In-office Laryngeal Procedures: a Modern Perspective for Vocal Fold Interventions

Introduction: The purpose of this article is to discuss in-office laryngeal procedures as an alternative to surgical intervention under general anesthesia. In-office procedures have become more common due to technological advancements. As a result, these approaches are less invasive and more patient-friendly, with increased pain tolerance and reduced procedure time and cost. Methods: We conducted a thematic analysis of published reports regarding the best known and performed in-office laryngeal interventions. Three questions guided our analysis: What laryngological procedures can be performed in the office setting? What are the advantages of in-office laryngology procedures compared to operating room surgical procedures? Why aren't more in-office procedures performed in some Latin American countries? Discussion: Despite being performed more frequently, there is still controversy whether in-office procedures should be performed as often due to the risk of complications. Furthermore, procedures that are done in the office setting are more popular in some countries than in others, even though their benefit has been well demonstrated. This article describes various in-office procedures, including biopsy, vocal fold injections, and laser surgery. We also discuss what factors might contribute to having office-procedures being performed more frequently in some countries than others. Conclusion: Awake interventions offer numerous benefits, including shorter procedure time, reduced costs, and lower patient morbidity. These advantages have significantly transformed the treatment of laryngeal diseases in modern laryngology practice in a global manner.

Introducción: El propósito de este artículo es discutir los procedimientos laríngeos en el consultorio como una alternativa a la intervención quirúrgica bajo anestesia general. Los procedimientos en consultorio se han vuelto más comunes debido a los avances tecnológicos. Como resultado, estos enfoques son menos invasivos y más amigables para el paciente, con mayor tolerancia al dolor y reducción del tiempo y costo del procedimiento. Métodos: Realizamos un análisis temático de los informes publicados sobre las intervenciones laríngeas más conocidas y realizadas. Tres preguntas guiaron nuestro análisis: ¿Qué procedimientos laringológicos se pueden realizar en el consultorio y cuales sin los más frecuentes?, ¿cuáles son las ventajas de los procedimientos laringológicos fuera del quirófano frente a los que se realizan bajo anestesia general?, ¿por qué no se realizan más procedimientos laringológicos en el consultorio en la mayoría de los países en Latinoamérica? Discusión: A pesar de que se realizan con mayor frecuencia, aún existe controversia sobre si los procedimientos en consultorio deben realizarse con tanta frecuencia debido al riesgo de complicaciones. Además, los procedimientos que se realizan en el consultorio son más populares en algunos países que en otros, aunque sus beneficios han sido bien demostrados. Este artículo describe varios procedimientos en el consultorio, incluida la biopsia, las inyecciones de cuerdas vocales y la cirugía con láser. También se discutieron los factores que podrían contribuir a que los procedimientos en el consultorio se realicen con más frecuencia en algunos países que en otros. Conclusión: Las intervenciones con pacientes despiertos ofrecen numerosos beneficios, incluido un tiempo de procedimiento más corto, costos reducidos y una menor morbilidad para el paciente. Estas ventajas han transformado significativamente el tratamiento de las enfermedades laríngeas en la práctica de la laringología moderna a nivel mundial.

BASALOID SQUAMOUS CELL CARCINOMA- A RARE METATYPICAL TUMOR- CASE REPORT

A rare kind of squamous cell cancer is called basaloid squamous cell carcinoma occurring in sixth to seventh decade of life with male predilection. It preferentially occurring in upper aerodigestive tract. Rare case reports are presented in the classical age group with a poor prognosis. A 46 year's senior old male patient showed up to otorhinolaryngology department with chief complain of growth on base on left side of tongue and supra-glottic growth. On radiological evaluation by Multislice CT Scanning, a heterogeneously enhancing mass lesion measuring approximately 25×38 mm was noted at the base of tongue. On cytological evaluation of the lesion, highly cellular smear showed malignant morphology of the cells. Histological evaluation reveals a tumour mass in which neoplastic cells were composed of two different cell types – the majority of the cells population consisted of basaloid cells with abrupt association of foci of squamous cells suggesting basaloid variant of Squamous cell carcinoma. We brought this case for acknowledgment due to its rare occurrence, lower age of presentation, poor prognostic value as well as high metastatic potential.

