Day 1 :
Project Chernobyl, USA
Keynote: Radiofrequency ablation with thyrablator bipolar headpiece for treatment of thyroid nodules
Time : 10:20-10:55
Daniel Igor Branovan is the Founder and President of Project Chernobyl, un-accredited not-for-profit international organization based in New York. He is a US-trained Head and Neck Surgeon and serves as Director and Chair of the New York Ear, Nose and Throat Institute. He has received his Medical training at Stanford University School of Medicine and Harvard University School of Public Health.
Objective: Minimally invasive modality, such radiofrequency (RFA), was reported to be an effective and save option to treat the nodular goiter and can be used to prevent the development of thyroid cancer. Our study aimed to assess the effectiveness of RFA for treatment of thyroid nodules.
Material & Methods: During RFA procedure, thermal energy was delivered through a bipolar applicator with a diameter of 1.3 mm (18-gauge), a shaft length of 102 mm and an active tip length of 10 mm. In total, there were 81 samples of resected thyroid tissue (44 of papillary thyroid carcinoma, 16 of follicular adenoma and 21 of adenomatous colloid goiter).
Results: Primary size in our series of nodules varied from 4.2 to 27.1 mm; accordingly, lesion size fluctuated from 2.2 to 14.1 mm and nodule size reduction changed from 22.4 to 100%. Therefore, in this range of nodules with every additional mm of primary nodule size we detected decreasing of lesion size by 2.4% (p<0.001). In addition, nodule size reduction in papillary thyroid carcinoma was in average, 8% less than in parenchymal or colloid benign thyroid nodules of the same primary size. Microscopic changes varied but shrinkage of follicles, necrotic foci, karyolysis or karyopyknosis of thyrocytes, connective tissue thickening and contracture of blood vessel were usual. RFA effectively induced lesions of similar size as in parenchymal as in colloid nodules. Substantial nodule size reduction was achieved albeit differences in consistency and or malignancy of the thyroid nodules. Multisession approach and call for pre-treatment to increase the electrical conductivity and radio-frequency influence need further consideration.rn
- Track 1: Head and Neck Cancer
Track 2: Surgical Approaches in Head and Neck Surgery
Track 3: Pediatric Head and Neck Surgery
Track 4: Brain Disorders
Metropolitan NeuroEar Group, USA
Rambam Health Care Campus, Israel
Roya Azadarmaki has completed her Medical School Training and Residency in Otolaryngology-Head and Neck Surgery at Temple University School of Medicine. She underwent her Fellowship Training in Otology-Neurotology at Metropolitan NeuroEar Group. She is currently practicing at Metropolitan NeuroEar Group with expertise in Eustachian tube surgery. She has authored many publications and continues to contribute to the literature.
For decades, successful surgical management of chronic dilatory Eustachian tube dysfunction and restoration of middle ear ventilation has bypassed the Eustachian tube itself. Balloon Eustachian tuboplasty has created a new era in management of this disease entity with promising results. New generation techniques in management of the Eustachian tube are discussed with review of the literature.
Beijing Tongren Hospital, China
Title: Clinical management as well as the genotypic and phenotypic analysis of 16 different hereditary MTC pedigrees from the mainland China
Time : 11:40-12:05
Xiaohong Chen is MD and a Professor. In 2005, he has obtained his ENT Doctor degree and he has worked as Post-doctor in UCLA from 2009-2010. He is the Vice- Director of Otolaryngology, Head and Neck Surgery Department in Beijing Tongren Hospital, Capital Medical University, China. He is a Member of the Committee of Beijing Anticancer Association and the Commission of Chinese Anti-Cancer Association and Melanoma Committee. He is an expert in diagnosis and treatment on rare diseases of head and neck, operation design for maintaining function of important organs and cosmetic result of incision design in head and neck tumor surgery, retention function of eye of the patients with the malignant nasal cavity and paranasal sinus tumor, salvage or radical surgery for advanced tumor of head and neck and familial hereditary tumor.
