This case series study seeks to identify and describe rhinologic procedures after facial transpla... more This case series study seeks to identify and describe rhinologic procedures after facial transplants to assess the clinical and radiologic indications for intervention as well as the outcomes after intervention.
International journal of radiation oncology, biology, physics, Jan 27, 2018
Programmed death-1 (PD-1) inhibitors are approved for the treatment of patients with recurrent an... more Programmed death-1 (PD-1) inhibitors are approved for the treatment of patients with recurrent and metastatic squamous cell carcinoma of the head and neck (SCCHN). Ongoing and planned randomized phase 3 trials are testing the benefit of combining PD-1/programmed death-ligand 1 (PD-L1) inhibitors with chemoradiation for patients with locoregionally confined SCCHN. Few studies have investigated relationships among potential predictive pathologic biomarkers such as PD-L1, PD-L2, and PD-1 in this population and associations between these markers and clinical characteristics. We retrospectively reviewed records and pathology from 81 patients with locoregional oropharynx SCCHN treated with curative intent. Samples were analyzed for PD-L1, PD-L2, PD-1, CD8, and CD56 expression using immunohistochemistry. Human papilloma virus (HPV) status was determined by p16-immunohistochemistry and confirmed by in situ hybridization or polymerase chain reaction-based HPV typing. Correlations between HPV...
To describe patterns of failure (POF) after reirradiation (reRT) with intensity modulated radiati... more To describe patterns of failure (POF) after reirradiation (reRT) with intensity modulated radiation therapy (IMRT) for recurrent/second primary squamous cell carcinoma of the head and neck. From 08/2004-02/2013, 75 consecutive patients received reRT with IMRT. Gross tumor was generally treated with a 5mm planning target volume (PTV) margin. For postoperative cases, a 5mm PTV was added to the clinical target volume which included the postoperative bed. Elective neck coverage was not standard. POF were characterized by correlating the recurrent tumor location on CT-imaging with the reRT IMRT plan. Patients received definitive reRT (55%) or postoperative reRT (45%) to a median 60Gy (range, 59.4-70Gy). Most patients (88%) received concurrent chemotherapy including induction (16%). The median overall survival was 1.8years. Isolated local-regional recurrence (LRR) was the most common failure-type (2-year cumulative incidence [CI] 22.5% [95% C.I. 13.6-32.7%]), but concurrent LRR and distan...
To familiarize the otolaryngologist with the evaluation and management of cervicodorsal manifesta... more To familiarize the otolaryngologist with the evaluation and management of cervicodorsal manifestations of lipodystrophy in patients who have been treated with HIV protease inhibitor medications. In addition, to share the benefits obtainable with ultrasonic tumescent liposuction treatment. Retrospective chart review of patients presenting to the senior author with symptomatic hypertrophic cervicodorsal fat pad attributable to HIV infection and HIV protease inhibitor use. Eight patients presented for evaluation of hypertrophic cervicodorsal fat pads between January 1, 2002 and December 31, 2004. All patients had been on protease inhibitors in the past and had minimal resolution after discontinuing offending agent. Most common presenting problems include disfigurement, limited range of upper extremity and neck motion, neck and back discomfort, and difficulty with sleep including sleep-study-confirmed obstructive sleep apnea. Five of eight patients underwent ultrasonic tumescent liposuction. Three patients had satisfactory improvement of symptoms after the first surgery, whereas the other two required additional operative sessions. No complications of hematoma, seroma, infection, prolonged pain, or re-accumulation of fat pad were encountered. The primary obstacle in the three nonoperative patients was insurance denial on the basis of deemed lack of established necessity. Cervicodorsal lipodystrophy is a well-recognized outcome of prolonged HIV infection and side effect of certain HIV medications. Patients may present with both esthetic and functional issues related to the excess tissue. Although cessation of associated medications may halt further progression, this alone does resolve the symptoms. Ultrasonic tumescent liposuction is shown in this study to be a well-suited modality for reduction of this fibrous adipose tissue. Multiple sessions may be necessary to achieve satisfactory results because of the tenacity of the tissue. It is important for the otolaryngologist to be familiar with the head and neck issues relevant to this disorder and its treatment.