Review of the Literature on Oral Cancer: Epidemiology, Management and Evidence-based Traditional Medicine Treatment

Oral cavity cancers are part of the upper aerodigestive tract cancers and represent a significant burden worldwide. Its epidemiology varies from country to country with high frequencies in South East Asian countries. Tobacco and alcohol are the main risk factors. Survival of oral cancer is low i.e., less than 40% in the advanced stage (stage III and IV), diagnosis of oral cavity cancer is based on a complete clinical examination of the oral cavity complete with biopsy, bio-markers are an adjunct to screening and diagnosis of oral cavity cancers, surgery, radiotherapy, chemotherapy and immunotherapy are part of the therapeutic armamentarium of oral cancer but also have limitations. Traditional medicine is an important and proven alternative in the treatment and support of patients with oral cavity cancer. Prevention of oral cavity cancers includes not only early detection of precancerous and cancerous lesions but also control of risk factors and education of the population. Surgery, radiotherapy, chemotherapy and immunotherapy are part of the therapeutic strategy of oral cancer treatment but also have limitations. Traditional Medicine is an important and proven alternative in the treatment and support of patients with oral cavity cancer. It is thus desirable to scientifically validate phytochemicals in order to integrate alternative medicine as part of national cancer management strategy. In silico advanced studies on secondary metabolites of medicinal plants traditionally used to treat oral cancer are in progress.

Prevention of upper aerodigestive tract cancer through active search strategies and use of equipped propaedeutics / Prevenção ao câncer do trato aerodigestivo superior através das estratégias de buscaativa e uso da propedêutica armada

Abstract Introduction Upper aerodigestive tract cancer is among the most frequent malignancies and has epidemiological importance worldwide. Most cases are already advanced at the diagnosis, with a strong negative impact on survival and high cost to the government. Campaigns directed against these cancers have often failed in Brazil. Objective To evaluate the effectiveness of screening for upper aerodigestive tract cancers, using active search strategies and the use of equipped propaedeutics. Methods A cross-sectional, prospective, descriptive, analytical and exploratory study, since its objectives are based on the visualization of cancerous lesions in a sample consisting of individuals with risk factors, aiming to expand the necessary knowledge for cancer detection, aiming at secondary prevention of the oral cavity, oropharynx, larynx and hypopharynx cancer. Results A total of 16.7% of precancerous lesions and 0.5% of cancer lesions located in the upper aerodigestive tract were clinically visualized. Conclusion The method was effective in the identification of precancerous lesions for the purpose of secondary prevention, but equally important against upper aerodigestive tract cancer, since in the present study the chance of finding the latter was increased by 22.7, showing it is an alternative for future campaigns against the disease.

Resumo Introdução O câncer do trato aerodigestivo superior configura-se entre os mais frequentes e apresenta-se com importância epidemiológica no mundo. A maior parte apresenta-se avançada ao diagnóstico, com forte impacto negativo na sobrevida e elevado custo ao erário. As campanhas feitas contra esses cânceres têm frequentemente falhado no Brasil. Objetivo Avaliar a efetividade do rastreamento para lesões cancerizáveis do trato aerodigestivo superior com estratégias de busca ativa e uso da propedêutica armada. Método Estudo transversal, prospectivo, descritivo, analítico e exploratório, uma vez que os seus objetivos se alicerçam na visualização das lesões cancerizáveis numa amostra composta por indivíduos com fatores de risco, de forma a aprofundar o conhecimento necessário para a sua detecção, visando à prevenção secundária do câncer da cavidade oral, orofaringe, laringe e hipofaringe. Resultado Foram visualizadas clinicamente 16,7% lesões cancerizáveis e 0,5% cânceres de localização no trato aerodigestivo superior. Conclusão O método mostrou-se efetivo na identificação de lesões cancerizáveis com intuito de prevenção secundária, mas igualmente importante contra o câncer do trato aerodigestivo superior, uma vez que neste presente estudo multiplicou-se a chance do encontro desse por 22,7; apresenta-se como opção para futuras campanhas contra a doença.

