Jih-Chin Lee

Primary clear cell carcinoma of the nasopharynx

hemo head sm and A63-year-old female presented to an outside institution with a 2-month history of repeated epistaxis, right-side tinnitus, and weight loss. Nasopharyngoscopy revealed a dark reddish, easily hemorrhagic, and partially whitish tumor arising from the right side of the nasopharynx with extension to the left choana (Fig 1A). Her head and neck examination showed no other lesions or lymphadenopathy. MRI showed a 3.99 3.42 4.85 cm protruding nasopharyngeal mass arising from the right lateral and posterior wall, obstructing the entire nasopharynx and choana, and extending to the level of the oropharynx with anterior displacement of the soft palate. Histology revealed polygonal to round-shaped hematoxylin and eosin–stained cells with clear cytoplasm, and uniform nuclei with little pleomorphism (Fig 1B). The cytoplasmic glycogen was confirmed by positive periodic acid-Schiff staining and was diastase soluble. The tumor cells stained negative for mucin and positive for high-molecular-weight keratin immunoactivity. No primary tumor was identified on evaluation of the kidney by CT scan. The patient further underwent endoscopic

Vocal cord immobility caused by the long-standing impaction of a fishbone in the hypopharynx.

Vocal cord immobility is a rare presentation of an impacted fishbone in the pharynx. The mechanisms can be classified into either mechanical articular fixation or direct/indirect neuropathy of the recurrent laryngeal nerve. We report a case of vocal cord immobility secondary to long‐standing impaction of a fishbone in the hypopharynx for at least 9 months. The diagnosis was made by computed tomography (CT) and rigid laryngoscopy because no reliable history was available. The cricoarytenoid joint was not fixed and the function of the vocal cords returned one month after removal of the fishbone. The mechanism of the vocal cord immobility was an injury to the recurrent laryngeal nerve due to the chronic inflammatory reaction in the paraglottic space. Laryngoscope, 119:228–230, 2009

The use of adjunctive traditional Chinese medicine therapy and survival outcome in patients with head and neck cancer: a nationwide population-based cohort study.

BACKGROUND Traditional Chinese medicine (TCM) is widely used in the treatment of patients with several types of cancer. However, no large-scale clinical studies have evaluated whether TCM is associated with better survival in patients with head and neck cancer (HNC). METHODS The Taiwan National Health Insurance Research Database was used to conduct a retrospective cohort study of patients with HNC between 2001 and 2011. The patients with HNC were separated into TCM users and non-users, and Cox regression models were applied to determine the association between the use of TCM and survival outcome. RESULTS The TCM and comparison cohorts comprised data for 2966 and 2670 patients, respectively. The mean age was 51.3 years in the TCM cohort and 51.7 years in the comparison cohort. Multivariate analysis demonstrated that the use of TCM was significantly associated with lower risk of all-cause mortality by 32% (adjusted hazard ratio, 0.68; 95% confidence interval, 0.62-0.75). Patients with longer TCM use had a lower mortality rate (P for trend < 0.001). CONCLUSIONS Our study showed that adjunctive therapy with TCM is associated with higher survival outcome. However, some limitations exist, such as the lack of information of cancer stage. In addition, causality cannot be assessed with this retrospective study. A randomized controlled trial to test the effect of adjunctive TCM therapy in HNC patients is needed.

Management of different kinds of head and neck defects with the submental flap for reconstruction

Head and neck surgeries often accompany with moderate-sized defects that require time-consuming reconstructions by free flaps. The submental flap is a versatile and time-effective option for reconstruction of orofacial defects providing acceptable cosmetic and functional results without requiring microsurgical techniques. A retrospective case series study of patients who underwent reconstruction with the submental flap between 2009 and 2013 was conducted. There were 36 patients (33 men and 3 women), with a mean age of 56.4 years, enrolled in this study. The primary lesion sites included oral cavity (24 patients), pharynx (8 patients), larynx (2 patients), neck (1 patient) as well as maxillary sinus (1 patient). All flaps were harvested as the myocutaneous flaps. All donor sites were closed primarily without the need of additional surgery. No complete loss of the flap was encountered and two cases developed marginal necrosis of the flap. The submental flap had a reliable pedicle and had minimal donor-site morbidity. It is an excellent flap option for patients with small- to medium-sized defects in head and neck region.

Tortuous internal carotid artery presenting as a pulsatile hypopharyngeal mass.

wing p ). An 83-year-old Asian woman was referred to our institute due to a six-month history of foreign body sensation in the throat that was aggravated when swallowing. She had been diagnosed with atherosclerosis and hypertension with regular medicine. Clinical examination revealed a pulsating bulge with normal overlying mucosa indenting and partially obliterating the right hypopharynx (Fig 1A). With these findings, we suspected a vascular pathology and investigated the lesion with computed tomography (CT) of the neck. CT scan revealed tortuous internal carotid artery (ICA) kinking with a wide acute angle on the posterolateral vicinity of the right hypopharynx (Fig 1B). The patient was informed about her pathology in

