Bio

Bio


Dr. Sirjani graduated from the University of Arizona with Honors in Biochemistry and was awarded the most outstanding senior award for the college of sciences and the Centennial Achievement Award. He matriculated to the University of Arizona School of Medicine on the Dean?s Scholarship.

He completed a residency in Otolaryngology at Washington University in St. Louis and a fellowship in Head and Neck Cancer and Microvascular reconstruction at the University of Washington in Seattle in 2009.

He joined the Division of Head and Neck Surgery in 2009 and, since 2012, has also served as Chief of Otolaryngology at the VA in Palo Alto. Dr. Sirjani has pioneered the use of telemedicine to provide complicated head and neck cancer care to remote VA satellite across the Pacific and Mountwaint West.

Under his leadership, the Stanford VA has become a premier hub for head and neck cancer care in the West Coast.

As the director of the salivary program at Stanford since 2013, Dr. Sirjani?s practice is focused on minimally invasive parotidectomy.

He was the first surgeon at Stanford to offer patients sialendoscopy. His research interests include innovations in minimizing morbidity from parotid cancer treatment.

Dr. Sirjani?s research interests focus on surgical simulation and surgical innovation. He invented the only partoidectomy surgical simulator in the country, which is funded by CIMIT and used to teach other surgeons about the tension placed on the facial nerve during Parotidectomy. Stanford is now a primary center for the treatment of salivary related cancers.

Dr. Sirjani is also interested in improving the quality of life in cancer patients and has collaboration with Dr. Quynh Le to study the protection of salivary tissue from radiation damage in order to prevent xerostomia (dry mouth).

Dr. Sirjani incorporates new innovations, basic science research, and his high volume of operative experience to tailor operations to best suite the patient.

Clinical Focus


  • Cancer > Head and Neck Cancer
  • Parotid Neoplasms
  • Salivary Gland Neoplasms
  • Skull Base Neoplasms
  • Surgical Flaps
  • Sialoendoscopy
  • Jaw
  • Otolaryngology
  • Neck Dissection
  • Carcinoma, Skin Appendage

Academic Appointments


Administrative Appointments


  • Chief of Otolaryngology, VA Palo Alto (2012 - Present)
  • Director, Stanford Salivary Gland Program (2013 - Present)

Honors & Awards


  • Faculty Teaching Award, Stanford Department of Otolaryngology (2013)
  • "Surgery at the End of Life", American College of Surgeons, Issues Committee of Resident and Associate Society (2012)
  • "Reconstructive Dilemma of a Rare Mandibular Tumor", Saint Louis ENT Club (2006)
  • Resident Award, Association for Research in Otolaryngology (2004)
  • Michael Paparella Award for Outstanding Research, Washington University (2003)
  • Young Investigator Award, Academy of Clinical Laboratory Physicians and Scientists (2000)
  • Caldwell Research Award, University of Arizona College of Medicine (1999)
  • Excellence in Teaching Histology, University of Arizona College of Medicine (1999)
  • Dean's Scholar, University of Arizona College of Medicine (1996-2001)
  • Centennial Achievement Award, University of Arizona (1996)
  • Most Outstanding Senior Award in Biochemistry, University of Arizona (1996)
  • Most Outstanding Senior Award in the College of Science, University of Arizona (1996)
  • Silver Bowl Award (4.0 GPA excluding last semester), University of Arizona (1996)
  • Phi Kappa Phi, University of Arizona (1992-96)

Boards, Advisory Committees, Professional Organizations


  • Active Candidate for Fellowship, Triological Society (2016 - Present)
  • Member, American Academy of Otolaryngology, Medical Devices and Drugs Committee (2013 - Present)
  • Member, North American Skull Base Society (2012 - Present)
  • Member, Association of Northern California Oncologist (2011 - Present)
  • Member, American Telemedicine Association (2011 - Present)

