So-Yoon Lee

Robot-Assisted Selective Neck Dissection via Modified Face-lift Approach for Early Oral Tongue Cancer: A Video Demonstration

Recently, early-stage oral cavity cancers are successfully resected via a transoral approach. Nodal metastasis is a crucial factor in determining the survival of oral cavity cancer patients. However, elective neck dissection in earlystage oral cavity cancers is a still controversial procedure. In recent period, in an attempt to hide the cervical scars, robotic modified neck dissection via a transaxillary approach has been introduced by Kang et al. in thyroid cancer with neck metastasis. However, there are limitations to dissect the upper neck level including level I via transaxillary approach. Therefore, we demonstrate our novel technique for robot-assisted neck dissection (RAND) for level I, II, and III via modified face-lift approach (MFLA) and show the pitfalls of the operation, as well as tips for its successful completion.

The Extended Indication of Parotidectomy Using the Modified Facelift Incision in Benign Lesions: Retrospective Analysis of a Single Institution

BackgroundRecently, the modified facelift incision (FLI) has gained increasing popularity for its cosmetic benefits in parotidectomy. However, many surgeons remain concerned with the adequacy of the exposure and are unwilling to use the FLI for anterior or superior tumors of the parotid gland because these tumors are closer to the superficially positioned facial nerve branch. To evaluate the changing trends in parotidectomy incisions for benign lesions at a single institute, and to compare the surgical outcomes between the modified Blair incision (BI) and FLI, and determine the adequacy and possible indications or limitations of the FLI, especially for tumors located in the anterior or superior parotid gland.Materials and methodsRetrospective study analyzed 357 patients who had various benign parotid diseases and underwent parotidectomy at Severance Hospital between January 2005 and December 2009. Revisions or recurrences and histologically confirmed malignancies were excluded. Tumor location was divided into superficial and deep lobes. The superficial lobe was subdivided into anterior, superior, inferior, and middle portions. Patients’ profiles, surgical outcomes, and cosmetic satisfaction score on a scale of 0 (extremely dissatisfied) to 10 (extremely satisfied) were compared.ResultsIn all, 344 patients underwent BI or FLI. The FLI was performed increasingly each year. For anterior (n = 58) or superior tumors (n = 32), there was no significant difference between the type of incision and tumor size or complications. No facial nerve palsy occurred in either group. For deep-lobe tumors (n = 67), the mean tumor size was significantly larger in the BI group (p = 0.025). There was a significant difference between facial nerve palsy and tumor size (p < 0.001) but no significant difference between facial nerve palsy and tumor location (p = 0.145) or the type of incision (p = 0.530). The mean scar satisfaction score was significantly higher in the FLI group (p <0.001). There was a positive correlation between the scar and deep hollow satisfaction score (Pearson coefficient of correlation = 0.547; p < 0.001)ConclusionsThe modified facelift incision is feasible for most benign parotid lesions regardless of tumor location, even for anterior or superior tumors. Using the modified facelift incision may be extended with a surgeon’s accumulated experience, but for a large deep-lobe tumor, the modified Blair incision is still considered useful.

Nineteen‐year oncologic outcomes and the benefit of elective neck dissection in salivary gland adenoid cystic carcinoma

The purposes of this study were to evaluate the oncologic outcomes of salivary gland adenoid cystic carcinoma (ACC) and to confirm the benefits of elective neck dissection.

The Effects of Alcohol Abstinence on BDNF, Ghrelin, and Leptin Secretions in Alcohol‐Dependent Patients with Glucose Intolerance

