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Background and Objectives@#Voice change after thyroidectomy is a common complication that affects a patient’s quality of life. In this study, we aimed to compare voice outcomes between minimally invasive open hemithyroidectomy (MIOT) and conventional hemithyroidectomy.Materials and Method We enrolled 215 patients who underwent hemithyroidectomy performed by an experienced surgeon at our institute between June 2017 and December 2021. All patients underwent voice evaluations, including subjective and objective assessments, preoperatively and 2 weeks and 2 months postoperatively. @*Results@#Sixty-one patients underwent MIOT (M group) and 154 patients underwent conventional hemithyroidectomy (C group). There were 50 female (82.0%) and 11 male (18.0%) in the M group, and 129 female (83.8%) and 25 male (16.2%) in the C group. In both groups, the thyroidectomy-related voice questionnaire score increased at 2 weeks and 2 months postoperatively. However, no statistically significant differences were observed between the two groups. Voice parameters were analyzed according to sex. There were some changes in the parameters in both groups. However, no statistically significant differences were observed between the two groups. @*Conclusion@#Our study showed no differences in the acoustic results between MIOT and conventional hemithyroidectomy.
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Background and Objectives@#Parotid cancer is a rare malignancy tumor, constituting about 3% of head and neck cancers. Treatment of parotid carcinoma is challenging because of its rarity and unpredictable clinical course. Therefore, it is important to evaluate risk factors associated with prognosis and to predict adverse outcomes. In this article, we aimed to analyze risk factors associated with recurrence free survival in our 10-year single center retrospective study.Subjects and Method Retrospective medical chart review was performed for patients with parotid gland cancer who underwent parotidectomy with or without adjuvant treatment in our institute 2011 to 2020. Patient demographics, histopathologic results, operative method, treatment outcome were assessed. @*Results@#A total of 8 patients (15%) experienced recurrence. Old age and low body mass index was associated with recurrence. Univariate analysis also revealed that high clinical stage, tumor involvement in deep lobe and facial nerve, postoperative radiotherapy or concurrent chemo radiotherapy, positive resection margin, and high histologic grade were statistically significant with recurrence. Multivariate analysis concluded that facial nerve involvement with tumor was associated with higher incidence of recurrence. Deep lobe and facial nerve involvement, postoperative radiotherapy or concurrent chemo radiotherapy, positive resection margin, clinical stage, and histologic grade were statistically significant factors associated with recurrence free survival. @*Conclusion@#Our 10-year single institute study will be helpful for predicting adverse outcomes in parotid cancer patients.
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Background and Objectives@#Globus pharyngeus is one of the most common symptoms of patients visiting otorhinolaryngology out-patient clinic, and usually long-lasting, difficult to treat, and frequently recurrent. Mucomyst®, N-acetyl cysteine is an inhalation agent mainly used for mucolysis and reducing inflammation in airway via antioxidative effect. The purpose of this study was to evaluate the efficacy of inhaled Mucomyst® treatment in patients with globus pharyngeus refractory to proton pump inhibitor (PPI).Materials and Method We prospectively evaluated the efficacy of Mucomyst® in relieving symptoms of globus pharyngeus refractory to PPI in nine medical centers. Three hundred and three patients enrolled and finally 229 patients finished the inhaled Mucomyst® therapy for 8 weeks. We analyzed the change of Reflux Symptom Index (RSI), Reflux Finding Score (RFS), Visual Analogue Scale (VAS) for globus, and Globus Pharyngeus Symptom Scale (GPS) after use of Mucomyst® for 4 and 8 weeks. @*Results@#The GPS, RSI, RFS, and VAS score significantly decreased serially in patients who finished 8 week-inhalation treatment. The GPS improvement gap was significantly correlated with initial GPS (p<0.001) in multiple regression analysis. @*Conclusion@#Inhaled Mucomyst® therapy was effective for the reduction of both subjective and objective findings in refractory globus patients. This study might suggest new treatment option for patients with globus. However, further thorough studies would be needed to assess the real effect of inhaled Mucomyst® treatment as a standard treatment for globus.