Professional Education


  • F.A.C.S, American College of Surgeons (2013)
  • Board Certification: Otolaryngology, American Board of Otolaryngology (2010)
  • Fellowship:University of Washington Medical Center (2009) WA
  • Residency:Washington University School Of Medicine (2008) MO
  • Internship:Washington University School Of Medicine (2002) MO
  • Post-Sophomore Fellow, University of Arizona College of Medicine, Pathology (1999)
  • Medical Education:University of Arizona College of Medicine (2001) AZ
  • Bachelor of Science, University of Arizona, Biochemistry (1996)

Research & Scholarship

Current Research and Scholarly Interests


Innovation of devices to improve the quality of life of patients with advanced head and neck cancers, minimal invasive parotid surgery, surgical simulation, flap reconstruction of large head and neck defects to restore cosmesis and function (speech, swallowing), stem cell recovery of radiation induced salivary damage, and salivary gland cancer biology

Clinical Trials


  • NBI to Characterize Patterns of Vascular Supply Within Lymphoepithelial Mucosa in Oropharyngeal Cancer Recruiting

    The purpose of this study is to characterize the blood supply at the base of the tongue and within the tonsil region. We hypothesize that high-resolution Narrow Band Imaging (NBI) will improve the diagnosis of oropharyngeal carcinoma (OPC). The goal is to provide the better assessment of tumor and thus providing better preoperative expectations to patients with OPC or tumor extent prior to radiation therapy.

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  • Phase I Panitumumab IRDye800 Optical Imaging Study Recruiting

    Phase I trial to evaluate the safety of escalating dose levels of conjugated panitumumab-IRDye800 in subjects with head and neck squamous cell carcinoma (HNSCC) that undergo surgery with curative intent.

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  • Cetuximab IRDye800 Study as an Optical Imaging Agent to Detect Cancer During Surgical Procedures Recruiting

    This study is an open label, single institution, Phase 1 dose-escalation study to determine the safety profile of cetuximab-IRDye800 used in subjects with head and neck squamous cell carcinoma (HNSCC) that undergo surgery with curative intent. Participants will be given a dose of an approved head and neck cancer drug (Cetuximab) along with an investigational study drug called Cetuximab-IRDye800. Cetuximab-IRDye800 is a drug that is given prior to surgery that attaches to cancer cells and appears to make them visible to the doctor when he uses a special camera during the operation. The investigators are evaluating whether or not the use of the study drug along with the special camera will better identify the cancer while patients are in the operating room.

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Teaching

2016-17 Courses


Publications

All Publications


  • Contemporary mandibular reconstruction. Current opinion in otolaryngology & head and neck surgery Divi, V., Schoppy, D. W., Williams, R. A., Sirjani, D. B. 2016; 24 (5): 433-439

    Abstract

    Multiple disease processes, including neoplasia, trauma, and medication side-effects, necessitate segmental resection and subsequent reconstruction of the mandible. As surgical techniques have advanced, several technologies have been developed with the potential to significantly transform a surgeon's approach to the restoration of mandibular continuity. The purpose of this review is to highlight many of these relatively newer tools and discuss their evolving role in mandibular reconstruction.Several contemporary studies have documented the application of different approaches and modifications to mandibular reconstruction - including computer-aided design or computer-aided modeling, contemporary plating systems, osseointegrated implants, and various modifications to existing osseocutaneous free tissue transfer options - and have reported relatively high success rates.In discussing these reports, we present a survey of current and developing technologies in the field of mandibular reconstruction and aim to provide sufficient context for the gradual integration of these techniques into practice.

    View details for DOI 10.1097/MOO.0000000000000284

    View details for PubMedID 27348352

  • Ameloblastoma: a clinical review and trends in management EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY McClary, A. C., West, R. B., McClary, A. C., Pollack, J. R., Fischbein, N. J., Holsinger, C. F., Sunwoo, J., Colevas, A. D., Sirjani, D. 2016; 273 (7): 1649-1661

    Abstract

    Ameloblastoma is a rare odontogenic neoplasm of the mandible and maxilla, with multiple histologic variants, and high recurrence rates if improperly treated. The current mainstay of treatment is wide local excision with appropriate margins and immediate reconstruction. Here we review the ameloblastoma literature, using the available evidence to highlight the change in management over the past several decades. In addition, we explore the recent molecular characterization of these tumors which may point towards new potential avenues of personalized treatment.

