Jung-Hae Cho

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.

Factors That Predict Postoperative Pulmonary Complications After Supracricoid Partial Laryngectomy

OBJECTIVE To determine the risk factors related to postoperative pulmonary complications in patients who undergo supracricoid partial laryngectomy. DESIGN Retrospective analysis of medical records. SETTING Tertiary care referral center. PATIENTS One hundred eleven patients who underwent supracricoid partial laryngectomy from January 1, 1993, through December 31, 2008. MAIN OUTCOME MEASURES Relationship between postoperative pulmonary complications and perioperative risk factors, such as age, sex, chronic lung disease, smoking status, tumor site, tumor stage, preoperative irradiation, extent of surgery, reconstruction method, and pulmonary function tests. RESULTS Thirty-six patients (32.4%) developed postoperative pulmonary complications. Significant correlations were found among age (P = .002), chronic lung disease (P = .005), smoking status (P = .02), and postoperative pulmonary complications. Cricohyoidopexy (P = .008) and ipsilateral arytenoidectomy (P = .03) were associated with postoperative pulmonary complications. The multivariate analysis showed a significant association of the postoperative pulmonary complications with age (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.2-11.7 in patients 60 to 69 years old; and OR, 7.1; 95% CI, 1.3-37.6 in patients 70 to 79 years old) and cricohyoidopexy (OR, 4.4; 95% CI, 1.1-18.1). CONCLUSION Patients 60 years or older and patients with cricohyoidopexy are at high risk of having postoperative pulmonary complications after supracricoid partial laryngectomy.

Endoscopic resection of haemangiomas in the sinonasal cavity

OBJECTIVES Haemangiomas do not develop as commonly in the sinonasal cavity, compared with other head and neck sites. The clinical characteristics of sinonasal cavity haemangiomas and the results for endoscopic resection have been addressed in the literature only briefly. Thus, this study aimed to evaluate these points. MATERIALS AND METHODS A retrospective chart review was undertaken of 22 patients who had undergone endoscopic excision of sinonasal cavity haemangiomas, in order to define clinical characteristics and tumour control rates. RESULTS AND ANALYSIS The most common presenting symptom was epistaxis. The most prevalent site was the inferior turbinate (45.5 per cent), followed by the maxillary sinus (18.2 per cent). No recurrence was observed in any patient. CONCLUSION Although past studies have described external approach sinonasal surgery as the mainstay of treatment, our results imply that endoscopic excision of sinonasal haemangiomas yields excellent outcomes in terms of tumour control and safety.

Pathological validation of supracricoid partial laryngectomy in laryngeal cancer

Objectives:  To validate pathologically whether supracricoid partial laryngectomy is an oncologically sound procedure in cases with invasion of the thyroid cartilage, paraglottic space, pre‐epiglottic space, anterior commissure, or subglottis.

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

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.

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

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.

Prognostic impact of lymph node micrometastasis in oral and oropharyngeal squamous cell carcinomas.

The purpose of this study was to determine the role of lymph node micrometastasis in oral and oropharyngeal cancers.

Clinical and radiologic features of submandibular triangle hemangioma.

Background The clinical and radiologic features of submandibular triangle hemangioma have not been systematically reported. Hemangiomas in the submandibular triangle are very rare and are often misdiagnosed as other benign cystic masses or inflammatory conditions. Methods We retrospectively reviewed the medical records of 5 patients who underwent surgery for submandibular triangle hemangioma between January 2006 and April 2011. Results All patients presented with fluctuating swelling with or without pain in the submandibular triangle. Computed tomographic (CT) scans showed cystic masses around the submandibular glands and calcified nodules in the lesions. Ill-defined vascular lesions and variably sized hard nodules were identified during surgery. Bleeding was controlled by early ligation of feeding vessels. The submandibular gland was removed for surgical exposure in 4 patients. Pathologic review of each specimen revealed that all were cavernous hemangiomas with thrombosis and phleboliths. Complications included 1 temporary marginal mandibular nerve paresis and 1 postoperative hematoma. No recurrence after surgery was seen during a follow-up period of 4 to 52 months. Conclusions The possibility of submandibular triangle hemangioma should first be considered when a cystic mass around the submandibular gland and multiple calcifications are present on CT. Ligation of feeding vessels and resection of the submandibular gland may be needed to obtain surgical exposure and prevent massive bleeding.