Background: There is still a need of data on MEN (multiple endocrine neoplasia) for variant RET mutations based on risk for aggressive MTC in China.
Methods: Sixteen different pedigrees have been taken from China and the efficacy as well as genotype and phenotype were analyzed retrospectively.
Results: The gene mutations of 16 different MTC pedigrees (86 patients and 10 clinically asymptomatic RET mutation carriers) are as follows: Risk Level A: p.S891A (N=1), p.L790F (N=2); Risk Level B: p.C618R (N=3), p.C620R (N=4); Risk Level C: p.C634R (N=6), p.C634Y/D707E (N=1), pC634Y/V292M (N=1), p.C634Y (N=2), p.C634S (N=1); Risk Level D: R982H (N=1); the mean age of MTC is 36.74±13.408y (14-77y). The incidence of PHEO is 32.56% (n=28), the bilateral rate of which is 100% with an average age of 39.09±9.451y (23-55y); the incidence of PTH is just 1.16% (n=1.22y); papillary thyroid carcinoma was found simultaneously in 2 cases; one esophagus involved, distant metastasises are found in 10.46% (n=9,15-69y: Liver (n=3), lung (n=3), bone (n=2), breast (n=1)); mortality rate is 6.98% (n=6). A female patient suffered from MTC, PHPT, PHEO, CLA and pituitary adenoma, fibroadenoma, back fibroma, knee vascular smooth muscle tumors and uterine fibroids simultaneously. Complete operation data of 22 patients was collected (9 cases were treated in our hospital, while the others were operated outside).
Conclusions: The clinical phenotypic differences still vary widely, even in the same RET gene point mutation, the presence of this phenomenon may be due to environmental or the joint influence of other related genes but the exact mechanism still needs further study.
Project Chernobyl, USA
Title: The combined influence of nitrates in drinking water and radiation on incidence of childhood thyroid cancer in Belarus after the Chernobyl accident
Time : 12:05-12:30
Valentina M Drozd is a Doctor of Science, author of more than 270 research papers and 7 monographs published in USA, Germany, Japan, Russia and Belarus. She has more than 25 years of research experience in medical issues related to the Chernobyl accident and radio induced thyroid cancer. She works as Professor in Endocrinology Department at Belarussian Medical Academy for Postgraduate Education, Minsk, Belarus since 2003 at International Fund “Help patients with radio induced thyroid cancer”, Minsk, Belarus, since 2004 and at Project Chernobyl, New-York, USA since 2007.
Recent epidemiological studies provide significant evidence that the worldwide rise in thyroid cancer incidence is not only due to more intensive screening diagnostics, but also suggest that an environmental factor could be also at play. Focusing on the experience of diagnosis of post-Chernobyl pediatric thyroid cancer in Belarus, we reviewed evidence of the effects of radiation, thyroid screening, iodine deficiency and content of nitrate in groundwater on regional differences in incidence rates of thyroid cancer. Previous studies have shown that chronic exposure to high levels of nitrate, similarly to the effect of iodine deficiency, might result in the development of goiter through TSH stimulation. There are other plausible mechanisms for associations between nitrate exposure and thyroid function as well as thyroid cancer in humans through endogenous formation of N-nitroso compounds that may act as the carcinogens. In Belarus, between 1960 and 1990, the use of nitrogen fertilizers increased 20-25 times from 4 to 92 kg/hectare, and the average level of nitrate in ground water increased from 1.1 to 41.6 mg/L. According to the Belarusian Ministry of Health, the proportion of pipeline water samples with nitrate concentration exceeding the WHO-recommended Maximum Contaminant Level (MCL) of 45 mg/L is about 1%. In contrast, about 40% of water samples from open wells have nitrate concentration exceeding the MCL. In Brest and Gomel Oblasts, the proportion of such samples reaches 40-60%, while in Mogilev Oblast, it is about 20%. Statistical analysis demonstrated that the effect of radiation on incidence of thyroid cancer significantly varied according to nitrate concentration (P=0.004). We propose that radiation effect might be modified by or depend upon the level of nitrates in drinking water. There is a need for analytic epidemiological investigation designed to evaluate a joint effect of nitrate exposure and radiation on risk of thyroid cancer. Such integrative approach may provide useful insights into the etiology and management of thyroid cancer.
