Ling-Feng Wang

Different impact from betel quid, alcohol and cigarette: risk factors for pharyngeal and laryngeal cancer.

The risks of betel quid chewing with or without tobacco, alcohol drinking and cigarette smoking have been well explored in the oral cavity but not in the pharynx and larynx. We conducted a case‐control study to investigate the association of these three risk factors to cancers of the pharynx and larynx in Taiwan. A total cases of 148 pharyngeal cancer, 128 laryngeal cancer and 255 hospital controls, all men, were recruited. Betel quid chewing was a significant independent risk factor (adjusted odds ratio [aOR] = 7.7; 95% confidence interval [CI] = 4.1–15.0) similar to that of alcohol drinking (aOR = 6.6; 95% CI = 3.5–13.0) for pharyngeal cancer, but not for laryngeal cancer (aOR = 1.3; 95% CI = 0.7–2.5) on which cigarette smoking (aOR = 7.1) exerts a stronger significant independent risk than alcohol drinking (aOR = 3.8). For pharyngeal cancers, chewers who consumed >20 quid/day, chewed with inflorescence in the quid or swallowed the betel quid juice were at higher risks; significant dose‐response effects were found in daily quantity of drinking and chewing, and cumulative quantity of drinking. Synergistic effects from the 3 risk factors existed both on the pharynx (aOR = 96.9) and the larynx (aOR = 40.3), and attributed for 93.1% and 92.9% respectively. Our study is the first evidence to show that betel quid chewing without tobacco has different impact on the pharynx (digestive tract) and the larynx (airway), and supports the concept that exposure quantity and direct mucosal contact with the betel quid juice may contribute to carcinogenesis. Our results show an important insight into the impact of betel quid chewing on other sites of the digestive tract other than the oral cavity.

The Efficacy of Intraoperative Corticosteroids in Recurrent Laryngeal Nerve Palsy after Thyroid Surgery

BackgroundRecurrent laryngeal nerve palsy (RLNP) is one of the most common complications after thyroidectomy. We aim to evaluate the role of intraoperative corticosteroids in preventing or treating postoperative RLNP.Materials and MethodsWe conducted a prospective study of 295 patients who underwent either total lobectomy or total thyroidectomy with or without using intraoperative corticosteroids. All cases were operated on by the same surgeon. Measurement of the RLNP rate was based on the number of nerves at risk. Data were analyzed for differences in postoperative temporary or permanent RLNP rate and recovery days.ResultThe rate of temporary/permanent RLNP was 5.7% (11 out of 194)/0.52% (1 out of 194) and 6.9% (12 out of 173)/0.58% (1 out of 173) according to groups with and without corticosteroids. This difference did not reach statistical significance. Among those 23 patients who recovered from RLNP, the mean time to recovery was significantly shorter for patients receiving intraoperative steroids (28.6 vs. 40.5 days, P = 0.045).ConclusionA single dose of intraoperative corticosteroids did not produce any benefit in terms of reducing the postoperative temporary/permanent RLNP rate, but it did shorten the recovery time for patients suffering from temporary RLNP.

A long-term study on hearing status in patients with nasopharyngeal carcinoma after radiotherapy.

Objective: To study the long-term sensorineural hearing status after radiotherapy in patients suffering from nasopharyngeal carcinoma. Study Design: A prospective study of 220 patients (395 ears) with a median follow-up of 36 months. Setting: A university hospital. Patients: Four criteria were needed. The patient had to have had at least 12 months of audiologic follow-up, no concurrent chronic ear disease, no direct tumor invasion of ear, and no significant sensorineural hearing loss before radiotherapy. Intervention: Pure-tone audiography and impedance audiometry—which were performed before and at the third month after completion of radiotherapy and at a yearly interval thereafter—formed the basis of the study. Main Outcome Measures: The significance level in this study was defined as a bone conduction threshold increase of more than 10 dB between the initial audiogram and those obtained after the completion of radiotherapy. An increase of more than 30 dB was defined as severe loss. Results: Paired t test indicated that the mean bone conduction threshold before and after radiotherapy were significantly different (paired t test, p < 0.05). Logistic regression showed that patient age was related to the significant loss at speech frequency but not to the loss at 4 kHz. The presence of postradiation otitis media with effusion, preirradiation hearing status, and addition of chemotherapy were found to be not influential on hearing change. Conclusion: Hearing deterioration may begin as early as 3 months after the completion of radiotherapy. Early change may be transient, but the effect of radiation on hearing tended to be chronic and progressive.

Matrix metalloproteinase-9 gene polymorphisms in nasal polyposis.