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Intraoperative neuromonitorng (IONM) has gained wide acceptance as a useful adjunct in identifying and preserving of recurrent laryngeal nerve (RLN) during thyroid surgery. The electromyographic endotracheal tube (EMG-ETT) method is the most widely used and well-validated method for thyroid IONM; however, malpositioning of the tube is a critical shortcoming of the EMG-ETT method. This is the main reason for the low positive predictive value of IONM in thyroid surgery. Needle and skin electrodes can obtain EMG signal regardless of patient position and are easy to apply during surgery and is economical compared to EMG-ETT method. New IONM system using needle or skin electrodes would be an alternative method which can overcome shortcomings of EMG-ETT.
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Background and Objectives@#During speech, the vocal folds oscillate at frequencies ranging from 100–200 Hz with amplitudes of a few millimeters. Mechanical stimulation is an essential factor which affects metabolism of human vocal folds. The effect of mechanical vibration on the cellular response in the human vocal fold fibroblasts cells (hVFFs) was evaluated.Materials and Method We created a culture systemic device capable of generating vibratory stimulations at human phonation frequencies. To establish optimal cell culture condition, cellular proliferation and viability assay was examined. Quantitative real time polymerase chain reaction was used to assess extracellular matrix (ECM) related and growth factors expression on response to changes in vibratory frequency and amplitude. Western blot was used to investigate ECM and inflammation-related transcription factor activation and its related cellular signaling transduction pathway. @*Results@#The cell viability was stable with vibratory stimulation within 24 h. A statistically significant increase of ECM genes (collagen type I alpha 1 and collagen type I alpha 2) and growth factor [transforming growth factor β1 (TGF-β1) and fibroblast growth factor 1 (FGF-1)] observe under the experimental conditions. Vibratory stimulation induced transcriptional activation of NF-κB by phosphorylation of p65 subunit through cellular Mitogen-activated protein kinases activation by extracellular signal regulated kinase and p38 mitogen-activated protein kinases (MAPKs) phosphorylation on hVFFs. @*Conclusion@#This study confirmed enhancing synthesis of collagen, TGF-β1 and FGF was testified by vibratory stimulation on hVFFs. This mechanism is thought to be due to the activation of NF-κB and MAPKs. Taken together, these results demonstrate that vibratory bioreactor may be a suitable alternative to hVFFs for studying vocal folds cellular response to vibratory vocalization.
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Background and Objectives@#During speech, the vocal folds oscillate at frequencies ranging from 100–200 Hz with amplitudes of a few millimeters. Mechanical stimulation is an essential factor which affects metabolism of human vocal folds. The effect of mechanical vibration on the cellular response in the human vocal fold fibroblasts cells (hVFFs) was evaluated.Materials and Method We created a culture systemic device capable of generating vibratory stimulations at human phonation frequencies. To establish optimal cell culture condition, cellular proliferation and viability assay was examined. Quantitative real time polymerase chain reaction was used to assess extracellular matrix (ECM) related and growth factors expression on response to changes in vibratory frequency and amplitude. Western blot was used to investigate ECM and inflammation-related transcription factor activation and its related cellular signaling transduction pathway. @*Results@#The cell viability was stable with vibratory stimulation within 24 h. A statistically significant increase of ECM genes (collagen type I alpha 1 and collagen type I alpha 2) and growth factor [transforming growth factor β1 (TGF-β1) and fibroblast growth factor 1 (FGF-1)] observe under the experimental conditions. Vibratory stimulation induced transcriptional activation of NF-κB by phosphorylation of p65 subunit through cellular Mitogen-activated protein kinases activation by extracellular signal regulated kinase and p38 mitogen-activated protein kinases (MAPKs) phosphorylation on hVFFs. @*Conclusion@#This study confirmed enhancing synthesis of collagen, TGF-β1 and FGF was testified by vibratory stimulation on hVFFs. This mechanism is thought to be due to the activation of NF-κB and MAPKs. Taken together, these results demonstrate that vibratory bioreactor may be a suitable alternative to hVFFs for studying vocal folds cellular response to vibratory vocalization.
