Risk of Head and Neck Cancer in Patients with Psoriasis: A Nationwide Population-based Study.

An association between psoriasis and cancer risk has been suggested in prior studies, but few have focused on head and neck cancers. Using the Korean National Health Insurance Service database, the relevance between psoriasis and head and neck cancer risks was investigated in a cross-sectional study of 3,869,264 individuals over 20 years of age, who received general health examination in 2009 and were followed until 2020. Head and neck cancer incidence rates were compared between individuals with and without psoriasis, and contributing factors were analysed. The head and neck cancer risk was significantly increased in the psoriasis group compared with the non-psoriasis group (hazard ratio [HR] 1.36; 95% confidence interval [CI] 1.07-1.74; p = 0.01) after adjusting for age, sex, body mass index, income, smoking, alcohol, exercise, diabetes mellitus, hypertension and dyslipidaemia. The risk was especially elevated for nasopharyngeal (HR 2.04; 95% CI 1.12-3.70; p = 0.02) and salivary gland cancer (HR 1.96; 95% CI 1.08-3.56; p = 0.03). Alcohol consumption significantly influenced the risk, particularly for oropharyngeal and oral cavity cancer. Our study provides insights into the potential risks of head and neck cancer in patients with psoriasis, which could aid in refining patient management strategies.

Oncological and functional outcomes of partial or total laryngopharyngectomy for hypopharyngeal cancer with thyroid or cricoid cartilage invasion.

BACKGROUND: Patients with cartilage invasion in hypopharyngeal squamous cell carcinoma (HPSCC) would benefit from partial laryngopharyngectomy (PLP). AIMS/OBJECTIVES: The purpose of this study was to examine the treatment outcomes of PLP for HPSCC with cartilage invasion, with a focus on the oncological safety and the function preservation. MATERIALS AND METHODS: We performed a retrospective review of 28 patients with HPSCC with thyroid or cricoid cartilage invasion who had undergone upfront surgery and were followed for more than one year between 1993 and 2019. RESULTS: Twelve patients treated with PLP (42.9%) and 16 patients treated with total laryngopharyngectomy (TLP) for cartilage invasion in HPSCC were identified. There was no significant difference in recurrence between the PLP group (7/12, 58.3%) and the TLP group (8/16, 50.0%) (p = .718). PLP was not associated with decreased five-year disease free survival (p = .662) or disease specific survival (p = .883) rates compared to TLP. Nine patients receiving PLP could be decannulated and retained intelligible speech (9/12, 75%). Gastrostomy tubes were placed in the PLP group (5/12, 42.9%) and TLP group (1/16, 6.2%) (p = .057). CONCLUSIONS AND SIGNIFICANCE: PLP appears to be a feasible option for the treatment of thyroid or cricoid cartilage invasion in HPSCC.

Comorbidities associated with high-risk obstructive sleep apnea based on the STOP-BANG questionnaire: a nationwide population-based study.

BACKGROUND/AIMS: We investigated the prevalence, associated factors, and comorbidities of high-risk obstructive sleep apnea (OSA) as determined by the STOP-BANG questionnaire in a Korean adult population. METHODS: Data were obtained from 7,650 adults (aged ≥ 40 years) who participated in the Korea National Health and Nutrition Examination Survey (2019-2020). Multiple logistic regression analyses were used to evaluate the association of socioeconomic status, lifestyle related factors, and comorbidities with high-risk OSA (STOP-BANG score, 5-8). RESULTS: The prevalence of high-risk OSA according to the STOP-BANG questionnaire was 12.0 %. Older age, male, current smoking, heavy alcohol consumption, and more comorbidities were associated with higher STOP-BANG scores. In multivariable adjusted analysis, diabetes mellitus (DM) (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.25 to 1.97), hypertension (OR, 4.81; 95% CI, 3.88 to 5.97), and obesity (OR, 2.02; 95% CI, 1.60 to 2.56) were associated with high risk of OSA, and when hypertension, DM, and obesity were combined, the risk increased synergistically (OR, 3.88; 95% CI, 2.94 to 5.11). CONCLUSION: According to the STOP-BANG questionnaire, the high risk of OSA was more common in males, and was associated with chronic metabolic disease, particularly in those with DM, hypertension, and obesity combined. Active OSA screening, prevention, and management may be beneficial to improving health outcomes related to OSA in these populations.

