Search

Background: Nutritional status and sarcopenia affects the prognosis of head and neck cancers including hypopharyngeal cancer. Hypopharyngeal cancer patients tend to exhibit sarcopenia, which is associated with poor treatment outcomes. This study aims to determine the correlation between nutritional status and sarcopenia, and their prognostic role in surgically treated hypopharyngeal cancer. Materials and Methods: Patients who had been diagnosed with squamous cell carcinoma originating from the hypopharynx and underwent surgery between January 2009 and December 2019 were enrolled in this study. The median neutrophil‐to‐lymphocyte ratio and prognostic nutritional index (PNI) of the cohort were considered the cut‐off values. Sarcopenia was evaluated by measuring skeletal muscle index (SMI) at the third lumbar vertebra. Clinical and serological factors predictive of survival outcomes were evaluated. Results: Patients with high PNI showed better 5‐year Overall survival (OS) (52.8% vs. 27.2%, p = 0.001) and disease‐free survival (DFS) (59.6% vs. 44.6%, p = 0.033) than those with low PNI. Likewise, patients with low SMI showed worse 5‐year OS (25.0% vs. 60.9%, p = 0.002) and DFS (42.4% vs. 68.7%, p = 0.034) than patients with high SMI. Among the patients with high PNI, those with sarcopenia displayed significantly worse OS than those with high SMI (78.0% vs. 34.4%, p = 0.049). High PNI with high SMI presented better overall (p = 0.010) and DFS (p = 0.055) than any other group. Conclusions: Both sarcopenia and PNI were associated with the prognosis of hypopharyngeal cancer. Considering that PNI and sarcopenia indicate the nutritional status, nutritional status may be a significant risk factor. Therefore, nutritional support that ameliorates sarcopenia may improve survival outcomes in surgically treated patients with hypopharyngeal cancer. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to assess the value of using videofluoroscopic swallowing study (VFSS) for assessing vocal fold paralysis. Methods: This was a retrospective study of patients who underwent VFSS with a vocal fold testing maneuver from June 2020 to February 2022, and who had undergone laryngoscopy within 2 weeks before or after VFSS. The vocal fold testing maneuver consisted of making an 'e' sound for about 2–3 seconds during VFSS anterior–posterior (AP) view. The diagnostic value of the VFSS was evaluated by a trained reviewer, who assessed the presence and laterality of vocal fold paralysis by examining videos of the patients performing the vocal fold testing maneuver. Intra‐rater reliability was determined by evaluation of the videos by the same reviewer 2 weeks later, and inter‐rater reliability was determined by evaluation by a second reviewer. Results: Seventy patients were enrolled in the study. The positive predictive value was 91.43% and the intra‐rater and inter‐rater reliabilities, as determined by Cohen's kappa value, were 0.746 and 0.824 respectively. Conclusions: The presence and laterality of vocal fold paralysis were identified accurately and reliably by the reviewers, showing that VFSS can be used to assess vocal fold paralysis. Level of evidence: 2. [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore the outcomes of motor‐innervated free flaps in hemi‐tongue reconstruction by assessing the tongue mobility through midsagittal images from cine‐magnetic resonance imaging. Methods: In this retrospective study, 47 patients who underwent tongue reconstruction following hemi‐glossectomy and 10 control subjects without any surgical history were included. Patients were classified into two groups: the motor and no‐motor innervation group. Various spatial parameters related to tongue mobility that were acquired from midsagittal sections were compared during consecutive swallowing phases. Results: Overall, the motor group showed improved functional swallowing scale compared with the no‐motor group. In case of tongue base resection, the motor group showed improved mobility of the tongue base during pharyngeal phase, whereas the no‐motor group showed increased laryngeal elevation for compensatory movement. Conclusion: The tongue reconstruction with motor‐innervated free flaps may facilitate swallowing capacity in patients with a hemi‐tongue defect combined with tongue base resection. [ABSTRACT FROM AUTHOR]

