Yen-Bin Hsu

Second Primary Malignancies in Squamous Cell Carcinomas of the Tongue and Larynx: An Analysis of Incidence, Pattern, and Outcome

Background: Head and neck cancer patients have a higher risk of developing a second primary malignancy (SPM) than the general population. This study was conducted to identify the characteristics of SPM and its impact on survival in patients with squamous cell carcinoma of the tongue (TSCC) and larynx (LSCC). Methods: A retrospective study was conducted of 538 patients who were treated by surgery primarily for TSCC (n = 146) and LSCC (n = 392) from 1990 to 2000. The incidence, site, and overall survival of SPMs were evaluated. Results: Seventy‐seven patients developed SPM during the follow‐up period (median, 73 months), including 18 (12%) with TSCC and 59 (15%) with LSCC. Fifty‐six percent of SPMs of the TSCC group appeared in the oral cavity. Among the SPMs of LSCC patients, 54% developed in the lung (31%) and larynx (24%). The 5‐year overall survival after the diagnosis of SPM in the head and neck was 39%, compared to 29% for SPM in other areas (p = 0.010). Conclusion: SPMs after treatment of TSCC and LSCC are similar in incidence but distinct in pattern. SPMs within the head and neck are associated with a better prognosis than those outside this area.

Induction of apoptosis by high-dose gold nanoparticles in nasopharyngeal carcinoma cells

OBJECTIVE Nasopharyngeal carcinoma (NPC) is a rare malignancy in most parts of the world, but is a common cancer in southern Asia. Local recurrent disease and distant metastasis of NPC are still the unsolved problems. Recently, gold nanoparticles (AuNPs) have been developed as potential in vivo diagnostic and therapeutic agents. However, their role on nasopharyngeal cancer remains unknown. The object of this study is to investigate if AuNPs can be used as a new therapeutic agent for NPC by evaluating their anti-tumor effect in vitro. METHODS The AuNPs were prepared by the reduction of chloroauric acid to neutral gold. Their size distribution and microstructures were characterized by transmission electron microscopy (TEM). To evaluate their cytotoxic effect, NPC cell line TW01 and Human Nasal Epithelial Cells (HNEpC) were cultured in various concentrations of AuNPs for 3 days. Cell viability was evaluated by Trypan Blue viability assay while morphologic findings were observed via light microscopy. Terminal deoxynucleotidyltransferase-mediated dUPT nick end labeling (TUNEL) assay was used to detect apoptosis. RESULTS AuNPs prepared in this study had an average diameter of 20.5nm and they were observed under light microscopy as dark material aggregated in the cells after treatment. Contrary to the HNEpC, the AuNPs reduced cell viability of NPC cell in a concentration-dependant manner by Trypan Blue assay, especially at high concentration. Besides, cell apoptosis was demonstrated by positive TUNEL assay. CONCLUSIONS The AuNP possesses specific imaging properties and is cytotoxic to NPC cells at high concentrations.

Longitudinal analysis of voice quality in patients with early glottic cancer after transoral laser microsurgery

We conducted longitudinal voice evaluations in patients with early glottic cancer who underwent transoral laser microsurgery (TLM) to determine the time to stability.

Percutaneous Corticosteroid Injection for Vocal Fold Polyp

OBJECTIVES To evaluate the applicability and effectiveness of percutaneous corticosteroid injection in patients with vocal fold polyp and to describe its advantages and limitations in this group of patients. DESIGN Prospective case series. SETTING Tertiary care teaching hospital. PATIENTS Twenty-four patients with vocal fold polyp treated between March 1 and December 31, 2007. INTERVENTIONS Percutaneous corticosteroid injection performed with the patient under topical anesthesia. Stroboscopic examination was carried out to evaluate the postoperative response. MAIN OUTCOME MEASURES The Grade of the Severity of Dysphonia, Roughness, Breathiness, Asthenicity, and Strain (GRBAS) scale and the Voice Handicap Index were used for subjective assessments. Phonatory results including maximum phonation time, mean flow rate, jitter, shimmer, and noise to harmonic ratio were also collected for objective evaluations. RESULTS The surgery was completed smoothly in 22 of the 24 patients, typically within 20 minutes. No complications were noted. The overall response rate by stroboscopy was 91% (20 of 22 patients) and complete remission rate was 59% (13 of 22). A significant improvement was noted between preoperative and postoperative results on the GRBAS scale (P < .001, P < .001, P = .003, P = .001, and P = .002, respectively, for the 5 measures). Mean Voice Handicap Index (P = .001), maximum phonation time (P = .02), jitter (P = .006), shimmer (P = .001), and noise to harmonic ratio (P = .01) also improved significantly after percutaneous corticosteroid injection. CONCLUSIONS Percutaneous corticosteroid injection can be used to manage vocal fold polyps with low invasiveness and minimal morbidity. It offers a simple and cost-effective alternative to traditional direct microlaryngoscopic procedures.

Predictors and timing of recovery in patients with immediate facial nerve dysfunction after parotidectomy

Identification of predictors for permanent facial nerve dysfunction and timing of recovery are important for the management of patients who experience immediate facial nerve dysfunction after parotidectomy.