BACKGROUND Alcohol use affecting the risk of type 2 diabetes mellitus (T2DM) is poorly identified as well as the role of brain-derived neurotrophic factor (BDNF), ghrelin, and leptin in alcohol dependence with T2DM. We tested the hypothesis that alcohol abstinence affects diabetes-related factors and BDNF, ghrelin, and leptin secretions in alcohol-dependent patients with glucose intolerance. METHODS A total of 64 male alcohol-dependent patients were classified into normal glucose tolerance (NGT), pre-diabetes mellitus (pre-DM), and diabetes mellitus (DM) groups according to a 75-g oral glucose tolerance test (OGTT). All participants got alcohol dependence rehabilitation treatment for 30 days, and then we compared changes in BDNF, ghrelin, and leptin between pre- and post-alcohol abstinence. RESULTS After alcohol abstinence, both pre-DM and DM groups had significantly decreased levels of fasting glucose. All 3 groups exhibited elevated ghrelin levels and reduced leptin levels, but BDNF levels were significantly increased only in the pre-DM group. The pre-DM group had large increases in BDNF and ghrelin levels compared with those of the NGT group. Moreover, decreases in homeostasis model assessment of insulin resistance (HOMA-IR), fasting glucose, and leptin levels in the DM group were larger than those in the NGT group. CONCLUSIONS Alcohol abstinence might influence diabetes-related factors of alcohol-dependent patients with glucose intolerance. Further, BDNF, ghrelin, and leptin differently affect this improvement, depending on the stage of DM. In the pre-DM group, elevated BDNF and ghrelin levels are likely to influence insulin sensitivity, insulin resistance, and fasting glucose levels. Further, reduced leptin levels after abstinence might be related to improved glucose kinetics in patients with diabetes.

Valence and spin states in delafossite AgNiO2 and the frustrated Jahn-Teller system ANiO2 "A=Li,Na…

Electronic structures of delafossite oxides AgNi1�xCoxO2 and the frustrated Jahn-Teller JT system ANiO2 A =L i,N a have been investigated by employing soft x-ray absorption spectroscopy and photoemission spectroscopy PES. It is found that Ni ions are in the Ni 2+ -Ni 3+ mixed-valent states and that the low-spin LS Ni 3+ component increases from LiNiO2 to AgNiO2 and NaNiO2, in agreement with the presence of the JT transition in NaNiO2 and the absence of the JT transition in LiNiO2 and AgNiO2 .I n AgNi 1�xCoxO2, the Ni 3+ component increases with x, while Co ions are in the LS Co 3+ states for all x, which is consistent with the metallic nature for low values of x. A good agreement is found between the measured PES spectra and the calculated local spin density approximation LSDA electronic structures of AgNiO2 and AgCoO2, but the pseudogap feature in PES of AgNiO2 is not described by the LSDA.

Photoemission, soft x-ray absorption, and magnetic circular dichroism spectroscopy study of Fe1−xCuxCr2S4 (0.1≤x≤0.5) spinel sulfides

The electronic and magnetic structures of Fe1−xCuxCr2S4 (0.1≤x≤0.5) spinel sulfides have been investigated systematically by performing photoemission spectroscopy (PES), soft x-ray absorption spectroscopy (XAS), and soft x-ray magnetic circular dichroism (XMCD) measurements using synchrotron radiation. Cr and Cu ions are found to be nearly trivalent (Cr3+) and monovalent (Cu+), respectively, and their valence states do not change with x. The Fe 2p XAS spectra of Fe1−xCuxCr2S4 are very similar to that of Fe metal, indicating that the Fe 3d electrons are strongly hybridized to other valence electrons. The Fe and Cr 2p XMCD spectra show that the magnetic moments of Cr ions and Fe ions are aligned antiparallel to each other and that both the Cr and Fe magnetic moments increase with increasing x. The valence-band PES study reveals that the Cr3+ () 3d states are located at ~1.5 eV below EF. The occupied Fe 3d states consist of the broad states, the states at ~4 eV below EF, and the states very close to EF. The filled Cu 3d10 states lie at ~2.5 eV below EF. This study suggests that the hybridized Fe and S 3p states near EF play an important role in determining the transport properties of Fe1−xCuxCr2S4 for x≤0.5.

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.

Analysis of Dysphagia Patterns Using a Modified Barium Swallowing Test Following Treatment of Head and Neck Cancer.

