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Objective: The aim of this study was to investigate whether Central lymph node (CLN) size as measured by an ultrasound can significantly predict CLN metastasis of papillary thyroid carcinoma (PTC). Materials and methods: This retrospective chart review of patients diagnosed with PTC who underwent ultrasound and central neck dissection (CND). We excluded patients who received previous thyroid surgery or radiation. We analyzed the correlation between CLN size and characteristics by ultrasound and histopathologic findings among positive CLN patients. Results: Of the 48 patients who underwent preoperative ultrasound and CND, 34 patients had positive CLN identified by ultrasound. The positive predictive value, negative predictive value, sensitivity, specificity, and accuracy of ultrasound in this diagnostic setting was 88.0%, 21.0%, 73.2%, 42.9%, and 68.7%, respectively. The risk of CLN metastasis of PTC was 67.7% and 85.7% for lymph node size 3.1 to 4 mm and 4.1 to 5 mm, respectively. The risk increased to 100% when the lymph node size was >5 mm. Positive preoperative ultrasound of lateral neck lymph node was found to be a significant risk factor for CLN metastasis (P = .003). Conclusion: Ultrasound was found to be an effective preoperative evaluation in patients with PTC to determine the likelihood of CLN metastasis and whether CND is indicated, especially in the ultrasound-positive central lymph node. A high risk of metastasis was found in CLN size >3 mm by ultrasound, and the risk dramatically increased in CLN size >5 mm. We also found positive lateral neck node from preoperative ultrasound to be a significant risk factor for CLN metastasis.
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OBJECTIVES: To determine proper characteristics of food which would be safe and satisfactory for swallowing in oral cavity cancer patients undergoing surgery and to create a recipe that provides adequate nutrients, energy, good taste, and can be easily made at home. MATERIALS AND METHODS: Patients who were enrolled in this study underwent oral cancer surgery in the Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital from September 2017 to July 2018. This experimental research was conducted postoperatively before receiving chemoradiation. Each type of food was prepared by the researchers to have a combination of two physical properties, which were 3 different consistencies (liquid, nectar-like, and honey-like) and 2 different temperatures (room temperature (25ºC) and cold temperature (4ºC)). Each patient had to swallow six different types of prepared food by random sequences. Flexible endoscopic evaluation of swallowing (FEES) was used to evaluate objective swallowing function by 3 parameters, including premature oropharyngeal spillage, laryngeal penetration or aspiration, and post-swallow retaining residues. Satisfaction measurement was evaluated with visual analog scale (VAS). RESULTS: There were 42 postoperative oral cavity cancer patients enrolled in this study. Subjects consisted of 23 males (54.8%) and 19 females (45.2%) with the mean age of 62 ± 13 years. Most patients had oral tongue carcinoma (64.3 %). FEES revealed nectar at room temperature was the safest with score of 0.83 ± 0.82 (possible score of 0-3, with 0 was best). However, patients significantly preferred liquid at room temperature more than other kinds of food (VAS taste = 8.26 ± 1.52 and VAS easy swallowing = 8.05 ± 1.74). When evaluating specifically in patients with oral tongue cancer, FEES scores, VAS taste, and VAS easy swallowing showed similar results the liquid at room temperature was the best. CONCLUSIONS: We suggested that the nectar-like thickened food at room temperature was determined to be the most proper food characteristic for oral cancer patients undergoing surgery in order to prevent aspiration. However, patients' satisfaction analysis suggested that they preferred other type of food. The physician should advise patients of the proper kind of food for safe swallowing and avoidance of serious complication especially aspiration pneumonia.
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Transtornos de Deglutição , Neoplasias Bucais , Neoplasias da Língua , Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Transtornos de Deglutição/etiologia , Néctar de Plantas , Neoplasias Bucais/cirurgia , Neoplasias Bucais/complicações , RefeiçõesRESUMO
PURPOSE: Sialendoscopy is a minimally invasive procedure for the treatment of salivary gland diseases. The purpose of this study was to review a series of the patients undergoing sialendoscopy and to present our experience regarding the management and outcome of obstructive sialadenitis treated by this procedure. METHODS: This study was a case series. We collected data on patients who underwent sialendoscopy in our institute between January 2016 and July 2019. The data included patients' demographics, involved salivary glands, diagnostic investigation, types of anesthesia, endoscopic findings, materials used, complications, adjunctive treatment, duration of follow-up, and therapeutic outcome. Descriptive statistics were used to analyze the surgical findings and outcome. RESULTS: There were 61 patients involving 76 glands (48 submandibular and 29 parotid glands). There were 43 females and 18 males with the median age 45 years at the time of sialendoscopy. The median duration of follow-up was 6 months. The most dominant symptom was pain with swelling (59.20%). The 2 most common sialendoscopic findings were ductal stenosis and sialolithiasis. We observed a success rate in achieving a complete relief of 77.6% at the first procedure and 96.7% at the last follow-up. We did not have any cases with postoperative complication or recurrence. CONCLUSION: Our study supports sialendoscopy as a safe and successful procedure that plays a dual role in diagnostics and in relieving symptoms of patients with obstructive sialadenitis with or without sialolithiasis. It should be advised for patients with non-neoplastic salivary duct obstruction either for diagnosis or therapeutic intervention.
