Browsing by Author "Jones, Alexander Joseph"

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    Head and Neck Juxtacortical Chondrosarcoma: A Systematic Review
    (SciTeMed, 2019-03) Jones, Alexander Joseph; Alwani, Mohamedkazim; Summerlin, Don-John; Otolaryngology -- Head and Neck Surgery, School of Medicine
    Objective: To present a case and systematically evaluate trends in clinical presentation, imaging, histopathology, and management modalities and outcomes of all head and neck juxtacortical chondrosarcoma (HNJCS) cases reported in the existing literature. Methods: We describe a rare case of HNJCS from our tertiary referral center following which the PubMed, MEDLINE, Embase, and Web of Science databases were searched for all HNJCS reports. Relevant titles and abstracts were screened. Resulting full-text articles were assessed for eligibility, and remaining studies were included for data extraction, summarization, and analysis. Results: Potential studies were identified dating from May 1946 to February 2019. A total of nine cases were included in our systematic review, eight of which were identified from full-text articles and one recruited from our tertiary referral center. The median presentation age was 41 years with a 66.7% male preponderance. The commonest presenting sign was a painless, isolated swelling after a median symptom duration of 2.5 months. CT imaging revealed hypodense lesions with peripheral enhancement and micro-calcifications. T1-weighted MRI showed hypo- to iso-intense, lobulated masses with peripheral and/or septal enhancement. The masses were diffusely hyper-intense on T2-weighted MRI. Histopathology demonstrated septated lobules of malignant hyaline cartilage with a peripheral fibrous capsule. Most tumors were low- or intermediate-grade tumors with average diameter of 4.3 cm. Local recurrence was identified in only one case (four years after initial resection). No distal and/or nodal metastases were identified. All tumors were managed by wide- or narrow-margin surgical excision. Two reports employed adjuvant treatment. There was no evidence of disease at final follow-up (median of 1.5 years). Conclusion: To the best of our knowledge, only nine cases of HNJCS have been adequately described. HNJCS have relatively consistent clinical and diagnostic profile regardless of location in the body. Surgical management yields excellent outcomes with low recurrence rates.
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    Retropharyngeal lipoblastoma causing severe pediatric obstructive sleep apnea
    (Elsevier, 2022) Jones, Alexander Joseph; Puello Yocum, Bianca N.; Matt, Bruce H.; Burgin, Sarah J.M.; Otolaryngology -- Head and Neck Surgery, School of Medicine
    Lipoblastomas are benign neoplasms of white adipose which usually occupy the trunk and limbs in pediatric patients. They can seldomly involve the head and neck, usually as a lateral cervical mass. Magnetic resonance imaging is the most useful modality for identifying these lesions. Treatment involves complete excision, and patients are followed with serial exams and/or imaging as recurrence is more common in the head and neck. Here we present an exceedingly rare case of retropharyngeal lipoblastoma in a two-year-old male causing severe obstructive sleep apnea which was identified during adenotonsillectomy. As this mass can be mistaken for other more common masses of the retropharyngeal space, we review the differential diagnoses, imaging, and histopathologic features of this neoplasm, which was responsible for upper airway obstruction in this case.
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    Sarcopenia is associated with blood transfusions in head and neck cancer free flap surgery
    (Wiley, 2021-04) Jones, Alexander Joseph; Campiti, Vincent J.; Alwani, Mohamedkazim; Novinger, Leah J.; Tucker, Brady Jay; Bonetto, Andrea; Yesensky, Jessica A.; Sim, Michael W.; Moore, Michael G.; Mantravadi, Avinash V.; Otolaryngology -- Head and Neck Surgery, School of Medicine
    Objective: To determine if sarcopenia is a predictor of blood transfusion requirements in head and neck cancer free flap reconstruction (HNCFFR). Methods: A single-institution, retrospective review was performed of HNCFFR patients with preoperative abdominal imaging from 2014 to 2019. Demographics, comorbidities (modified Charlson Comorbidity Index [mCCI]), skeletal muscle index (cm2/m2), oncologic history, intraoperative data, and 30-day postoperative complications (Clavien-Dindo score [CD]) were collected. Binary logistic regression was performed to determine predictors of transfusion. Results: Eighty (33.5%), 66 (27.6%), and 110 (46.0%) of n = 239 total patients received an intraoperative, postoperative, or any perioperative blood transfusion, respectively. Sixty-two (25.9%) patients had sarcopenia. Patients receiving intraoperative transfusions had older age (P = .035), more frequent alcoholism (P = .028) and sarcopenia (P < .001), greater mCCI (P < .001), lower preoperative hemoglobin (P < .001), reconstruction with flaps other than forearm (P = .003), and greater operative times (P = .001), intravenous fluids (P < .001), and estimated blood loss (EBL, P < .001). Postoperative transfusions were associated with major complications (CD ≥ 3; P < .001). Multivariate regression determined sarcopenia (P = .023), mCCI (P = .013), preoperative hemoglobin (P = .002), operative time (P = .036), and EBL (P < .001) as independent predictors of intraoperative transfusion requirements. Postoperative transfusions were predicted by preoperative hemoglobin (P = .007), osseous flap (P = .036), and CD ≥ 3 (P < .001). A perioperative transfusion was predicted by sarcopenia (P = .021), preoperative hemoglobin (P < .001), operative time (P = .008), and CD ≥ 3 (P = .018). Conclusion: Sarcopenia is associated with increased blood transfusions in HNCFFR. Patients should be counseled preoperatively on the associated risks, and the increased blood product requirement should be accounted in resource-limited scenarios.