Is ChatGPT accurate and reliable in answering questions regarding head and neck cancer?

Background and objective: Chat Generative Pre-trained Transformer (ChatGPT) is an artificial intelligence (AI)-based language processing model using deep learning to create human-like text dialogue. It has been a popular source of information covering vast number of topics including medicine. Patient education in head and neck cancer (HNC) is crucial to enhance the understanding of patients about their medical condition, diagnosis, and treatment options. Therefore, this study aims to examine the accuracy and reliability of ChatGPT in answering questions regarding HNC. Methods: 154 head and neck cancer-related questions were compiled from sources including professional societies, institutions, patient support groups, and social media. These questions were categorized into topics like basic knowledge, diagnosis, treatment, recovery, operative risks, complications, follow-up, and cancer prevention. ChatGPT was queried with each question, and two experienced head and neck surgeons assessed each response independently for accuracy and reproducibility. Responses were rated on a scale: (1) comprehensive/correct, (2) incomplete/partially correct, (3) a mix of accurate and inaccurate/misleading, and (4) completely inaccurate/irrelevant. Discrepancies in grading were resolved by a third reviewer. Reproducibility was evaluated by repeating questions and analyzing grading consistency. Results: ChatGPT yielded "comprehensive/correct" responses to 133/154 (86.4%) of the questions whereas, rates of "incomplete/partially correct" and "mixed with accurate and inaccurate data/misleading" responses were 11% and 2.6%, respectively. There were no "completely inaccurate/irrelevant" responses. According to category, the model provided "comprehensive/correct" answers to 80.6% of questions regarding "basic knowledge", 92.6% related to "diagnosis", 88.9% related to "treatment", 80% related to "recovery - operative risks - complications - follow-up", 100% related to "cancer prevention" and 92.9% related to "other". There was not any significant difference between the categories regarding the grades of ChatGPT responses (p=0.88). The rate of reproducibility was 94.1% (145 of 154 questions). Conclusion: ChatGPT generated substantially accurate and reproducible information to diverse medical queries related to HNC. Despite its limitations, it can be a useful source of information for both patients and medical professionals. With further developments in the model, ChatGPT can also play a crucial role in clinical decision support to provide the clinicians with up-to-date information.

Evaluation of sarcopenia as a prognostic biomarker in locally advanced head and neck squamous cell carcinoma.

Background: We aimed to evaluate the effect of sarcopenia on survival in head and neck squamous cell carcinoma patients treated with chemoradiotherapy. Materials & methods: Disease-free survival and overall survival were compared according to cervical computed tomography for radiotherapy in 123 sarcopenic and non-sarcopenic patients with locally advanced head and neck squamous cell carcinoma treated with chemoradiotherapy with weekly cisplatin. Results: In multivariate analyses, pretreatment sarcopenia was associated with lower disease-free survival (hazard ratio: 2.60; 95% CI: 1.38-4.87; p = 0.003) and overall survival (hazard ratio: 2.86; 95% CI: 1.40-5.85; p = 0.004). Sarcopenic patients experienced more frequent radiotherapy-related toxicities and platinum-related side effects than non-sarcopenic patients. Conclusion: Sarcopenia could be a potential biomarker to predict prognosis and treatment toxicity in head and neck squamous cell carcinoma.

Head and neck cancer is one of the main causes of cancer-related death worldwide. Most patients are diagnosed in the advanced stage. Muscle wasting with significant weight loss occurs in nearly half of the patients at the initial diagnosis. In oncology research, sarcopenia has often been described as the loss of skeletal muscle mass. In this study, we evaluated the effect of sarcopenia on survival in head and neck cancer patients. Muscle mass was calculated using information from head and neck computed tomography before radiotherapy treatment in patients. We showed that patients with low muscle mass had significantly worse survival rates and were more susceptible to treatment-related side effects. Sarcopenia may function as a marker showing the course of disease in patients with head and neck cancer.

Candidate Angiogenesis-Related Biomarkers in Patients with Laryngeal Carcinoma (AngLaC): A Prospective Cohort Study.

