[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to determine the role of preepiglottic space (PES) invasion in lymph node metastasis and prognosis in patients undergoing supracricoid partial laryngectomy (SCPL) with cricohyoidopexy (CHP).
Clinical and Experimental Otorhinolaryngology 09/2014; 7(3):205-9. · 0.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A new approach to modifying facelift incision was recently developed for robotic thyroid surgery that seemed to be advantageous over other existing approaches. In this study, we aimed to investigate the feasibility and safety of the facelift approach not only for robotic thyroid surgery, but also for endoscope-assisted thyroid surgery.
[Show abstract][Hide abstract] ABSTRACT: Abstract Conclusion: High-risk human papillomavirus (HPV) infection was significantly related to lymph node size in patients with single node metastasis of oral and oropharyngeal cancer. Objective: The purpose of this study was to examine the relationship between high-risk HPV infection and lymph node size in patients with single node metastasis of oral and oropharyngeal carcinoma. Methods: This study included 48 patients with oral and oropharyngeal carcinoma. Pathologic lymph node stages comprised 36 N1 and 12 N2a. Results: High-risk HPV in situ hybridization was positive in 29% of patients (14/48). Of those patients with high-risk HPV, there was a significant difference (p = 0.008) between oral (9.5%) and oropharyngeal (44.4%) cancers. Average lymph node diameter was 20.7 ± 12.6 mm (range 5-54 mm). We found a positive correlation between high-risk HPV status and lymph node size (p = 0.018). Mean lymph node diameter in high-risk HPV-positive cases was 27.3 ± 13.1 mm and 18.0 ± 11.5 mm in high-risk HPV-negative cases. Extracapsular spread (p = 0.030) and cystic nodal metastases (p = 0.019) were also significantly related to lymph node size. High-risk HPV negative status (p = 0.043), advanced tumor stage (p = 0.009), and extracapsular spread (p = 0.038) all had significant adverse effects on 5-year disease-specific survival.
[Show abstract][Hide abstract] ABSTRACT: The ductal cyst of the hypopharynx is a very rare tumor. We report a case of hypopharyngeal ductal cyst in a 63-year-old man presenting with globus sensation. It was removed by a laryngomicrosurgical technique, using a microdissection electrode. Masses of the hypopharynx may not always be easily visible on routine examination of the hypopharynx with flexible fiberoptic laryngoscopes. Particularly in cases of benign tumors, the diagnosis may be delayed due to a prolonged history of mild and subtle symptoms. We missed the hypopharyngeal mass at the initial presentation, but could detect the mass in the pyriform sinus with a double contrast barium swallow study. We describe the diagnostic method to detect hypopharyngeal tumors and the treatment of benign hypopharyngeal masses.
Clinical and Experimental Otorhinolaryngology 03/2014; 7(1):76-8. · 0.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The concept of natural orifice transluminal endoscopic surgery (NOTES) is an emerging experimental alternative to conventional surgery that eliminates skin incisions using an endoscope passed through a natural orifice (e.g., mouth, urethra, or anus). This study was designed to evaluate the feasibility and safety of thyroid resection via an entirely transoral tri-vestibular route using endoscopy, and to introduce NOTES to the head and neck area of medicine. We performed ten complete endoscopic thyroid lobectomies with central lymph node dissection via a tri-vestibular approach in fresh-frozen cadavers. A 5-mm endoscope with a deflectable tip was used to visualize the surgical field. Three cannulas were inserted through the midline and bilateral incision sites in the vestibule to position the instruments and endoscope. We refined and described the surgical technique in each step using video clips. We identified and preserved neighboring critical structures during surgery. We also confirmed that there were no obvious remnant thyroid tissues and no injury to the neighboring structures after exploration. The transoral tri-vestibular approach seems to provide a good view and surgical field for endoscopic thyroidectomy. However, the transoral approach for thyroidectomy remains experimental, and the detailed surgical technique should be refined via further clinical studies.
Archives of Oto-Rhino-Laryngology 02/2014; · 1.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although T stage is an important prognostic tool for oral tongue cancer, it fails to define the depth of invasion and true three-dimensional volume of primary tumors. The purpose of this paper is to determine the relations between tumor volume and lymph node metastasis and survival in early oral tongue cancer.
