Minhui Zhu

Effect of duration of denervation on outcomes of ansa-recurrent laryngeal nerve reinnervation

To investigate the efficacy of laryngeal reinnervation with ansa cervicalis among unilateral vocal fold paralysis (UVFP) patients with different denervation durations.

Reinnervation of Bilateral Posterior Cricoarytenoid Muscles Using the Left Phrenic Nerve in Patients with Bilateral Vocal Fold Paralysis

Objective To evaluate the feasibility, effectiveness, and safety of reinnervation of the bilateral posterior cricoarytenoid (PCA) muscles using the left phrenic nerve in patients with bilateral vocal fold paralysis. Methods Forty-four patients with bilateral vocal fold paralysis who underwent reinnervation of the bilateral PCA muscles using the left phrenic nerve were enrolled in this study. Videostroboscopy, perceptual evaluation, acoustic analysis, maximum phonation time, pulmonary function testing, and laryngeal electromyography were performed preoperatively and postoperatively. Patients were followed-up for at least 1 year after surgery. Results Videostroboscopy showed that within 1 year after reinnervation, abductive movement could be observed in the left vocal folds of 87% of patients and the right vocal folds of 72% of patients. Abductive excursion on the left side was significantly larger than that on the right side (P < 0.05); most of the vocal function parameters were improved postoperatively compared with the preoperative parameters, albeit without a significant difference (P > 0.05). No patients developed immediate dyspnea after surgery, and the pulmonary function parameters recovered to normal reference value levels within 1 year. Postoperative laryngeal electromyography confirmed successful reinnervation of the bilateral PCA muscles. Eighty-seven percent of patients in this series were decannulated and did not show obvious dyspnea after physical activity. Those who were decannulated after subsequent arytenoidectomy were not included in calculating the success rate of decannulation. Conclusions Reinnervation of the bilateral PCA muscles using the left phrenic nerve can restore inspiratory vocal fold abduction to a physiologically satisfactory extent while preserving phonatory function at the preoperative level without evident morbidity.

Meta-Analysis of MMP2, MMP3, and MMP9 Promoter Polymorphisms and Head and Neck Cancer Risk

Background The 1306 C>T, 1171 5A>6A, and 1562C>T polymorphisms of matrix metalloproteinase (MMP) 2, MMP3, and MMP9 genes, respectively, have been found to be functional and may contribute to head and neck carcinogenesis. However, the results of case-control studies examining associations between MMP polymorphisms and head and neck cancer (HNC) risk remain inconclusive. Therefore, we performed a meta-analysis to further evaluate the role of these polymorphisms in HNC development. Methods We searched PubMed, ISI Web of Knowledge, MEDLINE, Embase, and Google Scholar to identify all published case-control studies of MMP2-1306 C>T, MMP3-1171 5A>6A, and MMP9-1562 C>T polymorphisms and HNC risk in the meta-analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to assess the association between these polymorphisms and HNC risk. Results Thirteen studies were included in this meta-analysis. For MMP2-1306 C>T polymorphism, significant associations were observed under three genetic models both in overall comparison and in a hospital-based subgroup, and in oral cavity cancer and nasopharyngeal cancer under dominant model as well. For MMP3-1171 5A>6A and MMP9-1562 C>T polymorphisms, no association was found in overall comparison; however, in subgroup analyses based on ethnicity and tumor site, significant associations were detected between the MMP3-1171 5A>6A polymorphism and HNC risk in a European population and pharyngeal/laryngeal cancer under two genetic contrasts. Conclusion This meta-analysis suggests that the MMP2-1306 C>T polymorphism is associated with HNC risk, as is the MMP3-1171 5A>6A polymorphism specifically in some subgroups. Further studies with larger sample sizes are warranted.

Association between MMP1 -1607 1G>2G polymorphism and head and neck cancer risk: a meta-analysis.