Incidence and management of foreign bodies in aerodigestive tract in a tertiary level

Introduction: Foreign body (FB) ingestion and aspiration is a life-threatening condition which is quite common in children. It is important to diagnose foreign body aspiration early as delay in its recognition and treatment results in high morbidity and mortality. The objective of the present prospective study was to study foreign bodies in aerodigestive tract on the basis of history, examination, and investigation, their incidence, type of foreign body, site of lodgment, common symptoms with which presented, and the nature of the problem in dealing with these patients during the management. Materials and Methods: A total of 86 cases of FB in aerodigestive tract admitted in ENT ward of Bundelkhand Medical and Hospital were included in the study. The symptoms, site and radiographic findings were recorded for each patient. Various procedures were used for removal of various FB at different locations. Majority of these procedures were performed under anesthesia. Results: Of all admitted foreign body cases (86 cases), incidence was more for males (63 cases) than for females (23 cases). Likewise, it was encountered more commonly in the age group of 1-10 years. FB were removed smoothly and successfully in all cases. Overall outcome was excellentwith minimum morbidity and no mortality. According to the site of involvement, hospital stay was varied. Conclusion: In this study, it is evident that FB in aerodigestive tract is a common clinical problem in otorhinolaryngological practice. Although, some presents with serious and life-threatening emergencieswhilemany does not have an immediate problem of airway. Higher incidence of foreign body in children can be prevented by educating the parents about keeping the articleaway from reach of children and observing the activity of the child.

Characteristics, Prognostic Factors, and Survival of Patients with NK/T-Cell Lymphoma of Non-upper Aerodigestive Tract: A 17-Year Single-Center Experience / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The extranodal natural killer (NK)/T-cell lymphoma (NKTCL) of non-upper aerodigestive tract (NUAT) was found to have clinical heterogeneity compared with NKTCL of the upper aerodigestive tract (UAT) in small scale studies. We conducted this study in a much larger cohort to analyze the clinical characteristics, prognostic factors, treatment modality, and clinical outcomes of patients with NUAT-NKTCL. MATERIALS AND METHODS: From January 2001 to December 2017, a total of 757 NKTCL patients were identified and included in this study, including 92 NUAT-NKTCL patients (12.2%) and 665 UAT-NKTCLpatients (87.8%). RESULTS: NUAT-NKTCL patients had relatively poorer performance status, more unfavorable prognostic factors, and more advanced stage, compared with UAT-NKTCL patients. The 5-year overall survival (OS) was 34.7% for NUAT-NKTCL, which was significantly worse than UAT-NKTCL (64.2%, p<0.001). The median OS duration was 30.9 months for NUAT-NKTCL. Multivariate analysis showed that presence with B symptoms and elevated serum lactate dehydrogenase independently predicted worse OS. International prognostic index score and prognostic index of natural killer lymphoma score still had prognostic values in NUAT-NKTCL, while the Ann Arbor system could not accurately predict the OS. CONCLUSION: NUAT-NKTCL is a distinctive subtype of NKTCL in many aspects. Patients with NUAT-NKTCL have relatively poorer performance status, more unfavorable prognostic factors, more advanced stage, and poorer prognosis.

Oropharyngeal cancer: an emergent disease? / Cáncer de orofaringe: ¿una enfermedad emergente?

Abstract Oropharyngeal cancer incidence has recently increased, thereby attracting public attention. Akin to other malignancies of the upper aerodigestive tract, it has been attributed to the carcinogenic effects of tobacco and alcohol use. However, recent evidence shows that a substantial increase in the disease is attributable to the effects of human papillomavirus (HPV). Marked progress has been made in relation to the knowledge of molecular and genetic mechanisms involved in the genesis and progression of these cancers. This has led to the development of new and promising therapies of a more specific and less toxic nature that have prolonged life and improved its quality. However, these therapies have failed to significantly increase the proportion of patients who are cured. To decrease the mortality associated with these neoplasms, it is necessary to adopt public health measures aimed at prevention and early diagnosis.

Resumen El cáncer de orofarínge recientemente ha incrementado su incidencia, por lo que ha atraído la atención pública. Como en otras neoplasias malignas de las vías aerodigestivas superiores se atribuye a los efectos carcinogénicos del tabaco y alcohol, sin embargo evidencia reciente señala un incremento substancial atribuible a los efectos del virus del papiloma humano. Mucho se ha avanzado en relación a los conocimientos de los mecanismos moleculares y genéticos implicados en la génesis y progresión de estas neoplasias, lo que ha conducido al desarrollo de nuevas y prometedoras terapias, mas especificas y menos tóxicas, que han prolongado la vida y mejorado su calidad, pero no han logrado incrementar significativamente la proporción de pacientes curados. Si se desea abatir la mortalidad por estas neoplasias es necesario emprender medidas de salud publica dirigidas a su prevención y diagnóstico temprano.