Objective To investigate the prognostic significance of lysyl oxidase (LOX) expression in laryngeal cancer. Study Design Retrospective chart review and histologic analysis. Setting Tertiary referral academic center. Subjects and Methods Patients (N = 100) underwent surgical treatment for laryngeal cancer and had tissue specimens available. Immunohistochemical staining for LOX was performed on laryngeal cancer tissue microarrays, and the proportion and intensity of staining were evaluated. Patients with LOX scores ≤6 were classified into the low LOX group, while those with scores >6 were classified into the high LOX group. We analyzed the correlation between LOX expression and clinical factors as well as prognosis. Results LOX was predominantly expressed in the cytoplasm and nuclei of tumor cells. Kaplan-Meier analysis revealed that the high LOX group had worse overall survival and recurrence-free survival rates than the low LOX group ( P < .05). LOX expression exhibited marginally significant correlation with lymph node metastasis. In the Cox regression analysis, LOX expression and lymph node metastasis were significant factors correlated with overall survival rate (odds ratio [OR] = 3.92, 95% confidence interval [95% CI]: 1.35-11.37, P = .012; OR = 1.96, 95% CI: 0.93-1.43, P = .024, respectively). LOX expression was related to distant metastasis free survival rate (OR = 7.72, 95% CI: 1.02-19.18, P = .048). Conclusion A high expression level of LOX is associated with lymph node and distant metastasis as well as poor prognosis among patients with laryngeal cancer. [ABSTRACT FROM AUTHOR]

ABSTRACT Background The Korean Society of Thyroid Head and Neck Surgery established a nationwide multicenter registry of anaplastic thyroid carcinoma (ATC) and evaluated the prognostic factors and treatment outcomes of ATC. Methods The present study enrolled 329 patients who were diagnosed with ATC between January 2000 and December 2012 at 19 medical centers in Korea. Survival outcomes were evaluated according to various clinical factors and treatments. Results Multivariate analysis identified age ≥70 years old, the presence of initial clinical symptoms, distant metastasis, and treatment modality as significant risk factors ( p <.05). The patients who underwent curative resection and adjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CRT) showed the best survival on multivariate analysis ( p < 0.05). Conclusion Although ATC is a lethal neoplasm, long-term survival may be acquired in cases in which the aggressive management, including curative resection or RT/concurrent CRT, is possible for therapeutic intent. © 2016 Wiley Periodicals, Inc. Head Neck 39: 133-139, 2017 [ABSTRACT FROM AUTHOR]

We evaluated the efficacy and outcome of intracordal auricular cartilage injection in patients with unilateral vocal fold paralysis. Our interest developed from findings of a canine model study that reported that histologic characteristics of cartilage were preserved 2 and 3 years after intracordal autologous cartilage injection. Between May 2002 and July 2010, 29 patients with breathy dysphonia caused by unilateral vocal fold paralysis underwent intracordal auricular cartilage injection. Each subject underwent preoperative and postoperative perceptual assessments, acoustical voice analysis, and videostroboscopy. Fourteen patients were male, and the mean age was 52-years old. Patients were tracked for a mean duration of 257 days. Injections were performed through a transoral approach under general anesthesia. Perceptual assessments by GRBAS scale, acoustic parameters of jitter, shimmer, noise-to-harmonic ratio, and maximum phonation time significantly improved at 3, 6, and 12 months after cartilage injection ( p < 0.005). No major complications were observed after injection. Initial clinical results with intracordal auricular cartilage injection are promising for patients with unilateral vocal fold paralysis. Autologous auricular cartilage can be a safe, effective, and alternative material for vocal fold medialization, and can be a long lasting one. © 2014 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 103B: 47-51, 2015. [ABSTRACT FROM AUTHOR]

Background Lateral cervical lymph node metastasis without central lymph node (CLN) metastasis is not infrequent in papillary thyroid cancer (PTC). This study was designed to investigate the frequency and pattern of skip metastasis in PTC. Methods We reviewed 131 patients who underwent total thyroidectomy with CLN dissection and selective lymph node dissection. Tumor location was classified in 3 areas (upper, middle, and lower third) based on preoperative ultrasonographic findings. Results All skip metastases occurred in patients whose tumors had been on the upper part of the thyroid ( p < .001). Among 9 patients with skip metastasis, level III lymph nodes (66.7%) were the lymph nodes that were most frequently involved in skip metastasis. Conclusion Primary tumors in the upper portion of the thyroid are closely linked to skip metastasis. Careful preoperative evaluation of lateral cervical lymph nodes is suggested when a tumor is in the upper portion. © 2013 Wiley Periodicals, Inc. Head Neck 36: 887-891, 2014 [ABSTRACT FROM AUTHOR]