Background MMP1 is an important member of the MMP endopeptidase family that plays a critical role in the development of head and neck cancer (HNC). Several studies have investigated the association between the MMP1 -1607 1G>2G polymorphism and risk of HNC, but their results have been inconsistent. Here, we conducted a meta-analysis to further explore the role of the MMP1 -1607 1G>2G polymorphism in HNC development. Methods We identified all eligible studies in the electronic databases of PubMed, ISI Web of Knowledge, MEDLINE, Embase, and Google Scholar (from January 2000 to June 2012). A meta-analysis was performed to evaluate the association between the MMP1 -1607 1G>2G polymorphism and risk of HNC by calculating odds ratios (OR) and 95% confidence interval (CIs). Results Twelve studies were included in this meta-analysis. In overall comparison, significant associations were found using the recessive and allelic contrast models (OR, 1.38; 95% CI, 1.07–1.79 and OR, 1.27; 95% CI, 1.05–1.53, respectively), but no association was detected using the dominant model. In the stratified analyses by several variables, significant associations were observed using the recessive, dominant, and allelic contrast models in the Asian population (OR, 1.64; 95% CI, 1.29–2.08; OR, 1.39; 95% CI, 1.06–1.82; and OR, 1.41; 95% CI, 1.21–1.65, respectively), European population (OR, 0.58; 95% CI, 0.40–0.84; OR, 0.64; 95% CI, 0.44–0.92; and OR, 0.68; 95% CI, 0.54–0.85, respectively), and population-based subgroup (OR, 1.24; 95% CI,1.05–1.47; OR,1.48; 95% CI,1.04–2.12; and OR, 1.22; 95% CI, 1.07–1.38, respectively). Furthermore, significant associations were detected in oral cavity cancer and nasopharyngeal cancer under the recessive model. Conclusion Our results suggest that the MMP1 -1607 1G>2G polymorphism is associated with risk of HNC and that it plays different roles in Asian and European populations. Further studies with large sample size are needed to validate our findings.

Changes in sleep characteristics and airway obstruction in OSAHS patients with multi-level obstruction following simple UPPP, UPPP-GA, or UPPP-TBA: a prospective, single-center, parallel group study.

Objective: To investigate changes in S3 sleep and the apnea hypopnea index (AHI), SpO2 desaturation and CT90, and to determine changes in the degree of airway collapse and in the cross-sectional area of the retropalatal and lingual region in obstructive sleep apnea hypopnea syndrome patients. Method: All subjects underwent overnight polysomnography and were evaluated using Müllers test and magnetic resonance imaging at baseline, 3, and 12 months following surgery. Result: The mean S3 scores in patients receiving uvulopalatopharyngoplasty combined with genioglossus advancement (UPPP-GA) or UPPP combined with tongue base advancement using the Repose™ system (UPPP-TBA) noticeably increased. Marked improvement was seen in the mean AHI, LSO2, and CT90 scores 3 and 12 months following surgery compared to baseline. Airway collapsed by 25-50% in the greatest proportion undergoing surgery at the tongue base. Conclusion: UPPP-GA and UPPP-TBA more effectively improve S3 sleep, and mean AHI, LSO2, and CT90 scores. In addition, they effectively alleviate airway obstruction by improving the cross-sectional area of these regions.

Free flap combined with pectoralis major flap for reconstruction after total laryngopharyngectomy in patients with advanced hypopharyngeal carcinoma

Abstract Conclusion: The findings suggest that a pectoralis major flap combined with a free flap is a safe and reliable method of reconstruction after total pharyngolaryngectomy; with this technique, one can help these patients remain disease free, with normal swallowing function, for a relatively acceptable survival duration. Objectives: To determine the functional and oncological outcomes of a combined flap for the extensive defects after total pharyngolaryngectomy in patients with advanced squamous cell carcinoma of the hypopharynx (SCCHP). Method: This study determined the perioperative morbidity and functional and oncologic outcomes of 21 patients with advanced SCCHP who underwent total laryngopharyngectomy and reconstruction using a combination of a pectoralis major flap and a free flap. Results: The free flap and pectoralis major flap were used to reconstruct the defects for all 21 patients. Fourteen patients were reconstructed with jejunal free flaps and pectoralis major flaps; in the remaining seven patients, anterolateral thigh flaps and pectoralis major flaps were used. All the combined flaps worked well, and patients recovered normal swallowing function a mean 19.4 days after surgery. After an overall mean follow-up time of 31.3 months, 30% of patients were still alive at the time of this analysis, with no evidence of disease.

A Prospective Study of the Surgical Outcome of Simple Uvulopalatopharyngoplasty (UPPP), UPPP Combined With Genioglossus Advancement or Tongue Base Advancement for Obstructive Sleep Apnea Hypopnea Syndrome Patients With Multilevel Obstruction.