Al-Yarmouk Teaching Hospital, Iraq
Title: Treatment of inferior turbinate hypertrophy by (810 nm) diode laser and electrocoagulation (A comparative study)
Time : 12:30-12:55
Adnan Qahtan Khalaf was born in Baghdad 1974, done M.B.Ch.B in year 1999 from Baghdad Medical College. He was specialized with otolaryngology in year 2010 from Iraqi Board of medical and completed High diploma (Laser in medicine) From Institute of Laser /Baghdad University 2012. Now working in AL-Yarmouk teaching hospitals in Baghdad as ENT & Laser specialist.
Aim: This prospective study was carried out to evaluate the efficacy of diode laser (810 nm) and electrocautery in treatment of nasal obstruction attributable to inferior turbinate hypertrophy as a comparative study.
Introduction: Hypertrophy of the inferior turbinate is a common cause of chronic nasal obstruction. Etiology for mucosal turbinate hypertrophy includes chronic hypertrophic rhinitis both allergic and non-allergic rhinitis in which there is swelling of the sub-mucosa due to dilatation of the sub-mucosal venous sinusoid. A number of interventions are available for the treatment of inferior turbinate hypertrophy. An ideal procedure should be associated with minimal discomfort or adverse reactions and should preserve the physiological function of the turbinate.
Materials & Methods: This prospective study was carried out in Al-Yarmouk Teaching Hospital/Department of Otolaryngology from August 2013 to November 2013. Fourteen patients who complained from nasal obstruction due to inferior turbinate hypertrophy were included in this study. Diagnosis was made by anterior rhinoscopy and fiberoptic examination. The turbinate hypertrophy in one side was reduced by using diode laser while the other side was reduced by electrocoagulation without telling the patient’s which side is treated by using the diode laser. We used both subjective symptoms and objective tests to assess the efficacy of diode laser (810 nm) and electrocautery in treatment of nasal obstruction attributable to inferior turbinate hypertrophy.
Results: The symptoms of nasal obstruction, post-operative pain, crustation, bleeding, time of healing and complication were less with diode laser (810 nm) comparing with the electrocoagulation.
Conclusion: Diode laser photocoagulation for inferior turbinate reduction is effective and well tolerated when used to treat patients with turbinate hypertrophy not responding to medical treatment.
Dr. Phani’s Dental Clinics, India
Title: Reconstruction to regeneration: A paradigm shift in reconstruction of maxillofacial continuity defects
Time : 12:55-13:20
Phani Kumar Kuchimanchi has completed MDS from Meenakshi University, Chennai, India. He is a Life Member of Indian Dental Association (IDA) and Association of Oral & Maxillofacial Surgeons of India (AOMSI). He is in office bearer serving as Convener, CDE in Coastal branch, IDA Andhra Pradesh. He has been serving as Reviewer for journals of repute.
Distraction osteogenesis is gaining momentum in reconstruction of various deformities and defects in maxillofacial region. Reconstruction of maxillofacial defects is quite a challenge owing to many specialized features unique to the face and supporting skeleton. Various reconstruction modalities for soft tissue as well as hard tissue defects have been in extensive practice varying from pedicled to free grafts (micro vascular). Many of the widely practiced modalities of reconstruction require not only specialized training for surgical skills, but also result in donor site morbidity. The success rate of these reconstruction modalities depends on the surgical expertise of the operating surgeon. With the application of principles of distraction osteogenesis for reconstruction of maxillofacial defects and deformities has begun a new era in reconstructive surgery. Transport distraction osteogenesis is one such reconstructive modality which is widely explored in current treatment trends. Rather it is appropriate to term it as regeneration. The current paper throws light on a paradigm shift of reconstruction to regeneration in treating maxillofacial continuity defects.