Close Surgical Margins in Oral and Oropharyngeal Cancer: Do They Impact Prognosis?

Introduction. Mucosal margins exhibit a mean shrinkage of 30−40% after resection of oral and oropharyngeal cancers, and an adequate in situ surgical margin frequently results in a pathological close margin. However, the impact on prognosis remains unclear. We investigated the impact of a pathological close margin on disease-free survival (DFS) and overall survival (OS). Methods. We retrospectively reviewed the clinicopathological data of 418 patients diagnosed with squamous cell carcinomas of the oral cavity or oropharynx who underwent initial surgery (with curative intent) at our institute between 2010 and 2016. Results. Of the total population, the pathological marginal status of 290 (69.4%) patients was reported as clear (>5 mm), 61 (14.6%) as close (>1 mm, ≤5 mm), and 67 (16.0%) as positive (≤1 mm). The 5-year DFSs were 79.3%, 65.1%, and 52% in patients in the negative margin (group 1), close margin (group 2), and positive margin (group 3) groups, respectively. The difference between groups 1 and 2 was not significant (p = 0.213) but the difference between groups 2 and 3 was (p = 0.034). The 5-year OSs were 79.4%, 84%, and 52.3% in groups 1, 2, and 3, respectively. The difference between groups 1 and 2 was not significant (p = 0.824) but the difference between groups 2 and 3 was (p = 0.001). In multivariate analysis, older age, advanced T stage, and a positive margin were independently prognostic of the 5-year DFS and OS. Conclusion. In conclusion, the OS of patients with close margins was no different than that of others when appropriate postoperative adjuvant and/or salvage treatment were/was prescribed. However, we could not determine the impact of close margins on locoregional recurrence given various biases in our study setting. A future prospective study is needed.

Prophylactic contralateral neck dissection has no advantage in patients with early stage HPV-positive tonsil cancer.

BACKGROUND: Patients with locally advanced HPV-positive tonsil cancer would benefit from prophylactic contralateral neck dissection (pCND). AIMS/OBJECTIVES: The aim of this study was to analyze rates of contralateral lymph node metastases (LNM) and their prognostic effects on locally advanced HPV-positive tonsillar squamous cell carcinoma. MATERIALS AND METHODS: Medical records of 54 patients who underwent upfront primary surgery and pCND were retrospectively reviewed. RESULTS: Six (11.1%) patients had contralateral LNM in 54 locally advanced HPV-positive tonsil cancer. Of these, five patients had contralateral level II LNM and one patient had contralateral level II and III LNM. Contralateral LNM showed significant positive correlations with advanced T stage (p = .017) and the presence of extracapsular spread (p = .007). Contralateral lymph node metastasis had no significant association with five-year disease-specific survival. CONCLUSIONS AND SIGNIFICANCE: This study demonstrated no advantage in performing pCND in early stage HPV-positive tonsil cancer.

Synergistic association between underweight and type 2 diabetes on the development of laryngeal cancer: a national population-based retrospective cohort study.

BACKGROUND: Although cigarette smoking is the most significant risk factor for laryngeal cancer, other risk factors might also be associated with the development of laryngeal cancer. We investigated whether underweight and type 2 diabetes are associated with laryngeal cancer in a Korean population. METHODS: A total of 9,957,059 participants (≥20 years) without prior history of cancer who underwent a National Health Insurance Service health checkup in 2009 were followed up until December 31, 2018. Newly diagnosed laryngeal cancer was identified using claim data, and underweight was defined as body mass index (BMI) < 18.5 kg/m2. A Cox proportional-hazards models with multivariable adjustment were used to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs). RESULTS: During the median follow-up period of 8.3 years, 3504 cases of laryngeal cancer occurred. Underweight was associated with increased risk of laryngeal cancer after adjusting for potential confounders (HR: 1.43, 95% CI: 1.22-1.69) compared to those who were not underweight. Underweight and type 2 diabetes were synergistically associated with higher risk of laryngeal cancer (HR: 2.33, 95% CI: 1.54-3.51), compared to those without either condition. This relationship was stronger in those with an age < 65 years (HR: 3.33, 95% CI: 1.88-5.87) and alcohol consumption (HR: 2.72, 95% CI: 1.64-4.53). CONCLUSIONS: These results suggest that underweight may be a significant risk factor for laryngeal cancer and that underweight and type 2 diabetes might synergistically increase the risk of laryngeal cancer.