Pathology of Metastatic Brain Tumours – A one-year Prospective Study

Introduction Metastatic tumours are the most common neoplasms seen in the central nervous system (CNS) and continue to be the major systemic cause of cancer morbidity and mortality. The survival of metastasis in the CNS depends upon interaction between tumour cells and brain microenvironment during its development at this new site. Macroscopic features and corresponding radiological findings can be diagnostic in majority of cases. However, microscopic evaluation could be necessary when the differential diagnosis includes a primary CNS tumour or a primary tumour of unknown origin. The first step in the diagnosis of a metastatic brain lesion is to exclude a primary CNS tumour. Although general approach to a metastatic lesion from an unknown primary tumour is the same everywhere else, there are slight variations for the metastatic lesions in the CNS. Additional studies like immunohistochemical stains may be useful. Aim To evaluate the clinicopathological features of metastatic deposits in CNS and to differentiate them from primary CNS lesions. Materials and Methods Out of 4500 specimens, 112 were CNS biopsy specimens of which 64 were benign and 48 were malignant; 18 of them were CNS metastatic deposits. Haematoxylin and eosin (H&E) stained sections of these lesions were studied for their morphological features. When morphological features were not enough to establish definitive diagnosis, immunohistochemical stains were applied to arrive at a definite diagnosis. Diagnostic approach to CNS metastasis, immunohistochemical assessment of neoplasm of unknown primary (NUP) and primary CNS lesions entering in the differential diagnosis of metastases were analysed. Results Most CNS metastatic deposits in our study were adenocarcinomas from aerodigestive tract. Conclusion In the diagnosis of CNS metastatic lesions, the exclusion of the primary CNS tumour falling in the various differential diagnoses considered is the most important step followed by identification and verification of the site and type of unknown primary tumour.

Quadruple Mtachronous Primary Neoplasms in the Aerodigestive Tract / 대한내과학회지

Multiple primary neoplasms, defined as the occurrence of multiple malignant neoplasms in the same individual, were first reported by Billroth in 1889. With gradual improvements in diagnostics, and the early detection and effective treatment of malignant neoplasms, the prevalence of multiple primary neoplasms seems to be increasing. Although there have been several reports of triple primary neoplasms in Korea, cases of quadruple neoplasms are rare. Recently, we diagnosed a 69-year-old male with primary neoplasms in the lung, esophagus, vocal cords, and hypopharynx. The authors report this rare case of four metachronous primary neoplasms and provide a review of the literature.

Quadruple Mtachronous Primary Neoplasms in the Aerodigestive Tract / 대한내과학회지

Multiple primary neoplasms, defined as the occurrence of multiple malignant neoplasms in the same individual, were first reported by Billroth in 1889. With gradual improvements in diagnostics, and the early detection and effective treatment of malignant neoplasms, the prevalence of multiple primary neoplasms seems to be increasing. Although there have been several reports of triple primary neoplasms in Korea, cases of quadruple neoplasms are rare. Recently, we diagnosed a 69-year-old male with primary neoplasms in the lung, esophagus, vocal cords, and hypopharynx. The authors report this rare case of four metachronous primary neoplasms and provide a review of the literature.

Upper aerodigesiive tract neoplasm (uatn): an update / Neoplasia dl traacto aerodigestivo superior (uatn): una actualización

Introduction: according to the review carried out, while the majority of head and neck cancerous lesions are cutaneous and thyroid are associated with low lethality, there are others that are developed in the upper aerodigestive tract and are usually squamous cell carcinomas, which are usually diagnosed in advanced stages and are associated with very poor survival and functional prognosis. In Colombia, squamous cell carcinoma is the neoplasm of greatest occurrence in head and neck; it becomes evident as a detectable premalignant lesion and it registers between 100 and 120 new cases by year according to the Colombian National Cancer Institute in 1998. This update is important because of the new findings on the disease natural history and the characteristics of each location in the upper aerodigestive tract. Methodology: the relevant biomedical literature was searched in several databases such as Medline, Proquest, Science Direct, Ovid and Cochrane, as well as available information in web sites of national scientific journals and Organizations.