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Anestesia Dentária , Cálculos das Glândulas Salivares , Sialadenite , Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Cálculos das Glândulas Salivares/cirurgia , Resultado do Tratamento , Endoscopia/métodos , Hospitais , Estudos RetrospectivosRESUMO
PURPOSE: The majority of head and neck squamous cell carcinoma (HNSCC) cases in developing countries are associated with cigarette smoking and TP53 mutations. p53 is a transcription factor that activates downstream genes, including the hsa-miR-34a and hsa-miR-34b/c loci, to achieve cell-cycle arrest, senescence, and/or apoptosis. This study examined the differences in expression levels of miR-34 in HNSCC with or without TP53 mutations. METHODS: We examined surgically resected tumor samples and normal adjacent tissues from HNSCC in oral cavity, larynx, and hypopharynx for TP53 mutations (exons 5-8) and miR-34 expression levels. RESULTS: miR-34a, miR-34b, miR-34b*, and miR-34c are significantly up-regulated in tumors with wild-type TP53 genes (n = 23); while such up-regulation is not observed in tumors with mutant TP53 (n = 19). Although expression levels of miR-34-family miRNAs do not correlate with gender, age, or tumor staging, interestingly they are correlated with smoking status and tumor sites. miR-34b/b*/c are up-regulated in tumors from those who ever smoked or recently smoked (quit smoking less than 15 years ago); but such up-regulation was not seen in those who never smoked or quit smoking for at least 15 years. HNSCC of the oral cavity also up-regulated miR-34b/b*/c while no such overexpression was observed in HNSCC of the larynx and hypopharynx. CONCLUSIONS: Surgically resected HNSCC samples with no TP53 mutations have elevated levels of miR-34a and miR-34b/b*/c, while those with TP53 mutations show no such up-regulation. miR-34b/b*/c expression is also correlated with smoking status and tumor sites.
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Neoplasias de Cabeça e Pescoço/genética , MicroRNAs/metabolismo , Mutação , Carcinoma de Células Escamosas de Cabeça e Pescoço/genética , Proteína Supressora de Tumor p53/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Éxons , Feminino , Humanos , Masculino , MicroRNAs/genética , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Fumar/metabolismo , Regulação para Cima , Adulto JovemRESUMO
OBJECTIVE: To evaluate the incidence of post-hemithyroidectomy hypothyroidism and identify possible risk factors that indicates whether patients require thyroid function monitoring after surgery. MATERIAL AND METHOD: A retrospective review of patients with benign non-toxic thyroid disease undergoing hemithyroidectomy between April 2004 and November 2008 in the Department of Otorhinolaryngology, Siriraj Hospital was conducted All patients were in euthyroid state preoperatively. Thyroid specimens were examined for pathological diagnosis and degree of lymphocytic infiltration in thyroid tissue, and thyroid function was evaluated again six weeks after surgery. RESULTS: One hundred patients who received hemithyroidectomy were recruited for the present study. All had normal preoperative thyroid function. Six weeks after surgery, 27% of the cases developed hypothyroidism (6% overt or symptomatic hypothyroidism and 21% subclinical hypothyroidism). The mean preoperative thyrotropin level was significantly higher in the hypothyroid group than in the euthyroid group (1.9±1.2 vs. 1.1±0.7 micro IU/ml). Fifty-eight point three percent of patients with preoperative thyroid stimulating hormone (TSH) level more than or equal 2 micro IU/ml developed hypothyroidism in comparison to only 17.1% of those with preoperative TSH <2 micro IU/ml (odds ratio 6.8). Fifteen patients had signifcant lymphocytic infiltration (grade 2-4); nine of those (60%) had post-operative hypothyroidism. In contrary, only 18 of 85 patients (21.2%) with minimal infiltrates (grade 0-1) developed hypothyroidism (odds ratio 5.6). CONCLUSION: Twenty-seven percent of the patients in the present study developed hypothyroidism after hemithyroidectomy. Preoperative TSH more than or equal 2 micro IU/ml and significant lymphocytic infiltration in thyroid tissue or thyroiditis warrant post-operative close TSH monitoring. The awareness of such risk factors for post-operative hypothyroidism would improve patients care.