Prognostic Significance of the Metastatic Lingual Lymph Node in Oral Tongue and Floor of Mouth Squamous Cell Carcinoma.

PURPOSE: The lingual lymph node (LLN) located on the internal surface of mylohyoid muscle is not currently included in oral cavity cancer surgery or conventional neck dissection. We investigated the risk factors for LLN metastasis and evaluated its oncologic significance in patients with oral tongue and floor of mouth squamous cell carcinoma. PATIENTS AND METHODS: Adult patients (≥20 years) undergoing upfront surgery and LLN dissection for oral tongue and floor of mouth squamous cell carcinoma between 2009 and 2018 were retrospectively analyzed. Patients who had relapsed after previous treatment or had neoadjuvant chemotherapy or had not undergone surgery were excluded. Association between clinicopathological risk factors (age, gender, tumor differentiation, stage, lymphatic invasion, perineural invasion, vascular invasion, metastatic lymph node ratio, and extranodal extension) and LLN metastasis was evaluated using logistic regression analysis. Disease-free survival in accordance with LLN metastasis was evaluated by the Kaplan-Meier method. RESULTS: A total of 51 patients were included, and LLN metastasis was found in 9 patients (17.6%). LLN metastasis was significantly associated with advanced nodal stage, poor tumor differentiation, and vascular invasion. Cox proportional-hazards regression models showed that LLN metastasis was associated with an 8.0-fold higher risk of mortality than the absence of LLN metastasis. Patients with LLN metastasis had significantly worse 5-year disease-free survival rate than those without metastasis (22.2% vs 85.7%; P < .001). CONCLUSIONS: This study suggests that LLN metastasis is a poor prognostic factor in patients with oral tongue and floor of mouth squamous cell carcinoma. The sublingual space should be carefully evaluated preoperatively and intraoperatively.

Optimal Airway Management in the Treatment of Descending Necrotizing Mediastinitis Secondary to Deep Neck Infection.

PURPOSE: To review our experiences of descending necrotizing mediastinitis (DNM) secondary to deep neck infection (DNI) and determine appropriate airway management for decreasing mortality and morbidity of patients with DNM. METHODS: Medical records of 20 patients (8 women and 12 men) who had been managed for DNM secondary to DNI between March 2006 and December 2019 were analyzed. Diagnosis and extent of infection were confirmed by computed tomography of the neck and chest. The upper airway was closely monitored with a fiberoptic laryngoscope. Complications were evaluated according to various types of airway management in our serial cases. RESULTS: Five (25%) out of 20 patients died as a result of septic shock and multiorgan failure. None of these patients died of accidental airway obstruction or airway management mishaps. Keeping short-term orotracheal intubation was safe and adequate after the initial surgery. Early tracheotomy was performed for 4 patients and it was significantly associated with mortality (P = .032). Three patients who underwent late tracheotomy had no mortality. Patients with tracheotomy had longer duration of overall hospital stay than those without tracheotomy. CONCLUSIONS: Well-controlled airway management might decrease mortality, hospitalization, and airway complications in patients with DNM secondary to DNI. Keeping orotracheal intubation rather than upfront tracheotomy should be first considered when managing airway along with examination of the upper airway with a fiberoptic laryngoscope.

Use of a combination of N-acetylcysteine and clonazepam to treat burning mouth syndrome.

