Tuan-Jen Fang

Same-stage palatopharyngeal and hypopharyngeal surgery for severe obstructive sleep apnea

Objectives To investigate surgical outcomes with two types of combined palatopharyngeal and hypopharyngeal surgery for the treatment of severe obstructive sleep apnea (OSA). Material and methods Twelve consecutive OSA patients with a respiratory disturbance index (RDI) >30/h and Fujita type II anatomy were enrolled. Patients were divided into two groups according to their fiberscopic manifestations. Six patients with obstruction at the uvulopalatal complex and tongue base (Group 1) were selected for extended uvulopalatal flap (EUPF) and midline laser glossectomy (MLG). EUPF and laser lingual tonsillectomy were performed in another six patients shown to have obstruction at the uvulopalatal complex and lingual tonsil (Group 2). Polysomnographic parameters included the RDI and minimal oxygen saturation (MSAT). Surgical success was defined as a postoperative RDI of <20/h and a >50% reduction in the preoperative RDI. Results Six months postoperatively, 5 patients (83.3%) had responded successfully in Group 1 and none in Group 2. In Group 1 the mean RDI decreased from 50.7±12.6 to 8±14.3 (95% CI 23.0−62.7; p<0.01) and MSAT increased from 76.3%±11.6% to 88.8%±3.2% (95% CI −25.9–0.87; p=0.06). There was no improvement in sleep parameters in Group 2 patients. No persistent nasal regurgitation, swallowing disturbance or change in taste was noted at 1-year follow-up in either group. Conclusions EUPF combined with MLG improves OSA in Fujita type II patients. The hypertrophic lingual tonsil, although obscure the laryngeal structure, did not contribute significantly to OSA.

High Incidence of Malignant Transformation of Laryngeal Papilloma in Taiwan

Objectives: Papillomas of the larynx include solitary laryngeal papilloma and recurrent respiratory papillomatosis. This study investigated the incidence of malignant transformation and assessed possible risk factors for laryngeal papillomas.

Nasal Surgery for Snoring in Patients With Obstructive Sleep Apnea

Objective: To evaluate the efficacy of nasal surgery to relieve snoring and to identify predictive factors.

Patients with severe obstructive sleep apnea syndrome and elevated high-sensitivity C-reactive protein need priority treatment.

Objective: To evaluate the clinical factors predicting the significantly elevated high-sensitivity C-reactive protein (hs-CRP) concentrations, defined herein as hs-CRP ≥ 3 mg/L, in adult males with untreated obstructive sleep apnea syndrome (OSAS). Study Design: Cross-sectional study. Setting: Tertiary referral center. Subjects and Methods: Sixty-five consecutive male patients with newly diagnosed OSAS were enrolled to receive complete medical history review, physical examination, in-laboratory overnight polysomnography, and hs-CRP test. The patients had no current or history of cardiovascular disease. The patients had a mean age of 38.2 ± 9.9 years, body mass index (BMI) of 27.4 ± 3.5 kg/m2, and Epworth Sleepiness Scale (ESS) of 11.3 ± 4.6. The serum levels of hs-CRP were assessed using peripheral venous blood samples. Results: Twenty-three percent of the overall patients had significantly elevated serum levels of hs-CRP. The increase of hs-CRP correlated fairly with BMI, apnea-hypopnea index (AHI), tonsil size, and ESS (r = 0.450, 0.398, 0.393, and 0.300, respectively; all P ≤ 0.05) after adjustment for conventional coronary heart disease risk factors. However, only the AHI could predict for significantly elevated hs-CRP after stepwise multiple linear regression (R 2 = 0.251, P < 0.001). Conclusion: Patients in this study with hs-CRP ≥ 3 mg/L were more prevalent in the severe OSAS group. This observation suggests that the severe OSAS patients need to have their cardiovascular statuses evaluated by use of an hs-CRP screening test.

Energy types of snoring sounds in patients with obstructive sleep apnea syndrome: a preliminary observation.

