Inn-Chul Nam

Combination of Voice Therapy and Antireflux Therapy Rapidly Recovers Voice-Related Symptoms in Laryngopharyngeal Reflux Patients

Objective. Patients with laryngopharyngeal reflux frequently experience voice-related symptoms. This study was designed to investigate the effectiveness of combined voice and medical therapy in comparison with medical therapy alone in the improvement of voice-related symptoms and parameters in patients with laryngopharyngeal reflux. Study Design. Concurrent nonrandomized comparative trial. Setting. Otolaryngology department at a university hospital. Subjects and Methods. In this prospective study, 100 patients diagnosed with laryngopharyngeal reflux with voice symptoms were divided into 2 groups: 50 patients were treated with medication alone, and 50 were treated with medication plus voice therapy. The following data were recorded before treatment and at 1, 2, and 3 months posttreatment: reflux symptom index (RSI), reflux finding score (RFS), voice handicap index (VHI), perceptual analysis, and acoustic analysis. The numbers of patients showing clinically significant reductions in these parameters were compared between groups using the following cutoff values: change in RSI ≥5, change in RFS ≥3, change in VHI ≥15, and change in grade, roughness, breathiness, asthenia, and strain scale (GRBAS) ≥1. Results. Significantly more patients in the study group showed a clinically significant change in RSI, VHI, and GRBAS score at the 1-, 2-, and 3-month follow-up evaluations. No clinically significant change in RFS was achieved in either group at 1 or 2 months, but a significantly greater change was achieved in the study group at 3 months. Conclusions. Voice therapy may help to restore reversible mucosal change secondary to acidic reflux, inducing rapid resolution of symptoms and shortening of the treatment period.

Extracapsular spread and FDG PET/CT correlations in oral squamous cell carcinoma

The purpose of this study was to evaluate the use of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) to identify extracapsular spread (ECS) with histologic correlations in oral squamous cell carcinoma (OSCC). The medical records of 80 patients who underwent of FDG PET/CT for OSCC before surgery were reviewed. ECS was present in 60% (24/40) dissected necks and in 55% (39/71) of dissected cervical levels. A significant difference was found between the maximum standardized uptake (SUVmax) values of cervical lymph nodes with ECS and without ECS (3.33±1.91 vs. 1.12±1.24, p<0.001). When receiver operating characteristic (ROC) curve analysis and SUVmax values were used to detect ECS, the area under the ROC curve was 0.864±0.045 (p<0.001). At an optimal SUVmax cut-off value of 2.25 the sensitivity and specificity were 85% and 88%, respectively. The presence of ECS and a SUVmax>2.25 had a significant adverse effect on 5-year disease specific survival. A SUV(max)>2.25 was found to be associated with a greater risk of cervical lymph node metastasis in OSCC.

Human turbinate mesenchymal stromal cell sheets with bellows graft for rapid tracheal epithelial regeneration.

Rapid functional epithelial regeneration on the luminal surface is essential when using artificial tracheal grafts to repair tracheal defects. In this study, we imposed human turbinate mesenchymal stromal cell (hTMSC) sheets for tracheal epithelial regeneration, and then assessed their potential as a new clinical cell source. In vitro, hTMSCs sheets showed high capacity to differentiate into tracheal epithelium. We fabricated a poly(ε-caprolactone) (PCL) tracheal graft by indirect three-dimensional (3D) printing technique and created a composite construct by transplanting the hTMSC sheets to its luminal surface of the tracheal graft, then applied this tissue-engineered tracheal graft to non-circumferential tracheal reconstruction in a rabbit model. 4 weeks after implantation, the luminal surface of tissue-engineered tracheal graft was covered by a mature and highly-ciliated epithelium, whereas tracheal grafts without hTMSC sheets were covered by only a thin, immature epithelium. Therefore, hTMSC sheets on the luminal surface of a tissue-engineered tracheal graft can accelerate the tracheal epithelial regeneration, and the tissue-engineered tracheal graft with hTMSC sheets provides a useful clinical alternative for tracheal epithelial regeneration.

The value of preoperative 18F‐FDG PET/CT for the assessing contralateral neck in head and neck cancer patients with unilateral node metastasis (N1‐3)

The purpose of this study was to determine whether preoperative 18F‐FDG PET/CT is useful in assessing contralateral lymph node metastasis in the neck.

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.

Role of primary closure after transoral robotic surgery for tonsillar cancer

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.

Can the transoral approach secure a cancer-free deep margin in tonsil cancer?

OBJECTIVE This study was performed to verify the efficacy and feasibility of primary closure for communication defects in the neck after transoral robotic surgery (TORS) for tonsillar cancer, and to verify the necessity of en bloc resection, which can create communication defects during TORS. METHODS We applied a new primary closure technique in 13 cases of tonsillar cancer showing a communication defect with the neck after en bloc resection during TORS. This technique is composed of three steps: (1) suturing the remaining superior pharyngeal constrictor muscle and extrinsic tongue muscle complex; (2) suturing the digastric and mylohyoid muscles; and (3) securing reinforcement of the digastric-mylohyoid complex. We analyzed the medical records and pathology reports of these cases. RESULTS On pathology review, 69.2% of the patients developed invasion of the constrictor muscle. The mean defect size was 3.3 cm; the largest defect was 4.5 cm in diameter. In all patients, primary closure of the defect was possible. With regard to functional results, decannulation was possible within 1 week, oral feeding was possible within 9 days, and none of the patients showed pharyngocutaneous fistula formation. Two patients developed complications independent of the surgery itself. CONCLUSION The invasion rate of the pharyngeal constrictor muscle is high. Therefore, en bloc resection creating a communication defect during TORS should be considered in all cases of tonsillar cancer to secure safe margins. In addition, with our primary closure technique, even large defects can be closed without complication and with good preservation of function.

Significant Invasion of the Pharyngeal Constrictor Muscle in Early Squamous Cell Carcinoma of the Tonsil: Prediction of Multiple Regional Metastasis

To verify whether the submuscular plane of the constrictor muscle, which is the resection margin in a transoral approach, is sufficient for securing a cancer-free deep margin in tonsil cancer patients. Retrospective analysis of medical records and pathology specimens was done in sixty-two patients who were diagnosed with tonsil cancer and underwent surgery via a combined transoral-transcervical (transoral and transcervical lateral pharyngotomy) approach. The status of constrictor muscular invasion in tonsil cancer patients according to the TN stage and its predictors was investigated. Invasion or penetration of the constrictor muscle was found in three (27.3%), 30 (76.9%), and 12 (100%) stage T1, T2, and T3-4 patients, respectively. In the univariate analysis, invasion or penetration of the constrictor muscle was significantly correlated with gender (p=0.004), stage >T2 (tumor ≥2 cm; p=0.001), and N(+) (p=0.004). The multivariate analysis showed that stage >T2 [tumor ≥2 cm; odds ratio (OR), 18.226; 95% confidence interval (CI), 2.976-111.608; p=0.002] and N(+) (OR, 7.560; 95% CI, 1.478-38.671; p=0.015) were significantly correlated with an increased risk of muscle invasion or penetration. The transoral approach is seems to be insufficient for securing a cancer-free deep margin in tonsil cancer beyond stage T2 or N1. The tumor beyond this stage should be treated more aggressively using multiple treatment modalities including radical surgery, chemotherapy, and radiotherapy.