Wan‐Ni Lin

Analysis of acinic cell carcinoma of the parotid gland - 15 years experience

Abstract Conclusion: In our experience, the prognosis for parotid gland acinic cell carcinoma (AciCC) is good. Surgery alone would be sufficient in early-stage tumor. Postoperative adjuvant treatment in advanced-stage patients or those with positive resection margins usually gives satisfactory control of the disease. Objectives: AciCC is a rare tumor in parotid gland malignancy. The aim of this study was to retrospectively analyze the experience in our hospital in treating this malignancy. Methods: Twenty-five patients with AciCC diagnosed from 1983 to 2007 at the Chang Gung Memorial Hospital were retrospectively reviewed. Results: Thirteen male and 12 female patients ranged in age from 16 to 84 years (mean 37.5 years) at the time of diagnosis. Most patients (92%) presented with symptoms of infra-auricular mass. The tumor stage distributions of the patients were 24%, 44%, 28%, and 4% for stages I, II, III, and IV, respectively. Thirteen patients underwent superficial parotidectomy and 12 patients underwent total parotidectomy. Four patients had positive resection margins. Ten patients had surgery and postoperative radiotherapy; one received surgery and postoperative chemo/radiotherapy. The 10-year disease-free and overall actuarial survivals were both 84% in a mean follow-up of 75.8 months.

Laryngoscopic characteristics in vocal leukoplakia: Inter-rater reliability and correlation with histology grading

Vocal cord leukoplakia is a clinical diagnosis that comprises a spectrum of benignities, premalignancies, and malignancies. Accurate recordings of the visual characteristics of the affected area are important for communication between physicians and are helpful in further management. The objective of this study was to determine the laryngoscopic characteristics among patients with vocal cord leukoplakia and the reliability of examinations between different raters.

Obstructive sleep apnea syndrome in an adolescent girl with hypertrophic lingual thyroid

We present a 14‐year‐old girl whose initial diagnosis was obstructive sleep apnea syndrome (OSAS) with symptoms of habitual snore, sleep breath holding, shortness of breath, and lump in throat. Lingual thyroid was diagnosed by thyroid scan and histology, and was treated by radioactive iodine therapy and endoscopic carbon dioxide laser therapy. Her OSAS completely subsided after lingual thyroid surgery. Physicians should be aware of rare causes of OSAS in children, such as lingual thyroid and certainly if accompanied by difficulties in swallowing and speech problems. Pediatr Pulmonol. 2009; 44:93–95.

Role of flexible transnasal esophagoscopy and patient education in the management of globus pharyngeus

BACKGROUND/PURPOSE Globus pharyngeus and dysphagia are common complaints of patients referred to ear, nose, and throat (ENT) clinics. We aimed to establish an efficient method to rule out the presence of malignancy in patients with globus pharyngeus and dysphagia. METHODS The use of flexible transnasal esophagoscopy (TNE) was evaluated in 30 patients with globus pharyngeus and 6 patients with dysphagia. The patients were immediately informed of the findings on TNE examination, and then treatments were planned. All patients were treated with lansoprazole for 2 weeks and provided education on lifestyle changes at the initial examination and at the 3-month follow-up. RESULTS The patients reported an improvement in symptoms of globus pharyngeus after treatment (p<0.001). Follow-up TNE confirmed improvement with less dysphagia, erythema, and vocal cord edema evident (all p<0.001). CONCLUSION The use of TNE and patient education are efficient management strategies for patients with symptoms of globus pharyngeus and dysphagia.

Reliability of office-based narrow-band imaging–guided flexible laryngoscopic tissue samplings

Direct suspension laryngoscopic biopsy performed under general anesthesia is the conventional management for obtaining pathological diagnosis for neoplasms of the larynx, oropharynx, and hypopharynx. Since the development of distal chip laryngoscopy and digital imaging systems, transnasal flexible laryngoscopy tissue sampling has gained popularity as an office‐based procedure. Additional assessment with narrow‐band imaging (NBI) can help to increase the diagnostic yield. The aim of the study was to evaluate the accuracy, sensitivity, and specificity of a novel diagnostic tool: office‐based NBI (OB‐NBI) flexible laryngoscopic tissue sampling.

Classification of vocal fold leukoplakia by clinical scoring.

Vocal cord leukoplakia comprises a variety of lesions. The purpose of this study was to stratify vocal leukoplakias before surgery.

