Eddy W.Y. Wong

Low‐grade myofibroblastic sarcoma: A population‐based study

Low‐grade myofibroblastic sarcoma (LGMS) is a rare entity that is described as having a predilection for occurring in the head and neck region. Here we analyze its demographics, clinic‐pathologic, and survival characteristics.Objectives/Hypothesis Low-grade myofibroblastic sarcoma (LGMS) is a rare entity that is described as having a predilection for occurring in the head and neck region. Here we analyze its demographics, clinic-pathologic, and survival characteristics. Study Design Retrospective database analysis. Methods A cohort from the Surveillance, Epidemiology, and End Results Program database of cases with LGMS between 2001 and 2012. Results There were 49 cases with a 5-year overall survival of 71.6% and disease- specific survival of 76.3%. The majority of cases were in patients <60 years old, female, and white ethnicity. The most common sites were the extremities in 40.8% of cases followed by the head and neck region with 26.5% of cases. Multivariate analysis showed that only older age was significantly associated with worse survival (P < .05). Conclusions LGMS is uncommon in the United States and occurs most commonly in the extremities followed by the head and neck region, despite an existing characterization of a predilection for the head and neck region. Treatment most commonly involves surgery, but the optimal surgical extent and/or radiotherapy needs to be further investigated. Level of Evidence 2c Laryngoscope, 2016

Double free flaps for reconstruction of complex/composite defects in head and neck surgery

OBJECTIVE. To demonstrate the feasibility of double free flap surgery in head and neck reconstruction. DESIGN. Descriptive case series. SETTING. A university-affiliated hospital in Hong Kong. PATIENTS. Twelve patients with head and neck cancer (encountered over a 2.5-year period) who had reconstructive surgery with planned simultaneous double free flaps. RESULTS. The mean total operating time was 660 minutes and there were no flap failures. Postoperative stays ranged from 11 to 82 days; nine patients were discharged within 3 weeks and seven were able to maintain their weight with oral feeding. The survival rate up to 1 year was 64%. CONCLUSION. The use of double free flaps is an option worth considering for complex head and neck defects in carefully selected patients.

Endoscopic nasopharyngectomy in recurrent nasopharyngeal carcinoma: a case series, literature review, and pooled analysis

Background To critically evaluate the use of endoscopic nasopharyngectomy in the treatment of recurrent nasopharyngeal carcinoma (NPC) through a case series, systematic literature review, and pooled analysis. Methods A case series of 18 patients combined with systematic literature review and pooled analysis of PubMed, Web of Science, and Scopus search, identifying 576 papers. After excluding 307 papers as search engine duplicates, only 16 of the remaining papers had adequate patient data to be included. Results Our case series of 18 patients had a 2-year disease-free survival (DFS) and overall survival (OS) of 90.0% and 100%, respectively. The pooled analysis of 300 patients that had an endoscopic resection of recurrent NPC showed recurrence-free survival and overall survival were 85.8% and 82.9%, respectively. Most, 56.1%, were recurrent T1 lesions. Resection margins were negative in 90.2% of patients. Local recurrence occurred in 20.1% of patients. Major complications occurred in 13.6% of patients. The mean hospital stay was 5.8 days, the mean operating time was 228.3 minutes, and the mean operative blood loss was 163 mL. Conclusion Endoscopic resection of recurrent NPC occurs with low surgical morbidity. However, further long-term evaluation with longer follow-up data is needed to evaluate if the survival data is comparable or better than open approaches.To critically evaluate the use of endoscopic nasopharyngectomy in the treatment of recurrent nasopharyngeal carcinoma (NPC) through a case series, systematic literature review, and pooled analysis.

Non-nasopharyngeal head and neck lymphoepithelioma-like carcinoma in the United States: A population-based study.

Non‐nasopharyngeal head and neck lymphoepithelioma‐like carcinoma (LELC) is a rate entity. The purpose of this study was to analyze its demographic, clinicopathologic, and survival characteristics.Background Non-nasopharyngeal head and neck lymphoepithelioma-like carcinoma (LELC) is a rate entity. The purpose of this study was to analyze its demographic, clinicopathologic, and survival characteristics. Methods A cohort from the Surveillance, Epidemiology, and End Results (SEER) database of cases with non-nasopharyngeal head and neck LELC between 1973 and 2011. Results There were 378 cases with 5-year overall survival (OS) of 70.5% and disease-specific survival (DSS) of 77.7%. The majority of cases were <60-year-old white men. Salivary gland LELC had the highest OS (80.8%) and DSS (85.7%) at 5 years. Multivariate analysis showed that older age, no surgery, and no radiation were independently significantly associated with worse survival (p < .05). Conclusion Non-nasopharyngeal head and neck LELC is uncommon in the United States with salivary gland LELC having the highest OS and DSS compared with other head and neck sites. The optimal treatment with surgery and/or radiotherapy needs to be further investigated.

