J. Hun Hah

Chemocauterization of the internal opening with trichloroacetic acid as first-line treatment for pyriform sinus fistula.

Pyriform sinus fistula is a rare brachial pouch anomaly. However, it is difficult and risky to remove the fistula tract completely. Circumferential chemocauterization of the internal opening with trichloroacetic acid (TCA) for pyriform sinus fistula is simple, reproducible, reliable, and causes less morbidity. The aim of this study was to determine the feasibility of TCA chemocauterization for pyriform sinus fistula.

Pediatric tracheostomy revisited: A nine-year experience using horizontal intercartilaginous incision

To describe our tracheostomy procedure using a vertical skin incision and a horizontal intercartilaginous incision and to compare our postoperative results with those in the recent literature.

Predictive and prognostic value of PET/CT imaging post-chemoradiotherapy and clinical decision-making consequences in locally advanced head & neck squamous cell carcinoma: a retrospective study

BackgroundThe accuracy of 18F-fluorodeoxygluocose positron emission tomography/computed tomography (PET/CT) in predicting immediate failure after radical chemoradiotherapy (CRT) for HNSCC is poorly characterized at present. The purpose of this study was to examine PET/CT as a predictive and prognostic gauge of immediate failure after CRT and determine the impact of these studies on clinical decision making in terms of salvage surgery.MethodsMedical records of 78 consecutive patients receiving radical CRT for locally advanced HNSCC were reviewed, analyzing PET/CTs done before and 3xa0months after CRT. Immediate failure was defined as residual disease or locoregional and/or systemic relapse within 6xa0months after CRT.ResultsMaximum standard uptake value (SUV) of post CRT PET/CT (postSUVmax) was found optimal for predicting immediate failure at a cutpoint of 4.4. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were 90.0xa0%, 83.8xa0%, 98.3xa0%, and 45.0xa0%, respectively. Of 78 patients studied, postSUVmax ≥4.4 prevailed in 20 (25.6xa0%), with postSUVmax <4.4 in 58 (74.4xa0%). At postSUVmax ≥4.4 (vs. postSUVmax <4.4) OS was poorer by comparison (3-year OS: 56.9 vs. 87.7xa0%; Pu2009=u20090.005), as was progression-free survival (3-year PFS: 42.9 vs. 81.1xa0%; Pu2009<u20090.001). At postSUVmax ≥4.4, OS with and without immediate salvage surgery did not differ significantly (3-year OS: 60.0 vs. 55.6xa0%; Log-rank Pu2009=u20090.913).ConclusionPost CRT PET/CT imaging has prognostic value in terms of OS and PFS and is useful in predicting immediate therapeutic failure, given its high NPV. However, OS was not significantly altered by early salvage surgery done on the basis of post CRT PET/CT findings.

Influences of demographic changes and medical insurance status on tonsillectomy and adenoidectomy rates in Korea

In Korea, the proportion of the pediatric population is decreasing due to low fertility rates and aging of the society. It is hypothesized that this change in population structure and medical insurance status may affect rates of elective surgeries more significantly than clinical factors. An observational study conducted using data from the Health Insurance Review and Assessment Service for tonsillectomy and adenoidectomy, with 403,924 registered patients from 2007 through 2011. We analyzed longitudinal changes in crude and age-adjusted surgery rates of three surgeries—tonsillectomy without adenoidectomy (T), adenoidectomy without tonsillectomy (A), and tonsillectomy with adenoidectomy (T&A)—according to medical insurance status: health insurance (HI) group (better economic status) versus health aid (HA) group (poorer economic status). Most of the surgeries (51.8xa0% of T, 93.7xa0% of A, and 95.1xa0% of T&A) were performed in patients younger than 15. Over 5xa0years, the proportion of the child population numbers decreased, from 17.43 to 15.41xa0% in the HI group and from 21.20 to 13.15xa0% in the HA group. Thus, crude surgery rates for T, A, and T&A decreased more rapidly in the HA group (7.50, 14.79, and 15.55xa0%) than the HI group (1.69, 1.49, and 0.90xa0%) each year. Adjusted surgery rates for T, A, and T&A increased in the HI group (1.01, 2.64, and 3.36xa0%) and decreased in the HA group (1.39, 2.86, and 2.76xa0%) each year. These adjusted surgery rates partially explains the sharper decrease in crude surgery rates in the HA group than the HI group. The crude and adjusted rates of surgeries were usually higher in lower economic status groups. In conclusion, surgery rates were affected by changes in the population structure, but by other factors as well. Predictable socioeconomic factors could be used to calculate and predict the rates for other well-established surgeries.