OBJECTIVE: Angiogenesis is indeed a vital process in the progression of carcinomas, including that of larynx. Therefore, this study (AngLaC) aimed to identify candidate angiogenesis-related biomarkers in laryngeal carcinoma patients. STUDY DESIGN: Prospective controlled cohort study. SETTING: Tertiary referral center. METHODS: In silico analyses of angiogenesis-related genes in laryngeal carcinoma were performed to determine candidate biomarkers. Serum levels of candidate biomarkers were determined via enzyme-linked immunosorbent assay in laryngeal carcinoma patients as well as in an age and gender-matched control group. The associations of the biomarkers with clinical parameters were investigated. RESULTS: The study included 60 laryngeal carcinoma patients and 20 healthy controls. The serum levels of osteopontin, IGFBP-3, VEGF, sVEGFR-1, and VEGFR-2 were significantly higher in the patient group (p < .001, p ≤ .001, p < .001, p < .01, p < .01, respectively). High osteopontin and sVEGFR-1 levels were associated with locoregional-recurrence (p = .024, p = .016, respectively). IGFBP-3 had the highest diagnostic sensitivity (81.4%) and specificity (80%) among the molecules that were investigated (p < .001). High sVEGFR-1 and low VEGFR-2 levels were associated with poor overall-survival (p = .037, p = .027, respectively). High osteopontin and sVEGFR-1 levels were associated with poor disease-specific survival rates (p = .035, p = .018, respectively). CONCLUSION: High serum levels of sVEGFR-1 and osteopontin as well as low serum levels of VEGFR-2 proved to be poor prognostic in terms of survival in laryngeal carcinoma. VEGF, sVEGFR1, VEGFR2, IGFBP-3, and osteopontin levels were found to be significantly increased in larynx cancer patients compared to the normal population. Further studies on osteopontin and sVEGFR-1 are required in order to determine their associations with recurrence.

Lysyl Oxidase Like-4 (LOXL4) as a tumor marker and prognosticator in advanced stage laryngeal cancer / Proteína tipo-lisil oxidase-4 (LOXL4) como marcador tumoral e prognóstico no câncer de laringe em estágio avançado

Abstract Introduction: Lysyl oxidase-like 4 is an amine oxidase from the lysyl oxidase family that was previously shown to be overexpressed in head and neck cancer and upregulated in response to hypoxia. The possible role of lysyl oxidase-like 4 as a tumor marker in advanced stage larynx cancer was investigated. Objective: To investigate the expression of lysyl Oxidase-Like 4 protein in advanced stage laryngeal cancer and elucidate its possible role as a tumor marker, predictor of treatment response and prognosticator. Methods: Diagnostic specimens of 72 patients treated for stage III-IV laryngeal squamous cell carcinoma were evaluated for lysyl oxidase-like 4 expression by immunohistochemistry. Results: Lysyl oxidase-like 4 expression was correlated with advanced tumor stage (p = 0.041) and better differentiation (p = 0.025) but was independent of tumor diameter (p = 0.456). Response to induction chemotherapy or the need for salvage laryngectomy were not affected by lysyl oxidase-like 4 expression (p = 0.999, p = 0.070 respectively). Increased lysyl oxidase-like 4 expression was associated with better 2 year overall survival in both univariate (p = 0.036) and multivariate analyses (p = 0.014). Conclusion: Lysyl oxidase-like 4 expression emerges with advancing stages, is lost with worsening differentiation, and may have tumor suppressive properties in larynx cancer.

Resumo Introdução: A proteína tipo-lisil oxidase-4 é uma amina oxidase da família lisil oxidase cuja superexpressão em câncer de cabeça e pescoço e up-regulação em resposta à hipóxia foram previamente demonstradas. O possível papel da proteína tipo-lisil oxidase-4 como um marcador tumoral no câncer de laringe em estágio avançado foi investigado. Objetivos: Investigar a expressão da proteína tipo-lisil oxidase-4 no câncer de laringe em estágio avançado e elucidar seu possível papel como marcador tumoral, preditor da resposta ao tratamento e do prognóstico. Método: Amostras diagnósticas de 72 pacientes tratados para carcinoma espinocelular da laringe em estágio III-IV foram avaliadas quanto à expressão da proteína tipo-lisil oxidase-4 por imuno-histoquímica. Resultados: A expressão de proteína tipo-lisil oxidase-4 foi correlacionada com o estágio avançado do tumor (p = 0,041) e melhor diferenciação (p = 0,025), mas foi independente do diâmetro do tumor (p = 0,456). A resposta à quimioterapia de indução ou a necessidade de laringectomia de resgate não foram afetadas pela expressão da proteína tipo-lisil oxidase-4 (p = 0,999, p = 0,070 respectivamente). O aumento da expressão da proteína tipo-lisil oxidase-4 foi associado a melhor sobrevida global de 2 anos nas análises univariada (p = 0,036) e multivariada (p = 0,014). Conclusão: A expressão da proteína tipo-lisil oxidase-4 surge com o avanço dos estágios e desaparece com pioria da diferenciação e pode ter propriedades supressoras de tumor no câncer de laringe.