Forty-seven patients with T1-2 tongue cancer were included. Tumor volumes were measured by the computerized segmentation of T2-weighted magnetic resonance imaging.
The overall average tumor volume was 27.7 cm(3) (range, 1.4 to 60.1 cm(3)). A significant positive correlation was found between tumor volume and pathological T stage, depth of invasion, and cervical lymph node metastasis (P<0.001, P<0.001, and P=0.002, respectively). When the tumor volume exceeded 20 cm(3), the cervical metastasis rate increased to 69.2%. The overall 5-year disease specific survival rate was 80%. There was a statistically significant association between large tumor volume (≥20 cm(3)) and the 5-year disease-specific survival (P=0.046).
Tumor volume larger than 20 cm(3) was associated with greater risk cervical lymph node metastasis and poor 5-year disease-specific survival rate in early oral tongue cancer patients.
Clinical and Experimental Otorhinolaryngology 12/2013; 6(4):243-8. · 0.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract Conclusion: (18)F-FDG PET/CT is a useful technique for the evaluation of paraglottic space invasion and lymph node metastasis in patients with supracricoid partial laryngectomy (SCPL). Primary SUVmax values (using 7.0 as a cut-off) and nodal SUVmax values (using 2.2 as a cut-off) are important for recurrence and poor prognosis. Objectives: The purpose of this study was to evaluate the usefulness of (18)F-FDG PET/CT for paraglottic space invasion and lymph node metastasis and the prognostic significance in SCPL. Methods: The medical records of 42 patients who underwent (18)F-FDG PET/CT for SCPL before surgery were reviewed. Results: The median primary SUVmax was 6.63 ± 5.07 and the median nodal SUVmax was 1.25 ± 1.86. The primary SUVmax values with paraglottic space invasion (8.34 ± 5.92) and without (4.57 ± 2.74) were significantly different (p = 0.015). The (18)F-FDG PET/CT had an accuracy of 87% for the identification of cervical metastases on a level-by-level basis. A median primary SUVmax value of 7.0 and nodal SUVmax of 2.2 were associated with recurrence (p = 0.022 and p = 0.009, respectively) and 5-year disease-specific survival (p = 0.021 and p = 0.041, respectively).
[Show abstract][Hide abstract] ABSTRACT: Abstract Conclusion: Factors that affected prognosis were T stage and extracapsular spread in patients that underwent primary surgery with postoperative radiotherapy for pN2 head and neck carcinoma. Objectives: The purpose of this study was to examine treatment outcomes and define prognostic factors for pN2 head and neck carcinoma. Methods: A total of 209 patients underwent surgery with postoperative radiotherapy between 1994 and 2011. Primary tumor sites were the oropharynx (n = 70), hypopharynx (n = 48), larynx (n = 47), and oral cavity (n = 44). There were 21, 83, 60, and 45 patients with stage T1 to T4 cancers, respectively. The N stages were 20 N2a, 129 N2b, and 60 N2c. Results: The recurrence rate was 40% (83/209) over a mean observation period of 39 months. The 5-year disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS) rates in our cohort were 44%, 60%, and 56%, respectively. The presence of advanced T stage or extracapsular spread had a significant adverse effect on 5-year DFS, DSS, and OS rates according to Kaplan-Meier survival curves. Multivariate Cox regression analysis confirmed the significant association between 5-year DSS rate and advanced T stage (hazard ratio (HR), 2.20; 95% confidence interval (CI), 1.26-3.82; p = 0.005) and extracapsular spread (HR, 2.29; 95% CI, 1.24-4.21; p = 0.008).
[Show abstract][Hide abstract] ABSTRACT: Abstract Conclusion: Median maximum standardized uptake (SUVmax) cut-off values of FDG PET/CT higher than 3.85 were found to be associated with a greater risk cervical lymph node metastasis with extracapsular spread (ECS) in patients with oropharyngeal squamous cell carcinoma (OPSCC). Objectives: The purpose of this study was to evaluate the use of FDG PET/CT for the identification of ECS and to establish its histologic correlates in OPSCC. Methods: The medical records of 78 patients who underwent FDG PET/CT for OPSCC before surgery were reviewed. Results: ECS was present in 42% (42/69) of dissected necks and in 51% (54/106) of dissected cervical levels. The SUVmax values of cervical lymph nodes with and without ECS were found to be significantly different (6.73 ± 3.78 vs 3.02 ± 2.24, p < 0.001). The SUVmax cut-off value for differentiating necks with ECS from those without ECS was 3.85. The presence of ECS (p = 0.036) and median SUVmax (using 3.85 as a cut-off) (p = 0.037) were found to have a significant adverse effect on 5-year disease-specific survival by univariate analysis. The multivariate analysis showed a significant association of 5-year disease-specific survival with ECS (hazard ratio (HR) = 32.3 in cervical metastasis with ECS, p = 0.012; and HR = 19.6 in cervical metastasis without ECS, p = 0.024).
