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Purpose@#This study aimed to investigate the oncologic outcomes and prognostic factors of salvage treatments in patients with recurrent oropharyngeal squamous cell carcinoma (OPSCC) after radiotherapy (RT)-based treatment. @*Materials and Methods@#A cancer registry was used to retrieve the records of 337 patients treated with definitive RT or concurrent chemoradiotherapy (CRT) from 2008 to 2018 at a single institution. The poor-responder group (PRG) was defined as patients with residual or recurrent disease after primary treatment, and the oncologic outcomes for each salvage treatment method were analyzed. In addition, prognostic indicators of recurrence-free survival (RFS) and overall survival (OS) were identified in patients who underwent salvage treatment. @*Results@#After initial (C)RT, the PRG comprised 71 of the 337 patients (21.1%): 18 patients had residual disease, and 53 had recurrence after primary treatment (mean time to recurrence 19.5 months). Of these, 63 patients received salvage treatment (surgery 57.2%, re-(C)RT 23.8%, and chemotherapy 19.0%), and the salvage success rate was 47.6% at the last follow-up. The overall 2-year OS for salvage treatments was 56.4% (60.8% for the salvage surgery group and 46.2% for the salvage re-(C)RT). Salvage surgery patients with negative resection margins had better oncologic outcomes than those with close/positive resection margins. Using multivariate analyses, locoregional recurrence and residual disease after primary surgery were associated with poor outcome after salvage treatment. In Kaplan-Meier analyses, p16 status was significantly associated with OS in the initial treatment setting but not in the salvage setting. @*Conclusion@#In recurrent OPSCC after RT-based treatment, successful salvage was achieved in 56.4% patients who had undergone salvage surgery and radiation treatment. Salvage treatment methods should be selected carefully, given recurrence site as a prognostic factor for RFS.
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The traumatic perilymphatic fistula (PLF) can cause hearing loss and disabling dizziness.These symptoms can be recovered spontaneously or by surgical repair. However, even after surgical PLF repair, patients may suffer from recurrent vestibular symptoms. The mechanism of recurrent symptoms is not clear. We experienced two patients who complained of recurrent vertigo long after surgical PLF repair. Both patients had severe sensorineural hearing loss and vestibular loss after head trauma. In both cases, after surgical repair, dizziness was completely subsided. However, several years later, the disabling vertigo recurred in both cases. The symp-toms aggravated when position was changed. On the fistula test, the patients showed positive results. Surgical findings showed a fibrous band connection between the stapes and the tym-panic membrane. After stapedectomy, the symptoms subsided. We discuss the two cases in regards to the possible mechanism of recurrent vertigo after surgical PLF repair.
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Foreign bodies in the sinus are rare entities that are often associated with trauma. This paper presents a case of a metallic foreign body that was retained without any symptoms for over 40 years. A skull X-ray and computed tomography scans showed blades of scissors inside the maxillary sinus, extending to the middle meatus without affecting vital structures. The foreign body was successfully removed by an endoscopic approach. There were no complications during and after the surgery. The presence of retained foreign bodies in the maxillofacial region is rarely discussed in previous publications. This manuscript focuses on the asymptomatic period of this foreign body and aims to discuss the necessity and feasibility of a wait-and-see approach in selected cases.
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OBJECTIVES: Injection laryngoplasty (IL) is one of the major options for treatment of unilateral vocal fold paralysis (UVFP). Early IL in patients with abrupt-onset UVFP can reduce hoarseness and aspiration-related discomfort and complications. Temporary or short-lasting materials are recommended for the early IL since permanent or long-lasting materials may negatively affect the voice quality when vocal fold motion is spontaneously recovered. METHODS: Patients who received IL with a long-lasting material (ArteSense) within 1 month following development of postoperative UVFP were enrolled for this study. They were categorized into a spontaneously recovered group (n=30) and unrecovered group (n=276) from UVFP. The subjective and objective voice parameters were collected before and 6 months after IL. Patients' demographics and collected voice parameters were compared between the two groups. RESULTS: Age and sex distributions were not different between the two groups. Aspiration symptom, maximum phonation time (MPT), jitter, shimmer, noise to harmonic ratio (NHR), overall grade (G) and breathiness (B) of GRBAS (grade of dysphonia, roughness, breathiness, asthenia, strain) scale score, and voice handicap index (VHI) were significantly improved after IL in both groups. The amounts of improvement in MPT, jitter, shimmer, NHR and VHI were significantly greater in the recovered group. There was no IL-related complication including granuloma formation, hypersensitivity to injection material, or worsening of hoarseness. CONCLUSION: Early IL with a long-lasting material can be safely performed to improve voice quality and to reduce aspiration episode for the patients with postoperative UVFP, regardless of recovery from the paralysis. The amounts of improvement in the subjective and objective voice parameters were significantly greater in patients who showed spontaneous recovery from UVFP when compared with those in patients who did not.