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Myxofibrosarcoma (MFS) is a histologic subtype of malignant fibrous histiocytoma (MFH), with a predominant myxoid component. MFS is characterized by locally aggressive behavior and a high rate of local recurrence, however, with a good prognosis. Head and neck MFS accounts for 3% of all cases of MFS. To date, only two cases of laryngeal MFS have been reported. Owing to the rarity of MFS, the clinical characteristics and optimal treatment options remain controversial. Surgical resection with a clear margin is considered the treatment of choice. Compared to traditional MFS tumors, epithelioid variants have worse prognosis. Other factors associated with a poor prognosis of MFS tumors include inadequate surgical margins, large tumor size, old age, and high-grade tumors. Herein, we report a case of high-grade epithelioid variant MFS located in the false vocal fold, requiring total laryngectomy to obtain an adequate surgical margin. To our knowledge, this is the first case report of epithelioid variant of high-grade MFS presenting in the larynx.

This study proposed a constitutive equation to predict the change in yield strength according to the behavior of β″ metastable precipitates, which have a profound effect on strength among materials precipitated during the T6 heat treatment of Al-Mg-Si alloy. The β″ precipitate is a metastable phase before it becomes a β (Mg2Si) precipitate, and is distributed in the form of nano-scale rods in the aluminum alloy matrix. Existing precipitation strengthening models assume the shape of the precipitate to be spherical, and in that case the equation that depends on the Orowan mechanism with the average precipitate size and distribution should dominate. However, precipitates are formed in various shapes and sizes by anisotropic growth. In particular, rod-shaped precipitates are not suitable for the existing precipitation strengthening model. In this study, an Al-Mg-Si alloy was fabricated by gravity casting followed by T6 heat treatment. The new precipitation strengthening effect equation proposes that the β″ precipitate affects yield strength during plastic deformation of the Al-Mg-Si alloy. The proposed precipitation strengthening effect equation probabilistically considers the Critical Resolved Shear Stress (CRSS), which varies depending on the angle between the dislocation and the precipitate, when the dislocation passes through a rod-shaped precipitate.

Hyperparathyroidism is a common endocrine disorder, but intrathyroidal parathyroid adenoma is extremely rare. We report a on a case of hyperparathyroidism caused by intrathyroidal parathyroid adenoma. This case is important in that it affects an effective test for the diagnosis of intrathyroidal parathyroid adenoma, and shows the decision of the treatment process and the results.

OBJECTIVE. This retrospective study aimed to investigate the capability of the already-proposed thyroid imaging reporting and data system for detecting diffuse thyroid disease (DTD-TIRADS) on ultra...

Background/aim Head and neck squamous cell carcinoma (HNSCC) is an aggressive head and neck malignancy. The aim of this study was to elucidate the role of periostin (POSTN) in the epithelial-to-mesenchymal transition (EMT) process mediating the acquisition of radioresistance in HNSCC. Materials and methods The expression levels of EMT hallmark genes including POSTN and Erk/Akt signaling pathways were compared between radiosensitive and radioresistant HNSCC cells. Results POSTN mRNA expression was higher in radioresistant HNSCC cells, and silencing POSTN significantly impaired their invasiveness under the effect of EMT process represented by up-regulation of mesenchymal markers and down-regulation of an epithelial marker. Expression levels of Erk and Akt were higher in radioresistant cells. Conclusion POSTN in association with the Erk and Akt signaling pathways was up-regulated during the EMT process, leading to the conversion of radiosensitive to radioresistant HNSCC cells. POSTN may be a key marker for predicting the radioresistance and therapeutic target of HNSCC.

The endoscope-assisted hairline approach is becoming a preferred technique in several surgical disciplines because of its advantage of good cosmetic outcomes. However, such operations are not yet standard for benign lesions in the maxillofacial area due to the anatomical complexity of this region. This study describes an endoscope-assisted technique for resecting benign lesions in the maxillofacial area via a hairline approach. The clinical outcomes with this approach were compared to those obtained with the conventional transcutaneous approach. Benign maxillofacial lesions were excised via endoscope-assisted hairline approach in 27 patients and via transcutaneous approach in 28 patients. Clinical outcomes and complications related to the procedures were evaluated; the primary outcome was the efficacy of the procedure and the secondary outcome was cosmetic satisfaction. There were no significant differences with respect to overall demographic characteristics between the groups, although the operation time was longer for the hairline approach (P=0.001). Cosmetic satisfaction showed much better results for the hairline approach (P=0.001). Endoscope-assisted excision of benign maxillofacial lesions via the hairline approach is a feasible method with excellent cosmetic results.