Purpose The purposes of this study were to evaluate specific dysphagia patterns and to identify the factors affecting dysphagia, especially aspiration, following treatment of head and neck cancer. Materials and Methods A retrospective analysis of 57 patients was performed. Dysphagia was evaluated using a modified barium swallow (MBS) test. The MBS results were rated on the 8-point penetration-aspiration scale (PAS) and swallowing performance status (SPS) score. Results Reduced base of the tongue (BOT) retraction (64.9%), reduced laryngeal elevation (57.9%), and cricopharyngeus (CP) dysfunction (47.4%) were found. Reduced BOT retraction was correlated with clinical stage (p=0.011) and treatment modality (p=0.001). Aspiration in 42.1% and penetration in 33.3% of patients were observed. Twenty-four patients had PAS values over 6, implying aspiration. Forty-one patients had a SPS score of more than 3, 25 patients had a score greater than 5, and 13 patients had a SPS score of more than 7. Aspiration was found more often in patients with penetration (p=0.002) and in older patients (p=0.026). In older patients, abnormal swallowing caused aspiration even in those with a SPS score of more than 3, irrespective of stage or treatment, contrary to younger patients. Tube feeders (n=20) exhibited older age (65.0%), dysphagia/aspiration related structures (DARS) primaries (75.0%), higher stage disease (66.7%), and a history of radiotherapy (68.8%). Conclusion Reduced BOT retraction was the most common dysphagia pattern and was correlated with clinical stage and treatment regimens including radiotherapy. Aspiration was more frequent in patients who had penetration and in older patients. In contrast to younger patients, older patients showed greater risk of aspiration even with a single abnormal swallowing irrespective of stage or treatment.

Valence values of the cations in selenospinel Cu(Cr,Ti)2Se4

A long-standing issue about the Cu valency in selenospinel CuCr2Se4 was investigated by soft X-ray absorption spectroscopy (XAS) and magnetic circular dichroism (XMCD). Using the sensitivity of XAS and XMCD to the valence value of transition metal ion and its local symmetry, we checked the valence value of each cation in selenospinel CuCrxTi 2−xSe4 (x = 1.0, 1.1, 1.5, and 2.0) and obtained spectroscopic evidence that a small amount of the Cu cation changes the valency from Cu(I) to Cu(II) as the Cr concentration increases from 1.0 to 2.0. Dependence of the Cu(II) concentration and the mean field magnetic exchange energy on the Cr concentration suggests the Cu d-hole could play a crucial role in the intriguing magnetic/electrical properties of CuCr2Se4.

Characteristics, management of the neck, and oncological outcomes of malignant minor salivary gland tumours in the oral and sinonasal regions

The aim of this study was to evaluate the characteristics of malignant tumours of the minor salivary glands in the oral and sinonasal regions, to make sure that the neck was managed correctly, and to identify oncological outcomes, retrospectively, at a single hospital. A total of 60 patients were reviewed. Forty-nine patients had intraoral lesions and 11 had sinonasal lesions. Of the 60 patients, 28 had stage I to II malignant tumours, and 32 had stage III to IV tumours. Treatment was almost exclusively surgical. One of the 16 patients whose nodes were clinically clear had an elective neck dissection. Adjuvant radiotherapy was given if indicated. The mean follow-up period was 52 months (range 13-190). Sinonasal lesions were all advanced T-stage at diagnosis, had more invaded resection margins, and a higher local recurrence rate than intraoral lesions. There was no regional recurrence in those patients whose nodes were clinically invaded and who had therapeutic neck dissection, or in the patient whose nodes were clinically clear and who had an elective neck dissection. Occult metastases developed exclusively in adenoid cystic carcinomas (ACC), the rate of which was 4/16. Regional recurrence developed in 4 patients who had never had elective treatment to the neck 2 of whom mixed pattern ACC and 2 who had low grade mucoepidermoid carcinomas (MEC). The overall survival was 90% at 2 years, 77% at 5 years, and 74% at 10 years. Sinonasal minor salivary gland tumours require careful follow-up because resection margins are more likely to be invaded by tumour, and they have a higher local recurrence rate than intraoral lesions. Elective neck dissection is needed, particularly for MEC and also to prevent regional recurrence in ACC.