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Hipotireoidismo/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Doenças da Glândula Tireoide/cirurgia , Adenoma/cirurgia , Adenoma Oxífilo/cirurgia , Adolescente , Adulto , Idoso , Cistos/cirurgia , Feminino , Bócio/cirurgia , Hospitais Universitários , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/etiologia , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Estudos Retrospectivos , Fatores de Risco , Tailândia/epidemiologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Tireoidectomia/métodos , Tireoidite/cirurgia , Tireotropina/sangue , Adulto JovemRESUMO
Carotid body tumor is an uncommon hypervascular benign tumor in the head and neck region. It usually presents as a slow growing mass at the carotid bifurcation. Because of the high rate of neurovascular complications, resection of this tumor is considered challenging for otolaryngologists. Between 1988 and 2013, 40 carotid body tumors from 38 patients were diagnosed and underwent resection at Siriraj Hospital (25 female and 13 male patients). Their age ranged from 15 to 59 years. Seven patients had bilateral tumors simultaneously whereas six cases had familial history of carotid body tumor. Carotid angiography was performed in 29 cases; other additional diagnostic studies included CT scan, MRI, and MRA to detect the widening of carotid bifurcation, its extension, and multifocal tumors. All diagnosed tumors were successfully removed. However, internal carotid artery and carotid bifurcation were injured in 11 cases (27.5 %). Shamblin class III and previous biopsy history were considered risk factors for vascular injury. Postoperative cranial nerves deficit was found in 20 % of the cases and CNS complication occurred in two patients (5 %). There was no surgical mortality. Additionally, upon the mean follow-up period of 36 months, no recurrence or malignant transformation was detected in this study. Multidisciplinary approach, early tumor detection, meticulous preoperative evaluation, and modern vascular surgical technique are the key success factors for tumor removal.
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Lesões das Artérias Carótidas/etiologia , Tumor do Corpo Carotídeo/cirurgia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Vasculares/métodos , Adolescente , Adulto , Biópsia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Artéria Carótida Interna/cirurgia , Tumor do Corpo Carotídeo/diagnóstico por imagem , Tumor do Corpo Carotídeo/patologia , Traumatismos dos Nervos Cranianos/etiologia , Dissecação/efeitos adversos , Dissecação/métodos , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Paraganglioma , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Carga Tumoral , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Adulto JovemRESUMO
OBJECTIVE: To report the functional results and oncologic outcome of patients undergoing frontolateral laryngectomy in Siriraj Hospital. MATERIAL AND METHOD: A retrospective review of T and T2 glottic squamous cell carcinoma patients undergoingfrontolateral laryngectomy in the department of Otolaryngology, Faculty of Medicine Siriraj Hospital between 1986 and 2006 with a minimum of five years follow-up period RESULTS: Out of 55 patients who underwent frontolateral laryngectomy, 50 cases that fitted the criteria were recruited for the present study. After surgery, all patients but one had tracheotomy decannulation and recovered good respiratory function. Forty-three successfully decannulated patients (87.80%) had tube decannulation within 14 days. The mean duration offeeding via nasogastric tube was 11.4 days (ranged from 5 to 22 days). Forty-eight patients (96%) resumed oral feeding before discharge from the hospital and all but two had grade I subjective functional speech during hospitalization. The one, three, and five years overall survival rate in our study were 98%, 92%, and 92%, respectively. The 5-year tumor control rate was 97.1%for TI and 75%for T2 tumors. The larynx preservation rate was 90%. CONCLUSION: Frontolateral laryngectomy is one of the excellent therapeutic options for treatment of T1 and T2 glottic cancer; especially those with anterior commissure involvement. It conserves reasonable laryngeal function with short hospitalization. Its local tumor control rate was above other treatment modalities and the survival rates were impressive.