Primary thyroid lymphoma is a rare malignancy that can grow rapidly and compress the airway. In such cases, a tracheostomy or thyroidectomy is generally required. Here, we report a case of a 76-year-old woman diagnosed with primary thyroid diffuse large B-cell lymphoma (DLBL), with dyspnea attributed to tracheal compression by the enlarged thyroid. The patient’s poor general condition meant that thyroidectomy was considered challenging. Therefore, a temporary endotracheal silicone stent was successfully inserted to maintain the airway, as tracheal stenting has been shown to be an effective treatment for both benign and malignant obstructive airway diseases. We conclude that, in patients with primary thyroid DLBL who present with airway compression but are not eligible for surgery, tracheal stent insertion can maintain the airway and allow time for chemotherapy to be administered.

Objective Transoral surgery is gaining favor because it has the advantage of leaving no scar after surgery. The aim of this study was to evaluate the technical feasibility and safety of endoscope-assisted transoral accessory parotid mass excision. Study design Multicenter, prospective, observational study. Methods This study was designed as a 7-year, prospective, multicenter evaluation of endoscope-assisted transoral accessory parotid mass excision. Clinical outcomes and complications related to the procedures were evaluated in patients. Results Twenty patients underwent endoscope-assisted transoral accessory parotid mass excisions, and 22 patients underwent conventional parotidectomy approach excisions. There was no significant difference with respect to overall demographic characteristics between the groups. However, the operation times were shorter in the transoral approach group (P = 0.001), and cosmetic satisfaction was much better in the transoral group (P Conclusion Endoscope-assisted transoral accessory parotid mass excision is a potentially safe and effective procedure with excellent outcomes. Level of evidence 2 Laryngoscope, 130:1218-1226, 2020.

A 56-year-old female presented with clinical features of acute tonsillitis with subsequent cervical lymphadenitis. After taking empirical antibiotics for 1 week, the acute infection symptoms and signs were resolved. However, an asymmetric enlargement of the left palatine tonsil with ipsilateral neck swelling remained. Subsequent tonsillectomy and lymph node excisional biopsy were performed due to the possibility of malignancy. The patient was eventually diagnosed as malignant lymphoma according to pathological confirmation. We demonstrate the diagnostic challenges in such a rare case and emphasize the importance of differentiating malignant lymphoma from an atypically presenting acute infectious disease.

Head and neck squamous cell carcinoma (HNSCC) is an aggressive head and neck malignancy. The aim of this study was to elucidate the role of periostin (POSTN) in the epithelial-to-mesenchymal transition (EMT) process mediating the acquisition of radioresistance in HNSCC.The expression levels of EMT hallmark genes including POSTN and Erk/Akt signaling pathways were compared between radiosensitive and radioresistant HNSCC cells.POSTN mRNA expression was higher in radioresistant HNSCC cells, and silencing POSTN significantly impaired their invasiveness under the effect of EMT process represented by up-regulation of mesenchymal markers and down-regulation of an epithelial marker. Expression levels of Erk and Akt were higher in radioresistant cells.POSTN in association with the Erk and Akt signaling pathways was up-regulated during the EMT process, leading to the conversion of radiosensitive to radioresistant HNSCC cells. POSTN may be a key marker for predicting the radioresistance and therapeutic target of HNSCC.

Background Neck discomfort and voice change are common complications after thyroidectomy. These symptoms might be due to damaged laryngeal nerves, intrinsic structures, or extralaryngeal muscles. They can also occur without injury to any structure as with wound adhesion after thyroidectomy. The objective of this study was to determine causes of neck discomfort and voice change after thyroidectomy and to evaluate the effect of wound massage on symptom relief. Methods Forty-five female patients who underwent total thyroidectomy were included (21 in the experimental group and 24 in the control group). Wound massage was used as an intervention to release surgical adhesion. After wound massage education, participants in the experimental group received wound massage from 4 to 12 weeks after thyroidectomy. Analysis was performed for both groups. Results No laryngeal pathology was found after thyroidectomy. The experimental group had significantly better recovery from surgical adhesion and subjective visual analog scale, voice impairment score, and swallowing impairment score (all P Conclusion Neck discomfort and voice change after thyroidectomy are related to local wound adhesion, possibly associated with impairment of laryngeal vertical movement. Release of wound adhesion could help patients recover from neck discomfort and voice changes after thyroidectomy.