Investigation of the Effect of Radiotherapy Dose on Chewing and Swallowing Structures in Head and Neck Cancer Patients Treated with Concomitant Chemoradiotherapy.

Intensity-modulated radiotherapy (IMRT) is a treatment method that is used in the treatment of head and neck cancers. Impairment of chewing and swallowing functions in the early and late periods of radiotherapy is frequent. Therefore, revealing the dose-effect relationship is important. The main purpose of this study is to investigate the dose-effect relationship between chewing and swallowing structures objectively via a standardized videofluoroscopy protocol. The study included 35 participants treated with chemo-IMRT. A videofluoroscopic swallowing study (VFSS) was performed before IMRT, and 3 and 6 months after IMRT. VFSS results were scored according to the Modified Barium Swallow Impairment Profile (MBSImP) and the Penetration-Aspiration Scale (PAS). Maximum interincisor mouth opening, body mass index (BMI), and Functional Oral Intake Scale levels were determined in these cases. The quality of life of participants was evaluated. There was a significant increase in PAS and MBSImP scores and a significant decrease in BMI scores of the patients after treatment. Xerotomy and sticky saliva complaints increased after treatment. The dose to the mastication muscles (> 40 Gy) and the temporomandibular joint (> 46 Gy) were found to be associated with a decrease in BMI; the dose to the superior pharyngeal constructor muscle (> 58 Gy) was found to be associated with pharyngeal stripping wave. The presence of aspiration was associated with the inferior pharyngeal constructor muscle, glottic larynx, supraglottic larynx, and upper esophageal sphincter. Important findings to emerge from this study include detected toxic dose limits. These findings may guide physicians to minimize the side effects of IMRT.

Lysyl Oxidase Like-4 (LOXL4) as a tumor marker and prognosticator in advanced stage laryngeal cancer.

INTRODUCTION: Lysyl oxidase-like 4 is an amine oxidase from the lysyl oxidase family that was previously shown to be overexpressed in head and neck cancer and upregulated in response to hypoxia. The possible role of lysyl oxidase-like 4 as a tumor marker in advanced stage larynx cancer was investigated. OBJECTIVE: To investigate the expression of lysyl Oxidase-Like 4 protein in advanced stage laryngeal cancer and elucidate its possible role as a tumor marker, predictor of treatment response and prognosticator. METHODS: Diagnostic specimens of 72 patients treated for stage III-IV laryngeal squamous cell carcinoma were evaluated for lysyl oxidase-like 4 expression by immunohistochemistry. RESULTS: Lysyl oxidase-like 4 expression was correlated with advanced tumor stage (p = 0.041) and better differentiation (p = 0.025) but was independent of tumor diameter (p = 0.456). Response to induction chemotherapy or the need for salvage laryngectomy were not affected by lysyl oxidase-like 4 expression (p = 0.999, p = 0.070 respectively). Increased lysyl oxidase-like 4 expression was associated with better 2 year overall survival in both univariate (p = 0.036) and multivariate analyses (p = 0.014). CONCLUSION: Lysyl oxidase-like 4 expression emerges with advancing stages, is lost with worsening differentiation, and may have tumor suppressive properties in larynx cancer.

Human laryngeal squamous cell carcinoma cell line release of endogenous anandamide and 2-arachidonoylglycerol, and their antiproliferative effect via exogenous supplementation: an in vitro study.

