Papers by Lawrence Marentette
Archives of Facial Plastic Surgery, Mar 1, 2005
To review our experience of reconstructing the lateral and superior orbital walls after resection... more To review our experience of reconstructing the lateral and superior orbital walls after resection of sphenoid wing meningiomas. We will review the presentation and complications, examine the aesthetic results postoperatively, and compare preoperative and postoperative computed tomographic scans. To our knowledge, a comparative analysis of preoperative defect and postoperative reconstruction has not been performed. Methods: We conducted a retrospective analysis, with a minimum of 5 months and a maximum of 9 years of follow-up in an academic multidisciplinary skull base center. Twenty-two patients were treated for sphenoid wing meningiomas by resection and reconstruction with split calvarial bone graft and, for more than half of the patients, also with free abdominal fat graft. The main outcome measures were aesthetic evaluation of patients and analysis of tumor control using computed tomographic scans, survival, and complications. Results: A total of 24 resections were performed on 22 patients. The average follow-up was 14.6 months. All patients had meningiomas with similar preoperative presentations, and for 21 of the 22 patients aesthetic reconstruction resulted in the near symmetry of the 2 sides. All patients are currently alive, those who underwent complete resection are without recurrence, and 15 (68.2%) did not incur complications. One patient experienced a worsening of temporal wasting following radiation therapy. Conclusion: Reconstruction of the defect with split calvarial bone and free abdominal fat grafts affords the patient excellent aesthetic results as well as good symmetry, as demonstrated by a postoperative computed tomographic scan.
Skull Base Surgery, Oct 1, 1996
JAMA Otolaryngology–Head & Neck Surgery, 2019
Prior studies suggest that the use of facial nerve monitoring decreases the rate of immediate pos... more Prior studies suggest that the use of facial nerve monitoring decreases the rate of immediate postoperative facial nerve weakness in parotid surgery, but published data are lacking on normative values for these parameters or cutoff values to prognosticate facial nerve outcomes. OBJECTIVE To identify intraoperative facial nerve monitoring parameters associated with postoperative weakness and to evaluate cutoff values for these parameters under which normal nerve function is more likely. DESIGN, SETTING, AND PARTICIPANTS This retrospective case series of 222 adult patients undergoing parotid surgery for benign disease performed with intraoperative nerve monitoring was conducted at an academic medical institution from September 13, 2004, to October 30, 2014. The data analysis was conducted from May 2018 to January 2019. MAIN OUTCOMES AND MEASURES The main outcome measure was facial nerve weakness. Receiver operating characteristic curves were generated to define optimal cut point to maximize the sensitivity and specificity of the stimulation threshold, mechanical events, and spasm events associated with facial nerve weakness. RESULTS Of 222 participants, 121 were women and 101 were men, with a mean (SD) age of 51 (16) years. The rate of temporary facial nerve paresis of any nerve branch was 45%, and the rate of permanent paralysis was 1.3%. The mean predissection threshold was 0.22 milliamperes (mA) (range, 0.1-0.6 mA) and the mean postdissection threshold was 0.24 mA (range, 0.08-1.0 mA). The average number of mechanical events was 9 (range, 0-66), and mean number of spontaneous spasm events was 1 (range, 0-12). Both the postdissection threshold (area under the curve [AUC], 0.69; 95% CI, 0.62-0.77) and the number of mechanical events (AUC, 0.58; 95% CI, 0.50-0.66) were associated with early postoperative facial nerve outcome. The number of spasm events was not associated with facial nerve outcome. The optimal cutoff value for the threshold was 0.25 mA, and the optimal cutoff for number of mechanical events was 8. If a threshold of greater than 0.25 mA was paired with more than 8 mechanical events, there was a 77% chance of postoperative nerve weakness. Conversely, if a threshold was 0.25 mA or less and there were 8 mechanical events or less, there was 69% chance of normal postoperative nerve function. No parameters were associated with permanent facial nerve injury. CONCLUSIONS AND RELEVANCE Postdissection threshold and the number of mechanical events are associated with immediate postoperative facial nerve function. Accurate prediction of facial nerve function may provide anticipatory guidance to patients and may provide surgeons with intraoperative feedback allowing adjustment in operative techniques and perioperative management.