Purpose This study was conducted to compare the diagnostic yields of Ultrasonography-guided core needle biopsy (USG-CNB) and open surgical biopsy (OSB) in head and neck (HN) lymphoma and to identify the factors that shape USG-CNB diagnostic yield. Materials and methods All consecutive patients who were diagnosed with HN lymphoma in our hospital were analyzed. The frequencies with which these first-line procedures yielded a sample that permitted histological confirmation of lymphoma were determined. To identify the factors that shape the diagnostic yield of USG-CNB, the patients in whom USG-CNB was and was not sufficiently confirmatory were compared in terms of demographics, computed tomography (CT) and pathological findings. Results In total, 83 patients underwent USG-CNB (n = 26, 31.3%) or OSB (n = 57, 68.7%) for confirming lymphoma. USG-CNB yielded a fully sufficient diagnosis in 18 (69.2%) patients. By contrast, OSB yielded a confirmative diagnosis in 56 (98.2%) patients. Maximal standardized uptake value (SUVmax) of targeted LN on positron emission tomography-CT (PET-CT) in confirmatively diagnosed subjects was much higher than deferred counterparts (22.9 ± 13.4 vs. 10.1 ± 5.2, p = 0.017), however, there was no significant difference in other parameters associated with the first-line USG-CNB diagnostic success. Conclusions First-line USG-CNB was less frequently successful than OSB for diagnosing HN lymphoma involving cervical LN. Mean SUVmax of LN on PET-CT in confirmatively diagnosed subjects was higher than deferred counterparts on USG-CNB.

Transoral surgery is becoming a preferred technique because it does not leave any scar after surgery. However, transoral surgery for a dermoid cyst of the oral cavity is not standardized yet, due to the anatomic complexity of this region. The aim of this study was to evaluate the safety and efficacy of a transoral dermoid cyst excision.Multicenter prospective observational study.University hospital.This study was designed as a 4-year prospective multicenter evaluation of dermoid cyst excisions within the floor of mouth. Clinical outcomes and complications related to procedures were evaluated among patients. The primary outcome was the efficacy of the procedure, and the secondary outcome was cosmetic satisfaction of each procedure.Twenty-one patients underwent transoral dermoid cyst excisions, and 22 underwent transcervical excisions. In the transoral surgery group, the mean size of the dermoid cyst was 5.35 cm (95% CI, 4.79-5.91), and in the transcervical surgery group, it was 6.19 cm (95% CI, 5.67-6.71). There was no significant differences with respect to overall demographic characteristics between the groups. However, the duration of the operation was shorter with the transoral group than with the transcervical group ( P = .001), and cosmetic satisfaction was much better in the transoral group ( P.001).Transoral dermoid cyst excision is a potentially safe and effective method that can lead to easy and quick removal of an oral cavity dermoid cyst, with excellent cosmetic outcomes.

Background: No-scar transoral thyroglossal duct cyst (TGDC) excision is a newly developed treatment for TGDC, but limited information is available regarding the clinical outcomes in children. The aim of this study was to evaluate the safety, efficacy, and effects of transoral TGDC excision in children. Methods: Forty-four children

Summary Objectives The Voice Symptom Scale (VoiSS) questionnaire is a self-reported measure of voice function. Compared with previous voice-rating tools, the VoiSS focuses more on communication difficulties, pharyngeal symptoms, and psychosocial distress. This study aimed to translate the VoiSS into the Korean language, validate it, and assess its reliability. Study Design This is a prospective patient study utilizing questionnaires and acoustic analysis. Methods A recognized methodology was used to translate the questionnaires. The final Korean version was used in 31 patients scheduled for thyroidectomy between November 2013 and February 2015 for preoperative voice assessment, and at 2 weeks, 3 months, and 6 months postoperatively. The participants included had no specific vocal disorders before surgery and no vocal cord paralysis after surgery, and completed the Korean versions of the VoiSS and Voice Handicap Index (VHI), and acoustic analysis. Results The Korean version of the VoiSS demonstrated high internal consistency (α = 0.97) and test-retest reliability of its subscales. There was a significant correlation between the VoiSS and VHI scores in the total thyroidectomy group at each time-point. With regard to subjective symptoms, the VoiSS appeared to be more accurate than the VHI in terms of physical and functional subscales. Conclusions The Korean version of the VoiSS is ready for use for the assessment of voice dysfunction in Korean patients. It is an applicable and useful supplementary tool for evaluating patients' perceptions of voice dysfunction after thyroidectomy, for identifying multiple factors affecting patients' voices, and for measuring treatment efficacy before and after therapeutic intervention.

Background/Aims: Gastric cancer (GC) is the second most common cancer in Korea and the most common in men in the south of the country. We investigated the incidence of synchronous GC in patients with head and neck squamous cell carcinoma (HNSCC) in the southern part of Korea. Materials and Methods: We retrospectively reviewed the medical records of HNSCC patients treated between 2011 and 2014. In patients with synchronous GC, evaluation included a history of smoking and alcohol consumption, endoscopic findings, Campylobacter-like organism (CLO) test, and immunohistochemical analysis of preserved HNSCC tissues. Results: Analysis of the records of 153 HNSCC patients revealed tumors of the larynx in 56 patients (36.6%), of the pharynx in 74 patients (48.4%), and tumors at other locations in 23 patients (15.0%). The mean age of patients was 66.0 years, and the men:women ratio was 8:1. Synchronous cancers were detected in 12 patients. We observed esophageal squamous cell carcinoma (SCC) in five patients (3.3%), and gastric adenocarcinoma in seven patients (4.6%). Synchronous GC was detected in patients with laryngeal SCC. All cases of GC were classified as early GC. Conclusions: Synchronous GC was as frequent as esophageal SCC in patients with HNSCC, and all cases of GC were observed to be early stage cancers in this study. Thorough endoscopic examination should be performed in patients with laryngeal cancer to detect the presence of synchronous GC.