A Randomized, Multicenter, Phase II Study of Cetuximab With Docetaxel and Cisplatin as Induction Chemotherapy in Unresectable, Locally Advanced Head and Neck Cancer

BACKGROUNDnWe investigated the efficacy of cetuximab when added to induction chemotherapy followed by concurrent chemoradiotherapy (CCRT) in patients with locally advanced head and neck squamous cell carcinoma.nnnMETHODSnPatients were randomized to receive three cycles of docetaxel and cisplatin (TP regimen) with or without cetuximab (TP plus cetuximab [CTP] vs. TP) as induction chemotherapy. Patients in the CTP arm received CCRT with cetuximab and cisplatin, whereas patients in the TP arm received cisplatin alone. The primary endpoint was the objective response rate (ORR) after induction chemotherapy.nnnRESULTSnOverall, 92 patients were enrolled. The ORRs for induction chemotherapy in the CTP and TP arms were not different (81% vs. 82%). Adding cetuximab lowered the completion rate of induction chemotherapy and CCRT and resulted in more frequent dose reductions of the induction chemotherapy, although this did not reach statistical significance. In the CTP and TP arms, respectively, the 3-year progression-free survival (PFS) rates were 70% and 56% (p = .359), and the overall survival (OS) rates were 88% and 74% (p = .313). When limited to patients who completed induction chemotherapy, 3-year PFS rates of 78% and 59% (p = .085) and OS rates of 94% and 73% (p = .045) were observed in the CTP and TP arms, respectively.nnnCONCLUSIONnAdding cetuximab to sequential treatment did not increase the treatment efficacy and resulted in greater toxicity. In the intent-to-treat population, neither PFS nor OS was improved by the addition of cetuximab to sequential treatment; however, a suggestion of improved survival outcomes was observed in patients completing cetuximab-containing induction chemotherapy.

Novel experimental rabbit model of anterior glottic web formation.

Abstract Conclusion: The rabbit model of anterior glottic web (AGW) formation using the laryngofissure technique resulted in reproducible and stable AGW formation that may facilitate research into this area. Objective: To introduce and validate a novel experimental animal model of AGW formation using the rabbit. Methods: The inner larynges of eight New Zealand white rabbits were exposed through the laryngofissure technique. The mucosa of the bilateral true vocal fold was stripped off using the bevel of a needle tip. On the basis of the laryngoscopic findings at 8 weeks postoperatively, the extent of AGW was measured, and the success of this procedure was validated. Laryngeal specimens were sampled at 8 weeks for high-speed recording and histological analysis. Results: In seven (87.5%) rabbits, laryngoscopic examination revealed the formation of a scar band involving the anterior commissure. The mean extent of AGW ratio on the left and right sides was 0.58 ± 0.073 and 0.55 ± 0.075, respectively. The symmetric formation of AGW (p = 0.655, p = 0.128) and stability of the AGW procedure (p = 0.491, left; p = 0.501, right) were statistically validated. On high-speed recording, the vocal mucosal wave was hindered by AGW formation. Histologically, fibro-connective tissue, especially collagen fiber, was observed in the anterior commissure.

Modified Sistrunk operation: New concept for management of thyroglossal duct cyst

OBJECTIVEnTo describe a method of hyoid cartilage division during Sistrunk operation for management of thyroglossal duct cyst (TGDC) and compare postoperative outcomes with those of conventional hyoid bone cutting.nnnMETHODSnFifty-nine patients who received operative treatment for TGDC from January 2005 to July 2013 were enrolled. The degree of fusion in the cartilaginous portion of the hyoid was evaluated by preoperative neck computed tomography and classified into (1) non-fusion, (2) partial fusion, and (3) complete fusion. Techniques of hyoid management, division of the cartilaginous portion of the hyoid or conventional hyoid bone cutting, during Sistrunk operation were analyzed according to the fusion classification.nnnRESULTSnOf the 59 patients, 27 were pediatric patients and 32 were adults. In 32 adults undergoing TGDC, there were 13 cases (41%) of complete hyoid fusion and 7 (22%) of non-fusion. A total of 20 adult patients (63%) were treated with the cartilage division. Among the pediatric patients, 96% of cases were classified as non-fusion of the hyoid, and all of these were treated with the cartilage division. Patients who were treated with the cartilage division showed better postoperative results. However, there were no statistical differences.nnnCONCLUSIONSnOur cartilage division technique at Sistrunk operation for TGDC is feasible and comparable to conventional hyoid cutting with regard to postoperative results.

Role of surgery in the management of anaplastic thyroid carcinoma: Korean nationwide multicenter study of 329 patients with anaplastic thyroid carcinoma, 2000 to 2012

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.

Desmoid tumor arising from omohyoid muscle: The first report for unusual complication after transaxillary robotic thyroidectomy.

Transaxillary robotic (TAR) thyroidectomy has been performed for better aesthetic results by many surgeons. In this report, we describe a rare case of a desmoid tumor developed after TAR thyroidectomy, which is speculated to be a late‐term complication.

Chemocauterization of second branchial cleft fistula using trichloroacetic acid: A preliminary report

OBJECTIVEnAlthough second branchial cleft fistula (BCF) can be well treated with surgical excision, neck scarring is unavoidable. We previously reported chemocauterization with trichloroacetic acid (TCA) to close various fistulas. Here, we report chemocauterization of a second BCF without a consequent incision scar.nnnMETHODSnThis procedure was applied in four pediatric patients whose parents were reluctant to undergo surgical excision for a second BCF. Under general anesthesia, a thin metal suction tip or cut down tube was inserted through the skin opening. Normal saline with or without dye was injected to identify the pharyngeal opening around the palatine tonsil, and 75% TCA solution mixed with dye was injected. Leaked TCA at the pharynx was sucked out meticulously to avoid extensive and unexpected injury to the mucosa, and the external opening was sealed with a thin adhesive film.nnnRESULTSnThere were no immediate complications and recurrence of a second BCF in all patients during the median follow-up of 23 months (range, 18-88 months) with minimal neck scarring.nnnCONCLUSIONnTCA chemocauterization of second BCF could be a simple, less invasive, and feasible treatment option in pediatric patients.