[Show abstract][Hide abstract] ABSTRACT: Abstract Conclusion: Our findings show that copy number loss of FHIT is associated with lymph node metastasis (LNM) and suggest that the down-regulation of Fhit indicates poor prognosis in early oral squamous cell carcinoma (OSCC). Objectives: The purpose of this study was to identify alterations in genetic markers related to LNM in early OSCC. Methods: Genome-wide copy number alterations were analyzed in 14 early OSCCs with (n = 7) or without (n = 7) cervical LNM using 180K array-comparative genomic hybridization. To explore the prognostic implications of the most significantly associated genetic alteration with cervical LNM, immunohistochemical analysis was conducted in 30 OSCCs. Results: A total of 11 recurrently altered regions (RARs) were identified in the 14 OSCC cases. Six RARs on chromosomes 3p26-3p14, 5q22, and 9p21 were found to be significantly more common in early OSCC with LNM (p < 0.05). Among these, loss of 3p14.2 (where the FHIT gene is located) was the most frequent (five of seven patients with LNM, and none of seven without LNM), and most significantly associated with cervical LNM (p = 0.005). Fhit immunohistochemical staining of 30 OSCCs showed that Fhit negativity was associated with cervical LNM (p = 0.032) and poor disease-specific survival (p = 0.045).
[Show abstract][Hide abstract] ABSTRACT: (18)F-FDG PET/CT is clinically useful in the initial staging and follow-up of patients with head and neck squamous cell carcinoma (HNSCC). We studied the potential prognostic significance of preoperative (18)F-FDG PET/CT in HNSCC. The medical records of 294 patients who underwent preoperative (18)F-FDG PET/CT for HNSCC were retrospectively reviewed. The median SUVmax of the primary lesions (SUVmax-p) and cervical lymph nodes (SUVmax-n) was 7.98 ± 5.04 (range 1.2-28.7) and 3.34 ± 3.70 (range 1.0-20.4), respectively. There was a significant difference between with and without recurrence in SUVmax-p (11.14 ± 5.36 vs. 6.78 ± 4.35, p < 0.001) and SUVmax-n (5.60 ± 4.22 vs. 1.75 ± 1.46, p < 0.001). The cut-off values of SUVmax-p and SUVmax-n in the context of recurrence and cancer-related death were 8.5 and 3.5. The 5-year disease-free survival of patients with SUVmax-p < 8.5 and SUVmax-n < 3.5 was 79 and 79 %, respectively, whereas that of patients with SUVmax-p ≥ 8.5 and SUVmax-n ≥ 3.5 was 39 and 30 %, respectively. Multivariate analysis confirmed the significant association between 5-year disease-free survival and SUVmax-p ≥ 8.5 (hazard ratio (HR) 2.68, p < 0.001) and SUVmax-n ≥ 3.5 (HR 2.29, p = 0.007). Furthermore, SUVmax-p ≥ 8.5 (HR 3.20, p = 0.012) and SUVmax-n ≥ 3.5 (HR 2.14, p < 0.001) were associated with 5-year overall survival. (18)F-FDG PET/CT cut-off values of SUVmax-p ≥ 8.5 or SUVmax-n ≥ 3.5 are associated with a recurrence and survival in HNSCC.