Journal of Neurological Surgery Part B: Skull Base, 2017
Objective We aimed to compare major complication rates in patients undergoing open versus endosco... more Objective We aimed to compare major complication rates in patients undergoing open versus endoscopic resection of olfactory neuroblastoma (ONB) and to determine the prognostic utility of the Kadish staging and Hyams grading systems with respect to progression-free survival (PFS) and overall survival (OS). Methods It is a retrospective review of experience in treating ONB at a single tertiary care hospital from 1987 through 2015. Major complications were defined as cerebrospinal fluid (CSF) leak, meningitis, osteomyelitis, tracheostomy, and severe neurologic injury. Results Forty-one patients were included. An open approach was used in 34 (83%), endoscopic in 6 (15%), and combined in 1 (2%) case. Rates of major complications by surgical approach were 17% after endoscopic versus 31% after open (p = 0.65). There was no significant difference in PFS or OS based on Kadish B versus C (PFS, p = 0.28; OS, p = 0.11) or Hyams grade 1 and 2 versus Hyams grade 3 and 4 (PFS, p = 0.53; OS, p = 0....
Journal of Neurological Surgery Part B: Skull Base, 2016
Journal of Neurological Surgery Part B: Skull Base, 2016
Cancer Research, 2015
Inverted sinonasal papilloma (ISP) is a locally aggressive neoplasm associated with sinonasal squ... more Inverted sinonasal papilloma (ISP) is a locally aggressive neoplasm associated with sinonasal squamous cell carcinoma (SNSCC) in 10% to 25% of cases. To date, no recurrent mutations have been identified in ISP or SNSCC. Using targeted next-generation sequencing and Sanger sequencing, we identified activating EGFR mutations in 88% of ISP and 77% of ISP-associated SNSCC. Identical EGFR genotypes were found in matched pairs of ISP and associated SNSCC, providing the first genetic evidence of a biologic link between these tumors. EGFR mutations were not identified in exophytic or oncocytic papillomas or non–ISP-associated SNSCC, suggesting that the ISP/SNSCC spectrum is biologically distinct among sinonasal squamous tumors. Patients with ISP harboring EGFR mutations also exhibited an increased progression-free survival compared with those with wild-type EGFR. Finally, treatment of ISP-associated carcinoma cells with irreversible EGFR inhibitors resulted in inactivation of EGFR signaling...
Journal of Neurological Surgery Part B: Skull Base, 2015
Journal of Neurological Surgery Part B: Skull Base, 2014
Skull base : official journal of North American Skull Base Society ... [et al.], 2009
This article reports on the presence of an anatomic feature of the extracranial skull base that m... more This article reports on the presence of an anatomic feature of the extracranial skull base that may result in internal carotid artery injury if secure and complete pterygomaxillary separation is not achieved before maxillary downfracture in the Le Fort I osteotomy. The extracranial skull base of 129 adult skulls and 10 pediatric skulls was examined in the region near the foramen lacerum. This region was inspected for the presence or absence of a bony protrusion that projected posteriorly from the base of the sphenoid, lying inferior to the foramen lacerum. The bony protrusion was present bilaterally in 71% of the adult skulls and 60% of the pediatric skulls. The protrusion was a bony "spike" that pointed posteriorly and was located inferior to the foramen lacerum on the extracranial skull base. Due to its size, shape, and location, the bony protrusion described in this study poses considerable risk to the internal carotid artery if the protrusion is displaced superiorly th...
Skull Base, 2011
Objectives To demonstrate the advantages of the thoracodorsal artery scapular tip autogenous tran... more Objectives To demonstrate the advantages of the thoracodorsal artery scapular tip autogenous transplant (Tdast) for patients requiring restoration of the orbital aesthetic subunit. Design Prospective case series. Setting Tertiary center. Participants Ten patients (M:F,6:4) with a mean age of 56 years (range, 21 to 78 years) underwent restoration of the orbital aesthetic subunit and radiation therapy between 2001 and 2008. Main Outcome Measures The two reconstructive advantages of the thoracodorsal artery system of flaps for orbital reconstruction are a long pedicle and the suitability of the scapula tip to meet the three-dimensional requirements of the orbit. Patients were assessed 1 year or more after treatment for cosmetic outcome, work status, and socialization. Results Eight of 10 patients benefited from the three-dimensional nature of the scapula tip bone and 7 of 10 avoided vein grafting. Four of five evaluable patients reported "frequently" socializing outside their home. Four of five evaluable patients working before undergoing their treatment were able to return to work posttreatment. Seven of nine patients with postoperative photographs had minimal or no facial contour deformity. Conclusions The Tdast can restore orbital contour without osteotomy, and the thoracodorsal artery system of flaps has a long vascular pedicle that reduces vein grafting. Patients have an acceptable cosmetic result and return to preoperative work status and socialization.