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Background and Objectives@#Presbyphonia is characterized by hoarse, breathy, weak vocal intensity. Extracellular matrix (ECM) in lamina propria (LP) of the vocal folds play an important role in voice production, and change of ECM according to the aging leads to the presbyphonia. The aim of this study was to investigate the histologic analysis of aging vocal fold of rat.Materials and Method Six and twenty two months old Sprague-Dawley rats (n=8, each group) were used and classified into young (six months old rats) and old (twenty two months old rats) group. Histologic analysis and immunohistochemical staining for ECM of LP were performed. @*Results@#Overall cellular density was significantly decreased in old rat group. Elastin fibers of LP were significantly decreased in old rat group. Type I collagen was significantly increased in old rat group. Type III collagen did not show significant difference. Hyaluronic acids did not show significant difference in Alcian blue staining and immunohistochemical staining. @*Conclusion@#Decreased general cellular density and elastin fiber and increased type I collagen were observed in the LP of vocal folds of aging rats. These ECM changes might to contribute the aging voice.
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Background and Objectives@#Presbyphonia is characterized by hoarse, breathy, weak vocal intensity. Extracellular matrix (ECM) in lamina propria (LP) of the vocal folds play an important role in voice production, and change of ECM according to the aging leads to the presbyphonia. The aim of this study was to investigate the histologic analysis of aging vocal fold of rat.Materials and Method Six and twenty two months old Sprague-Dawley rats (n=8, each group) were used and classified into young (six months old rats) and old (twenty two months old rats) group. Histologic analysis and immunohistochemical staining for ECM of LP were performed. @*Results@#Overall cellular density was significantly decreased in old rat group. Elastin fibers of LP were significantly decreased in old rat group. Type I collagen was significantly increased in old rat group. Type III collagen did not show significant difference. Hyaluronic acids did not show significant difference in Alcian blue staining and immunohistochemical staining. @*Conclusion@#Decreased general cellular density and elastin fiber and increased type I collagen were observed in the LP of vocal folds of aging rats. These ECM changes might to contribute the aging voice.
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Parapharyngeal abscess is relatively common but it can cause life-threatening complications like internal jugular vein thrombophlebitis, septic shock, airway obstruction, and mediastinitis. The diagnosis is dependent on physical examination, endoscopic view, and CT and MR imaging. The treatment is antibiotics but sometimes incision and drainage are necessary. Pseudoaneurysm in deep neck space is very rare and mainly caused by trauma, postoperative state of head and neck surgery and radiation therapy. We herein report a case of massive oropharyngeal bleeding from pseudoaneurysm of the superior thyroid artery associated with parapharyngeal abscess with a review of related literature.
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Absceso , Obstrucción de las Vías Aéreas , Aneurisma Falso , Antibacterianos , Arterias , Diagnóstico , Drenaje , Cabeza , Hemorragia , Venas Yugulares , Imagen por Resonancia Magnética , Mediastinitis , Cuello , Examen Físico , Choque Séptico , Tromboflebitis , Glándula TiroidesRESUMEN
BACKGROUND AND OBJECTIVES: To identify the relation between the preservation status of the parathyroid glands and the risk of hypoparathyroidism after total thyroidectomy and central lymph node dissection in papillary thyroid carcinoma. SUBJECTS AND METHOD: A retrospective review was carried out for the medical records of 63 patients with papillary thyroid carcinoma (PTC), who satisfied our inclusion criteria and received treatment at the Department of Otolaryngology-Head and Neck Surgery, Hospital from May 2010 to December 2011. Patients with PTC who underwent total thyroidectomy with central lymph node dissection (CLND) were included and grouped according to the number of preserved parathyroid glands as follows: Group 1 (with four intact glands), Group 2 (three intact glands), Group 3 (less than two intact glands). The total and ionized serum calcium and intact parathyroid hormone levels of each group were monitored after the surgery. Patients with postoperative symptomatic hypocalcemia were considered to have postoperative hypoparathyroidism and received calcium/vitamin D therapy. The hypoparathyroidism was considered to be permanent when calcium/vitamin D therapy was still required six months after surgery. RESULTS: Out of 63 cases of total thyroidectomy with CLND, 31 (49.2%) showed postoperative hypoparathyroidism as demonstrated by laboratory findings. Permanent hypoparathyroidism, however, was not observed in these cases. The development of hypoparathyroidism was not significantly related with the number of preserved parathyroid glands. CONCLUSION: To prevent postoperative hypoparathyroidism following total thyroidectomy and CLND, at least two parathyroid glands should be preserved in situ with an intact blood supply in order to prevent permanent hypoparathyroidism after the surgery.