BackgroundMatrix metalloproteinase (MMP) is involved in the upper airway remodeling process. We hypothesized that genetic variants of the MMP-9 gene are associated with cases of chronic rhinosinusitis with nasal polyposis.MethodsWe conducted a case-control study where 203 cases of chronic rhinosinusitis with nasal polyposis and 730 controls were enrolled. Three tagging single nucleotide polymorphisms (SNPs) and one promoter functional SNP rs3918242 were selected. Hardy-Weinberg equilibrium (HWE) was tested for each SNP, and genetic effects were evaluated according to three inheritance modes. Haplotype analysis was also performed. Permutation was used to adjust for multiple testing.ResultsAll four SNPs were in HWE. The T allele of promoter SNP rs3918242 was associated with chronic rhinosinusitis with nasal polyposis under the dominant (nominal p = 0.023, empirical p = 0.022, OR = 1.62) and additive models (nominal p= 0.012, empirical p = 0.011, OR = 1.60). The A allele of rs2274756 has a nominal p value of 0.034 under the dominant model and 0.020 under the additive model. Haplotype analysis including the four SNPs showed a global p value of 0.015 and the most significant haplotype had a p value of 0.0045. We did not see any SNP that was more significant in the recurrent cases.ConclusionsWe concluded that MMP-9 gene polymorphisms may influence susceptibility to the development of chronic rhinosinusitis with nasal polyposis in Chinese population.

Incidence of dehiscence of the facial nerve at surgery for middle ear cholesteatoma.

OBJECTIVE: To identify the incidence of dehiscence of the facial nerve in patients undergoing surgery for cholesteatoma and to describe its relevance with iatrogenic facial nerve injury. STUDY DESIGN AND SETTING: This was a retrospective study including 117 tympanoplasties with or without mastoidectomy performed in 49 men and 66 women. RESULTS: The presences of FND after exenteration of disease are 33.3% of total surgical procedures, 33% of the initial procedures, and 37.5% of the revision procedures. The locations of facial nerve dehiscence were 87.2% in only the tympanic segment, 7.7% in only the vertical segment, and 5.1% in both the tympanic and vertical segments. CONCLUSIONS AND SIGNIFICANCE: The incidence of facial nerve dehiscence is high (33.3%) in our study. The surgeon should keep in mind that the location of facial nerve dehiscence with cholesteatoma is comparable with the most common area of iatrogenic facial nerve injury during otologic surgery.

Head and neck extranodal lymphoma in a single institute: A 17-year retrospective analysis

The studys purposes are to identify patient characteristics, treatment response and survival rate, and to describe the important prognostic factors for our patients with extranodal head and neck lymphoma. Furthermore, no study has systemically discussed the overall figure of this disease in Taiwan and we analyzed our data on this topic. A retrospective review was performed for 86 patients with extranodal head and neck lymphoma, diagnosed in Kaohsiung Medical University Hospital, between 1990 and 2007. We evaluated the medical records and analyzed the possible factors affecting treatment outcomes, survival rate, and free‐from‐disease (FFD) survival rate. Forty‐nine male and 37 female patients were included with a male:female ratio of 1.32：1. The most frequent histologic type was diffuse large B cell lymphoma, accounting for 41.9% of the total. The most common primary site involved with extranodal head and neck non‐Hodgkins lymphoma was a tonsil with 27 cases (31.4%). Stage, international prognostic index (IPI) score, B symptoms, lactate dehydrogenase (LDH) level, and lymph node status significantly affected treatment response. The overall 5‐ and 10‐year survival rates were 68.0% and 57.8%, respectively. The FFD survival rate was 53.6% and 49.3% at 5 and 10 years, respectively. Factors including stage, lymph node status, LDH level, and IPI score produced significant differences in both overall survival and FFD survival. Our analyzed information is similar to other previously presented studies. Stage, IPI score, B symptoms, LDH level, and neck nodal status can be used to evaluate the treatment outcomes. Neck nodal status and stage are the two significant prognostic factors for overall survival.

Serum 25-hydroxyvitamin D levels are lower in chronic rhinosinusitis with nasal polyposis and are correlated with disease severity in Taiwanese patients.

Background Vitamin D deficiency is reported to be associated with increased incidence of allergic airway diseases and is correlated with the severity of asthma. This study was designed to determine if serum Vitamin D level is lower in chronic rhinosinusitis with nasal polyposis (CRSwNP) patients and if low serum Vitamin D level is correlated with the severity of CRSwNP. Methods New CRSwNP patients undergoing elective endoscopic sinus surgery were recruited. Patients with malignancies or asthma were excluded. Twenty chronic rhinosinusitis without nasal polyposis (CRSsNP) patients were used as control. Demographic characteristic information was collected. The severity of CRSwNP was assessed with the Lund-Mackay (LM) score and polyp grading system. Vitamin D status was assessed by measuring circulating 25-hydroxyvitamin D (25OHD) by using commercial chemiluminescence immunoassay. Data were stratified by factors known to affect serum 25OHD, including sex, race, and body mass index. Results Serum 25OHD levels (ng/mL ± SD) were significantly lower in patients with CRSwNP (21.4 ± 5.7) than in those with CRSsNP (28.8 ± 6.2; p < 0.001). The incidences of vitamin D deficiency (<20 ng/mL) in CRSwNP and CRSsNP patients were 45.5 and 6.3%; however, the incidences of vitamin D insufficiency (20–30 ng/mL) in these patients were 50.0 and 62.5%, respectively. A significantly negative relationship was found between serum 25OHD level and polyp grade (r = −0.63; p = 0.001), indicating lower serum 25OHD was associated with higher polyp grade. Serum 25OHD was inversely related to both LM score and total IgE level as well; however, statistical significance was not found. Conclusion A significantly lower vitamin D level was found in a group of Taiwanese CRSwNP patients, which revealed an association with greater nasal polyp size. Serum vitamin D levels could be added to the routine workup of patients suffering from CRS and these data could be used to potentially help determine the disease severity.