Cidofovir Injection for Recurrent Laryngeal Papillomatosis

Background: Recurrent laryngeal papillomatosis is caused by the human papilloma virus and characterized by multiple exophytic lesions of the vocal tract; it is a benign disease, but one that tends to recur after removal of growths. Due to the nature of the disease, alternative treatment strategies have focused on antiviral injection at lesion sites that eliminate repeated surgical procedures. The purpose of this study was to evaluate the efficacy of cidofovir injection following initial papilloma excision with a microdebrider. Methods: Cidofovir injections (at a concentration of 7.5 mg/mL) were conducted in 5 patients (1 child; 4 adults). The injection number per patient varied from 2 mL to 6 mL. Repeated cidofovir injections were indicated only if recurrent or newly grown lesions were found in any of 3‐week follow‐up visits. Results: Short‐term complete remission was observed with different duration, from 11 to 21 weeks, following initial 2 to 3 cidofovir injections. All patients relapsed eventually, and their recurrent lesions were not successfully eradicated by repeated cidofovir injection. One patients prognosis was complicated by scarring of both vocal cords. Conclusion: Surgical excision combined with cidofovir injection failed to prevent relapsing laryngeal papillomatosis. Once lesions recurred, repeated cidofovir injections alone were not able to achieve complete remission, although these procedures might be helpful in lessening the severity of the clinical course. Further studies in determining the dosage, duration of injection, and more long‐term follow‐up are required to clarify the efficacy of cidofovir for the treatment of recurrent laryngeal papillomatosis.

Extensive blue nevus of the pharynx.

Sir, The blue nevus is a benign, acquired melanocytic lesion that typically presents as an asymptomatic, slate‐blue or blue‐black, smooth‐surfaced macule or papule, measuring less than 6 mm in diameter usually.[1] This lesion occurs mostly on the skin and rarely in the oral mucosa.[2] It is the most common type of nevus occurring in the oral cavity after intramucosal nevi and accounts for 19% to 36% of oral nevi.[3] Intraoral blue nevus was first described in 1959. Intraoral blue nevi occur most frequently on the hard palate, with the buccal mucosa being the second most common site.[2] We describe a case of blue nevus of the pharyngeal mucosa. To the best of our knowledge, this is the first report on blue nevi occurring in this unusual site.

Giant cell tumor of the larynx

A 53-year-old man presented with husky voice and a mass that has been enlarging on the right side of the neck for the previous 2 months. In a local hospital, the computed tomography (CT) of the neck showed an enhancing mass that originated from right-thyroid cartilage. The paralaryngeal space and strap muscles seemed to be involved. Right true and false vocal folds were displaced medially. He was then referred to our institution. Gross examination revealed a firm mass on right side of the neck overlying the thyroid cartilage, measuring approximately 3 cm in diameter. Indirect laryngoscopy showed that right vocal folds were compressed medially (Fig 1). T1-weighted precontrast and postcontrast magnetic resonance images (MRI) showed a hyperintense enhancing mass destructing right-thyroid cartilage. An open biopsy was performed. Microscopic examination showed the specimen to be composed of multinucleated giant cells and ovoid to spindle-like mononuclear cells. The giant cells dispersed uniformly without any area of aggregation (Fig 2). Giant cell tumor (GCT) of the larynx was diagnosed. The patient underwent vertical partial laryngectomy for complete resection of the tumor. Grossly, the tumor, an expansile mass, centered on the right-thyroid cartilage and involved the corresponding cricoid cartilage; it compressed the surrounding soft tissue. In the latest follow-up 1 year after surgery, the patient was free of the disease; his voice was acceptable postoperatively.

Gender Differences in the Association between Moderate Alcohol Consumption and Hearing Threshold Shifts

Hearing loss is a global public health problem with a high prevalence, significantly impairing communication and leading to a decrease in the quality of life. The association between moderate alcohol consumption (MAC) and hearing impairment has been addressed in several studies with inconsistent results. The intent of our study is to clarify the correlation between MAC and the hearing threshold and further investigate the interplay between MAC and the hearing threshold categorized by gender. The study included 4,075 participants aged 20–69 years from the 1999–2004 data of National Health and Nutrition Examination Survey (NHANES). The associations among MAC, gender differences, and high-frequency and low-frequency hearing thresholds were analyzed. We found that current female drinkers with MAC tended to have lower hearing thresholds. There is a significant protective effect of MAC on hearing threshold shifts in the US adult population, especially in females. Our research was the first study to further indicate that there is a gender difference in the association between MAC and hearing impairment. In accordance with our results, if people drink, they should consume moderate rather than higher amounts, especially in women, which may result in a reduced risk of hearing loss.

The association of superior attachment of uncinate process with pneumatization of middle turbinate: a computed tomographic analysis

The frontal sinus outflow pathway is complex and can be influenced by the configuration of the uncinate process (UP). The UP can attach superior to the lamina papyracea, skull base, and middle turbinate. The factors associated with superior attachment remain unclear. This study analyzed the relationships between different types of superior UP attachment and characteristics of the surrounding structures including the agger nasi cell, skull base, and middle turbinate. This retrospective study utilized computed tomography images of 836 sides with identifiable sinus structure from 434 Taiwanese patients. Types of superior UP attachment, height of the ethmoid cribriform plate, prevalence of agger nasi cell, and degree of pneumatization of the middle turbinate were analyzed. In the current study, neither the presence of an agger nasi cell nor height of the cribriform plate had significant relationship with superior UP attachment type. However, UP attachment type was statistically significantly associated with pneumatized middle turbinate (PMT) type (p < 0.01). The PMT group had a higher incidence of UP attachment to the middle turbinate (38%) than the non-PMT group (18%). In the extensive PMT group, the incidence of UP attachment to the middle turbinate was high to 49%. In conclusion, superior UP attachment to the middle turbinate was associated with pneumatization of the middle turbinate. The UP has a greater tendency to attach to the middle turbinate in cases with more PMT.