (P = .002). There was no significant difference in body mass index, neck circumference, overall tension, or mandibular width between responders and nonresponders. However, there was a significant difference in the tension:width ratio between responders (53.9 +/- 6.38 g/mm) and nonresponders (65.4 +/- 11.2 g/mm; 95% confidence interval, 0.92-22.1; P = .036). CONCLUSION: This article describes a novel approach to determine the force applied to the genioglossus during advancement and its correlation to postoperative outcomes. The tension:width ratio may be an indicator for postoperative success and delta AHI improvement in OSA patients.

Objective/UNASSIGNED:To assess the characteristics and quality of cost utility analyses (CUA) related to otolaryngology within the CEA registry and to summarize their collective results. Methods/UNASSIGNED:All cost-utility analyses published between 1976 and 2011 contained in the Cost-Effectiveness Analysis Registry (CEA Registry) were evaluated. Topics that fall within the care of an otolaryngologist were included in the review regardless of the presence of an otolaryngologist author. Potential associations between various study characteristics and CEA registry quality scores were evaluated using the Pearson product moment correlation coefficient. Results/UNASSIGNED:Sixty-one of 2913 (2.1%) total CUA publications screened were related to otolaryngology. Eighteen of 61 (29.5%) publications included an otolaryngologist as an author. Fourteen studies agreed on the cost effectiveness of at least unilateral cochlear implantation and six of seven (85.7%) studies demonstrated the cost effectiveness of continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA). Forty-six percent (28 of 61) of all manuscripts were published between 2008 and 2011. A more recent publication year was associated with a higher CEA registry quality score while the presence of an otolaryngologist author and journal impact factor had no significant correlation with the quality of the CUA. Conclusion/UNASSIGNED:Based on current evidence in the CEA registry, unilateral cochlear implantation for hearing loss and CPAP for OSA are both cost-effective therapeutic interventions. Although CUAs in otolaryngology have increased in quantity and improved in quality in more recent years, there is a relative lack of CUAs in otolaryngology in comparison to other subspecialties.

Primitive neuroectodermal tumors of the central nervous system (CNS-PNETs) are highly aggressive, poorly differentiated embryonal tumors occurring predominantly in young children but also affecting adolescents and adults. Herein, we demonstrate that a significant proportion of institutionally diagnosed CNS-PNETs display molecular profiles indistinguishable from those of various other well-defined CNS tumor entities, facilitating diagnosis and appropriate therapy for patients with these tumors. From the remaining fraction of CNS-PNETs, we identify four new CNS tumor entities, each associated with a recurrent genetic alteration and distinct histopathological and clinical features. These new molecular entities, designated "CNS neuroblastoma with FOXR2 activation (CNS NB-FOXR2)," "CNS Ewing sarcoma family tumor with CIC alteration (CNS EFT-CIC)," "CNS high-grade neuroepithelial tumor with MN1 alteration (CNS HGNET-MN1)," and "CNS high-grade neuroepithelial tumor with BCOR alteration (CNS HGNET-BCOR)," will enable meaningful clinical trials and the development of therapeutic strategies for patients affected by poorly differentiated CNS tumors.

Oxytocin is a neuropeptide important for social behaviors such as maternal care and parent-infant bonding. It is believed that oxytocin receptor signaling in the brain is critical for these behaviors, but it is unknown precisely when and where oxytocin receptors are expressed or which neural circuits are directly sensitive to oxytocin. To overcome this challenge, we generated specific antibodies to the mouse oxytocin receptor and examined receptor expression throughout the brain. We identified a distributed network of female mouse brain regions for maternal behaviors that are especially enriched for oxytocin receptors, including the piriform cortex, the left auditory cortex, and CA2 of the hippocampus. Electron microscopic analysis of the cerebral cortex revealed that oxytocin receptors were mainly expressed at synapses, as well as on axons and glial processes. Functionally, oxytocin transiently reduced synaptic inhibition in multiple brain regions and enabled long-term synaptic plasticity in the auditory cortex. Thus modulation of inhibition may be a general mechanism by which oxytocin can act throughout the brain to regulate parental behaviors and social cognition. SIGNIFICANCE STATEMENT: Oxytocin is an important peptide hormone involved in maternal behavior and social cognition, but it has been unclear what elements of neural circuits express oxytocin receptors due to the paucity of suitable antibodies. Here, we developed new antibodies to the mouse oxytocin receptor. Oxytocin receptors were found in discrete brain regions and at cortical synapses for modulating excitatory-inhibitory balance and plasticity. These antibodies should be useful for future studies of oxytocin and social behavior.

