Byung-Joon Chun

How Can We Screen Voice Problems Effectively in Patients Undergoing Thyroid Surgery

BACKGROUND Voice problems following thyroid surgery are well known, and perioperative voice analysis in patients undergoing thyroidectomy no longer seems optional. However, multiple means of assessing vocal function are time-consuming, require specific instruments and specialists, and increase costs. Therefore, we designed this study to develop an efficient and cost-effective screening tool for detecting voice disorders following thyroidectomy. METHODS We developed the Perioperative Voice-Screening Protocol for Thyroid Surgery (PVST) using the Thyroidectomy-Related Voice Questionnaire (TVQ) to provide a cost-effective diagnostic flow chart for patients following thyroidectomy. The TVQ is a simple questionnaire that was developed at our institution and has already demonstrated its effectiveness in detecting pre- and postthyroidectomy voice-related disorders in our previous studies. To investigate the PVST, we enrolled 242 subjects who underwent thyroidectomy and let them follow the PVST. All subjects underwent a voice work-up by a voice specialist to verify the predictive value of the protocol. RESULTS Using PVST, we could effectively screen for abnormal preoperative laryngeal findings with sensitivity and specificity of 82.1% and 50.5%, respectively, especially laryngeal benign mucosal disease with sensitivity and specificity of 100% and 45.6%, respectively. We could also screen for postoperative voice-related problems with sensitivity and specificity of 100% and 50.4% for detecting vocal-cord palsy, and 66.7% and 51.2% for detecting a low-pitched voice, respectively. If all 242 patients followed the protocol, US

Transoral endoscopic thyroidectomy via the tri-vestibular routes: results of a preclinical cadaver feasibility study

42,768 would be saved, and the PVST was estimated to decrease costs by 43.5%. CONCLUSIONS The PVST is a reliable and cost-effective perioperative screening tool that enables thyroid surgeons to detect patients with voice problems in their routine outpatient clinic for early and appropriate referral to voice specialists.

Efficacy of 18F‐fluorodeoxyglucose positron emission tomography/CT imaging for extracapsular spread of laryngeal squamous cell carcinoma

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.

Therapeutic Decision Making of the Unilateral Vocal Cord Palsy after Thyroidectomy Using Thyroidectomy-Related Voice Questionnaire

We evaluated the use of fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT for the identification of extracapsular spread (ECS) with supporting histologic correlations in laryngeal cancer.

Early Postoperative Vocal Function Evaluation After Thyroidectomy Using Thyroidectomy Related Voice Questionnaire

Objectives: Investigate the efficacy of early management of post-thyroidectomy unilateral vocal cord palsy (UVCP) and the clinical utility of the thyroidectomy-related voice questionnaire (TVQ) when planning UVCP treatment. Methods: The study group comprised 48 consecutive patients diagnosed with UVCP after thyroidectomy. Laryngoscopic examination and voice analysis were conducted, and the TVQ was administered pre-thyroidectomy and at 2 weeks and 1, 3, 6, and 12 months post-thyroidectomy. Twenty-five patients with aspiration symptoms and severe vocal difficulties received injection laryngoplasty, and 23 with no aspiration symptoms and relatively mild vocal difficulties underwent voice therapy. We performed a video fluoroscopic swallowing study on each patient 2 weeks after thyroidectomy and 1 month following the procedure. Results: The average total TVQ scores 2 weeks afterthyroidectomy were 51.92 ± 11.42 in the injection laryngoplasty group and 35.78 ± 12.99 in the voice therapy group. Both subjective and objective parameters improved significantly at 1 month after treatment and continued to improve slowly over the next 12 months (P < .01) in both groups. TVQ scores were significantly lower in the injection laryngoplasty group than in the voice therapy group 1 month post-intervention (P < .01). At the study end point, the greatest improvement in subjective symptoms occurred in temporary VCP patients who underwent injection laryngoplasty. The optimal TVQ score cutoff distinguishing the 2 groups was 45 (68.0% sensitivity, 78.3% specificity). Conclusions: Early management following timely diagnosis of post-thyroidectomy UVCP can improve symptoms within 1 month. Moreover, application of TVQ will aid clinicians to plan treatment for postoperative VCP patients.