Maxillary Swing: The Paramedian Palatal Incision

The maxillary swing procedure offers an open approach to the nasopharynx. In their original description of the technique, Wei et al placed the hard palate mucosal incision in the midline and performed a midline osteotomy (Figure 1). Postoperative palatal wound breakdown led to a palatal fistula in 20% to 25% of cases with this technique (Figure 2). To overcome this problem, Ng and Wei modified their incision by placing the palatal incision far laterally (Figure 3) and elevating a mucoperiosteal flap from the incision to across the midline. We have been using a paramedian palatal incision since 2002 as we deemed it unnecessary to elevate a palatal flap to the extent described previously. Instead of placing the palatal incision laterally at the gingival margin, we place the incision in a paramedian position (Figure 4). This modified technique has resulted in a significant drop in the fistula rate.

High-level expression of early growth response-1 and association of polymorphism with total IgE and atopy in allergic rhinitis adults.

BACKGROUND Early growth response-1 (Egr-1) is expressed in human airways and its polymorphisms have been associated with total IgE and atopy in asthmatic patients. We investigated the effects of Chinese-tagging single nucleotide polymorphism (SNP) of Egr-1 and its mRNA expression on allergic rhinitis (AR) traits. METHODS Among 214 Chinese AR adults and 259 controls, tag SNP -4071 A-->G was genotyped and mRNA expression in peripheral blood was quantified by real-time PCR. RESULTS Egr-1 mRNA expression was significantly higher in patients than controls (median of 0.23 vs 0.15 fold GAPDH expression; p<0.001). Its expression was not associated with -4071 polymorphism. However, significant correlations were found between -4071 A-->G with increased plasma total IgE (p=0.028) and atopy (p=0.030) in patients. Logistic regression confirmed the association (p=0.034) with age and gender adjusted. Patients homozygous for the A allele had a 2.3-fold and 1.9-fold risks, respectively of having increased plasma total IgE and atopy than those G allele carriers. CONCLUSIONS We showed high levels of Egr-1 mRNA expression and demonstrated a significant association of polymorphism with increased plasma total IgE and atopy in AR patients. It may be useful to explore the pharmacogenetics of Egr-1 inhibitors.

Early results of a safety and feasibility clinical trial of a novel single-port flexible robot for transoral robotic surgery

The aim of this study was to describe the early results of a phase 1 safety and feasibility clinical trial of the first clinical use of a novel robot for transoral robotic surgery (TORS)—the da Vinci SP (Intuitive Surgical Inc., Sunnyvale, CA, USA). Study design of this study is prospective clinical trial. The methods used in this study are prospective innovation, development, exploration, assessment, and long-term study phase 1 clinical trial. Early results of six patients underwent TORS with the da Vinci SP (Intuitive Surgical Inc., Sunnyvale, CA, USA) demonstrate access the nasopharynx, oropharynx, larynx, and hypopharynx. There were no conversions of the robotic surgical system. There were no serious adverse events or adverse events related to the use of the robot at 30-day follow-up for all six patients. The early results of this safety and feasibility trial of the da Vinci SP (Intuitive Surgical Inc., Sunnyvale, CA, USA) clearly demonstrate that the device is safe and that it is feasible in performing TORS to access the nasopharynx, oropharynx, larynx, and hypopharynx.

Narrow Band Imaging Endoscopy of the Nasopharynx for Malignancy: An Inter- and Intraobserver Study: Narrow Band Imaging: Observer Variation

To assess interobserver agreement and intraobserver reproducibility when assessing the nasopharynx for malignancy under white light and narrow band imaging endoscopy because the decision to biopsy hinges on the examiners perceived chance of malignancy.

Transoral radical tonsillectomy and retropharyngeal lymph node dissection with a flexible next generation robotic surgical system

The purpose of this study was to describe the use of a novel flexible, single‐arm robot in performing a transoral radical tonsillectomy and retropharyngeal lymph node dissection.

Diagnostic accuracy of sialendoscopy referenced to current imaging modalities

The aim of the present study was to determine the accuracy of diagnostic sialendoscopy in patients with suspected obstructive salivary duct disease referenced to current imaging modalities.