Archives of Otolaryngology–Head & Neck Surgery, 2005
To evaluate the resulting aesthetics, function, and donor site morbidity of the osseocutaneous ra... more To evaluate the resulting aesthetics, function, and donor site morbidity of the osseocutaneous radial forearm free flap (OCRFFF) used for midface reconstruction. Design: Prospective case series and a retrospective review of results. Patients: Ten patients from an academic practice who underwent reconstruction at the University of Michigan Hospitals between 1995 and 2001. Interventions: All patients had maxillectomy defects in which the entire infraorbital rim was reconstructed with an OCRFFF. Of the 10 patients included in the study, 3 underwent a total maxillectomy with orbital exenteration, 4 had a total maxillectomy without orbital exenteration, and 3 had a limited maxillectomy that did not involve the palate. Patients with palatal defects underwent reconstruction with a prosthetic palatal obturator. Main Outcome Measures: Facial contour and aesthetic results, speech understandability, ability to eat solid foods, oronasal separation, socializing outside the home, and return-to-work status. Flap success, donor site morbidity, and orbital complications were also studied. Results: Mean±SEM follow-up was 23.2±5.0 months. A modified Funk facial deformity scale was used, and 7 of the 10 patients had either no deformity or minimal deformity. The mean aesthetic score for these reconstructions was 2.1±0.3 on a scale of 1 to 4, with 1 representing no deformity and 4 representing a severe deformity. All patients returned to a solid diet and had understandable speech, although patients who had an orbital exenteration trended to poorer scores. All patients socialized either frequently or occasionally outside the home, and all patients not retired or disabled prior to surgery returned to work. Conclusion: The OCRFFF reconstruction of the infraorbital rim in patients with total maxillectomy defects and obturator of the palatal defect controls orbital complications and optimizes aesthetic outcome while achieving nearly normal palatal function.
American Journal of Neuroradiology, 2012
BACKGROUND AND PURPOSE: Juvenile angiofibromas are hypervascular tumors that may benefit from pre... more BACKGROUND AND PURPOSE: Juvenile angiofibromas are hypervascular tumors that may benefit from preoperative devascularization to reduce intraoperative blood loss. Our purpose was to evaluate the extent of angiographic devascularization and intraoperative blood loss by using only Onyx for percutaneous juvenile angiofibroma tumor embolization. MATERIALS AND METHODS: We reviewed the clinical records and preoperative and postoperative imaging studies of a consecutive series of 9 patients with juvenile angiofibromas who were treated with preoperative embolization with direct percutaneous injection of Onyx followed by resection from a standard open surgical or endoscopic approach. RESULTS: Two Fisch type I, 1 Fisch type II, 5 Fisch type IIIa, and 1 Fisch type IVa tumor were treated. Complete devascularization was achieved in all cases percutaneously with only Onyx. There were no complications. The average intraoperative blood loss was 567.7 mL (range, 10-1700 mL). An average of 2.2 needles (range, 1-5 needles) was placed into the tumor. An average of 14.6 mL of Onyx (range, 2-25 mL) was injected into each tumor. Four Fisch type IIIa tumors were removed completely from only an ENE approach. CONCLUSIONS: Presurgical direct percutaneous embolization of a juvenile angiofibroma with only EVOH before surgical resection is safe and feasible. Our preliminary experience suggests that Onyx may offer a higher degree of devascularization compared with other embolic agents. This may facilitate an easier surgical resection with lower blood loss. ABBREVIATIONS: EBL ϭ estimated blood loss; ECA ϭ external carotid artery; ENE ϭ expanded nasal endoscopic approach; EVOH ϭ ethylene-vinyl alcohol copolymer; PRBC ϭ packed red blood cells
American Journal of Neuroradiology, 2009
