Despite the large size of these goiters and the significant involvement of the major mediastinal structures, all were approached through the transcervical incision. Further, despite significant tracheal involvement, there were no cases of tracheomalacia or major complications. For intraoperative planning, the authors advocate the routine use of preoperative computed tomography scanning.

This study is a prospective, nonrandomized clinical trial initiated to assess the safety and efficacy of radiofrequency tissue reduction of the palate for the treatment of bothersome snoring and sleep-disordered breathing. Twelve healthy volunteers with socially disruptive snoring underwent a baseline polysomnogram along with a battery of visual analog scales (VASs) to measure daytime sleepiness, snoring level, pain, and disturbances of speech and swallowing. After radiofrequency tissue reduction of the palate, they were re-evaluated with a mean follow-up after the final procedure of 15.7 +/- 5.1 (mean +/- SD) weeks. As rated by the bed partner, a significant reduction in the level of snoring occurred in all 12 patients, with a mean pretreatment snoring level of 8.3 +/- 2.1 to a mean posttreatment snoring level of 2.1 +/- 1.4. (Student t test, P < 0.0001) These patients required an average of 2.3 treatment sessions each. Nine of 12 had a reduction in snoring from a bothersome level (VAS range 5-10) to a nonbothersome level (VAS range 0-3). Daytime sleepiness as measured by the Epworth Sleepiness Scale (0-24) decreased from 10.8 +/- 4.4 to 8.3 +/- 4.1 (P = 0.011). Posttreatment pain was considered absent or minimal in 11 of 12 patients and was managed with acetaminophen. No significant adverse events or complications were reported.

) and 77.6 cm 2 (range, 50 -120 cm 2 ) for the fibula and iliac crest, respectively. Mean bone flap lengths were 8.37, 7.65, and 10.1 cm, respectively, for the SOFF, fibula, and iliac crest. Dual skin paddles were used in 50% of the SOFF procedures versus 2.8% for the fibula flap procedures. There were no significant complications of the donor site in any patient, and there was only one flap failure (4.1%). Related to the SOFF, donor site morbidity was subjectively judged as "mild," for pain, mobility, and strength. There were no complaints of poor appearance of the donor site. Activities of daily living were judged as "not limited" or "limited a little" in the majority of patients. Objective measurements of range of motion revealed an average reduction of 1°to 12°in five different shoulder functions. Elbow and arm ranges of motion were not limited. Strength was minimally reduced in the shoulder, while the arm and forearm showed no reduction in strength. Conclusions: The SOFF is a versatile osteocutaneous free flap that can be used for a multitude of reconstructive problems. This and its relative lack of significant donor site morbidity have caused its use to increase significantly.

Objective: To analyze the presentation, evaluation, and treatment of a s ubset of patients with well· differentiate d thyroid carcinoma who present with a lateral n eck mass and no palpable disease in the thyroid gland. t1. ,dy Desig n: A retros pective r eview of all patients und rgoing thyroidectomy for malignancy. Metliod.s: A databa of all thyroid ctomies performed for malignancy by the Va nderbilt University Depart· m nt of Otolaryngology-Head and N ck Surgery fro m 1992 to 1997 was created. Patie nts who pre· sented with an isolated n eck mas without evidence of palpable disea e in the thyroid were selecte d for the tudy population. R esults: There were 60 cases of thyroid malignancy, with 14 cases (23.3%) that presented as i olated late ral n eck mass. The characteris· tics of this group (com par · d with the population of all thyroid malignancies) include younger age at presen · tation (37. 7 ± 15.2 y vs. 49.8 ± 15.6 y; Student t test: P = .019) a nd long· tending pr sence of symptoms (27.4 ± 39.6 mo vs. 3.6 ± 3.9 mo; P = .023). These patients gen eraJJy pr sented from a referring facility after having an excisional biopsy, which was lOOo/o accurate. Fin -ne die aspiration is b coming more u seful a nd was 66.7% accurate. Histological examination revealed cane r in the thyroid gland in all patients, 11 cases of p a pillary carcinoma, 2 follicular carcinomas, and on medullary carcinoma. The m ean size of the primary focus was 10.9 ± 8.7 nun, with 29% d emons trating bilat ral dis a e and 14 d emon trating mul· tifocal di sea se in the ips ilnte ral gland. The neck specimen revealed an average of 5.3 ± 3.2 me tas tatic nod es in levels II-IV and 3.9 ± 4.6 metas tatic nodes in

To our knowledge, this study is the first to explore how paclitaxel and carboplatin, alone or in combination, differentially affect cell-cycle checkpoint response and HNSCC cell growth. These results provide molecular validation for the current clinical use of both drugs in combination and set the stage for analyses of patient tumor specimens.