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Carcinoma de Células Escamosas/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Feminino , Seguimentos , Glote/patologia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Neoplasias Laríngeas/patologia , Laringe/patologia , Laringe/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Carcinoma de Células Escamosas de Cabeça e Pescoço , Taxa de SobrevidaRESUMO
OBJECTIVES/HYPOTHESIS: To assess outcomes including efficacy, adverse effects, and quality of life (QOL) of an adjustable thermoplastic mandibular advancement device (AT-MAD) fitted by an otolaryngologist for obstructive sleep apnea (OSA) treatment. STUDY DESIGN: Prospective, nonrandomized, before-after study. METHODS: Sixty-four adult patients (40 men and 24 women) were recruited. Inclusion criteria were OSA patients who had failed or refused treatment with continuous positive airway pressure and surgery. Exclusion criteria were insufficient teeth, active intraoral disease, and temporomandibular joint (TMJ) disorders. Outcomes were measured using polysomnography, symptom questionnaires, Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire (FOSQ) before treatment and 4 to 6 months thereafter. RESULTS: Mean apnea-hypopnea index (AHI) and ESS scores decreased from 17.7 ± 14.6 to 7.5 ± 10.9 and from 8.7 ± 4.9 to 6.5 ± 4.4, respectively, after treatment (P < .001). Thirty-nine patients (60.9%) achieved post-treatment AHI of <5, with the highest success rate in those with mild OSA (75%). FOSQ global scores increased from 16.4 ± 2.8 to 17.7 ± 3.0 (P < .05), along with most FOSQ subscale scores. Thirty-four patients (53.1%) regularly used the device for ≥5 nights per week. Adverse effects include TMJ discomfort, dry mouth, and excessive salivation, which were largely tolerable. Only four patients withdrew from the study because of adverse effects. CONCLUSIONS: This is the first study in Asians demonstrating that an AT-MAD, if done properly, is a practical short-term treatment of OSA, with good outcomes including improved QOL. Its advantages are its low cost and ready-to-use nature. However, further randomized controlled trials are required.
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Avanço Mandibular/instrumentação , Qualidade de Vida , Apneia Obstrutiva do Sono/reabilitação , Sono/fisiologia , Adulto , Idoso , Pressão Positiva Contínua nas Vias Aéreas , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Estudos Prospectivos , Desenho de Prótese , Apneia Obstrutiva do Sono/fisiopatologia , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVE: To assess the efficacy of dexpanthenol nasal spray compared with normal saline spray in the postoperative treatment of patients with chronic rhinosinusitis (CRS) who underwent endoscopic sinus surgery (ESS). MATERIALS AND METHOD: A prospective, randomized controlled study was conducted in CRS patients who underwent ESS. The enrolled patients had never been operated intranasally. These patients received either dexpanthenol or normal saline nasal spray intranasally four times a day for six weeks post-operatively. RESULTS: Fifty CRS patients were recruited in the present study. Age ranged from 23 to 63 years (means 43.4 +/- 11.2 years). Forty-four percent of patients were diagnosed as CRS without nasal polyps (NP) (CRSs NP) and 56% were CRS with NP (CRSw NP). Twenty-five cases were randomly assigned to use dexpanthenol nasal spray whereas the other 25 cases used normal saline nasal spray. The preoperative severity of CRS, determined by the computerized tomography (CT) scan scoring system of Lund-McKay was 13.9 +/- 6.2 in the dexpanthenol group and 13.6 +/- 6.9 in the normal saline group, which were not statistically different (p > 0.05). The endoscopic scoring was 10.2 +/- 2 in the dexpanthenol group and 10.7 +/- 3 in the normal saline group, which were not statistically different (p > 0.05). The mucociliary transit time improvement (time difference between pre- and post-treatment by nasal spray) was 8.4 +/- 3.3 minutes in the dexpanthenol group and 1.7 +/- 1.2 minutes in the normal saline group, which were statistically different (p < 0.05). CONCLUSION: The majority of the postoperative symptom scores and all of the endoscopic scores of the dexpanthenol group were not statistically different from those of the normal saline group. However, dexpanthenol nasal spray has superior efficacy compared with normal saline nasal spray on improvement of mucociliary clearance and nasal discharge in the postoperative care of CRS patients after ESS.