Background Nodal metastasis in papillary thyroid cancer (PTC) usually occurs in the central compartment of the ipsilateral neck and spreads laterally. The purpose of this study was to evaluate the diagnostic accuracy of frozen biopsy for quantitative nodal evaluation of central neck metastasis in PTC. Methods In all, 252 patients with PTC underwent total thyroidectomy with bilateral central neck dissection (CND). All tissues from ipsilateral CND were examined by frozen biopsy. Results Among them, 53% of patients had central neck metastasis. The sensitivity and specificity of frozen biopsy for central neck metastasis were 92% and 99%, respectively. The positive predictive value and the negative predictive value were 99% and 84%, respectively. The diagnostic accuracy for the exact number of metastatic nodes was 91% compared to permanent biopsy. Conclusions Frozen biopsy for quantitative analysis of central compartment is a useful tool for the precise evaluation of central lymphatic status intraoperatively with a high sensitivity and specificity. © 2012 Wiley Periodicals, Inc. Head Neck, 2013 [ABSTRACT FROM AUTHOR]

Objective: Arteriovenous malformations (AVMs) are composed of abnormally connecting feeding arteries and draining veins and lack a regulatory system. Frequent recurrences and unpredictable behavior are their main problems. This study introduces a complicated case of AVM with massive bleeding through the external auditory canal that was treated with a multidisciplinary approach. Method: We report a complicated case of a huge AVM with a fistula and massive bleeding in the head and neck region to share our treatment experience, together with a literature review. Results: The patient underwent wide excision with free flap reconstruction after embolization of the bilateral ECA the day before surgery. We used a subtemporal‐infratemporal fossa approach. The dura was exposed after the middle fossa approach and the masticator space before removing the mass. The mass measured 15x15 cm, and the external jugular vein was dilated. The defect was reconstructed using a latissimus dorsi musculocutaneous free flap, measuring 25x15cm in size and 15 mm thick. No flap or wound complication was observed on CT. Conclusion: The treatment of complicated AVMs in the head and neck region is challenging and a multidisciplinary approach is needed to eradicate the AVM completely without recurrence or complications. This consists of preoperative embolization of vessels, meticulous resection without injuring the feeding vessels, and a reconstruction with well‐vascularized free flap. [ABSTRACT FROM AUTHOR]

Objective: To investigate the patterns and predictive factors of central lymph node metastasis in patients with papillary thyroid cancer located in the isthmus. Method: Retrospective chart review. We evaluated 447 cases with solitary nodule out of 1257 patients with papillary thyroid cancer who underwent total thyroidectomy with bilateral central lymph node compartment dissection. The patients were analyzed in 2 groups: group I, patients with cancer located in the isthmus (n = 35) and group II, patients with cancer in other regions (n = 412). We evaluated the clinicopathological characteristics and predictive factors and compared the 2 groups. Results: The frequency of central lymph node(CLN) involvement was 52.1% (233 cases) in the patients with single nodule of papillary thyroid cancer. The frequency of papillary thyroid cancer located in the isthmus was 7.8% (35 cases). Mean age at diagnosis in group I and II was 45.3 years and 46.2 years, respectively (P =. 892). Size, sex, extrathyroidal extension, and ultrasound findings (eg, marked hypoechoic, taller than wide) showed no significant difference between the 2 groups. CLN metastasis in group I and group II was 62.5% and 56.5%, respectively (P =. 228). Bilateral CLN metastasis was 18.8% in group I and 11.5% in the group II (P =. 067). Conclusion: Papillary thyroid cancer located in the isthmus showed a tendency to involve bilateral CLN. In conclusion, it is recommended that bilateral central compartment neck dissection is needed as an appropriate surgical option for papillary thyroid cancer with single nodule located in the isthmus. [ABSTRACT FROM AUTHOR]

Objective: Nodal metastasis in PTC occurs in the central compartment of the ipsilateral neck and spreads laterally. Occult lateral neck metastasis can be predictable by lymphatic status of central compartment. This study was to evaluate the diagnostic accuracy of frozen biopsy for quantitative nodal evaluation of central neck metastasis. Method: A total of 264 patients with papillary thyroid cancer underwent total thyroidectomy with central compartment neck dissection as an initial operation. All fresh tissues from ipsilateral central neck dissection were examined by frozen biopsy for central neck metastasis with quantitative nodal analysis. Results: Among them, 134 patients (51% [134/262]) had central neck metastasis. The sensitivity and specificity of frozen biopsy for the detection of central neck metastasis were 100% and 99.2% in 264 patients who underwent total thyroidectomy with bilateral central neck dissection. The diagnostic accuracy for the number of metastatic ipsilateral central lymph nodes was 85.8% compared with permanent biopsy in 134 patients who had central neck metastasis. Conclusion: Frozen biopsy for quantitative analysis of central compartment is a precise tool for intraoperative evaluation of central lymphatic status and would also be helpful for prediction of nodal involvement of lateral neck. [ABSTRACT FROM AUTHOR]