The level of the major endocannabinoids anandamide (AEA) and 2-arachidonoylglycerol (2-AG) are altered in several types of carcinomas, and are known to regulate tumor growth. Thusly, this study hypothesized that the HEp-2 human laryngeal squamous cell carcinoma (LSCC) cell line releases AEA and 2-AG, and aimed to determine if their exogenous supplementation has an anti-proliferative effect in vitro. In this in vitro observational study a commercial human LSCC cell line (HEp-2) was used to test for endogenous AEA and 2-AG release via liquid chromatography-tandem mass spectrometry (LC-MS/MS). The anti-proliferative effect of AEA and 2-AG supplementation was evaluated via WST-1 proliferation assay. It was observed that the HEp-2 LSCC cell line released AEA and 2-AG; the median quantity of AEA released was 15.69 ng mL-1 (range: 14.55-15.95 ng mL-1) and the median quantity of 2-AG released was 2.72 ng -1 (range: 2.67-2.74 ng mL-1). Additionally, both AEA and 2-AG exhibited an anti-proliferative effect. The anti-proliferative effect of 2-AG was stronger than that of AEA. These findings suggest that AEA might function via a CB1 receptor-independent pathway and that 2-AG might function via a CB2-dependent pathway. The present findings show that the HEp-2 LSCC cell line releases the major endocannabinoids AEA and 2-AG, and that their supplementation inhibits tumor cell proliferation in vitro. Thus, cannabinoid ligands might represent novel drug candidates for laryngeal cancers, although functional in vivo studies are required in order to validate their potency.

Role of indocyanine green combined with radiotracer-Technetium 99 m in neck surgery for primary and recurrent head and neck cancer: preliminary results of a tertiary cancer center.

PURPOSE: Neck dissection (ND), whether therapeutic or elective, is an essential component of the treatment of head and neck squamous cell carcinoma (HNSCC). Due to altered anatomy and fibrosis caused by initial treatments, surgeons face challenges during salvage ND. A combination of Technetium-99 m and indocyanine green (ICG) previously used in the sentinel lymph node (SLN) biopsy for oral cavity cancers, may be useful in different types of neck surgeries. We aimed to show the additional advantage of this combination in detecting HNSCC and thyroid cancer recurrences, as well as individual lymphatic drainage in elective ND. METHODS: We retrospectively reviewed medical records of patients, underwent neck surgery guided with ICG and Tc-99 m, in Hacettepe University Hospital between June 2018 and December 2020. In a total of 28 patients, intraoperative gamma probes were paired with near infrared (NIR) cameras. Patients are divided into two groups: neck surgery with recurrent occult lesion localization (NS- ROLL) (n: 14) and ND with SLN screening (ND-SLNS) (n: 14). RESULTS: Among all 14 patients in NS-ROLL group, recurrent diseases, hidden behind tissues were 100% successfully localized. In ND-SLNS group, 238 lymph nodes were harvested, metastasis rate was 31.3% (10/32) in sentinel nodes. SLNS revealed 100% accuracy in detecting metastasis in clinically N0 neck (10/238). Contralateral lymphatic drainage was observed in three patients (lateral-sided oral cavity SCC). In two patients (floor of mouth), three sentinel nodes were detected by NIR only. CONCLUSION: The use of ICG-radiotracer provides additional value in disease removal for both primary and recurrent tumors of the head and neck.

Development and validation of an improved classification and risk stratification system for carotid body tumors: Multinational collaborative cohort study.

BACKGROUND: This study aims to develop and validate a new classification system that better predicts combined risk of neurological and neurovascular complications following CBT surgery, crucial for treatment decision-making. METHODS: Multinational retrospective cohort study with 199 consecutive cases. A cohort of 132 CBT cases was used to develop the new classification. To undertake external validation, assessment was made between the actual complication rate and predicted risk by the model on an independent cohort (n = 67). RESULTS: Univariate analyses showed statistically significant associations between developing a complication and the following factors: craniocaudal dimension, volume, Shamblin classification, and Mehanna types. In the multivariate prognostic model, only Mehanna type remained as a significant risk predictor. The risk of developing complications increases with increasing Mehanna type. CONCLUSIONS: We have developed and then validated a new classification and risk stratification system for CBTs, which demonstrated better prognostic power for the risk of developing neurovascular complications after surgery.