Malformations of the auricle are not uncommon and occur in 1 out of 12500 births. They can occur ... more Malformations of the auricle are not uncommon and occur in 1 out of 12500 births. They can occur alone or can be associated with genetically determined syndromes. Most congenital malformations in the human occur during the third to twelfth weeks of embryonic life. During this period, the external ear is undergoing development and can be affected in many ways. There are three parts to the external ear: the auricle, the cartilaginous external auditory canal, and the bony external canal. The auricle (pinna) and the cartilaginous canal are closely related and probably develop from the same anlage. The bony canal is derived from the tympanic ring which is an incomplete cylinder of membranous bone. It must be clearly understood that, although this article is primarily concerned with the morphogenesis and dysmorphogenesis of the auricle, the rest of the external ear, specifically the external auditory canal, is developing simultaneously. Therefore, maldevelopment of the external canal and the auricle will frequently occur together.
Major salivary gland malignancies are rare. Treatment of the primary tumor involves resection wit... more Major salivary gland malignancies are rare. Treatment of the primary tumor involves resection with or without postoperative radiation therapy. When there is clinical neck disease, neck dissection is performed to remove gross disease. Treatment of the N0 neck is controversial. Most centers treat the high-risk patient and perform either elective neck dissection or elective neck irradiation to eradicate residual occult disease.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2013
Long term follow-up of face transplant patients is fundamental to our understanding of risks and ... more Long term follow-up of face transplant patients is fundamental to our understanding of risks and benefits of this procedure. Worldwide experience has shown that function improves gradually over time. In April of 2009, a multidisciplinary team at Brigham and Women's Hospital performed face transplantation on a male patient to address a severe facial defect caused by high-voltage burns. Physical and occupational therapy was performed for the first six post-operative months. Close monitoring of the patient's functional recovery, immunosuppression, and quality of life was performed at set time points. Three years after face transplantation, the patient has recovered near-normal sensation. Along with satisfactory aesthetic results, his motor function continues to improve, aiding his speech, facial expressions, and social interaction. Furthermore, the patient reports continued improvements in quality of life. Infectious, metabolic, and immunologic complications have been successfully managed in a team approach. Immunosuppression doses have been effectively reduced, and steroid therapy was withdrawn before the end of the first postoperative year. The presented outcomes demonstrate the procedure's growing role in reconstructive surgery as teams continue to focus their efforts on further optimization of immunosuppression and surgical technique.
This case series study seeks to identify and describe rhinologic procedures after facial transpla... more This case series study seeks to identify and describe rhinologic procedures after facial transplants to assess the clinical and radiologic indications for intervention as well as the outcomes after intervention.
International journal of radiation oncology, biology, physics, Jan 27, 2018
Programmed death-1 (PD-1) inhibitors are approved for the treatment of patients with recurrent an... more Programmed death-1 (PD-1) inhibitors are approved for the treatment of patients with recurrent and metastatic squamous cell carcinoma of the head and neck (SCCHN). Ongoing and planned randomized phase 3 trials are testing the benefit of combining PD-1/programmed death-ligand 1 (PD-L1) inhibitors with chemoradiation for patients with locoregionally confined SCCHN. Few studies have investigated relationships among potential predictive pathologic biomarkers such as PD-L1, PD-L2, and PD-1 in this population and associations between these markers and clinical characteristics. We retrospectively reviewed records and pathology from 81 patients with locoregional oropharynx SCCHN treated with curative intent. Samples were analyzed for PD-L1, PD-L2, PD-1, CD8, and CD56 expression using immunohistochemistry. Human papilloma virus (HPV) status was determined by p16-immunohistochemistry and confirmed by in situ hybridization or polymerase chain reaction-based HPV typing. Correlations between HPV...
To describe patterns of failure (POF) after reirradiation (reRT) with intensity modulated radiati... more To describe patterns of failure (POF) after reirradiation (reRT) with intensity modulated radiation therapy (IMRT) for recurrent/second primary squamous cell carcinoma of the head and neck. From 08/2004-02/2013, 75 consecutive patients received reRT with IMRT. Gross tumor was generally treated with a 5mm planning target volume (PTV) margin. For postoperative cases, a 5mm PTV was added to the clinical target volume which included the postoperative bed. Elective neck coverage was not standard. POF were characterized by correlating the recurrent tumor location on CT-imaging with the reRT IMRT plan. Patients received definitive reRT (55%) or postoperative reRT (45%) to a median 60Gy (range, 59.4-70Gy). Most patients (88%) received concurrent chemotherapy including induction (16%). The median overall survival was 1.8years. Isolated local-regional recurrence (LRR) was the most common failure-type (2-year cumulative incidence [CI] 22.5% [95% C.I. 13.6-32.7%]), but concurrent LRR and distan...
