Discrepancy between cTNM and pTNM staging of oral cavity cancers and its prognostic significance.

INTRODUCTION: Accurate tumor-node-metastasis(TNM) staging of oral cavity cancer(OCC) is very important in the management of this dismal disease. However, stage migration from cTNM to pTNM was found in a portion of OCC patients. The objective of this study was to determine the possible causes of discrepancy between cTNM and pTNM in OCC and the clinical impacts of stage migration. METHODS: Clinical and pathological data of 252 OCC patients were retrospectively reviewed and compared each other. Clinical staging was determined through the multidisciplinary evaluation of pre-treatment work-ups including PET/CT. In addition, we compared the up-staged cases with those in the no-change group with the same pTNM stages to identify the clinical impacts of such change. RESULTS: Clinical staging yielded overall 82.5% diagnostic accuracy in predicting pathological tumor status, and tumor extent was under-estimated in 9.5-13.5% of cases. The main causes of T up-staging were under-estimation of surface dimension (62.5%) and deep invasion to tongue extrinsic muscles (37.5%). N up-staging was due to occult single (57.6%) and multiple (42.4%) metastases. Surprisingly, TNM up-staging in our series did not have prognostic significance under the current management protocol. CONCLUSION: Clinical under-estimation of pathological tumor extent occurred in approximately 13% of OCC, without clinical impacts on prognosis.

A Comparison of Olfactory and Sinonasal Outcomes in Endoscopic Pituitary Surgery Performed by a Single Neurosurgeon or a Collaborative Team of Surgeons.

OBJECTIVES: Endoscopic pituitary surgery usually requires a collaboration between neurosurgeons and ENT surgeons to achieve optimal outcomes. However, neurosurgeons occasionally perform these procedures alone without an ENT surgeon. In this study, postoperative sinonasal quality of life and olfactory function were compared in patients who underwent endoscopic pituitary surgery performed by a single neurosurgeon or by a collaborative team of a neurosurgeon and an ENT surgeon. METHODS: A retrospective review of prospectively collected data was performed. Patients who underwent endoscopic pituitary surgery for pituitary adenoma from January 2015 to April 2018 were included. The study patients were divided into two groups; patients in group 1 underwent surgery performed by a single neurosurgeon, while patients in group 2 received surgery performed by a collaborative team of surgeons. Olfaction was assessed using a subjective Likert scale, the Cross-Cultural Smell Identification Test (CC-SIT), and the butanol threshold test (BTT). In addition, patients answered the Sino-nasal Outcome Test (SNOT-22) questionnaire regarding sinonasal quality of life before and 3 months after surgery. RESULTS: This study included 152 patients (46 patients in group 1 and 106 patients in group 2). Significant differences were not observed between the two groups regarding age, sex, tumor size, or operation time. Although subjective olfaction was not significantly different before and after surgery, group 2 showed significantly better objective olfactory function based on the CC-SIT (8.44±3.00 vs. 9.84±1.40; P=0.012) and BTT (4.67±0.84 vs. 5.02±0.33; P=0.022) scores at 3 months after surgery. The SNOT-22 scores were not statistically significantly different between the two groups (P>0.05). CONCLUSION: In the present study, better olfactory outcomes were observed in patients who underwent surgery performed by a collaborative team of a neurosurgeon and an ENT surgeon. This result shows the need for collaboration between neurosurgeons and ENT surgeons in endoscopic pituitary surgery.

Intranasal distribution and clearance of thermoreversible gel in an animal model.

BACKGROUND: Poloxamer 407 (P407) has been investigated for an intranasal drug delivery system. However, there is little known about the distribution and clearance of intranasally applied P407. The purpose of this study was to evaluate the distribution and clearance time of P407 in an animal model. METHODS: Five male pigs were administered the experimental solution (18% of P407 with 0.01% of fluorescein) and the control solution (normal saline with 0.01% of fluorescein) into their right and left nasal cavity, respectively. For quantitative analysis, endoscopic images of each nasal cavity were taken immediately and at 10, 20, 30, and 60 minutes after intranasal administration. RESULTS: The experimental group showed a significantly wider distribution of fluorescein than the control group at 10, 20, and 30 minutes. The experimental group also showed a significantly higher mean intensity of fluorescein than the control group at 10, 20, and 30 minutes. The mean intensity in the control group was significantly decreased during 30 minutes but the mean intensity in the experimental group was significantly decreased during 60 minutes. CONCLUSION: A substantial amount of P407 remained in the nasal cavity for at least 30 minutes post-application.

Comparison of Endoscopic Tympanoplasty to Microscopic Tympanoplasty.

OBJECTIVES: This study aimed to compare the outcome of endoscopic and microscopic tympanoplasty. METHODS: This was a retrospective comparative study of 73 patients (35 males and 38 females) who underwent type I tympanoplasty at Samsung Medical Center from April to December 2014. The subjects were classified into two groups; endoscopic tympanoplasty (ET, n=25), microscopic tympanoplasty (MT, n=48). Demographic data, perforation size of tympanic membrane at preoperative state, pure tone audiometric results preoperatively and 3 months postoperatively, operation time, sequential postoperative pain scale (NRS-11), and graft success rate were evaluated. RESULTS: The perforation size of the tympanic membrane in ET and MT group was 25.3%±11.7% and 20.1%±11.9%, respectively (P=0.074). Mean operation time of MT (88.9±28.5 minutes) was longer than that of the ET (68.2±22.1 minutes) with a statistical significance (P=0.002). External auditory canal (EAC) width was shorter in the ET group than in the MT group (P=0.011). However, EAC widening was not necessary in the ET group and was performed in 33.3% of patients in the MT group. Graft success rate in the ET and MT group were 100% and 95.8%, respectively; the values were not significantly different (P=0.304). Pre- and postoperative audiometric results including bone and air conduction thresholds and air-bone gap were not significantly different between the groups. In all groups, the postoperative air-bone gap was significantly improved compared to the preoperative air-bone gap. Immediate postoperative pain was similar between the groups. However, pain of 1 day after surgery was significantly less in the ET group. CONCLUSION: With endoscopic system, minimal invasive tympanoplasty can be possible with similar graft success rate and less pain.