    View details for DOI 10.1007/s00405-015-3631-8

    View details for Web of Science ID 000377413500003

    View details for PubMedID 25926124

  • Consultation via telemedicine and access to operative care for patients with head and neck cancer in a Veterans Health Administration population HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK Beswick, D. M., Vashi, A., Song, Y., Pham, R., Holsinger, F. C., Rayl, J. D., Walker, B., Chardos, J., Yuan, A., Benadam-Lenrow, E., Davis, D., Sung, C. K., Divi, V., Sirjani, D. B. 2016; 38 (6): 925-929

    Abstract

    The purpose of this study was to evaluate a telemedicine model that utilizes an audiovisual teleconference as a preoperative visit.Veterans Health Administration (VHA) patients with head and neck cancer at 2 remote locations were provided access to the Palo Alto Veterans Affairs (PAVA) Health Care System otolaryngology department via the telemedicine protocol: tissue diagnosis and imaging at the patient site; data review at PAVA; and a preoperative teleconference connecting the patient to PAVA. Operative care occurred at PAVA. Follow-up care was provided remotely via teleconference.Fifteen patients were evaluated. Eleven underwent surgery, 4 with high-grade neoplasms (carcinoma). Average time from referral to operation was 28 days (range, 17-36 days) and 72 (range, 31-108 days), respectively, for high-grade and low-grade groups. The average patient was spared 28 hours traveling time and $900/patient was saved on travel-related costs.A telemedicine model enables timely access to surgical care and permits considerable savings among select VHA patients with head and neck cancer. 2016 Wiley Periodicals, Inc. Head Neck 38: 925-929, 2016.

    View details for DOI 10.1002/hed.24386

    View details for Web of Science ID 000379939900021

    View details for PubMedID 26899939

  • Botulinum Toxin Confers Radioprotection in Murine Salivary Glands INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Zeidan, Y. H., Xiao, N., Cao, H., Kong, C., Le, Q., Sirjani, D. 2016; 94 (5): 1190-1197
  • Anterolateral approach to the upper cervical spine: Case report and operative technique HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK Song, Y., Tharin, S., Divi, V., Prolo, L. M., Sirjani, D. B. 2015; 37 (9): E115-E119

    View details for DOI 10.1002/hed.23951

    View details for Web of Science ID 000359605700004

  • CD271 is a functional and targetable marker of tumor-initiating cells in head and neck squamous cell carcinoma ONCOTARGET Murillo-Sauca, O., Chung, M. K., Shin, J. H., Karamboulas, C., Kwok, S., Jung, Y. H., Oakley, R., Tysome, J. R., Farnebo, L. O., Kaplan, M. J., Sirjani, D., Divi, V., Holsinger, F. C., Tomeh, C., Nichols, A., Le, Q. T., Colevas, A. D., Kong, C. S., Uppaluri, R., Lewis, J. S., Ailles, L. E., Sunwoo, J. B. 2014; 5 (16): 6854-6866

    Abstract

    Tumor-initiating cells (TICs) in squamous cell carcinoma of the head and neck (SCCHN) are best characterized by their surface expression of CD44. Although there is great interest in identifying strategies to target this population, no marker of these cells has been found to be functionally active. Here, we examined the expression of the purported marker of normal human oral epithelial stem cells, CD271. We show that CD271 expression is restricted to a subset of the CD44+ cells. Using xenograft assays, we show that the CD44+CD271+ subpopulation contains the most tumorigenic cells. Loss of CD271 function results in a block in the G2-M phase of the cell cycle and a profound negative impact on the capacity of these cells to initiate tumor formation in vivo. Incubation with recombinant NGF results in enhanced phosphorylation of Erk, providing additional evidence that CD271 is functionally active. Finally, incubation of SCCHN cells with antibody to CD271 results in decreased Erk phosphorylation and decreased tumor formation in vivo. Thus, our data are the first to demonstrate that CD271 more specifically identifies the TIC subpopulation within the CD44+ compartment in SCCHN and that this receptor is a functionally active and targetable molecule.