To familiarize the otolaryngologist with the evaluation and management of cervicodorsal manifesta... more To familiarize the otolaryngologist with the evaluation and management of cervicodorsal manifestations of lipodystrophy in patients who have been treated with HIV protease inhibitor medications. In addition, to share the benefits obtainable with ultrasonic tumescent liposuction treatment. Retrospective chart review of patients presenting to the senior author with symptomatic hypertrophic cervicodorsal fat pad attributable to HIV infection and HIV protease inhibitor use. Eight patients presented for evaluation of hypertrophic cervicodorsal fat pads between January 1, 2002 and December 31, 2004. All patients had been on protease inhibitors in the past and had minimal resolution after discontinuing offending agent. Most common presenting problems include disfigurement, limited range of upper extremity and neck motion, neck and back discomfort, and difficulty with sleep including sleep-study-confirmed obstructive sleep apnea. Five of eight patients underwent ultrasonic tumescent liposuction. Three patients had satisfactory improvement of symptoms after the first surgery, whereas the other two required additional operative sessions. No complications of hematoma, seroma, infection, prolonged pain, or re-accumulation of fat pad were encountered. The primary obstacle in the three nonoperative patients was insurance denial on the basis of deemed lack of established necessity. Cervicodorsal lipodystrophy is a well-recognized outcome of prolonged HIV infection and side effect of certain HIV medications. Patients may present with both esthetic and functional issues related to the excess tissue. Although cessation of associated medications may halt further progression, this alone does resolve the symptoms. Ultrasonic tumescent liposuction is shown in this study to be a well-suited modality for reduction of this fibrous adipose tissue. Multiple sessions may be necessary to achieve satisfactory results because of the tenacity of the tissue. It is important for the otolaryngologist to be familiar with the head and neck issues relevant to this disorder and its treatment.
Malformations of the auricle are not uncommon and occur in 1 out of 12500 births. They can occur ... more Malformations of the auricle are not uncommon and occur in 1 out of 12500 births. They can occur alone or can be associated with genetically determined syndromes. Most congenital malformations in the human occur during the third to twelfth weeks of embryonic life. During this period, the external ear is undergoing development and can be affected in many ways. There are three parts to the external ear: the auricle, the cartilaginous external auditory canal, and the bony external canal. The auricle (pinna) and the cartilaginous canal are closely related and probably develop from the same anlage. The bony canal is derived from the tympanic ring which is an incomplete cylinder of membranous bone. It must be clearly understood that, although this article is primarily concerned with the morphogenesis and dysmorphogenesis of the auricle, the rest of the external ear, specifically the external auditory canal, is developing simultaneously. Therefore, maldevelopment of the external canal and the auricle will frequently occur together.
Major salivary gland malignancies are rare. Treatment of the primary tumor involves resection wit... more Major salivary gland malignancies are rare. Treatment of the primary tumor involves resection with or without postoperative radiation therapy. When there is clinical neck disease, neck dissection is performed to remove gross disease. Treatment of the N0 neck is controversial. Most centers treat the high-risk patient and perform either elective neck dissection or elective neck irradiation to eradicate residual occult disease.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2013
Long term follow-up of face transplant patients is fundamental to our understanding of risks and ... more Long term follow-up of face transplant patients is fundamental to our understanding of risks and benefits of this procedure. Worldwide experience has shown that function improves gradually over time. In April of 2009, a multidisciplinary team at Brigham and Women's Hospital performed face transplantation on a male patient to address a severe facial defect caused by high-voltage burns. Physical and occupational therapy was performed for the first six post-operative months. Close monitoring of the patient's functional recovery, immunosuppression, and quality of life was performed at set time points. Three years after face transplantation, the patient has recovered near-normal sensation. Along with satisfactory aesthetic results, his motor function continues to improve, aiding his speech, facial expressions, and social interaction. Furthermore, the patient reports continued improvements in quality of life. Infectious, metabolic, and immunologic complications have been successfully managed in a team approach. Immunosuppression doses have been effectively reduced, and steroid therapy was withdrawn before the end of the first postoperative year. The presented outcomes demonstrate the procedure's growing role in reconstructive surgery as teams continue to focus their efforts on further optimization of immunosuppression and surgical technique.
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Papers by Donald Annino