Carcinosarcoma of the salivary gland is an extremely rare tumor that is composed of both malignant epithelial and mesenchymal components. Diagnosing carcinosarcoma with fine-needle aspiration cytology is challenging because of its overlapping cytomorphologic characteristics with other high-grade malignant salivary gland tumors. Among the many features, including pleomorphic oncocytoid epithelial components, necrotic background, and mitoses, recognizing the singly scattered atypical spindle cells is most essential in carcinosarcoma. We present a case of a 66-year-old male patient with characteristic features of carcinosarcoma, who was successfully treated by wide local excision and subsequent radiation therapy.

Endoscope-assisted surgery is becoming the standard and most frequently preferred technique in a number of surgical disciplines because of its advantages of leaving a minimal or concealed postoperative scar compared with the conventional approaches. However, such operations are not yet standard in submandibular gland (SMG) surgery due to the anatomic complexity of this region.We conducted a prospective comparative analysis of the clinical outcome of patients who underwent SMG resection using the hairline approach versus the conventional transcervical approach. We evaluated the feasibility of the procedure by comparing the operation (operation time, hospital stay) and patient (drainage, complications) variable and the cosmetic satisfaction of the patients in each group.Twenty patients underwent the hairline approach and 20 underwent the conventional transcervical approach. Among the operation factors, only the operation time in the hairline approach group was longer than in the conventional group (P0.003); we observed no other significant differences in the overall operation and patient factors between the two groups. Cosmetic satisfaction evaluated with a graded scale showed much better results in the hairline approach group (P0.001).SMG excision using endoscope assisted hairline incision is a feasible method for treating SMG disease with excellent cosmetic results.

Objectives/Hypothesis Endoscope-assisted transoral removal of a thyroglossal duct cyst (TGDC) has been introduced to clinical practice. However, the technical feasibility, efficacy, and safety of this procedure have not been studied. Herein, we conducted a prospective clinical trial to evaluate endoscope-assisted transoral removal of a TGDC. Study Design Prospective cohort study. Methods Thirty patients were included. We performed endoscope-assisted transoral removal of TGDCs and evaluated the clinical results and complications over more than 2 years. Results Endoscope-assisted transoral resection was successful in all cases. However, transient morbidity was noted in one patient. The mean operation time was 67.33 ± 17.26 minutes. Surgery was not required for recurrence or revision during a follow-up. Conclusions Endoscope-assisted transoral resection of a TGDC is a potentially safe and effective procedure leading to excellent functional and cosmetic outcomes. Additionally, considering the embryological development of TGDCs, the transoral approach can open a new access route to these cysts. Level of Evidence 2b. Laryngoscope, 2015

【In this study, porous stainless steel (STS316L) sintered body was fabricated by powder metallurgy method and its properties such as porosity, compressive yield strength, hardness, and permeability were evaluated. 67.5Fe-17Cr- 13Ni-2.5Mo (wt%) powder was produced by a water atomization. The atomized powder was classified into size with under $45{\mu}m$ and over $180{\mu}m$ , and then they were compacted with various pressures and sintered at $1210^{\circ}C$ for 1 h in a vacuum atmosphere. The porosities of sintered bodies could be obtained in range of 20~53% by controlling the compaction pressure. Compressive yield strength and hardness were achieved up to 268 MPa and 94 Shore D, respectively. Air permeability was obtained up to $79l/min{\cdot}cm^2$ . As a result, mechanical properties and air permeability of the optimized porous body having a porosity of 25~40% were very superior to that of Al alloy.】

Background This study evaluated the feasibility of endoscopic-assisted extracapsular dissection of benign parotid tumors using only hairline incision. Methods Endoscope-assisted extracapsular dissection via only hairline incision was performed in 18 cases (5 men and 13 women) of benign parotid gland tumor (pleomorphic adenoma in 4 cases, Warthin's tumor in 14 cases). Results All 18 operations were successfully performed and no conversions to conventional open resection were necessary. One patient had transient facial paresis and recovered within 1 month. The duration of the procedure was 82.5 ± 18.5 minutes. Conclusion Endoscope-assisted extracapsular dissection using only hairline incision is a feasible method for treatment of benign parotid tumors. The main advantage of this procedure is that the operative scar is concealed in the hairline area. © 2015 Wiley Periodicals, Inc. Head Neck 38: 375–379, 2016