Objectives To investigate the surgical outcomes of different uvulopalatopharyngoplasty (UPPP). Methods All subjects underwent overnight polysomnography and were evaluated using the Epworth sleepiness scale (ESS), the Quebec sleep questionnaire and the snoring scale at the baseline and 3 and 12 months following operation. The primary endpoint was the overall effective rate representing the sum of the surgical success rate and effective rate. Results The overall effective rate at 12 months post surgery was 55.6% for simple UPPP, 95.8% for UPPP+GA, and 92.3% for UPPP+TBA. The surgical success rate at 3 and 12 months postoperation for UPPP+GA or UPPP+TBA was significantly higher than simple UPPP (P<0.05). Marked improvement was observed in all patients in the snoring scale score and the ESS score 3 and 12 months following surgery compared to the baseline (P<0.05 in all). Conclusion UPPP, UPPP+GA, and UPPP+TBA are all effective in improving the surgical outcome of obstructive sleep apnea hypopnea syndrome (OSAHS) patients with multilevel obstruction. UPPP+TBA appears to be the most effective in treating OSAHS patients.

Characterization of Upper Airway Obstruction by Fiber-Optic Nasolaryngoscopy and MRI in Preoperative OSAHS Patients

Objective: To investigate changes in the upper airway and its surrounding soft tissue and to characterize the extent and severity of upper airway obstruction in 136 obstructive sleep apnea/hypopnea syndrome (OSAHS) patients who were awake. Methods: OSAHS patients and healthy controls were evaluated by fiber-optic nasolaryngoscopy and MRI. The cross-sectional area and pharyngeal wall thickness of the retropalatal, retroglossal and epiglottic region were determined. Results: Ninety-five percent of the mild OSAHS subjects had single-plane obstruction (vs. severe OSAHS, p < 0.05), 5.0% of the mild OSAHS subjects had two-plane obstruction (p < 0.05) and none of them had three-plane obstruction (p < 0.05). The cross-sectional area of the retropalatal, retroglossal and epiglottic region progressively declined as the severity of OSAHS increased (severe OSAHS vs. controls, p < 0.05). The lateral pharyngeal wall was significantly thicker in OSAHS subjects than in healthy controls (p < 0.05). The cross-sectional area of the soft palate in moderate and severe OSAHS subjects was markedly larger than that of the healthy controls (p < 0.05) and positively correlated with the apnea/hypopnea index (p < 0.05). Conclusion: Moderate and severe OSAHS patients exhibit multi-plane obstruction of the upper airway, particularly in the retropalatal and retroglossal region. The severity of OSAHS negatively correlates with the thickness, length and cross-sectional area size of the soft palate.

Self-targeted salinomycin-loaded DSPE-PEG-methotrexate nanomicelles for targeting both head and neck squamous cell carcinoma cancer cells and cancer stem cells.

AIM To target both head and neck squamous cell carcinoma (HNSCC) cells and cancer stem cells (CSCs) by salinomycin-loaded DSPE-PEG-MTX (synthesized using DSPE-PEG2000-NH2 and methotrexate) nanomicelles (M-SAL-MTX). MATERIALS & METHODS The characterization, antitumor activity and mechanism of M-SAL-MTX were evaluated. RESULTS & CONCLUSION M-SAL-MTX showed enhanced inhibitory effect toward both HNSCC CSCs and non-CSCs compared with a single treatment of methotrexate and salinomycin. In nude mice-bearing HNSCC xenografts, M-SAL-MTX suppressed tumor growth more effectively than other controls including combination of methotrexate and salinomycin. Therefore, M-SAL-MTX may provide a strategy for treating HNSCC by targeting both HNSCC CSCs and HNSCC cells.

Organ preservation surgery for patients with T4a laryngeal cancer

PurposeSurgical preservation of laryngeal function is very challenging in patients with advanced SCCL, especially those of stage T4a. The purpose of this study was to assess the feasibility of organ preservation surgery for patients with T4a squamous cell carcinoma of the larynx (SCCL).MethodsWe enrolled 32 patients with T4a SCCL and performed organ preservation surgery on them. Surgical details and perioperative morbidity were described, functional and oncologic outcomes were also evaluated.ResultsAll patients underwent supracricoid subtotal laryngectomy with unilateral or bilateral neck dissection, restoring laryngeal function via direct anastomosis of the cricoid cartilage and tongue base. The patients recovered well and exhibited relatively acceptable survival duration, with a 5-year overall survival rate of 62.5%. Most patients commenced oral intake within 2 weeks, and aspiration was commonly observed. Subjective functional outcomes indicated a relatively acceptable swallowing function and voice quality.ConclusionOur retrospective analysis of 32 patients with T4a SCCL showed that successful organ preservation surgery is safe and reliable, and associated with a relatively acceptable disease-free survival, normal swallowing function, and acceptable voice quality. More patients with T4a SCCL who wish to preserve the larynx should be considered for organ preservation surgery.