OBJECTIVE: This study was intended to evaluate the clinical efficacy of a combination of N-acetylcysteine (NAC) and clonazepam for treatment of burning mouth syndrome (BMS). STUDY DESIGN: A total of 160 patients with BMS were divided into 3 groups: group 1 received NAC (400 mg/d), group 2 received clonazepam (0.5 mg/d), and group 3 received both NAC and clonazepam. We evaluated symptom relief after 8 weeks of treatment using a visual analog scale (VAS). To assess oral health-related quality of life, we used the validated Korean version of an oral health impact profile (OHIP-14K). RESULTS: The overall response rates of the 3 groups were 60.3%, 51.3%, and 80.0%, respectively. The mean VAS and OHIP-14K scores significantly decreased in all groups after the 8-week treatments. The VAS score changes were -12.2 ± 19.5, -10.0 ± 14.1, and -21.0 ± 24.6, respectively (P = .001), in the 3 groups and the OHIP-14K changes were -2.3 ± 9.2, -4.4 ± 6.9, and -8.7 ± 10.3, respectively (P = .020). Group 3 showed significantly larger differences in VAS and OHIP-14K scores than group 2, before and after treatment. CONCLUSIONS: In the treatment of BMS, the NAC/clonazepam combination therapy was more effective than either monotherapy.

Possible association between oral health and sleep duration: A cross-sectional study based on the Korean National Health and Nutrition Examination Surveys from 2010 to 2015.

ABSTRACT: This study was performed to investigate the association between oral health and sleep duration in South Korean subjects using 2010-2015 data from the Korean National Health and Nutrition Examination Survey (KNHANES).Cross-sectional data on 35,599 adults over the age of 19 years who completed KNHANES were analyzed. All participants reported subjective oral health status and their daily average sleep duration using a self-reported questionnaire. Sleep duration and oral health status were divided into 3 categories: ≤5, 6-8, ≥9 h/day and good, fair, poor, respectively.The overall prevalence of poor oral health status was 43.8%. Univariate analysis demonstrated that poor oral health status was significantly associated with age, smoking, alcohol, diabetes, education, income, depression, marital status, and sleep duration. After adjusting for covariates (age, sex, diabetes mellitus, hypertension, obesity, smoking, income, education, marital status), sleep durations of ≤5 hours (OR = 1.42; 95% CI, 1.26-1.60) and ≥9 hours (OR = 1.21; 95% CI, 1.04-1.40) were significantly associated with poor oral health, compared to a sleep duration of 6-8 hours. Short or long sleep duration was more likely to have an impact on the development of poor oral health status in men than in women. A significant relationship between sleep duration and oral health status was found in participants younger than 60 years.This is the first report that both short and long sleep durations are significantly associated with the development of poor oral health status. The effect of short or long sleep duration on poor oral health was more significant in younger subjects and in men.

Sonographicdetectionof a metastatic lingual lymph node in a patient with tongue cancer.

A 41-year-old male was diagnosed with tongue cancer. Preoperative imaging revealed no metastatic lymph nodes. Intraoperative sonography detected a minute hypoechoic lesion in the sublingual space. A pea-sized mass was found during dissection of that space and histopathology revealed a metastatic lymph node. The lingual lymph node should routinely be evaluated sonographically prior to surgical resection of tongue cancer.

Utility of acoustic pharyngometry for screening of obstructive sleep apnea.

OBJECTIVE: To determine whether combining acoustic pharyngometric parameters with cephalometric and clinical parameters could improve the predictive power for significant obstructive sleep apnea (OSA) in a Korean population. METHODS: A total of 229 consecutive adult patients with suspected OSA were enrolled. The predictability for significant OSA using acoustic pharyngometric or cephalometric parameters or combining these parameters and clinical factors was calculated and compared using multivariate logistic regression and receiver operating characteristic (ROC) curves. RESULTS: In multivariate logistic regression, age, sex, minimum upper airway cross-sectional area (UA-CSA), and mandibular plane to hyoid distance (MPH) were all significant independent predictors of significant OSA. The minimum UA-CSA of 0.85 cm2 provided fair discrimination for OSA [area under the curve (AUC): 0.60, 95% confidence interval (CI): 0.52-0.67]. The MPH of 18.75 mm provided fair discrimination for OSA (AUC; 0.65, 95% CI: 0.58-0.72). The discriminative ability of the final model of multivariate ROC curve analyses that included the minimum UA-CSA, age, sex, body mass index (BMI), and MPH was better than the minimum UA-CSA alone (AUCs: 0.77 vs. 0.60). Optimal cut-off values of predictors for discriminating significant OSA were as follows: male for sex, 40 years for age, 25.5 kg/m2 for BMI, 1.06 cm2 for minimum UA-CSA, and 18 mm for MPH. CONCLUSION: Minimum UA-CSA measured using acoustic pharyngometry while sitting might be a useful method to predict OSA. Combining minimum UA-CSA with age, sex, BMI and MPH improved the predictive value for significant OSA.