Rambam Health Care Campus, Israel
Title: The importance and timing of optic canal exploration and decompression during endoscopic endonasal resection of tuberculum sella and planum sphenoidale meningiomas
Time : 14:20-14:45
Attia M is a Board Certified Neurosurgeon in the Department of Neurosurgery at Rambam Medical Center in Haifa, Israel since 2012. His specialty focuses on skull base and cerebrovascular surgery. He is serving as Residency Program Director and as attending Neurosurgeon in his Department. He has graduated from the Hebrew University and Hadassah Medical School in 2001 and completed Residency in Neurosurgery at Chaim Sheba Medical Center in Tel HaShomer in 2007. Afterwards, he has accomplished a three years Clinical Fellowship specializing in Skull Base and Cerebrovascular Neurosurgery at the University of Washington and University of Illinois at Chicago and at Hadassah Medical Center. He has then served as an Attending Neurosurgeon at Hadassah.
Background: Suprasellar meningiomas often invade the optic canals (OCs). The feasibility of removing these tumors through a minimal-access endonasal route has been demonstrated but the importance, safety and timing of OC exploration and decompression are not well described.
Objective: To create a simple decision-tree algorithm for OC exploration and decompression in the endonasal endoscopic surgery for planum sphenoidale and tuberculum sella meningiomas.
Methods: We identified a consecutive series of 8 planum sphenoidale and tuberculum sella meningiomas resected endonasally. "Late" OC exploration and decompression was performed in 4 of 8 patients. The extent of resection, visual outcome and complications were recorded.
Results: Five patients had OC invasion on magnetic resonance imaging. Endoscopic inspection did not reveal additional OC invasion. The OC was opened bilaterally in 2 patients and unilaterally in 2 patients. Gross total resection was achieved in 6 of 7 patients in whom it was the goal. Vision improved in 3 patients (3 of 3 OCs opened) and was stable in 4 (1 of 4 OCs opened). In 1 patient, the bitemporal hemianopsia improved but there was unilateral deterioration (no OC invasion) because the tumor was extremely adherent to 1 optic nerve. After an average follow-up of 20.9 months, all patients had Glasgow Outcome Scale score of 5 and there were no cerebrospinal fluid leaks.
Conclusion: Exploration and decompression of the OC are feasible, safe and important to optimize visual outcome and to minimize recurrence in planum sphenoidale and tuberculum sella meningiomas resected endonasally. It may not be important to open the canal early during surgery because tumor debulking can be performed without manipulating the optic nerves. Early decompression however is technically feasible.
Public Foundation Children’s Medical Center “Moltur Koz”, Kyrgyzstan
Time : 14:45-15:10
Nuriia Tursunova has obtained her Master of Special Education from Kyrgyz State University named after I Arabaev, Institute of Pedagogy. She has completed her Psychologist course from Kyrgyz-Russian Academy of Education and PhD from Kyrgyz State University.
Our fund has been engaged in teaching children with disabilities since 2000. Communication system of teaching deaf children on a basis of verbal speech was developed in the 50s of the 20th century. Nowadays, there are two boarding schools for deaf and hard-of-hearing children and two kindergartens in Bishkek with equipment of the 1980s. Problems of deaf-and-dumb pedagogy in the Kyrgyz Republic are: There isn’t any special methodology in the Kyrgyz language, since the number of deaf and hard-of-hearing children is increasing in the regions of the country; There isn’t any new methodological literature for children with cochlear implant; There isn’t any possibility of maintenance of cochlear implant; Teachers of the deaf and hard-of-hearing children are not taught new teaching methods; and it is very important to work with parents but we are not able to give a competent assistance from state structure. Prospects of development of children with disabilities in the Kyrgyz Republic are to develop modern state concept for specialized agencies, teaching of specialists for work with cochlear implant and equipment for special auditory classes.