    View details for Web of Science ID 000347920100028

  • Neurotrophic factor GDNF promotes survival of salivary stem cells JOURNAL OF CLINICAL INVESTIGATION Xiao, N., Lin, Y., Cao, H., Sirjani, D., Giaccia, A. J., Koong, A. C., Kong, C. S., Diehn, M., Quynh-Thu Le, Q. T. 2014; 124 (8): 3364-3377

    Abstract

    Stem cell-based regenerative therapy is a promising treatment for head and neck cancer patients that suffer from chronic dry mouth (xerostomia) due to salivary gland injury from radiation therapy. Current xerostomia therapies only provide temporary symptom relief, while permanent restoration of salivary function is not currently feasible. Here, we identified and characterized a stem cell population from adult murine submandibular glands. Of the different cells isolated from the submandibular gland, this specific population, Lin-CD24+c-Kit+Sca1+, possessed the highest capacity for proliferation, self renewal, and differentiation during serial passage in vitro. Serial transplantations of this stem cell population into the submandibular gland of irradiated mice successfully restored saliva secretion and increased the number of functional acini. Gene-expression analysis revealed that glial cell line-derived neurotrophic factor (Gdnf) is highly expressed in Lin-CD24+c-Kit+Sca1+ stem cells. Furthermore, GDNF expression was upregulated upon radiation therapy in submandibular glands of both mice and humans. Administration of GDNF improved saliva production and enriched the number of functional acini in submandibular glands of irradiated animals and enhanced salisphere formation in cultured salivary stem cells, but did not accelerate growth of head and neck cancer cells. These data indicate that modulation of the GDNF pathway may have potential therapeutic benefit for management of radiation-induced xerostomia.

    View details for DOI 10.1172/JCI74096

    View details for Web of Science ID 000339984000013

  • A novel aldehyde dehydrogenase-3 activator (Alda-89) protects submandibular gland function from irradiation without accelerating tumor growth. Clinical cancer research Xiao, N., Cao, H., Chen, C., Kong, C. S., Ali, R., Chan, C., Sirjani, D., Graves, E., Koong, A., Giaccia, A., Mochly-Rosen, D., Le, Q. 2013; 19 (16): 4455-4464

    Abstract

    To determine the effect of Alda-89 (an ALDH3 activitor) on (1) the function of irradiated (RT) submandibular gland (SMG) in mice, (2) its toxicity profile and (3) its effect on the growth of head and neck cancer (HNC) in vitro and in vivo.Adult mice were infused with Alda-89 or vehicle before, during and after RT. Saliva secretion was monitored weekly. Hematology, metabolic profile and post-mortem evaluation for toxicity were examined at the time of sacrifice. Alda-89 or vehicle was applied to HNC cell lines in vitro, and SCID mice transplanted with HNC in vivo with or without radiation; HNC growth was monitored. The ALDH3A1 and ALDH3A2 protein expression was evaluated in 89 HNC patients and correlated to freedom from relapse (FFR) and overall survival (OS).Alda-89 infusion significantly resulted in more whole saliva production and a higher percentage of preserved acini after RT compared to vehicle control. There was no difference in the complete blood count, metabolic profile, and major organ morphology between the Alda-89 and vehicle groups. Compared to vehicle control, Alda-89 treatment did not accelerate HNC cell proliferation in vitro, nor did it affect tumor growth in vivo with or without RT. Higher expression of ALDH3A1 or ALDH3A2 was not significantly associated with worse FFR or OS in either HPV-positive or HPV-negative group.Alda-89 preserves salivary function after RT without affecting HNC growth or causing measurable toxicity in mice. It is a promising candidate to mitigate RT-related xerostomia.