Introducción: De acuerdo a la revisión llevada a cabo, mientras que la mayoría de las lesiones cancerosas de cabeza y cuello son cutáneas y asociadas con la tiroides y de baja letalidad, hay otras que se desarrollan en el tracto aerodigestivo superior y usualmente son carcinomas de células escamosas, las cuales son usualmente diagnosticadas en estados avanzados y asociadas con una muy pobre supervivencia y pronóstico funcional. En Colombia, el carcinoma de células escamosas es la neoplasia de mayor ocurrencia en la cabeza y el cuello, esta se manifiesta como una lesión premaligna detectable y registra entre 100 a 120 casos nuevos al año en Colombia de accauerdo al Instituto Nacional de Cancerología en 1998. Esta actualización es importante debido a los nuevos hallazgos en la historia natural de la enfermedad y a las características de cada localización en el tracto aerodigestivo superior. Metodología: Fue buscada la literatura biomédica relevante en algunas bases de datos tales como Medline, Proquest, Science Direct, Ovid y Cochrane, así como también la información disponible en sitios Web de organizaciones y revistas científicas nacionales.

Sarcomatoid carcinoma of the upper aerodigestive tract: An immunohistochemical analysis demonstrating latent Epstein-Barr virus in a subset of eight cases.

Background: Sarcomatoid or spindle cell carcinomas are rare malignancies which are considered as a poorly differentiated variant of squamous cell carcinoma. Epstein-Barr virus (EBV) is associated with a wide variety of malignancies. Materials and Methods: We examined the expression of EBV latent membrane protein-1 (LMP-1) and EBV EBNA-2 as well as the immunohistochemical profile of AE-1/AE-3, vimentin, desmin, CK 5-6, smooth muscle actin (SMA), p63, S-100, p53 and CD-117 with the clinicopathological correlation of eight patients of sarcomatoid carcinoma (SC) in the upper aerodigestive tract. Results: Four cases showed EBV LMP-1 positivity (50%) and there was no EBV EBNA-2 positivity. However, the EBV LMP-1 results of our series could be considered only as a coincidental finding in the SCs of the upper aerodigestive tract. Conclusions: This finding supports the idea that further studies based on larger series might be helpful enlighting the role played by EBV in carcinogenesis of SC.

Penfigóide cicatricial no trato aerodigestivo superior: relato de dois casos / Cicatricial pemphygoid in the upper aerodigestive tract: report of two cases

Penfigóide Cicatricial (Penfigóide Cicatricial de Membrana Mucosa) é uma doença auto-imune inflamatória crônica caracterizada pela presença de bolhas subepiteliais em membranas mucosas e, ocasionalmente na pele. Pode haver acometimento oral, nasal, faríngeo, laríngeo, ocular, esofágico, anogenital e de pele, predominantemente em pacientes na quinta e sexta décadas de vida. O tratamento preconizado inclui corticóides sistêmicos e agentes imunossupressores. Descrevemos neste trabalho dois casos com a doença em atividade, sendo que um evoluiu com complicação séptica pelo uso de imunossupressor e outro que apresentou estenose supraglótica exigindo traqueotomia.

Cicatricial pemphygoid (mucous membrane cicatricial pemphygoid) is a chronic autoimmune inflammatory disease characterized by subepithelial bubbles in mucous membranes and, occasionally on the skin. It may affect the mouth, the nose, pharynx, larynx, the eyes, esophagus, anus, genitals and skin; especially affecting patients between fifty and sixty years of life. Treatment includes systemic steroids and immunosuppressive agents. In the present paper we describe two cases with the active disease, and one of them had sepsis because of using immunosuppressive agents and another that presented supraglottic stenosis requiring tracheostomy.

Lymphome de Burkitt pediatrique a revelation ORL: quelle prise en charge en milieu sub sahelien ? Reflexion sur trois cas

Le lymphome de Burkitt dans sa forme Africaine peut se manifester sous des signes d'emprunt ORL a type de tumefaction orbito-maxillo-faciale. Le diagnostic peut etre fait par les ORL a travers un faisceau de signes cliniques et une cytoponction. La prise en charge se fait dans des unites d'oncologie medicale ou le bilan d'extension et le lancement de la chimiotherapie sont des imperatifs incontournables. Actuellement cette tumeur a potentiel tres agressif repond a une poly chimiotherapie bien conduite

Clinical Features of Patients with Lung Cancer and Upper Aerodigestive Tract Cancer / 결핵및호흡기질환