Effects of an antiadhesive agent on functional recovery of the greater auricular nerve after parotidectomy: a double-blind randomized controlled trial.

PURPOSE: Periauricular sensory deficit occurs frequently after parotidectomy even in cases with preservation of the greater auricular nerve (GAN). This study was performed to evaluate the effects of antiadhesive agent in functional recovery of the GAN after parotidectomy. METHODS: Ninety-eight patients undergoing partial parotidectomy for benign parotid tumors were prospectively enrolled in this multicenter, double-blind randomized controlled study and randomly assigned to either the study or control group. Antiadhesive agent was applied in the study group. The results of sensory tests (tactile, heat, and cold sensitivity) and a questionnaire on quality of life (QoL) were acquired at postoperative 1, 8, and 24 weeks after surgery. Clinical parameters, and the results of the sensory tests and the questionnaire, were compared between the two groups. RESULTS: A total of 80 patients were finally enrolled. On sensory evaluation, tactile sensation and warm sensation in the ear lobule, and warm sensation in the mastoid area, showed significant improvement at 24 weeks postoperatively in the study group. There were no significant differences between the two groups on any questions in the QoL questionnaire, at any follow-up time point. CONCLUSIONS: Antiadhesive agents have some positive effects on functional recovery of the GAN after parotidectomy. Therefore, applying antiadhesive agents after parotidectomy can reduce discomfort in patients.

Clinical Significance of Contralateral Reactive Lesion in Vocal Fold Polyp and Cyst.

OBJECTIVE: We investigated the clinical significance of contralateral reactive lesions in patients undergoing laryngeal microsurgery for benign vocal fold lesions such as vocal polyps and cysts. STUDY DESIGN: This was a retrospective, single institution cohort study. METHODS: Patient medical records were reviewed for demographic characteristics; acoustic, aerodynamic, and perceptual analyses; and Voice Handicap Index score before and after laryngeal microsurgery. Definitive diagnoses were made via intraoperative microlaryngoscopic evaluations. Clinical parameters were assessed to identify risk factors for contralateral reactive lesions. We evaluated surgical outcome using voice analysis. RESULTS: We enrolled 268 patients (109 men and 159 women) with benign vocal fold lesions. A total of 195 (72.8%) had a contralateral reactive vocal fold lesion. A multivariable analysis revealed that being a never smoker and having a hoarseness duration ≥6 months, vocal polyps, and small primary lesions were independent risk factors for contralateral reactive lesions (P <0.05). The preoperative perceptual evaluation and maximum phonation time were significantly worse in patients with a contralateral reactive lesion than in those without one (P = 0.014, P = 0.004, respectively). The voice parameters in patients who underwent excision of the contralateral reactive lesion were generally better than those who received conservative treatment, particularly the noise-to-harmonic ratio (P = 0.004). CONCLUSIONS: Contralateral reactive vocal fold lesions are frequently detected in patients with vocal polyp and cyst. The reactive lesions had an adverse effect on voice quality. Simultaneous excision of primary and contralateral reactive lesions may be an alternative treatment for better voice outcome.

Anticancer Effects of Colchicine on Hypopharyngeal Cancer.