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Endoscopia/métodos , Ácido Pantotênico/análogos & derivados , Rinite/cirurgia , Sinusite/cirurgia , Complexo Vitamínico B/administração & dosagem , Cicatrização/efeitos dos fármacos , Administração Intranasal , Adulto , Distribuição de Qui-Quadrado , Doença Crônica , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ácido Pantotênico/administração & dosagem , Estudos Prospectivos , Cloreto de Sódio/administração & dosagem , Resultado do TratamentoRESUMO
PURPOSES: The objectives of this study are to test the reliability and validity of the Thai version of the Epworth sleepiness scale (ESS) and to assess the relationship between the ESS score and the severity of obstructive sleep disordered breathing. METHODS: A total of 228 subjects (149 males and 79 females) were recruited. In order to check the discriminant validity of the ESS, we included 32 healthy volunteers and 39 patients with primary snoring to be the control groups and 126 patients with obstructive sleep apnea (OSA) confirmed by full polysomnography to be the disease groups. The test-retest reliability was investigated in 71 subjects. To check the responsiveness properties of the questionnaire, we asked a separate group of 31 patients who were successfully treated with either continuous positive airway pressure (CPAP) or upper airway surgery to complete the ESS before and after treatment at 3-6 months. RESULTS: The internal consistency demonstrated by Cronbach's alpha coefficients for standardized item was 0.87 and a range from 0.84 to 0.86 if some items were deleted. The test-retest reliability was shown by intra-class correlation coefficients of 0.79. There was a statistically significant difference between the mean of the ESS scores of the control groups (6.1 ± 3.0) and the OSA patients (9.9 ± 5.3) (p < 0.001). The ESS scores decreased significantly after a successful treatment with both CPAP and surgery (p < 0.001); however, there was no statistically significant difference among different severities of OSA. CONCLUSIONS: Our Thai version of the ESS showed an excellent internal consistency and test-retest reliability. It is able to discriminate between control subjects and OSA patients and to assess the response of treatment; however, it has a weak relationship with the apnea-hypopnea index. Therefore, we recommend use it to combine with more comprehensive clinical evaluation in obstructive sleep disordered breathing patients.
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Comparação Transcultural , Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Apneia Obstrutiva do Sono/diagnóstico , Inquéritos e Questionários , Adulto , Pressão Positiva Contínua nas Vias Aéreas , Estudos Transversais , Distúrbios do Sono por Sonolência Excessiva/epidemiologia , Distúrbios do Sono por Sonolência Excessiva/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria/estatística & dados numéricos , Reprodutibilidade dos Testes , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/terapia , Ronco/diagnóstico , Ronco/epidemiologia , Ronco/terapia , Tailândia , TraduçãoRESUMO
Choanal atresia is caused by failure of resorption of the bucco-pharyngeal membrane during embryonic development. The atresia can be membranous or bony in nature, but is usually mixed in most cases. When the atresia is bilateral, newborns can have severe airway distress and cyanosis is alleviated by crying. Bilateral choanal atresia is managed with an oropharyngeal airway. Flexible nasal endoscopy and computed tomography can confirm the diagnosis. Surgery is the definitive treatment with two main approaches, namely transnasal or transpalatal. The transnasal route is currently the preferred procedure and can be performed in a minimally invasive fashion with endoscopic instrumentation. It is a safe and rapid procedure even in very young children, with no complications and a high rate of success. The use of a navigation system for surgical planning and intraoperative guidance and powered instrumentation can improve treatment outcome. The transpalatal approach is more invasive and reserved for failed endoscopic cases.
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Atresia das Cóanas/cirurgia , Endoscopia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Atresia das Cóanas/diagnóstico por imagem , Humanos , Recém-Nascido , Stents , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Midfacial degloving surgical approach is an excellent alternative to the lateral rhinotomy in exposure to the nasal cavity, paranasal sinuses and the nasopharynx. By lifting the soft tissue from the midportion of the face, many extensive benign tumors such as inverted papilloma, nasopharyngeal angiofibroma and some limited malignant lesions could be safely removed. This procedure could be combined with other approaches such as transtemporal, intracranial approach to resect more extensive tumors around the orbit, central skull base, as well. This technique was applied in 40 cases, ranging from 12-72 years of age and in a variety of diseases in Siriraj Hospital from 1991 to 2000. Fifty five per cent were diagnosed as inverted papilloma and 20 per cent were nasopharyngeal angiofibroma. The surgical technique in this operation was emphasized and it has proved to be an extensively valuable procedure for wide exposure of the operative field without any external scar. Functional outcome was obtained in most of the cases with minimal complications.