Background The immunotherapeutic role of programmed death-ligand 1 (PD-L1) in life expectancy in many cancers has been highlighted. However, data regarding PD-L1 expression in papillary thyroid carcinoma (PTC) are limited. In this study, we describe the PD-L1 and programmed cell death protein 1 (PD-1) expressions in PTC and analyze their correlation with lymph node (LN) metastasis. Methods Clinicopathological data were obtained from 116 patients with PTC who were treated in Gyeongsang National University Hospital, Jinju, Korea in 2009. Tissue microarray blocks were made using representative paraffin blocks of classical PTCs excluding follicular variants. Two pathologists graded the proportion and intensity of PD-L1 and PD-1 expression in both tumor and inflammatory cells. According to their proportions, positive PTC cells were scored as negative (0%), grade 1 (1%–50%), and grade 2 (51%–100%). Similarly, positive inflammatory cells were graded as negative (0%), grade 1 (1%–10%), and grade 2 (11%–20%). The intensity of each protein expression was simplified as positive or negative. Results A statistically significant correlation exists between the proportions of PD-1 and PD-L1 expression both in papillary carcinoma (p=.001) and peritumoral lymphoid cells in the thyroid (p

// Jin Hyun Kim 1, 2 , Myeong Hee Jung 1 , Jin Pyeong Kim 2, 3 , Hyun-Jung Kim 2, 4 , Jung Hwa Jung 2, 4 , Jong Ryeal Hahm 2, 4 , Ki Mun Kang 2, 5 , Bae-Kwon Jeong 2, 5 and Seung Hoon Woo 2, 3, 6 1 Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Gyeongnam, Republic of Korea 2 Institute of Health Science, Gyeongsang National University, Jinju, Gyeongnam, Republic of Korea 3 Department of Otolaryngology, Gyeongsang National University, Jinju, Gyeongnam, Republic of Korea 4 Department of Internal Medicine, Gyeongsang National University, Jinju, Gyeongnam, Republic of Korea 5 Department of Radiation Oncology, Gyeongsang National University, Jinju, Gyeongnam, Republic of Korea 6 Beckman Laser Institute, University of California, Irvine, California, USA Correspondence to: Seung Hoon Woo, email: lesaby@hanmail.net Keywords: alpha lipoic acid, oral mucosa, radiation, Hif-1a, complications Received: May 05, 2017 Accepted: July 25, 2017 Published: August 16, 2017 ABSTRACT Purpose: Radiotherapy is currently one of the main treatment modalities for head and neck cancer; however, it also results in severe toxicity to the normal tissue, to the detriment of patients. This study aimed to investigate whether alpha lipoic acid (ALA) could protect against radiation-induced oral mucositis in a rat model. Results: On post-irradiation days 4 and 7, the epithelial layer on oral mucosa showed pronounced injury (shortening of the layer) and it is diminished by ALA pretreatment before radiation. Hif-1a expression was significantly induced in the radiation group on days 4, 7, and 28. GLUT1 expression was also induced by radiation at all time points, and the expression levels peaked on day 28. Phosphorylated p53 level was significantly higher in the radiation group on days 4 and 7, and Bax protein expression was significantly higher in the same group on day 4 than ALA-pretreated radiation group. TUNEL-positive staining was significantly lower in the ALA-pretreated radiation group. Materials and methods: Rats were assigned to one of the following four groups: control, ALA only (100 mg/kg, i.p.), irradiated, and ALA administered 24 h and 30 min prior to irradiation, with the neck area including the oral mucosa evenly irradiated with 2 Gy per minute (total dose, 18 Gy) using a photon 6-MV linear accelerator. Rats were sacrificed 4, 7, 28, or 56 days after radiation. Conclusions: The results show that ALA can be used to ameliorate radiation-induced oral mucositis with head and neck cancer.

Purpose Concurrent chemoradiation (CRT) with 3-weekly doses of cisplatin is a standard treatment for loco-regionally advanced head and neck squamous cell carcinoma (HNSCC). However, treatment with 3-weekly doses of cisplatin is often associated with several adverse events. Therefore, we conducted this retrospective analysis to determine the efficacy and tolerance of CRT with a low weekly dose of cisplatin in stage IV HNSCC patients. Materials and methods Medical records of patients who were diagnosed with stage IV HNSCC and received concurrent CRT were analyzed. All patients were treated weekly with cisplatin at 20-30 mg/m(2) until radiotherapy was completed. Results A total of 35 patients were reviewed. Median follow up was 10.7 months (range, 1.7 to 90.5 months), the median radiation dose was 7,040 cGy, and the median dose of cisplatin received was 157 mg/m(2). Eleven patients received docetaxel combination chemotherapy. Overall, 25 patients (71.4%) achieved complete response (CR), eight (22.9%) showed partial response. The median overall survival was 42.7 months, the 3-year survival rate was 51.2% and the 3 year disease-free survival rate was 72.8%. Overall survival was improved in patients who achieved CR relative to others (59.7 months vs. 13.4 months; p=0.008). There were significant differences in survival between patients who received docetaxel combination and cisplatin alone (51.8 months vs. 7.9 months; p=0.009). Grade 3-4 adverse events included stomatitis (82.9%), dermatitis (22.9%), infection (11.4%), dysphagia (8.6%), and neutropenia (5.7%). Conclusion CRT with low dose weekly cisplatin is likely effective and tolerable, even in patients with locally advanced-stage IV HNSCC.