BACKGROUND: To define the clinical features of patients with lung and upper aerodigestive tract cancer through a review of the histopathology, clinical features and follow-up results. METHODS: Patients with lung and upper aerodigestive tract cancer who were diagnosed in Young dong Severance Hospital from 1992 to 2005, were retrospectively reviewed. The clinical data, radiologic findings, pathologic findings, treatment modalities were evaluated. Result: There was a total of 20 patients with aerodigestive tract cancer who were diagnosed with lung cancer over a 13 years period. The mean age was 58.45 +/-15.09 years and 19 cases were male. There were 14 smokers with an average pack year of 46 years. Twelve patients had aerodigestive tract cancer and later developed lung cancer, and 5 lung cancer patients were later diagnosed with aerodigestive tract cancer. CONCLUSION: These results suggest that cancers of the aerodigestive tract and lung can arise as either dependent or independent events and most aerodigestive tract cancer patients who developed lung cancer are not treated properly. Therefore, regular low dose chest CT with close suspicion is needed to properly manage upper aerodigestive tract cancer patients.

Role of CT in evaluating upper aerodigestive tract injuries.

This study was aimed to assess the role of CT in upper aerodigestive tract injuries. Twenty six patients presenting with upper aerodigestive tract injury were examined by CT. Nineteen patients had blunt trauma to the neck while seven had penetrating injury. Most of the patients presented soon after injury. Symptoms included respiratory distress (14), neck tenderness (18), hoarseness (7), haemoptysis (2) and odynophagia (3). Soft tissue injuries were seen in 8 patients, aryepiglottic fold edema in 4, aryepiglottic fold haematoma in 1, vocal cord edema in 2 and pyriform sinus obliteration in 5 patients. Supraglottic injuries were seen in six patients, glottic injury in 8 patients and subglottic injuries in 4 patients. Tracheal injuries were seen in 8 patients and included cricotracheal separation (1), tracheal tears (5) and tracheal narrowing (4). Hypopharyngoesophageal injuries were seen in 2 patients. CT was helpful for localization of foreign bodies in 2 cases. CT is useful in deciding management of patients with upper aerodigestive tract injuries obviating the need of open exploration in patients with minimal mucosal injuries, undisplaced fracture and sealed tears. It is particularly helpful in cases when indirect laryngoscopy was not possible.

Pattern of Lymph Node Metastasis on the Prophylactic Central Neck Node Dissection in Management of Papillary Carcinoma of Thyroid / 대한내분비외과학회지

PURPOSE: In papillary thyroid carcinoma, lymph node metastasis at presentation does not seem to affect survival adversely, but does increase the risk of loco-regional tumor recurrence. The benefits of prophylactic central neck node dissection (PCND) have not been clearly demonstrated so far and should be weighed against the potential risks of the procedure. The aims of this study are as follows; to determine the frequency and the pattern of the lymph node metastasis and the risk factors influencing the metastasis to level VI lymph nodes, and to determine the necessity of the contralateral central lymph node dissection. METHODS: A retrospective analysis had been carefully performed over 68 patients with papillary carcinomas undergoing total thyroidectomy with PCND during the period from July 1, 2000 to August 31, 2002. In addition to the analyses of the incidence and the pattern of central lymph node metastasis, we statistically analyzed the correlation between lymph node metastases and the risk factors such as tumor size, age, lymphatic tumor emboli, vascular tumor emboli, perithyroidal soft tissue invasion, and multifocality, etc. RESULTS: The mean age was 46 years (22~76) and the tumor size ranged from 0.2 to 9 cm (mean 2.2 cm). The micropapillary carcinoma was detected by pathological findings in 10 patients (14.7%). The lymphatic tumor emboli and vascular tumor emboli occurred in 8 patients (11.8%) and 2 patients (2.9%) respectively. Thirty eight patients (55.9%) showed perithyroidal tissue invasion. The mean number of harvested lymph nodes in level VI was 13.7 (6~32). Among 68 patients, lymph node metastasis occurred in 49 patients (72.1%) and the mean number of metastatic lymph node was 5.4. Among the patients with metastasis, the rate of metastasis among the harvest nodes amounted to 39.0%. Metastasis to Delphian nodes was detected in 2 patients (2.9%). In addition, 15 patients (22.1%) showed metastatic contralateral central nodes. Patients less than 40 years old tend to have more metastatic lymph nodes (P=0.012). Futhermore, the patients with tumor larger than 2 cm increased incidence of lymph node metastasis (P=0.036). CONCLUSION: After the prophylactic central neck nodes dissection in case of papillary carcinoma patients, metastatic lymph nodes were found in 72.1%. In conclusion, we would like to recommend prophylactic central neck node dissection to papillary carcinoma patients in order not only to prevent local recurrence but to avoid the difficulties of reoperation, especially for those with high risk for nodal involvement (less than 40 years old or more than 2 cm of tumor size). Because of the relatively high incidence of contralateral central lymph nodes metastasis, we suggest the importance of dissection of contralateral central lymph nodes along with unilateral central.