Colchicine is an alkaloid widely used for the treatment of inflammatory diseases, such as gout. It suppresses cell division by inhibiting mitosis. We investigated the anticancer effects of colchicine on human hypopharyngeal cancer cells and the mechanisms underlying its anticancer effects. XTT cell proliferation assay showed that colchicine inhibited the growth and proliferation of human hypopharyngeal cancer cells (FaDu and SNU1041) in a dose- and time-dependent manner. Colchicine also inhibited the migration, invasion, and adhesion of hypopharyngeal cancer cells in a dose-dependent manner. The levels of mRNA expression and activity of matrix metalloproteinase-9 (MMP9) and urokinase-type plasminogen activator (uPA) decreased after treatment with colchicine. Further investigation revealed that colchicine inhibited the phosphorylation of the FAK/SRC complex and paxillin. Tumor volume ratios in colchicine-treated mice (0.1 mg/kg, every 2 days for 14 days) increased less than in control mice. To our knowledge, this is the first report showing that colchicine can suppress cell invasion, migration, and adhesion through reduced expression of MMP9, the uPA system, and the FAK/SRC complex. Colchicine has the potential to prevent disease progression in hypopharyngeal cancer and may have application as an adjunctive treatment.

A possible association between dysphonia and sleep duration: A cross-sectional study based on the Korean National Health and nutrition examination surveys from 2010 to 2012.

BACKGROUND: Sleep is important in terms of good general health and appropriate sleep duration has been linked to quality-of-life. Dysphonia may impair communication and social relationships, and is thus also closely related to quality-of-life. No large-scale, cross-sectional epidemiological study of a sample representative of the population of an entire country has yet assessed the possible existence of a relationship between sleep duration and dysphonia. METHODS: We investigated a possible association between subjective voice problems and self-reported sleep duration in South Korean subjects using 2010-2012 data from the Korean National Health and Nutrition Examination Survey (KNHANES). Cross-sectional data on 17,806 adults (7,578 males and 10,228 females) over the age of 19 years who completed the KNHANES were analyzed. All participants reported voice problems (if present) and their daily average sleep duration using a self-reporting questionnaire. Sleep duration was classified into five categories as follows: ≤5, 6, 7, 8, and ≥9 h/day. RESULTS: The overall prevalence of dysphonia was 6.8%; 5.7% in males and 7.7% in females. The prevalence for dysphonia by sleep duration exhibited a U-shape, with the lowest point being at sleep duration of 7-8h. After adjustment for covariates (age, sex, smoking status, alcohol consumption, regular exercise, low income, high-level education), a sleep duration of ≤5 h (OR = 1.454; 95% CI, 1.153-1.832) and a sleep duration of ≥9 h (OR = 1.365; 95% CI, 1.017-1.832) were significantly associated with dysphonia, compared to a sleep duration of 7 h. In terms of gender, males who slept for ≥9 h were at a 2-fold (OR = 2.028; 95% CI, 1.22-3.35) higher odds for dysphonia (p<0.05) compared to those who slept for 7 h. A sleep duration ≤5 h was associated with a 1.6-fold (OR = 1.574; 95% CI, 1.203-2.247) higher odds of dysphonia ≥3 weeks in duration (long-term dysphonia). CONCLUSIONS: This is the first study to show that both short and long sleep duration were significantly associated with the development of dysphonia. The association between sleep duration and dysphonia was more marked in males than females. A sleep duration ≤5 h had a significant impact on the prevalence of long-term dysphonia.

Prognostic implication of ERCC1 protein expression in resected oropharynx and oral cavity cancer.

BACKGROUND: Excision repair cross complement group 1 (ERCC1) expression is a predictive biomarker for platinum-containing treatment in squamous cell carcinoma of head and neck (SCCHN). However, the prognostic significance after surgical resection is not well understood. METHODS: Oropharynx (n=143) or oral cavity (n=61) SCCHN patients undergoing surgery were included. ERCC1 protein expression and HPV status were assessed by ERCC1 and p16 immunohistochemistry. RESULTS: The ERCC1, over-expressed in 66.7% of patients, was associated with oral cavity cancer (P<0.001), well differentiation (P=0.036), and HPV negativity (P<0.001). In TCGA database, ERCC1 mRNA upregulation was enriched in HPV-negative and oral cavity cancers, and associated with HRAS mutation (P<0.001). The prognostic role of ERCC1 was not different according to HPV status. High ERCC1 expression showed a trend toward poor prognosis in patients with an advanced stage (P=0.079) with marginal significance. CONCLUSIONS: The ERCC1 expression was not prognostic in surgically resected oropharynx/oral cavity SCCHN, irrespective of HPV status. However, it could provide additional prognostic information for advanced stage patients.