Space Infection of the Head and Neck

Deep neck infection may be lethal, especially when life-threatening complications occur. We conducted a retrospective analysis of 184 patients with deep neck infection who were treated at Kaohsiung Medical University Hospital during the past 6 years. Factors such as age, sex, hospitalization days, clinical presentations, involved spaces, imaging studies, microbiology, and treatment method were analyzed. There were 122 men and 62 women with a mean age of 41.7 years. The average hospitalization was 8.4 days. The involved spaces, determined by physical examination and radiologic findings, were the peritonsillar space (59 patients), parapharyngeal space (77 patients), submandibular space (55 patients), and retropharyngeal space (20 patients). Of the 49 patients for whom the origin of infection was identified, 29 were infected via the upper respiratory tract and 13 had infection of odontogenic origin. The most common isolated organism was Klebsiella pneumoniae. One hundred and thirty-seven patients (74.5%) underwent surgery, including repeated needle aspiration (87 patients) and surgical drainage (50 patients). The remaining 47 patients recovered uneventfully with antibiotic therapy alone. Eighteen patients developed life-threatening complications, such as descending mediastinitis, sepsis, airway obstruction, and jugular vein thrombosis. Two patients died of septic shock. The combination of accurate diagnosis, effective antibiotic therapy, airway maintenance, and intensive surgical debridement for those who fail to respond to conservative treatment will lead to a good prognosis.

Corelationship between matrix metalloproteinase 2 and 9 expression and severity of chronic rhinosinusitis with nasal polyposis.

Background Matrix metalloproteinase (MMP) is involved in the remodeling process of inflammatory airway diseases and is correlated with the severity of asthma. We hypothesized that MMP was associated with the severity of chronic rhinosinusitis with nasal polyps (CRSwNPs). We also investigated the effect of allergy on the expression of MMP in the polyp. Methods The expression of MMP-2 and -9 was investigated in recurrent nasal polyps of 30 patients and in nonrecurrent nasal polyps of 31 patients undergoing endoscopic sinus surgery. These expressions were then compared with those in control nasal mucosal samples obtained from 32 patients with chronic hypertrophic rhinitis. Demographic data, Lund-Mackay (LM) score, polyp grade, and allergy status were obtained for all patients. Tissue samples were assessed via immunohistochemistry. Results MMP-2 and -9 were constantly expressed in recurrent NPs, primary NPs, and control nasal mucosa. The expression of MMP-9 was significantly enhanced in glands and MMP-2 positivity was significantly increased in surface epithelium for patients with NPs when compared with control nasal mucosa. The expression of MMP-9 and -2 was not correlated with polyp grade and LM score. Allergic status is an independent factor in the expression of MMP-2 and -9. Conclusion These results suggested up-regulation of MMP-9, and MMP-2 in gland and surface epithelium, respectively, were characteristic of NPs. Therefore, patients with allergy will exhibit greater MMP-2 and -9 positivity. However, the MMP-2 and -9 expression intensity was not correlated with the severity of CRS with nasal polyposis.

Branchial cleft cyst as the initial impression of a metastatic thyroid papillary carcinoma: two case reports.

Branchial cleft cysts are the most common lesions in lateral neck cysts, predominantly occurring in the fourth decade of life and without sexual propensity. Rare branchial cleft cysts are associated with malignant tumors metastatic from the oral cavity, nasal cavity, pharynx or thyroid gland. Occult thyroid papillary carcinomas often present as a solid mass in the lateral neck, with only a few cases revealing a branchial cleft cyst as the initial manifestation. Herein, we report two cases of metastatic thyroid papillary carcinoma that presented as lateral neck cysts, with preoperative diagnosis of branchial cleft cyst. Finally, after complete surgical resection and histopathologic examination, one case was diagnosed as cystic change of metastatic lymph node from thyroid papillary carcinoma, and the other was determined to be a branchial cleft cyst with concurrent lymph node metastasis from thyroid papillary carcinoma. When a branchial cleft cyst is diagnosed by clinical or histopathologic examination, a metastatic thyroid papillary carcinoma should be considered as part of the differential diagnosis.