    View details for DOI 10.1158/1078-0432.CCR-13-0127

    View details for PubMedID 23812668

  • Cost-effectiveness landscape analysis of treatments addressing xerostomia in patients receiving head and neck radiation therapy ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY ORAL RADIOLOGY Sasportas, L. S., Hosford, D. N., Sodini, M. A., Waters, D. J., Zambricki, E. A., Barral, J. K., Graves, E. E., Brinton, T. J., Yock, P. G., Le, Q., Sirjani, D. 2013; 116 (1): E37-E51
  • Impact of positron emission tomography/computed tomography surveillance at 12 and 24 months for detecting head and neck cancer recurrence CANCER Ho, A. S., Tsao, G. J., Chen, F. W., Shen, T., Kaplan, M. J., Colevas, A. D., Fischbein, N. J., Quon, A., Quynh-Thu Le, Q. T., Pinto, H. A., Fee, W. E., Sunwoo, J. B., Sirjani, D., Hara, W., Yao, M. 2013; 119 (7): 1349-1356

    View details for DOI 10.1002/cncr.27892

    View details for Web of Science ID 000316811900010

  • A Novel Aldehyde Dehydrogenase-3 Activator Leads to Adult Salivary Stem Cell Enrichment In Vivo CLINICAL CANCER RESEARCH Banh, A., Xiao, N., Cao, H., Chen, C., Kuo, P., Krakow, T., Bavan, B., Khong, B., Yao, M., Ha, C., Kaplan, M. J., Sirjani, D., Jensen, K., Kong, C. S., Mochly-Rosen, D., Koong, A. C., Quynh-Thu Le, Q. T. 2011; 17 (23): 7265-7272

    Abstract

    To assess aldehyde dehydrogenase (ALDH) expression in adult human and murine submandibular gland (SMG) stem cells and to determine the effect of ALDH3 activation in SMG stem cell enrichment.Adult human and murine SMG stem cells were selected by cell surface markers (CD34 for human and c-Kit for mouse) and characterized for various other stem cell surface markers by flow cytometry and ALDH isozymes expression by quantitative reverse transcriptase PCR. Sphere formation and bromodeoxyuridine (BrdUrd) incorporation assays were used on selected cells to confirm their renewal capacity and three-dimensional (3D) collagen matrix culture was applied to observe differentiation. To determine whether ALDH3 activation would increase stem cell yield, adult mice were infused with a novel ALDH3 activator (Alda-89) or with vehicle followed by quantification of c-Kit(+)/CD90(+) SMG stem cells and BrdUrd(+) salispheres.More than 99% of CD34(+) huSMG stem cells stained positive for c-Kit, CD90 and 70% colocalized with CD44, Nestin. Similarly, 73.8% c-Kit(+) mSMG stem cells colocalized with Sca-1, whereas 80.7% with CD90. Functionally, these cells formed BrdUrd(+) salispheres, which differentiated into acinar- and ductal-like structures when cultured in 3D collagen. Both adult human and murine SMG stem cells showed higher expression of ALDH3 than in their non-stem cells and 84% of these cells have measurable ALDH1 activity. Alda-89 infusion in adult mice significantly increased c-Kit(+)/CD90(+) SMG population and BrdUrd(+) sphere formation compared with control.This is the first study to characterize expression of different ALDH isozymes in SMG stem cells. In vivo activation of ALDH3 can increase SMG stem cell yield, thus providing a novel means for SMG stem cell enrichment for future stem cell therapy.

    View details for DOI 10.1158/1078-0432.CCR-11-0179

    View details for Web of Science ID 000298133600009

    View details for PubMedID 21998334

  • Lefort I Osteotomy access to the Anterior Skull Base Operative Techniques in Otolaryngology Sirjani DB, Futran N. 2010; 21 (1): 22-25

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