Archives of Oto-Rhino-Laryngology 08/2013; · 1.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective
The aim of this study was to evaluate the prognostic factors of patients with pathologically negative lymph node (pN0) head and neck cancer.Study DesignCase series with chart review.SettingCollege medical center.Subjects and Methods
The medical records of 120 patients were reviewed. Primary tumor sites included 46 larynx, 45 oral cavity, 17 oropharynx, and 12 hypopharynx.ResultsThe recurrence rate was 14% (17/120) over a mean observation period of 33 months. Median (18)F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) maximal standardized uptake value (SUVmax; using 8.5 as a cutoff; P = .001), positive surgical margins (P = .005), and pathologic T stage (P = .012) were found to be associated with recurrence. The 5-year disease-specific survival rate (DSSR) in our cohort was 86%. Patients with an SUVmax value higher than 8.5 and positive surgical margins had significantly decreased 5-year DSSR based on Kaplan-Meier survival curves. Multivariate Cox regression analysis confirmed the significant association between median SUVmax (using 8.5 as a cutoff; hazard ratio [HR], 6.13; 95% confidence interval [CI], 1.79-20.93; P = .004) and margin involvement (HR, 4.98; 95% CI, 1.42-17.47; P = .012).ConclusionA median (18)F-FDG PET/CT SUVmax cutoff values of 8.5 or greater and positive surgical margins were associated with adverse outcomes in patients with pN0 head and neck cancer.
Otolaryngology Head and Neck Surgery 08/2013; · 1.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to describe a technique using the fascia lata (FL) component of the anterolateral thigh (ALT) flap to re-create the orbital floor and lateral nasal wall after total maxillectomy.
Retrospective analysis of medical records.
A total of 22 patients underwent maxillary reconstruction using a composite ALT-FL flap following cancer resection. All patients underwent total maxillectomies via the Weber-Ferguson approach. The ALT flap was harvested with the deep fascia of the thigh with the aim of using it for lining of the orbital floor and lateral nasal cavity. The FL was sutured to the palatine bone inferiorly, nasal bone and zygomatic bone superiorly, and nasopharyngeal mucosa posteriorly to provide an orbital floor and make a neonasal cavity.
There was 100% free flap survival. Speech was normal in eight (36%) patients, near normal in 10 (46%), and intelligible in four (18%). Seventeen (77%) patients gained a good facial appearance, and five (23%) a fair appearance. Sixteen (73%) patients complained of mild nasal crust formation, and the rest (27%) developed moderate crust.
Microvascular reconstruction using a composite ALT-FL flap provided a reliable fascial component for orbital floor and nasal surface reconstruction of total maxillectomy defects.
4. Laryngoscope, 2013.
[Show abstract][Hide abstract] ABSTRACT: High-risk human papillomavirus (HPV) is an oncogenic virus that causes oropharyngeal cancers, and it has a favorable outcome after the treatment. Unlike in oropharyngeal cancer, the prevalence and role of high-risk HPV in the etiology of hypopharyngeal squamous cell carcinoma (HPSCC) is uncertain.
The aim of the present study was to evaluate the effect and prognostic significance of high-risk HPV in patients with HPSCC.
The study included 64 subjects with HPSCC who underwent radical surgery with or without radiation-based adjuvant therapy. Primary tumor sites were the pyriform sinus in 42 patients, posterior pharyngeal wall in 19 patients, and postcricoid area in 3 patients. High-risk HPV in situ hybridization was performed to detect HPV infection.
The positive rate of high-risk HPV in situ hybridization was 10.9% (7/64). There was a significant difference in the fraction of positive high-risk HPV among pyriform sinus cancer (16.7%), posterior pharyngeal wall cancer (0%), and postcricoid area cancer (0%) (p = 0.042). The laryngoscopic examination revealed a granulomatous and exophytic appearance in 85.7% (6/7) of patients with high-risk HPV-positive pyriform sinus cancer, but in only 31.4% (11/35) of patients with high-risk HPV-negative pyriform sinus cancer (p = 0.012). Significant correlations were found between positive high-risk HPV and younger age (p = 0.050) and non-smoking status (p = 0.017). HPV-positive patients had a significantly better disease-free survival (p = 0.026) and disease-specific survival (p = 0.047) than HPV-negative patients.
High-risk HPV infection is significantly related to pyriform sinus cancer in patients with HPSCC.