The effect of topical FK506 (tacrolimus) in a mouse model of allergic rhinitis.

Background The management of allergic rhinitis (AR) encompasses education, pharmacotherapy, immunotherapy, and surgery. FK506 (tacrolimus) is an immunosuppressant that inhibits allergic reactions. The purpose of this study was to reveal whether FK506 treatment reduces allergic inflammation in an AR mouse model and to elucidate the mechanisms. Methods Forty mice were divided into four groups: control, AR, FK (FK506), and dexamethasone (DEX). All mice except for the control group were sensitized by an i.p. injection of ovalbumin (OVA). After sensitization, the FK and DEX groups were treated with FK506 and DEX intranasally. All sensitized mice were challenged intranasally with OVA. Allergic symptoms and tissue eosinophil counts were recorded. Interleukin (IL)-5, interferon gamma, and IL-10 levels in nasal lavage fluid (NALF) and serum OVA-specific IgE levels were measured. T-bet, GATA-3, and Foxp3 mRNA expression in splenic mononuclear cells were determined by real-time polymerase chain reaction. Results In the FK group and DEX group, allergic symptoms, serum OVA-specific IgE, tissue eosinophil counts, IL-5 in NALF, and GATA-3 mRNAs expression decreased (p < 0.05), and IL-10 in NALF and Foxp3 mRNAs expression increased compared with the AR group (p < 0.05). No significant difference was observed between the FK group and the DEX group. Conclusion These results suggest that topical FK506 may reduce allergic inflammation and have potency equal to DEX in the AR model. This mechanism may involve not only Th2 cells but also regulatory T cells. Additional studies are needed on FK506, but in the future, we can consider FK506 as an alternative to topical steroids in the treatment of AR.

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

OBJECTIVE To determine whether invasion of the pharyngeal constrictor muscle in early squamous cell carcinoma of the tonsil is correlated with lymph node metastasis. DESIGN Retrospective analysis of medical records and pathology specimens. SETTING Tertiary care referral center. PATIENTS Forty-eight patients who were diagnosed as having T2 squamous cell carcinoma of the tonsil and who underwent surgery. They were divided into 2 groups: an invasive group with invasion of the pharyngeal constrictor muscle and a noninvasive group without invasion of the pharyngeal constrictor muscle. MAIN OUTCOME MEASURES Comparison of regional metastasis, 5-year locoregional recurrence, and 5-year disease-specific survival between the 2 groups. RESULTS Invasion of the pharyngeal constrictor muscle was found in 36 patients (75%) with T2 squamous cell carcinoma of the tonsil. The rate of lymph node metastasis, the mean (SD) number of positive nodes, and the mean (SD) lymph node density were 81%, 5.47 (9.27), and 0.15 (0.22) in the invasive group, respectively, and 50%, 1.33 (1.72), and 0.04 (0.04) in the noninvasive group, respectively (P = .04, P = .02, and P = .01, respectively). Five-year locoregional recurrence was significantly correlated with invasion of the pharyngeal constrictor muscle (P = .05) and with multiple lymph node metastasis (≥5 nodes) (P = .04) in the univariate analyses. No factor was correlated with 5-year locoregional recurrence in the multivariate analysis. Five-year disease-specific survival was significantly correlated with multiple lymph node metastasis (≥5 nodes) in the univariate analyses (P = .009). Five-year disease-specific survival was not significantly correlated with any clinicopathological factor in the multivariate analysis. CONCLUSION Higher risk for multiple lymph node metastasis and 5-year locoregional recurrence seems to be predicted in patients with extratonsillar invasion of the pharyngeal constrictor muscle, even in early squamous cell carcinoma of the tonsil.