Does Submandibular Gland Sacrificing Neck Dissection Decrease Salivary Output and Quality of Life?

PURPOSE: Our study aimed to quantify the impact of submandibular gland (SMG) resection during Level I neck dissection (ND) on stimulated salivary output (SSO) and xerostomia-related quality of life in patients with head and neck cancer (HNC). METHODS: A retrospective cohort was formed from 32 patients that underwent unilateral or bilateral Level I ND and a control group of 23 patients that had level II-IV ND. SSO (Saxon test) and University of Washington Quality of Life survey results for both groups were compared. RESULTS: Mean SSO was 3.41 g in the SMG resection group and 3.86 g in the control group, with no significant statistical difference. There was no difference in mean SSO between patients with 2 SMGs, a single remaining SMG, or no glands. The mean SSO of SMG resection cases with a history of adjuvant RT was 2.61 g which was below the xerostomia threshold for the Saxon test (2.75 g) and control group patients with RT had a significantly higher mean SSO (4.07 g). The lowest UW-QoL saliva domain score average (53.8) was in the SMG-resected, RT-positive group. CONCLUSION: Results indicate unilateral or bilateral resection of SMG does not reduce SSO to a significant extent. Adjuvant radiotherapy and SMG resection are additive risk factors for xerostomia and the related loss in quality of life. SMG sparing may be necessary in HNC patients with higher risk for the need of adjuvant radiation.

Fat transfer after parotidectomy: fat resorption rates, aesthetic and functional outcomes of en-bloc fat graft versus lipofilling technique.

PURPOSE: Reconstruction of parotidectomy involves the correction of facial contour abnormalities and prevention from Frey Syndrome. Reconstruction of parotidectomy field with autologous fat has not been popular among head and neck surgeons due to unclear predictability of fat resorption rates. The aim of this paper is to compare the fat resorption rates between different fat transfer techniques using radiologic measurements and reviewing the aesthetic and functional outcomes. METHODS: We retrospectively reviewed medical records of patients, who underwent parotidectomy in Hacettepe University Hospital between 2015 and 2018. The aesthetic and functional outcomes of en-bloc fat graft and lipofilling techniques were compared among themselves, as well as with patients who had no reconstruction, using objective parameters. Fat resorption rates were compared using calculation of fat volumes obtained by MRI scans, 1 year after surgery. RESULTS: Among 77 patients, 26 underwent reconstruction with en-bloc fat graft (P-EBFG); 21 patients reconstruction with lipofilling technique (P-LFT), whereas 30 patients had no reconstruction of parotidectomy field (P-NR). In three groups, there was no statistically significant difference in mean resected parotid tissue volumes (mean 18 ± 10.8 cm3, p = 0.754). We found a significant difference in decreased presence of Frey Syndrome and increased satisfation rates of cosmetic appearance in P-EBFG and P-LFT, in comparison to P-NR (p < 0.001). There was no significant difference in fat resorption rates between P-EBFG (50.75 + 21.20%) and P-LFT (48.59 + 17.93%) (p = 0.771). CONCLUSION: Both en-bloc fat graft and lipofilling techniques have been found to be safe and to have similar fat resorption rates for reconstruction after parotidectomy.

Clinical impact of 68Ga-DOTATATE PET-CT imaging in patients with medullary thyroid cancer.