Background Annoying snore is the principle symptom and problem in obstructive sleep apnea syndrome (OSAS). However, investigation has been hampered by the complex snoring sound analyses. Objective This study was aimed to investigate the energy types of the full-night snoring sounds in patients with OSAS. Patients and Method Twenty male OSAS patients underwent snoring sound recording throughout 6 hours of in-lab overnight polysomnogragphy. Snoring sounds were processed and analyzed by a new sound analytic program, named as Snore Map®. We transformed the 6-hour snoring sound power spectra into the energy spectrum and classified it as snore map type 1 (monosyllabic low-frequency snore), type 2 (duplex low-&mid-frequency snore), type 3 (duplex low- & high-frequency snore), and type 4 (triplex low-, mid-, & high-frequency snore). The interrator and test-retest reliabilities of snore map typing were assessed. The snore map types and their associations among demographic data, subjective snoring questionnaires, and polysomnographic parameters were explored. Results The interrator reliability of snore map typing were almost perfect (κu200a=u200a0.87) and the test-retest reliability was high (ru200a=u200a0.71). The snore map type was proportional to the body mass index (ru200a=u200a0.63, Pu200a=u200a0.003) and neck circumference (ru200a=u200a0.52, Pu200a=u200a0.018). Snore map types were unrelated to subjective snoring questionnaire scores (All P>0.05). After adjustment for body mass index and neck circumference, snore map type 3–4 was significantly associated with severity of OSAS (ru200a=u200a0.52, Pu200a=u200a0.026). Conclusions Snore map typing of a full-night energy spectrum is feasible and reliable. The presence of a higher snore map type is a warning sign of severe OSAS and indicated priority OSAS management. Future studies are warranted to evaluate whether snore map type can be used to discriminate OSAS from primary snoring and whether it is affected by OSAS management.

Increasing rates of low-risk human papillomavirus infections in patients with oral cavity squamous cell carcinoma: Association with clinical outcomes

BACKGROUNDnAlthough human papillomavirus (HPV) infections have been causally linked to oral cavity squamous cell carcinoma (OSCC), the potential role of low-risk HPV (LR-HPV) types in the pathogenesis of this malignancy remains unclear.nnnOBJECTIVESnWe sought to investigate the distribution of HPV genotypes and their prognostic significance in OSCC patients treated by radical surgery, either with or without adjuvant therapy.nnnSTUDY DESIGNnWe studied two non-overlapping OSCC cohorts for the periods 2005-2006 (2005 cohort, n = 204) and 2010-2011 (2010 cohort, n = 206). Paraffin-embedded tissue blocks were collected, and the HPV genotype was determined using PCR plus HPV blot tests. The primary study endpoint was the prevalence of HPV genotypes. The secondary endpoints were the 2-year therapeutic outcomes.nnnRESULTSnThe overall prevalence of HPV infections did not differ significantly in the two study cohorts. However, the prevalence of LR-HPV was significantly higher in the 2010 cohort than in the 2005 cohort (p = 0.002). The overall prevalence of HPV infections was not significantly associated with the 2-year outcomes. However, multivariate analysis demonstrated that LR-HPV infection was a predictor of poor 2-year disease-free survival (p = 0.036, hazard ratio [HR] = 3.1), disease-specific survival (p = 0.014, HR = 3.8), and overall survival (p = 0.016, HR = 3.2) in the subgroups of OSCC patients with poor differentiation, pN2 lymph node metastases, or extracapsular spread (n = 150).nnnCONCLUSIONSnLR-HPV infections may have an important role in determining the clinical outcomes of certain OSCC patients bearing specific risk factors.

A Comparison of the Long‐Term Outcome and Effects of Surgery or Continuous Positive Airway Pressure on Patients with Obstructive Sleep Apnea Syndrome

Objectives: To compare the long‐term (3‐year) outcome and effects of continuous positive airway pressure (CPAP) and extended uvulopalatoplasty (EUPF) treatment on patients with obstructive sleep apnea syndrome.

Association between multidisciplinary team care approach and survival rates in patients with oral cavity squamous cell carcinoma

The purpose of this study was to investigate whether multidisciplinary team care (MDTC) is associated with outcomes in oral cavity squamous cell carcinoma (SCC).

Transoral laser microsurgery elevates fundamental frequency in early glottic cancer.

OBJECTIVEnTo evaluate the long-term voice characteristics and quality of life of early glottic cancer patients after definitive treatment.nnnSTUDY DESIGNnCase series with chart review in a tertiary care medical center in Taiwan.nnnMETHODSnForty-two consecutive patients who received radiation therapy (RT) or transoral laser microsurgery (TLM) for early glottic cancer over 12 months were evaluated for voice laboratory data and quality-of-life measurements.nnnRESULTSnTwenty-four patients received RT, and 18 underwent TLM. There was no difference between the two groups on acoustic and aerodynamic voice measures except for modal fundamental frequency in males. In the Functional Assessment of Cancer Therapy-Head and Neck survey, the TLM group had better communication than the RT group, but there were no differences in voice quality and strength. There was also no significant difference in the Voice Handicap Index 10 evaluation.nnnCONCLUSIONSnMale patients who received TLM have higher modal fundamental frequency than male patients who received RT and norms. Voice-related life quality is similar in patients regardless of RT or TLM treatment for early glottic cancer, but those who receive TLM have better communication abilities than those who receive RT.

Evaluation of velopharyngeal function after relocation pharyngoplasty for obstructive sleep apnea

To assess if relocation pharyngoplasty (RP) causes velopharyngeal dysfunction in patients with obstructive sleep apnea (OSA) by evaluating perioperative nasalance, nasality, voice, and articulation.