Dr. Phani’s Dental Clinics, India
Title: Technique for immediate functional efficiency in post hard tissue reconstructive head and neck surgery patients using basal osseointegrated implants
Time : 15:10-15:35
Deepak Bhimana has completed MDS from Dr. NTR Health University, Vijayawada, India. He is a life Member of Indian Dental Association (IDA) and Association of Oral & Maxillofacial Surgeons of India (AOMSI). He is also a Member of International Association of Oral and Maxillofacial Surgery (IAOMS). He has completed his thesis on Basal Osseointegrated Implants and proved the feasibility and durability of the basal implants in his thesis. His interest in head and neck oncology has persuaded him to take steps towards fellowship in head and neck oncology.
The treatment of oral and related cancers has evolved greatly since early part of 20th century. Reconstruction of hard tissue after a head and neck surgery is being inevitable if in the case of a cancer surgery. But post reconstruction the attainment of full functionality to the patient within the terms of esthetics, function and speech, where the patient is brought near to normal state is the ultimate success of the head and neck surgeon. Using dental Implants for reconstruction of the dentofacial component is not a new method but has many restraining factors and also need full bulk of the graft also affect the outcome of the final result. This lecture deals with a new technique of using Basal Osseointegrated implants (BOI) for the most predictable, successful and satisfying outcome both for the patient and surgeon. In this lecture we deal with the history, evolution, need for BOI, planning and surgical techniques for the Basal Osseointegrated Implants and scope of research in the same.
International University of Kyrgyzstan, Kyrgyzstan
Title: Assessment of the risk of hearing congenital pathology of children and mothers contacting with sources of radiation
Time : 15:35-16:00
Shakirova Nazilia has graduated from International University of Kyrgyzstan, Specializing in Management in Public Health and Arabaev Pedagogical University in Deaf-and-dumb Pedagogue. She has extensive experience in working with deaf and hearing-impaired young children. She works at the Institute of Biotechnology for the projects related to radioactive contamination.
Assessment of the risk of hearing congenital pathology of children and mothers contacting with sources of radiation: It is article about assessment of the impact of radioactive contamination on the health of women and children in adverse radio-ecological regions of Kyrgyzstan (Min-Kush, Mailu-Suu and Kaji-Say) is certainly a topical issue due to the pollution of the environment as a result of radioactive elements removal from about 50 uranium tailings and more than 80 piles of rocks formed as a result of mining of uranium and polymetallic ores (mercury, antimony, lead, cadmium and others) where more than 70 million m3 of waste is conserved causing ecological threat to flora, fauna and the population. Adverse environmental factors near uranium provinces of Kyrgyzstan affect women and children’s health. According to the data of the Ministry of Public Health of the Republic, the majority of children born and living near uranium deposits have several chronic diseases of various organs and systems occurring against a background of sharp delay of physical, mental and sexual maturation. There is a tendency to high level of children birth with multiple stigmas of embryogenesis, hearing defects that ultimately lead to the formation of a society of the deaf and hearing-impaired. In the Republic, this issue is not given at the appropriate level of attention. It is important to study the effect of radiation factors on embryonic development of children, as it is during this period when hearing development begins from the first day of pregnancy until child birth. In the areas of uranium tailings, expectant mothers, being constantly in contact with radioactively contaminated objects, are doomed to giving birth to children with hearing defects and further need of specialists-audiologists help. Timely detection of hearing loss as well as early pedagogical effects is crucial factors for the overall development of hearing-impaired children. It is necessary to implement universal newborn hearing screening for early diagnosis and using appropriate measures.