PURPOSE: Medullary thyroid cancer (MTC) arises from neuroendocrine C cells of the thyroid. There is no single diagnostic imaging method that can reveal all MTC recurrences or metastases. 68Ga-DOTATATE is an alternative PET radiotracer that showed acceptable efficacy in the detection of MTC. In this study, we aimed to reveal the clinical efficacy and impact of this radiotracer on the management of patients with MTC. METHODS: The 68Ga-DOTATATE PET-CT records of 38 patients with confirmed MTC were included in the study. The demographic data, clinical indication for the scan, previous therapies, and tumor marker levels were recorded. The site and SUVmax of the lesions were also noted. A consensus was reached on the additional value of 68Ga-DOTATATE PET-CT, and sites with discordant results on conventional imaging (CI). Finally, changes in management after the scan were evaluated. RESULTS: 68Ga-DOTATATE PET-CT outperformed CI in 14/38 (37%) patients. In these 14 patients, metastatic lymph nodes were detected in 8, bone metastases in 4, and both bone and lymph nodes metastases in 2 patients. In 16/38 (42%) patients, 68Ga-DOTATATE PET-CT performed equally well as CI. In 5/38 (13%) patients, CI outperformed PET-CT. Most of the patients (4/5) in this group had hepatic metastases. 68Ga-DOTATATE PET-CT positivity was also correlated with tumor marker expression [median calcitonin; PET-positive: 743 ± 5439 vs PET-negative: 45 ± 17 (p:0.012), median CEA; PET-positive: 41 ± 162 vs PET-negative: 2.6 ± 1.4 (p:0.015)]. 68Ga-DOTATATE PET-CT changed the clinical management of 13/38 (34%) patients. The information provided by PET-CT resulted in neck surgery in 5/13 patients, external radiotherapy in 3/13 and both in one patient. Four of these thirteen patients were found to be eligible for peptide receptor radionuclide therapy. CONCLUSION: 68 Ga-DOTATATE is an essential part of the work-up for patients with MTC. This modality outperformed CI in 14/38 (37%) patients and changed the clinical management in 13/38 (34%) patients. Prospective randomized studies with image-guided therapy decisions are needed to further reveal the impact of PET imaging in patients with MTC.

Radioguided occult lesion localization in patients with recurrent thyroid cancer.

PURPOSE: Well planned re-surgery is critical for recurrent/persistent thyroid cancer (TC). We aimed to investigate the clinical outcome of radioguided-occult lesion localization (ROLL) guided surgery in patients with recurrent/persistent TC. METHODS: This study includes 29 patients [F/M: 22/7, median age 43 ± 12 years (18-58)] with a diagnosis of TC (22 papillary, 2 follicular and 5 medullary). Before surgery, all patients underwent ultrasonography (USG) guided mapping and intra-lesional radioactivity injection. Surgery was performed based on the excision of radioactivity injected lesions by a gamma probe and non-injected tumor foci via USG-neck map. Researchers determined surgical success by post-operative tumor markers and neck-USG. RESULTS: Among 29 patients, 60 metastatic lesions were identified by USG [median size 10 ± 6.3 mm (range 5-30)]. Neck-USG performed after surgery provided no evidence of disease (NED) in %97 (28/29) of TC patients. In the follow-up, stimulated thyroglobulin (Tg) levels were less than 1 ng/ml in 79%(19/24) of DTC patients and suppressed Tg < 0.2 ng/ml was noted in 92% (22/24).In patients with DTC with an incomplete structural response, we dramatically changed the American Thyroid Association (ATA) response category and achieved an excellent response in 92% (22/24) of patients. Among patients with MTC, 5/5 patients had normal USG and calcitonin levels were reduced by 60-80% in 4/5 and > 80% in1/5 patients. CONCLUSIONS: In this study we have shown that, ROLL-guided surgery yielded NED rate of %97 (28/29) and increased excellent response rates according to ATA guidelines. Further studies with larger patient groups and longer follow-up should be performed to confirm the efficacy of this surgery.

Sudden hearing loss: an effectivity comparison of intratympanic and systemic steroid treatments.

Corticosteroid treatment has been considered the most effective treatment modality for sudden sensorineural hearing loss so far. Application route of corticosteroids may vary. We have designed a prospective randomized case-controlled clinical trial to evaluate the effectivenesses of the different application routes of steroids in the treatment of SSHL. Thirty-five patients were distributed randomly to two groups which were treated with either 'oral' or 'intratympanic' corticosteroids. Intratympanic steroid administration was performed three times every other day transtympanically. At the end of third month, recovery rate in the 'intratympanic' group was 84.2%, whereas in the 'oral' group, it was 87.5%. The difference between the recovery rates was not statistically significant. There were no major complications related to transtympanic steroid administration. These findings support that intratympanic steroid therapy is an alternative to systemic steroid therapy in the initial treatment of sudden hearing loss. In addition, transtympanic technique is an easy to perform and safe method for delivering steroids into the inner ear.

Total and Partial Laser Arytenoidectomy for Bilateral Vocal Fold Paralysis.