PLoS ONE 01/2013; 8(11):e78718. · 3.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES: Limited information is available regarding the characteristics of histiocytic necrotizing lymphadenitis (HNL) in children. This study compares the clinical and laboratory features as well as the immunohistochemical findings of HNL in children with those of adults. STUDY DESIGN: Retrospective analysis. METHODS: Thirty patients who underwent a biopsy of a cervical lymph node and were histologically proven to have HNL were enrolled in this study. There were 13 children and 17 adults. CD68, CD163 and myeloperoxidase expression were analyzed by immunohistochemical staining. RESULTS: Children had more bilateral lymphadenopathy (P=0.045) and a higher expression of CD68 (P=0.043) than did the adult patients. However, there was no significant difference between the groups in the following variables: patient gender, presence of fever, size and necrosis of enlarged lymph node, multiplicity of lymphadenopathy, WBC count, ESR, CRP, recurrence, and expression of myeloperoxidase and CD163. CONCLUSIONS: The clinical and immunohistological characteristics of HNL in pediatric patients are similar to those of adults. Bilateral involvement of lymph nodes and a high expression of CD68 were the only features significantly associated with children with HNL.
International journal of pediatric otorhinolaryngology 12/2012; · 0.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE To determine whether invasion of the pharyngeal constrictor muscle in early squamous cell carcinoma of the tonsil is correlated with lymph node metastasis. DESIGN Retrospective analysis of medical records and pathology specimens. SETTING Tertiary care referral center. PATIENTS Forty-eight patients who were diagnosed as having T2 squamous cell carcinoma of the tonsil and who underwent surgery. They were divided into 2 groups: an invasive group with invasion of the pharyngeal constrictor muscle and a noninvasive group without invasion of the pharyngeal constrictor muscle. MAIN OUTCOME MEASURES Comparison of regional metastasis, 5-year locoregional recurrence, and 5-year disease-specific survival between the 2 groups. RESULTS Invasion of the pharyngeal constrictor muscle was found in 36 patients (75%) with T2 squamous cell carcinoma of the tonsil. The rate of lymph node metastasis, the mean (SD) number of positive nodes, and the mean (SD) lymph node density were 81%, 5.47 (9.27), and 0.15 (0.22) in the invasive group, respectively, and 50%, 1.33 (1.72), and 0.04 (0.04) in the noninvasive group, respectively (P = .04, P = .02, and P = .01, respectively). Five-year locoregional recurrence was significantly correlated with invasion of the pharyngeal constrictor muscle (P = .05) and with multiple lymph node metastasis (≥5 nodes) (P = .04) in the univariate analyses. No factor was correlated with 5-year locoregional recurrence in the multivariate analysis. Five-year disease-specific survival was significantly correlated with multiple lymph node metastasis (≥5 nodes) in the univariate analyses (P = .009). Five-year disease-specific survival was not significantly correlated with any clinicopathological factor in the multivariate analysis. CONCLUSION Higher risk for multiple lymph node metastasis and 5-year locoregional recurrence seems to be predicted in patients with extratonsillar invasion of the pharyngeal constrictor muscle, even in early squamous cell carcinoma of the tonsil.
Archives of otolaryngology--head & neck surgery 11/2012; 138(11):1034-9. · 1.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: The purpose of this study was to investigate the relationship between the radial forearm free flap (RFFF) volume changes and speech and swallowing outcomes. METHODS: The study included 18 subjects with squamous cell carcinoma of the oral tongue. RESULTS: Average percentage changes in flap volume between 3 and 12months was 19.2%. Postoperative free flap volume changes were significantly and negatively correlated with the word and sentence intelligibility (Y=-0.338X+43.641, r(2)=0.383, p=0.006 and Y=-0.246X+34.322, r(2)=0.321, p=0.014, respectively). A significant positive correlation was also found between word and sentence intelligibility and floor of mouth resected, postoperative irradiation. Postoperative flap volume changes between 3 and 12months were correlated with reduced posterior bolus movement by tongue (p=0.002), reduced tongue base to posterior pharyngeal wall contact (p=0.002), reduced laryngeal elevation (p=0.005), increased aspiration (p=0.005), delayed oral (p=0.010) and pharyngeal transit time (p=0.011). Floor of mouth resected, tongue base resected, and postoperative irradiation also influenced the swallowing outcomes. CONCLUSIONS: This study shows that postoperative flap volume changes are significantly related to speech and swallowing outcomes in patients undergoing partial glossectomy reconstructed with RFFF.