Efficacy and Safety of Adjunctive Steroid Injection After Microsurgical Removal of Benign Vocal Fold Lesions.

OBJECTIVE: This study aims to investigate the clinical efficacy and safety of immediate intralesional steroid injection in patients undergoing laryngeal microsurgery (LMS) for benign vocal fold lesions (BVFLs). STUDY DESIGN: This is a single-institution, retrospective cohort study. METHODS: Patients were divided into two groups according to whether or not they received adjunctive steroid injection after LMS. We evaluated the outcomes using objective, perceptual voice analysis and videostroboscopy. We also analyzed clinical parameters and identified risk factors associated with persistent dysphonia after LMS. RESULTS: The study included a total of 211 patients with BVFLs (82 men and 129 women), which comprised 136 vocal polyps (64.5%), 49 nodules (23.2%), and 30 cysts (14.2%); 84 patients (39.8 %) had intralesional steroid administration combined with LMS. The overall results for postoperative voice parameters in both groups were significantly improved. On videostroboscopic examination, the rate of recurrent lesions was lower in the group that received adjunctive steroid injection than in the group with only LMS (P = 0.014). In the multivariate analysis, older age (compared to <50 years of age; odds ratio [OR] = 2.697, 95% confidence interval [CI]: 1.300-5.595, P = 0.008) and duration of hoarseness longer than 6 months (compared to <3 months; OR = 2.729, 95% CI: 1.193-6.242, P = 0.017) were identified as independent risk factors associated with persistent dysphonia. Nevertheless, adjunctive steroid injection was associated with a 0.3-fold (OR = 0.345, 95% CI: 0.152-0.784, P = 0.011) lower risk of persistent dysphonia. CONCLUSION: Steroid injection combined with LMS in the treatment of BVFLs was safe and associated with improved voice quality.

Prognostic impact of lymph node micrometastasis in oral and oropharyngeal squamous cell carcinomas.

BACKGROUND: The purpose of this study was to determine the role of lymph node micrometastasis in oral and oropharyngeal cancers. METHODS: We investigated the presence of micrometastases by cytokeratin immunohistochemical staining in 54 patients with node-negative oral and oropharyngeal carcinomas. RESULTS: The positive rate of cytokeratin expression was 13.0% (7 of 54 patients). The incidence of micrometastasis was significantly higher in patients with more invasive tumors (p < .001) and larger tumor size (p = .034). The 5-year disease-specific (DS) survival rate significantly correlated with micrometastasis, margin involvement, and depth of invasion in the univariate analyses. Multivariate Cox regression analysis confirmed a significant association between the 5-year DS survival rate and micrometastasis (hazard ratio [HR] = 7.89; 95% confidence interval [CI] = 1.09-57.14; p = .041) and margin involvement (HR = 11.68; 95% CI = 1.22-111.75; p = .033). CONCLUSION: Micrometastasis was significantly correlated with the depth of invasion and tumor size in oral and oropharyngeal cancers. Furthermore, micrometastasis was associated with adverse outcomes. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1777-E1782, 2016.

Efficacy of 18F-fluorodeoxyglucose positron emission tomography/CT imaging for extracapsular spread of laryngeal squamous cell carcinoma.

BACKGROUND: We evaluated the use of fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT for the identification of extracapsular spread (ECS) with supporting histologic correlations in laryngeal cancer. METHODS: We reviewed the medical records of 89 patients with laryngeal cancer who underwent FDG PET/CT before surgery. RESULTS: ECS was present in 38.2% (18 of 47) of dissected necks and in 32.2% (20 of 62) of dissected cervical levels. There was a significant difference in the standardized uptake value maximum (SUVmax ) between cervical lymph nodes with and without ECS (6.39 ± 4.53 vs 1.21 ± 1.70; p < .001); the cutoff value for differentiating nodes with ECS from those without ECS was 2.8, with a sensitivity of 85.7% and specificity of 85.6%. CONCLUSION: A median SUVmax cutoff value >2.8 was associated with an increased risk of cervical lymph node metastasis and ECS in patients with laryngeal cancer.