Introduction. Treatment for bilateral vocal fold paralysis (BVFP) has evolved from external irreversible procedures to endolaryngeal laser surgery with greater focus on anatomic and functional preservation. Since the introduction of endolaryngeal laser arytenoidectomy, certain modifications have been described, such as partial resection procedures and mucosa sparing techniques as opposed to total arytenoidectomy. Discussion. The primary outcome measure in studies on BVFP treatment using total or partial arytenoidectomy is avoidance of tracheotomy or decannulation and reported success ranges between 90 and 100% in this regard. Phonation is invariably affected and arytenoidectomy worsens both aerodynamic and acoustic vocal properties. Recent reports indicate that partial and total arytenoidectomies have similar outcome in respect to phonation and swallowing. We use CO2 laser assisted partial arytenoidectomy with a posteromedially based mucosal flap for primary cases and reserve total arytenoidectomy for revision. Lateral suturing of preserved mucosa provides tension on the vocal fold leading to better voice and leaves no raw surgical field to unpredictable scarring or granulation. Conclusion. Arytenoidectomy as a permanent static procedure remains a traditional yet sound choice in the treatment of BVFP. Laser dissection provides a precise dissection in a narrow surgical field and the possibility to perform partial arytenoidectomy.

The role of suprahyoid neck dissection in the treatment of squamous cell carcinoma of the lower lip: 20 years' experience at a Tertiary Center.

PURPOSE: To evaluate the efficacy of L1-2ND in the management of the lower lip squamous cell carcinoma and to achieve the highest cure rates with adequate neck dissection. METHODS: A retrospective review was completed on patients treated between 1994 and 2014. The case histories of 184 patients who were treated with surgical excision of the primary tumor along with neck dissection, and 24 patients who were treated only with surgical excision without neck dissection at another center, were studied. All patients were followed up for evidence of recurrent disease. RESULTS: In 208 patients (193 men, 15 women) with a mean age of 51 years, 12 were N1, 3 were N2, and 169 were N0; 24 patients had undergone operation at another center without neck dissection. Lymph node metastases were present in 34 patients (18.4%) with dissected necks and occult metastases were detected in 19 patients with clinically N0 necks (11.2%). The median follow-up of each patient was 28 months. Only 1 patient developed neck recurrence, and there was no local recurrence. The overall survival rate (OAS) of patients with clinical N0 disease who underwent neck dissection was 94.7%; the OAS of the patients who were not treated with neck dissection was 29.1%. CONCLUSION: Level 1-2 neck dissection (L1-2ND) is the treatment of choice for controlling neck disease in patients with lower lip carcinoma, and serves as a staging procedure to detect patients who require adjuvant therapy.

The rising incidence of papillary thyroid microcarcinoma and is completion surgery necessary or not?

Papillary thyroid microcarcinoma (PTMC) is defined as a papillary cancer that is 1 cm or less in its maximal diameter. The incidence of thyroid cancer has increased during the past 30 years. The aim of this study is to evaluate the rising incidence of PTMC (papillary thyroid microcarcinoma) and whether is lobectomy enough or not. The data of 462 consecutive patients who underwent thyroidectomy (hemithyroidectomy and total thyroidectomy) at the Hacettepe University Hospitals Department of ENT from 2000 to 2015 were analyzed. Surgical procedure, histopathologic examinations, postoperative complications, follow-up time and mortality were recorded. USG and FNAC were performed on all cases. Of the 344 patients with thyroid malignancy and 118 patients underwent total laryngectomy with thyroidectomy. 364 patients with TT and 98 patients with HT. The first group included 204 patients (Surgery time 2000-2007), 91 of them ( 44.6%) had PTMC. The second group included 258 patients, 192of them (74,4%) had PTMC (p<0.001). 22 Patients with PTMC underwent completion surgery and 40 of them just followed by hemithyroidectomy. There was no recurrence. PTMC has been rising incidence because of ,pathological and radiological, increased awareness and completion surgery is not necessary for all PTMC cases especially incidental PTMC.

The rising incidence of papillary thyroid microcarcinoma and is completion surgery necessary or not?