Transverse Retropalatal Collapsibility Is Associated with Obstructive Sleep Apnea Severity and Outcome of Relocation Pharyngoplasty

Objective The aim of this study was to investigate whether the retropalatal airway shape and collapsibility defined by awake nasopharyngoscopy with Müller’s maneuver were associated with apnea-hypopnea index (AHI), positional dependency, and surgical outcome of relocation pharyngoplasty in patients with obstructive sleep apnea. Study Design Case series with planned data collection. Setting Tertiary referral center. Subjects and Methods A total of 45 obstructive sleep apnea patients were included who underwent conservative treatment (n = 13) or relocation pharyngoplasty (n = 32), and their baseline and postoperative polysomnographies and awake nasopharyngoscopies with Müller’s maneuver were reviewed. Shape ratio (transverse diameter [TD] / longitudinal diameter [LD]) in the stationary and Müller’s phases and collapsibility (ColTD and ColLD) of the airway at the level of the uvular base were measured with a picture archiving and communication system. Intra- and interrater reliabilities were assessed. Associations among nasopharyngoscopic measurements, AHI, positional dependency, and surgical success (defined as a reduction of AHI ≥50% and a postoperative AHI ≤20/h) were statistically analyzed. Results Reliability tests indicated substantial agreements of all nasopharyngoscopic measurements between raters and within raters. A higher baseline ColTD was significantly associated with an elevated AHI (r = 0.49, P = .001), whereas a lower postoperative ColTD was significantly related to surgical success (r = −0.38, P = .034). Nasopharyngoscopic findings were not statistically significantly correlated with positional dependency. Conclusion Transverse retropalatal collapsibility measured by awake nasopharyngoscopy with Müller’s maneuver helps to predict individuals with moderate to severe sleep apnea and surgical outcome.

Quantitative laryngeal electromyography assessment of cricothyroid function in patients with unilateral vocal fold paralysis.

Determination of superior laryngeal nerve (SLN) involvement in addition to recurrent laryngeal nerve (RLN) paralysis in patients with unilateral vocal fold paralysis (UVFP) relies on traditional, qualitative laryngeal electromyography (LEMG) examination. It is necessary to develop a quantitative measurement that reflects the degree of denervation of the cricothyroid (CT) muscle. The present study aimed to establish a standard quantitative assessment of CT function in patients with UVFP by measuring the turn frequency.

Dynamic Drug-Induced Sleep Computed Tomography in Adults With Obstructive Sleep Apnea

Surgical success for obstructive sleep apnea (OSA) depends on identifying sites of obstruction in the upper airway. In this study, we investigated sites of obstruction by evaluating dynamic changes in the upper airway using drug-induced sleep computed tomography (DI-SCT) in patients with OSA. Thirty-five adult patients with OSA were prospectively enrolled. Sleep was induced with propofol under light sedation (bispectral index 70–75), and low-dose 320-detector row CT was performed for 10 seconds over a span of 2–3 respiratory cycles with supporting a continuous positive airway pressure model. Most (89%) of the patients had multi-level obstructions. Total obstruction most commonly occurred in the velum (86%), followed by the tongue (57%), oropharyngeal lateral wall (49%), and epiglottis (26%). There were two types of anterior-posterior obstruction of the soft palate, uvular (94%) and velar (6%), and three types of tongue obstruction, upper (30%), lower (37%), and upper plus lower obstruction (33%). DI-SCT is a fast and safe tool to identify simulated sleep airway obstruction in patients with OSA. It provides data on dynamic airway movement in the sagittal view which can be used to differentiate palate and tongue obstructions, and this can be helpful when planning surgery for patients with OSA.

Drug-Induced Sleep Computed Tomography–Directed Upper Airway Surgery for Obstructive Sleep Apnea: A Pilot Study

Objective A surgical response to upper airway (UA) surgery for obstructive sleep apnea (OSA) depends on adequate correction of collapsible sites in the UA. This pilot study aimed to examine the surgical response to UA surgery directed by drug-induced sleep computed tomography (DI-SCT) for OSA. Study Design Prospective case series. Setting Tertiary referral center. Subjects and Methods This study recruited 29 OSA patients (median age, 41 years; median body mass index, 26.9 kg/m2) who underwent single-stage DI-SCT-directed UA surgery between October 2012 and September 2014. DI-SCT was performed with propofol for light sedation with a bispectral monitor before and after UA surgery. Nonresponders were defined as those with a reduction in apnea-hypopnea index <50% after 6 months following UA surgery. Results DI-SCT showed that 28 (97%) patients had collapses at multiple sites, all of whom underwent multilevel UA surgery accordingly. The apnea-hypopnea index decreased from 53.6 to 26.8 (P < .001). There were 18 (62%) nonresponders and 11 (38%) responders. Multiple-site collapses could not predict surgical response (P > .99). The nonresponders had significant improvements in velopharyngeal, oropharyngeal lateral wall, and tongue collapses (all P < .05), whereas the responders had significant improvements in velopharyngeal and oropharyngeal lateral wall collapses (both P ≤ .05). Conclusion Despite multilevel OSA surgery, residual UA obstruction in nonresponders likely occurs due to multiple mechanisms. DI-SCT may help to elucidate the reasons for a nonresponse.