The dichotomy between vocal learners and non-learners is a fundamental distinction in the study of animal communication. Male zebra finches (Taeniopygia guttata) are vocal learners that acquire a song resembling their tutors', whereas females can only produce innate calls. The acoustic structure of short calls, produced by both males and females, is not learned. However, these calls can be precisely coordinated across individuals. To examine how birds learn to synchronize their calls, we developed a vocal robot that exchanges calls with a partner bird. Because birds answer the robot with stereotyped latencies, we could program it to disrupt each bird's responses by producing calls that are likely to coincide with the bird's. Within minutes, the birds learned to avoid this disruptive masking (jamming) by adjusting the timing of their responses. Notably, females exhibited greater adaptive timing plasticity than males. Further, when challenged with complex rhythms containing jamming elements, birds dynamically adjusted the timing of their calls in anticipation of jamming. Blocking the song system cortical output dramatically reduced the precision of birds' response timing and abolished their ability to avoid jamming. Surprisingly, we observed this effect in both males and females, indicating that the female song system is functional rather than vestigial. We suggest that descending forebrain projections, including the song-production pathway, function as a general-purpose sensorimotor communication system. In the case of calls, it enables plasticity in vocal timing to facilitate social interactions, whereas in the case of songs, plasticity extends to developmental changes in vocal structure.

Oral medicine (stomatology) is a recognized and increasingly important dental specialty in many parts of the world that recognizes and fosters the interplay between medical health and oral health. Its dental activities rely greatly on the underlying biology of disease and evidence-based outcomes. However, full recognition of the importance of oral medicine to patient care, research, and education is not yet totally universally acknowledged. To address these shortcomings, we outline the birth, growth, and future of oral medicine globally, and record identifiable past contributions to the development of the specialty, providing an accurate, unique, and valuable resource on oral medicine. Although it was challenging to gather the data, we present this information as a review that endeavors to summarize the salient points about oral medicine, based on MEDLINE, other internet searches, communication with oral medicine and stomatological societies across the world, the web page http://en.wikipedia.org/wiki/List_of_dental_organizations, and discussions with a wide range of key senior persons in the specialty.

Objectives To identify measurable anatomical factors that may guide the surgical approach for posterior fossa selective vestibular neurectomy (SVN) and predict identification of the vestibulocochlear cleavage (VCC) plane. Study Design Dissection of fixed cadaveric heads through retrolabyrinthine and retrosigmoid-internal auditory canal (RSG-IAC) approaches with measurement of landmarks. Setting Cadaveric dissection model. Main Outcome Measures Area of the Trautmann triangle (TT) and the distance from the posterior semicircular canal to the anterior border of the sigmoid along the posterior Donaldson line (pDL). VCC planes from each approach were calculated and compared. Results Overall mean pDL was 8.53 mm (range: 5-11.5 mm); mean TT area was 124 mm(2) (range: 95-237 mm(2)). The VCC was identified in 63% of ears through the retrolabyrinthine (RVN) approach alone, whereas 37% of ears required the RSG-IAC approach. In ears requiring IAC dissection, the VCC was found within 1 to 2 mm distal to the porus. The pDL (p < 0.05) and area of TT (p < 0.05) were significantly larger in the RVN group compared with the RSG-IAC group. Conclusion Ears amenable to the RVN approach had a greater pDL and TT area. These anatomical measurements may have a role in surgical planning and the choice of approach for SVN.

Background: The transcochlear approach extends the anterior exposure afforded by the translabyrinthine technique. Although this wider exposure allows improved access to cranial nerves and the brainstem with less retraction on the cerebellum, the classical description involving facial nerve transposition often results in permanent facial paresis. This study discusses the role of the transcochlear approach in resection of cerebellopontine angle tumors including patient selection, surgical technique, and outcomes. Study Design: Retrospective review. Methods: This is a retrospective review conducted at a single academic institution. Cases performed by our skull base team (neurotologist and neurosurgeon) between 2000 and 2015 were reviewed. All cases utilizing the transcochlear approach were included. Factors including tumor size, completeness of resection, facial nerve function, post-operative complications, and length of stay were analyzed. Results: Fourteen cases were included. All of these patients had pre-operative severe hearing loss except for two in which surgery was performed urgently in the setting of hydrocephalus and brainstem compression. Eight out of 14 patients had pre-operative facial paresis. Tumor size ranged from 2.2-7 cm in greatest dimension (mean = 4.56 cm). All patients underwent a transcochlear approach to and removal of tumor with blind sac of the external auditory canal. In addition, 3 patients underwent an immediate facial nerve to hypoglossal anastomosis. Post-operatively, patients remained in the hospital for 3-5 days (mean = 4). Of the patients who started out with normal facial nerve function (n = 6), 3 recovered to House-Brackmann scores II or greater. There were no reported CSF leaks requiring hospitalization and 1 abdominal hematoma from fat graft harvest. There was a single mortality reported in the peri-operative period; however, on autopsy the cause of death was unrelated to the surgery itself or any subsequent intracranial event. Conclusions: As in other surgical approaches destructive to the labyrinth, patients were selected with consideration of their pre-operative hearing status and/or their candidacy for hearing preservation surgery. Patients with pre-operative facial nerve paralysis and hearing loss were deemed particularly appropriate candidates for the transcochlear technique given the additional exposure and the lack of added morbidity. In these cases the surgeon also has the option to perform dynamic facial nerve reanimation at the time of tumor resection