Papillary thyroid microcarcinoma (PTMC) is defined as a papillary cancer that is 1 cm or less in its maximal diameter. The incidence of thyroid cancer has increased during the past 30 years. The aim of this study is to evaluate the rising incidence of PTMC (papillary thyroid microcarcinoma) and whether is lobectomy enough or not. The data of 462 consecutive patients who underwent thyroidectomy (hemithyroidectomy and total thyroidectomy) at the Hacettepe University Hospitals Department of ENT from 2000 to 2015 were analyzed. Surgical procedure, histopathologic examinations, postoperative complications, follow-up time and mortality were recorded. USG and FNAC were performed on all cases. Of the 344 patients with thyroid malignancy and 118 patients underwent total laryngectomy with thyroidectomy. 364 patients with TT and 98 patients with HT. The first group included 204 patients (Surgery time 2000-2007), 91 of them ( 44.6%) had PTMC. The second group included 258 patients, 192of them (74,4%) had PTMC (p&lt;0.001). 22 Patients with PTMC underwent completion surgery and 40 of them just followed by hemithyroidectomy. There was no recurrence. PTMC has been rising incidence because of ,pathological and radiological, increased awareness and completion surgery is not necessary for all PTMC cases especially incidental PTMC.

Early oral feeding after total laryngectomy: Outcome of 602 patients in one cancer center.

OBJECTIVE: Pharyngocutaneous fistula (PCF) is the most frequent complication after total laryngectomy. However, delayed oral feeding and inserting a nasogastric tube has been considered as a safe practice among head and neck surgeons, and there is no general agreement on the initiation of the oral intake. The aim of the study is to determine the incidence of PCF after primary total laryngectomy in a large homogenous case series and to evaluate whether fistula and early oral feeding are related. METHODS: Patients who underwent total laryngectomy/laryngopharyngectomy with primary closure of pharynx between 1990 and 2014 were reviewed. Patients who had a history of previous radiotherapy, chemotherapy or chemoradiotherapy, and patients who underwent more complex reconstruction techniques (e.g. pedicled or free flaps) for closure were excluded. In total, 602 patients underwent total laryngectomy (n=580) or total laryngectomy plus partial pharyngectomy (n=22). RESULTS: The overall PCF rate was 12%. In 582 of the 602 patients (99.8%), a nasogastric tube was not inserted. In 95.7% of the patients (576/602), oral feeding was started within 3 days of surgery. Among the patients who developed PCF (72/602), PCF rate was not significantly higher in early oral fed patients (69/582, 11.8%) than the patients with nasogastric tube insertion (3/20, 15%) (p=0.722). CONCLUSION: The low PCF rate in our study indicates that early oral feeding is a safe and effective method in primary total laryngectomy.

Microtrapdoor Flap Technique for Treatment of Glottic Laryngeal Stenosis: Experience With 34 Cases.

OBJECTIVES: Laryngeal stenosis is the most challenging disorder for the laryngologist to treat. Microtrapdoor flap technique was described in 1980s; however, it has not been popular since then. The reason may be the difficulty of the technique. In this study, we will report our experience with microtrapdoor flap technique to treat glottic stenosis of 34 patients. STUDY DESIGN: Retrospective case series of a tertiary referral center. METHODS: Twelve male and 22 female patients make up our study group. All patients, but one, had pure glottic stenosis. The other patient had combined supraglottic and glottic stenosis. Unilateral or bilateral microtrapdoor technique was applied to all patients. The patients are required to have at least 1 year postoperative follow-up. RESULTS: The etiology of glottic stenosis includes 19 cases due to failed surgery for bilateral vocal fold paralysis; seven cases due to microlaryngoscopy (three laryngeal papilloma, one leukoplakia excision, one glottic cancer excision, one foreign body extraction, one biopsy from interarytenoid region); four cases due to prolonged intubation; one case due to laryngeal fracture, one case due to vertical laryngectomy, one case due to smoke inhalation (burn), and one case congenital or idiopathic. Seventeen patients had tracheotomy. All seventeen of them were decannulated 2 months postoperatively. Thirty-three patients (97%) were dyspnea free on exertion 1 year postoperatively. One patient developed restenosis and dyspnea 1 year after treatment; she needs retreatment. CONCLUSIONS: Microtrapdoor flap technique is a successful surgical option for treatment of short-segment laryngeal stenosis.