Transoral removal of stones for the treatment of submandibular sialolithiasis has been popularised, even for stones in the hilum. Without sialodochoplasty after surgical retrieval, the affected glands seem to recover well functionally, even without sialodochoplasty. However, the anatomical changes of structural recovery have not been fully studied. We investigated the outcomes and the changes to the salivary duct system after transoral removal of hilar stones using postoperative sialography. We enrolled 28 patients (29 sides) who had transoral removal of stones for submandibular hilar sialolithiasis without sialodochoplasty, and prospectively analysed the structural outcomes 3 months and 12 months postoperatively using sialography. We found 23 ducts (79%) recovered with a normal size, while 4 ducts (14%) developed saccular dilatation and one duct (3%) partially stenosed. Saccular dilatation developed after removal of stones larger than 10mm in diameter, but patients had no recurrent symptoms. By the 12 months' follow up, one stone had formed severe adhesions to the salivary duct that caused stenosis, and this patient had recurrent symptoms. Transoral removal of submandibular hilar stones without sialodochoplasty is an effective treatment with good anatomical restoration of the salivary duct and flow.

The objective of the study was to examine the prognostic value of hypoxia-inducible factor-1α (HIF-1α), carbonic anhydrase-IX (CA-IX), cyclooxygenase-2 (COX-2), Ki-67, and erythropoietin receptor in patients with oral tongue squamous cell carcinoma. Immunohistochemical analysis of marker expression was performed on tissue samples from 25 patients with tongue squamous cell carcinoma. The Kaplan-Meier method, univariate and multivariate analyses, and the Cox proportional hazards model were used to examine associations between patient and tumor characteristics, and the immunohistochemical results and disease-specific survival. There was no association between the expression of the five markers and disease-specific survival, and there was no statistically significant difference in the hazards ratio according to postoperative radiotherapy. There was no correlation between marker expression and prognosis. There was no association between marker expression and radioresistance or disease-specific survival. Therefore, HIF-1α, CA-IX, COX-2, Ki-67, and erythropoietin receptor are not suitable prognostic markers for tongue squamous cell carcinoma.

Background. The purpose of this study was to examine the predictive value of hypoxia-inducible factor (HIF)21a, carbonic anhy- drase (CA)-IX, glucose transporter (GLUT)21, cyclooxygenase (COX)22, Ki-67, and erythropoietin receptor (EPOR) as immunohistochemical markers for determining the optimal treatment modality for early stage laryngeal carcinoma. Methods. Tissue samples from 42 early stage laryngeal carcinomas treated with radiotherapy alone were analyzed immunohistochemically for the expression of 6 markers. The Kaplan-Meier method, univariate and multivariate analyses, and the Cox proportional hazards model were used to analyze the associations between patient and tumor characteris- tics and immunohistochemical results, and locoregional control. Results. Increased expression of HIF-1a and CA-IX was significantly cor- related with residual tumor; no correlations were observed for the other immunohistochemical markers. Conclusion. High levels of HIF-1a or CA-IX expression were significantly correlated with residual tumor after radiotherapy for early stage laryngeal carcinomas. Alternative treatment modalities to primary radiotherapy should be considered for early stage laryngeal carcinomas showing high HIF-1a or CA-IX expression. V C 2014 Wiley Periodicals, Inc. Head Neck 00: 000-000, 2014 50%. 2 Patients with HNSCC with similar histological grade and clinical stage often have different prognosis; these differences may be associated with the expression of spe- cific immunohistochemical markers. Therefore, the identi- fication of immunohistochemical markers associated with the clinicopathological features of HNSCC is very impor- tant. Endogenous hypoxia-related markers are associated with the prognoses of patients with different types of car- cinoma. Clinically relevant hypoxia is detected in approx- imately 50% of all solid tumors. 3 Hypoxia is the result of an imbalance between oxygen delivery and oxygen con- sumption, and is one of the most important events during

Objectives To introduce a new injection material for vocal fold diseases, which could be readily translated to clinical practice, we investigated the effectiveness of platelet-rich plasma (PRP) injection on the injured vocal fold in terms of histological recovery. Methods Blood samples were drawn from New Zealand White rabbits and PRP was isolated through centrifugation and separation of the samples. Using a CO2 laser, we made a linear wound in the 24 vocal fold sides of 12 rabbits and injected each wound with PRP on one vocal fold side and normal saline (NS) on the other. Morphologic analyses were conducted at 2, 4, and 12 weeks after injection, and inflammatory response, collagen deposit, and changes in growth factors were assessed using H&E and masson trichrome (MT) staining and western blot assay. Results PRP was prepared in approximately 40 minutes. The mean platelet concentration was 1,315,000 platelets/mm3. In morphological analyses, decreased granulation was observed in the PRP-injected vocal folds (P