Evaluating the Autonomic Nervous System in Patients with Laryngopharyngeal Reflux

Objectives The pathogenesis of laryngopharyngeal reflux (LPR) remains unclear. It is linked to but distinct from gastroesophageal reflux disease (GERD), which has been shown to be related to disturbed autonomic regulation. The aim of this study is to investigate whether autonomic dysfunction also plays a role in the pathogenesis of LPR. Study Design Case-control study. Setting Tertiary care center. Subjects and Methods Seventeen patients with LPR and 19 healthy controls, aged between 19 and 50 years, were enrolled in the study. The patients were diagnosed with LPR if they had a reflux symptom index (RSI) ≥13 and a reflux finding score (RFS) ≥7. Spectral analysis of heart rate variability (HRV) analysis was used to assess autonomic function. Anxiety and depression levels measured by the Beck Anxiety Inventory (BAI) and Beck Depression Inventory II (BDI-II) were also conducted. Results In HRV analysis, high frequency (HF) represents the parasympathetic activity of the autonomic nervous system, whereas low frequency (LF) represents the total autonomic activity. There were no significant differences in the LF power and HF power between the 2 groups. However, significantly lower HF% (P = .003) and a higher LF/HF ratio (P = .012) were found in patients with LPR, who demonstrated poor autonomic modulation and higher sympathetic activity. Anxiety was also frequently observed in the patient group. Conclusion The study suggests that autonomic dysfunction seems to be involved in the pathogenesis of LPR. The potential beneficial effect of autonomic nervous system modulation as a therapeutic modality for LPR merits further investigation.

Modified type III cordectomy to improve voice outcomes after transoral laser microsurgery for early glottic canser

We proposed a modified type III cordectomy for the treatment of early glottic cancer that removed the upper part of the vocalis muscle to improve glottic closure and voice outcomes.

The predictive value of drug-induced sleep endoscopy for CPAP titration in OSA patients

PurposeThe aim of this study was to identify possible upper airway obstructions causing a higher continuous positive airway pressure (CPAP) titration level, utilizing drug-induced sleep endoscopy (DISE).MethodsA total of 76 patients with obstructive sleep apnea (OSA) underwent CPAP titration and DISE. DISE findings were recorded using the VOTE classification system. Polysomnographic (PSG) data, anthropometric variables, and patterns of airway collapse during DISE were analyzed with CPAP titration levels.ResultsA significant association was found between the CPAP titration level and BMI, oxygen desaturation index (ODI), apnea-hypopnea index (AHI), and neck circumference (NC) (P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively, by Spearman correlation). Patients with concentric collapse of the velum or lateral oropharyngeal collapse were associated with a significantly higher CPAP titration level (P < 0.001 and P = 0.043, respectively, by nonparametric Mann-Whitney U test; P < 0.001 and P = 0.004, respectively, by Spearman correlation). No significant association was found between the CPAP titration level and any other collapse at the tongue base or epiglottis.ConclusionsBy analyzing PSG data, anthropometric variables, and DISE results with CPAP titration levels, we can better understand possible mechanisms resulting in a higher CPAP titration level. We believe that the role of DISE can be expanded as a tool to identify the possible anatomical structures that may be corrected by oral appliance therapy or surgical intervention to improve CPAP compliance.

Pretreatment pain predicts perineural invasion in oral squamous cell carcinoma: A prospective study.

OBJECTIVES Perineural invasion (PNI) is an established poor prognostic pathological feature for oral squamous cell carcinoma (OSCC). The purpose of this study was to analyze the role of pretreatment parameters in predicting PNI for OSCC. MATERIALS AND METHODS We prospectively enrolled into our study 102 newly diagnosed OSCC patients, who were surgically treated from 2011 to 2012. Before treatment, patients completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire H&N35 and the visual analogue scale (VAS) for cancer pain. Pathological examination was performed to ascertain PNI status in all patients. Patients were divided into two groups, those with PNI and without PNI. Pretreatment parameters were compared between the two groups. RESULTS In univariate analysis, clinical T classification (P<0.001), painkiller use (P=0.001), problem with social eating (P<0.001) and social contact (P=0.002), VAS scores of primary pain (P<0.001) and referred pain (P=0.004) were found to be associated with PNI. Multivariate logistic regression analysis further revealed VAS score of primary pain (P=0.001, OR 2.014) and T3-4 classification (P=0.014, OR 6.422) were independent predictors of PNI. A regression equation incorporating pretreatment pain was developed to predict the probability of having PNI. CONCLUSION PNI can be predicted by higher pretreatment VAS score of primary pain, as well as more advanced clinical T classification. Careful evaluation of pretreatment pain of primary tumor can thus be helpful in improving treatment decision making for OSCC.

Safety of Outpatient Airway Dilation for Adult Laryngotracheal Stenosis

Objectives: To evaluate the safety of outpatient airway dilation for adult patients with subglottic or tracheal stenosis. Methods: The records of patients treated with airway dilation between October 2003 and September 2013 were reviewed. Outcomes of patients who underwent dilation as inpatients versus outpatients were compared. Emergency room visits, readmissions, and 3 or more primary care physician visits within 30 days postoperatively were specifically evaluated. Postoperative hemorrhage, airway edema, recurrent laryngeal nerve paralysis, reintubation, tracheostomy, tracheal rupture, pneumomediastinum, pneumothorax, acute respiratory distress, or death were also reviewed. Results: One hundred fourteen dilations performed in 53 patients with airway stenosis were included. Outpatient dilation was performed in 93 (82%); 21 (18%) underwent the procedure in the inpatient setting. Complications were low among both inpatient and outpatient groups (10% vs 1%, P = .09). No complications occurred during the overnight stay of the inpatient group. Conclusions: Outpatient airway dilation is a safe and feasible procedure. It can be routinely performed on an ambulatory basis.