Treatment of Well-differentiated Thyroid Carcinoma with Aerodigestive Tract Invasion / 대한내분비외과학회지

PURPOSE: Well differentiated thyroid carcinomas are mostly curable diseases. Invasion of aerodigestive tract by thyroid carcinoma is rare. However, it is considered as a poor prognostic indicator of survival. Some studies showed that local invasion of thyroid carcinoma was the cause of death in many patients. Therefore, adequate local control of the tumor is critical to avoid the mortality as well as the morbidity of the disease. To find proper and adequate treatment modality of locally invasive thyroid carcinoma, we evaluated treatment modalities and outcomes in the patients with thyroid carcinoma with invasion of aerodigestive tract. METHODS: Forty patients with thyroid carcinoma invading aerodigestive tract who were treated from July 1989 through July 2002 were reviewed retrospectively. RESULTS: Direct intraluminal invasion of the thyroid carcinoma requires definitive resection of the aerodigestive tract. In case that the extent of tumor was thought to be limited to perichondrium or extraluminal invasion, tracheal shaving procedure was performed. Five-year and 10-year local control rates were 81.6% and 57.4%, respectively. Disease-specific survival rates of 5-year and 10-year were 90.1% and 81.1%, respectively. CONCLUSION: For the successful treatment of invasive thyroid carcinoma, the resection of the functional structures or the aerodigestive tract should be determined prudently according to the presence of the intraluminal invasion.

Intraluminal Invasion of Upper Aerodigestive Tract by Thyroid Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Thyroid carcinoma infrequently invades the upper aerodigestive tract. However, when invasion occurs, it is the source of significant morbidity and mortality. If the tumor extends into the lumen of the upper aerodigestive tract, more critical problems can happen. There have been much debates about surgical therapy of thyroid carcinoma invading the upper aerodigestive tract whether it should be radical or conservative. This study was designed to investigate the intraluminal extension of the upper aerodigestive tract by thyroid carcinoma and review the spectrum of radical resection. MATERIALS AND METHODS: From 1996 to 2000, six patients with thyroid carcinoma invading the upper aerodigestive tract (intraluminal involvement) were radically resected at Inha University Hospital. Clinical records were reviewed retrospectively. RESULTS: The radical resection consisted of a total thyroidectomy and a neck dissection, combined with radical excisions that included three laryngectomies, two laryngopharyngoesophargectomies, and a case of partial pharyngectomy. The histologic types consisted of 5 papillary carcinoma and 1 anaplastic carcinoma. There was one preoperative mortality. Five patients received radioactive iodine therapy postoperatively. One patient died of nodal recurrence at the 13th postoperative month, and 4 patients are still alive with a follow-up period of 19-52 months. CONCLUSION: Based on our results of these six patients who had intraluminal involvement of the upper aerodigestive tract, we suggest that radical resection might be a worthwhile procedure. But it should be considered that radical resection might cause loss of functions in the head and neck organs, and therefore possibilites of conservative resection should be considered throughly during the preoperative examination.

Upper aerodigestive tract endoscopy during the first year of life: A current review.

A five-year retrospective review of 52 infants who underwent 67 endoscopic procedures of the upper aerodigestive tract was performed. The ages of the patients ranged from one day to one year with a mean of 157 days. The most common indication of endoscopy was stridor/respiratory distress (46.3 per cent) and persistent wheezing (16.4 per cent). Congenital anomalies were the causes of airway problems in more than half of the patients and laryngomalacia was the most common diagnosis (34.6 per cent), followed by congenital subglottic stenosis (7.6 per cent). There were 19.2 per cent of cases who had more than one airway lesion. Diagnosis was obtained from endoscopy in90.4 per cent of cases. There were two cases of gastroesophageal reflux (GER) diagnosed by nuclear scintigraphy. Therapeutic procedures during and after endoscopy were also reviewed. Only minor complications were found in three cases (4.5 per cent) (one bronchospasm, two subglottic oedema ). Endoscopy was found to be a safe, accurate diagnostic method which also offered useful therapeutic interventions.