BACKGROUND AND PURPOSE: Few reports have described the embolization of head and neck lesions by u... more BACKGROUND AND PURPOSE: Few reports have described the embolization of head and neck lesions by using direct percutaneous techniques. We report our preliminary experience in the direct percutaneous embolization of hypervascular head and neck tumors by using Onyx in conjunction with standard endovascular embolization techniques. We describe the technical aspects of the procedure and its efficacy in reducing intraoperative blood loss. MATERIALS AND METHODS: We retrospectively studied 14 patients (3 females and 11 males; mean age, 33.4 years; range, 11-56 years) with 15 hypervascular tumors of the head and neck that underwent direct percutaneous embolization with Onyx in conjunction with particulate embolization. Nine paragangliomas and 6 JNAs underwent treatment. Documented blood loss was obtained from operative reports in these 15 patients with surgical resection performed 24-48 hours after the embolization. RESULTS: Intratumoral penetration with progressive blood flow stasis was achieved during each injection. A mean of 3.1 needles (20-gauge, 3.5-inch spinal needle) were placed percutaneously into the lesion (range, 1-6). The mean intraoperative blood loss was 780 mL (range, Ͻ50-2200 mL). Near total angiographic devascularization was achieved in 13 of 15 tumors. There were no local complications or neurologic deficits from the percutaneous access or embolization of these hypervascular tumors. CONCLUSIONS: In this study, the use of percutaneous injected Onyx in conjunction with standard endovascular embolization techniques in patients with hypervascular head and neck tumors seemed to enhance the ability to devascularize these tumors before operative removal. ABBREVIATIONS: AVM ϭ arteriovenous malformation; CBT ϭ carotid body tumor; CTA ϭ CT angiography; DMSO ϭ dimethyl sulfoxide; DPE ϭ direct percutaneous embolization; DSA ϭ digital subtraction angiography; EBL ϭ estimated blood loss; ECA ϭ external carotid artery; EEG ϭ electroencephalogram; EVOH ϭ ethylene-vinyl alcohol copolymer; ICA ϭ internal carotid artery; JNA ϭ juvenile angiofibroma; JUG ϭ jugular; LCCA ϭ left common carotid artery; MIP ϭ maximum intensity projection; n-BCA ϭ n-butyl cyanoacrylate; PARA ϭ paraganglioma; PVA ϭ polyvinyl alcohol; RCCA ϭ right common carotid artery; VA ϭ vertebral artery; VM ϭ vascular malformation
Skull Base Surgery, 1999
Cran iofacial Resection: Decreased Compl ication Rate with a Modified Subcranial Approach Craniof... more Cran iofacial Resection: Decreased Compl ication Rate with a Modified Subcranial Approach Craniofacial approaches have become the procedures of choice for most tumors, trauma, and congenital anomalies involving the anterior cranial fossa and the orbits, nasal cavity, or paranasal sinuses. However, recent reports continue to document a complication rate of 39-50% and a mortality of 3-5% with these procedures,I prompting some authors to state that they are too morbid for routine use.2 We have used a modified subcranial approach for a variety of lesions at the anterior cranial base and have achieved a lower complication rate than previously reported. We report our technique and results in 31 consecutive cases. MATERIALS AND METHODS This series consists of 31 consecutive patients operated upon over a 4-year period by the authors. Patients were evaluated in a multidisciplinary clinic staffed by a team representing the neurosurgery, otorhinolaryngology, and neuro-otology disciplines. Patients were considered appropriate for a subcranial approach when they had tumors, trauma, or congenital anomalies for which surgery was indicated and that anatomically involved the face, orbit(s), nasal cavity, and/or paranasal sinuses 95
The Laryngoscope, 2011
Objective: To measure the effect of routine perioperative lumbar drain placement during anterior ... more Objective: To measure the effect of routine perioperative lumbar drain placement during anterior skull base surgery on the frequency of: 1) tension pneumocephalus and 2) total intracranial complications. Design: Retrospective review of a series of patients (n ¼ 161) who underwent the transglabellar/subcranial approach to lesions of the anterior skull base between December 1995 and November 2009. A retrospective cohort (n ¼ 45) underwent routine lumbar drain placement at the time of skull base surgery. The remainder of the series did not undergo routine perioperative lumbar drain placement. Intervention: Transglabellar/subcranial surgical approach to the anterior skull base, with or without routine perioperative lumbar drain placement. Results: Routine placement of perioperative lumbar drains was an independent predictor of tension pneumocephalus (P ¼.022, odds ratio ¼ 11.22 [1.218-103.3]). In addition, this practice was also associated with an increased risk of intracranial complications overall (P ¼.025, odds ratio ¼ 2.623 [1.104-6.233]). Conclusion: Routine placement of perioperative lumbar drain may be associated with an increased risk of tension pneumocephalus and intracranial complications during surgery of the anterior cranial base.
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Papers by Lawrence Marentette