Foreign bodies in the oral cavity and pharynx are commonly encountered in the emergency room and outpatient departments, and the most frequently observed of these foreign bodies are fish bones. Among the possible complications resulting from a pharyngeal foreign body, vocal cord fixation is extremely rare, with only three cases previously reported in the English literature. The mechanisms of vocal cord fixation can be classified into mechanical articular fixation, direct injury of the recurrent laryngeal nerve, or recurrent laryngeal nerve paralysis secondary to inflammation. The case discussed here is different from previous cases. We report a rare case of vocal cord paralysis caused by the venom of a stingray tail in the hypopharynx.

Purpose Hypocalcemia is the most common complication after total thyroidectomy. The purpose of this study was to determine whether measurement of intact parathyroid hormone (i-PTH) level in thyroidectomy patients could predict hypocalcemia. Materials and Methods We performed a prospective study of patients undergoing total thyroidectomy. Serum concentration of i-PTH, total calcium (Ca), ionized calcium (Ca2+), phosphate (P), magnesium (Mg), and albumin were measured preoperatively and at 0 hour, 6 hours, 12 hours, 24 hours, 48 hours, and 72 hours postoperatively. Results 108 patients were recruited to the study. A total of 50 patients (46%) experienced hypocalcemia. The serum i-PTH concentration was linearly related to the time of measurement, while concentrations of P, Mg, albumin, Ca, and Ca2+ were not. We compared odds ratios, and found that the concentration of i-PTH at 6 hours post operation was the most closely related to the occurrence of hypocalcemic symptom. On ROC analysis using i-PTH level at 6 hours, an i-PTH level of 10.6 mg/dL was found to maximize both sensitivity and specificity at the same time point. Conclusion We found that i-PTH was a predictor of hypocalcemia, and that the earliest predictor of hypocalcemic symptoms was an i-PTH concentration lower than 10.6 mg/dL obtained 6 hours after total thyroidectomy.

Summary Objectives Temporary or permanent vocal paralysis can occur after head and neck surgery for thyroid cancer, esophageal resection, a chest operation that includes lung parenchymal resection due to a vagus or recurrent laryngeal nerve injury, and so forth. These days, the main treatment for vocal fold paralysis is the injection laryngoplasty through the cricothyroid (CT) approach. However, the CT approach is difficult in that an operator cannot see from the tip of the needle to the vocal fold. The aim of this study was to determine the efficacy of the thyrohyoid (TH) approach compared with the CT approach using calcium hydroxyapatite (CaHA) in patients with permanent unilateral vocal fold palsy. Methods From March 2008 to July 2012, 68 consecutive injection laryngoplasties were performed in patients with unilateral glottic insufficiency. Percutaneous injection was performed under local anesthesia into the vocalis muscle, using disposable 25 gauge, 11cm long spinal needles through the CT membrane or TH membrane. Of the 68 patients, videostroboscopic findings and acoustic, perceptual, and subjective evaluations were completed for 64 patients before injection and at 3 months after injection. Results In the 64 patients, the CT and TH approaches were used in 30 and 34 patients, respectively. The videostroboscopic findings, acoustic and perceptual parameters (maximum phonation time, jitter, shimmer, and noise-to-harmonic ratio), and Voice Handicap Index significantly improved after the injection in both the CT and TH groups ( P Conclusion Based on the results of this trial, injection laryngoplasty using the TH approach is an effective alternative to the CT approach, especially for the injection of CaHA in patients with permanent unilateral vocal fold palsy.

Aim This study aimed to determine predictive values for volumetric measures in patients with oropharyngeal cancer who received definitive chemoradiotherapy (CCRT). Methods Contrast-enhanced computed tomography (CT) scans were obtained before radiotherapy (RT) (I), after delivering a median RT of 50.6 Gy (R) and three months after RT (F). Primary site gross tumor volumes (GTV) were assessed using these scans (GTVI, GTVR and GTVF). The percentage volume change between GTVI and GTVR (GTV change) was calculated. Volumetric analyses of primary site local control (LC) and progression-free survival (PFS) were performed. Results In total, 35 patients were evaluated, with a median 31 months of follow-up. The 2-year LC rates (LCRs) were 95.0% for patients with GTVI

Objective The objective of this study was to define the radiological characteristics of 2-phase computed tomography (CT) of parotid gland Warthin tumors (WTs) with a pathologic basis for these findings. Methods We prospectively enrolled 116 patients with parotid gland tumor who underwent preoperative 2-phase CT scans(scanning delays of 30 and 120 seconds). The attenuation changes and enhancement patterns were analyzed according to pathology. We also evaluated size-matched samples of WTs and pleomorphic adenoma by staining CD31, vascular endothelial growth factor-receptor 2, collagen IV, and smooth muscle actin. Results Computed tomography numbers in WTs were significantly higher than those in other tumors in early-phase scans and lower in delayed scans. Pathologically, CD31(+) blood vessel area was significantly higher in WTs than in pleomorphic adenomas. In addition, WTs had an extensive capillary network and many leaky blood vessels. Conclusions The enhancement pattern of early fill-in and early washout is the typical finding of WTs on 2-phase CT scans, which may be attributed pathologically to abundant blood vessel and extensive capillary network.

Objectives: The indications and benefits of surgery in the management of pediatric acute suppurative cervical lymphadenitis (ASCL) remain unclear. We aimed to design a management protocol focusing on the avoidance of unnecessary operation in pediatric ASCL patients. Methods: The study population consisted of 45 pediatric patients with ASCL treated with antibiotics alone and 30 surgically treated patients. The primary outcome was the determination of differences in patient characteristics and radiologic findings in the 2 groups. The secondary outcome, after matching 20 cases with 20 controls, was to determine the benefits of surgery to patients. Results: There were no significant differences between the 2 groups in patient characteristics and radiologic findings at initial presentation. In the matched case-control analysis, intravenous antibiotics alone yielded successful treatment outcomes when compared with surgery, with no significant differences in time to symptom resolution, normalized laboratory test results, and duration of hospitalization (all P > .05). Conclusions: The size and location of suppurated lymph nodes are not absolute determinants for surgical drainage in the stable pediatric ASCL patients. If patients show no clinical improvements despite appropriate second- and third-line antibiotics, patients should be carefully reevaluated and image-guided aspiration considered.

Background and Aims Tracheobronchial foreign body aspiration is a life-threatening emergency. Using a rigid bronchoscope with optical forceps is the most effective method for foreign body removal. However, occasionally for some infants these instruments could not be used, as they may be too large for their small airways. Here, they present the apnea technique with only an optical forceps for foreign body removal in infants with very small airways. Methods Foreign bodies were removed using only an optical forceps for infants who had very small diameter airways. After general anesthesia, the suspension laryngoscope was set just above the vocal cord, and the inserted ventilation tube was pulled out, followed by a new one being inserted through the suspension laryngoscope and placed at the trachea. With the oxygen saturation at 100%, we pulled out the ventilation tube and inserted the optical forceps with an endoscope. After that, the foreign body was removed by the optical forceps. Results The foreign body removal using only an optical forceps is technically feasible for an infant. The mean operation time was 40.33 ± 8.06 min, and the hospital stay was 2.25 ± 0.62 days. When we pulled out the ventilation tube, the O2 saturation mean time (apnea time) was 106.25 ± 14.30 sec. In 12 infants, the foreign body was removed completely without a need for a second procedure. Conclusions The apnea technique for the removal of foreign body from the airway, using only an optical forceps with an endoscope, is useful in infants who had very small airways.

Purpose The incidence of maxillary sinus cancer (MSC) is extremely rare, representing less than 1% of all cancers. Because of its rarity, the management of locally advanced MSC is a challenging issue. The objective of the present study was to retrospectively compare the efficacy of 2 traditional treatment strategies, concurrent chemoradiotherapy (CCRT) versus combination of surgery and radiotherapy and/or chemotherapy (SRCT) in MSC. Patients and Methods From 1989 to 2010, 65 patients with histologically confirmed stage III or IVA/IVB were retrospectively analyzed. Results The median age of our subjects was 60 years (range 36 to 81). The present study involved 18 women (27.7%) and 47 men (72.3%). Of the 65 patients, 52 (80.0%) had squamous cell carcinoma. The TNM stage was stage III, as determined by the American Joint Committee on Cancer, 6th edition, in 27 patients (41.5%). Stage IVA or IVB was observed in 38 patients (58.5%). Of the 65 patients, 41 underwent treatment. Of these 41 patients, 26 and 15 patients underwent SRCT and CCRT, respectively. During the 75.6 months (range 6.4 to 249.4) of median follow-up, the median progression-free survival duration was 45.1 months (95% confidence interval 0.0 to 142.7). The 5-year overall survival rate was 64.8%. However, the patients who had undergone surgery had better progression-free survival (hazard ratio 2.363, 95% confidence interval 1.098 to 5.085, P = .028) and overall survival (hazard ratio 4.989, 95% confidence interval 1.646 to 15.118, P = .004). The SRCT group had a better progression-free survival ( P = .043) and overall survival ( P = .029) duration than did the CCRT group. Conclusion SRCT might be superior to CCRT for locally advanced MSC. Additional studies comparing the treatment outcomes of CCRT with SRCT are warranted.