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Warthin tumor with ulceration of the surrounding skin is extremely rare, making it difficult to differentiate from parotid cancer in the clinical setting. We report a 65-year-old man with a Warthin tumor in the right parotid gland that had ulceration of the overlying skin. The patient presented with right upper neck mass 2 years ago. Ultrasound and fine needle aspiration were done, and Warthin tumor was suspected. One year later, the mass was enlarged with ulceration of the skin. Superficial parotidectomy with fusiform excision of the skin was performed, and histopathological diagnosis revealed a Warthin tumor with inflammatory change. We proposed that this unique manifestation may have been induced by fine needle aspiration, enlargement of the tumor, and ischemic changes secondary to pulmonary arteriovenous malformations.

Abstract: Osteomyelitis of the skull base is a rare disorder, and even more so when the etiology is noninfectious. Symptoms are noisome and include headache and cranial nerve deficits. Because [...]

A mucosal pypogenic granuloma is a reactive angiomatous proliferation with a higher preponderance for the maxillary gingiva. A giant growth within the oral cavity is rarely encountered. Tentative diagnosis is [...]

Multifocal oropharyngeal hemangioma occurs infrequently. The differential diagnosis may include arteriovenous malformation, telangiectasia, pyogenic granuloma, and angiosarcoma. Historically, intervention for inconspicuous cases is not required. We evaluated a 26-year-old man [...]

The mechanisms by which hypoxic tumours evade immunological pressure and anti-tumour immunity remain elusive. Here, we report that two hypoxia-responsive microRNAs, miR-25 and miR-93, are important for establishing an immunosuppressive tumour microenvironment by downregulating expression of the DNA sensor cGAS. Mechanistically, miR-25/93 targets NCOA3, an epigenetic factor that maintains basal levels of cGAS expression, leading to repression of cGAS during hypoxia. This allows hypoxic tumour cells to escape immunological responses induced by damage-associated molecular pattern molecules, specifically the release of mitochondrial DNA. Moreover, restoring cGAS expression results in an anti-tumour immune response. Clinically, decreased levels of cGAS are associated with poor prognosis for patients with breast cancer harbouring high levels of miR-25/93. Together, these data suggest that inactivation of the cGAS pathway plays a critical role in tumour progression, and reveal a direct link between hypoxia-responsive miRNAs and adaptive immune responses to the hypoxic tumour microenvironment, thus unveiling potential new therapeutic strategies.

The aim of this work, based on a recent review of the literature, is to update the surgical techniques for endoscopic vidian neurectomy (EVN).

To evaluate cigarette smoking prevalence and to examine the clustering of adverse behaviors among young military conscripts in Taiwan.

AbstractThis article reports the epidemiological characteristics and the possible contributing etiology of oral cavity cancer in Taiwan. Data on oral cavity cancer from the period between 1986 and 1997 were compiled from the Taiwan Cancer Registry Annual Report. The amount of average annual consumption per person of cigarettes, alcohol and betel nut were extracted from the Annual Report of Taiwan Tobacco and Wine Monopoly Bureau and the Agriculture Counsel of Taiwan. The incidence of oral cavity cancer increased annually. Both the total and male incidence have increased substantially since 1993. Regarding the peak incidence, most cases were seen in the sixth to eighth decades of life. Multiple regression models indicated that 86.2% variation in the incidence of oral cavity cancer was explained by the annual average betel nut consumption per person. These results imply that those who chew betel nut belong to a high-risk group and require special consideration and attention regarding health education and health promotion.Copyright © 2005 S. Karger AG, Basel

Objective: This study evaluates the prevalence of betel-nut chewing among military personnel stationed on Taiwan's offshore islands. Furthermore, this study examines variables to identify which may predict a greater predilection toward betel-nut chewing among the conscript population studied. Methods: A cross-sectional mass screening was conducted of compulsory military service personnel stationed on Taiwan's offshore islands between August 1 and December 31, 2001. A total of 7574 military employees were included in this survey. Information regarding betel-nut chewing habits were ascertained using a standard structured questionnaire, which including the level and duration of betel-nut chewing as well as respondents' knowledge, attitude and practices with regard to consumption of this product. Results: Conscripts were found to be less likely to chew betel-nut regularly while performing military service. There are 1535 (20.3%) of respondents reporting to habitually chew betel-nut prior to active duty shrank to 1048 (13.8%) after going on active-duty. The most reasons to chew betel-nut among the recruits after military services are curiosity (33.3%) and as a stimulant (29.8%). About 46% of military employees who currently chew betel-nut report an interest to quit in the future. The risk factors for betel-nut chewing include individual factors (e.g., age, education, knowledge, and attitude toward betel-nut chewing), lifestyle habits (e.g., cigarette smoking), and familial factors (e.g., consumption of betel-nut by parents). More interesting, the recruits had thehabit of cigarette smoking associated with increase risk for betel-nut chewing (OR: 7.18; 95% CI: 5.66–9.20). Conclusions: Although the military has made considerable progress in reducing betel-nut chewing on military campuses, the prevalence of betel-nut chewing is still relatively high and, in 2001, affected about one quarter of all military personnel stationed on the abovementioned offshore islands. In future efforts to lower betel-nut consumption among high risk groups, targeting the group of conscripted military personnel described in this study should be considered.

While autogenous fat augmentation for glottic insufficiency has been used before, relatively little information is currently available on the effectiveness of fat injection in patients with nonparalytic glottic insufficiency resulting from problems such as various defects of vocal atrophy or sulcus vocalis. This paper compares retrospectively the efficiency of fat injection after surgery in patients with vocal atrophy (n = 16) and sulcus vocalis (n = 8). The perceptual acoustic and phonatory functions and videolaryngostroboscopic data were evaluated before and after fat augmentation in 24 patients. The mean follow-up time was 19.5 months. Fifteen patients displayed excellent results; 1 showed some improvement; 6 experienced postprocedure failure, and 2 were not available for follow-up analysis. Perceptual rating showed significant improvement in grade, roughness and breathiness (p < 0.05). The videolaryngostroboscopic rating showed significant improvements in vocal fold edge linearity, vocal fold vibration amplitude and mucosal wave excursion (p < 0.05). More improvement in vocal atrophy was observed compared with sulcus vocalis following fat injection procedures. Our research showed that middle defects improved more compared to those in the anterior and posterior area. Fat injection is an effective autogenous implant and may be considered as an option in the treatment of patients with vocal atrophy or sulcus vocalis. Although fat reabsorption was a problem, repeating the procedure could be considered.

While the effectiveness of autogenous fat augmentation after microsurgical removal (FAMSR) of the vocal nodules (VN) has been previously shown in patient treatment programs, relatively little information is available regarding the long-term effectiveness of such a procedure. This paper examines, in retrospect, the long-term effectiveness of FAMSR in patients with VN (n = 41) using pre- and post-FAMSR perceptual acoustic and phonatory function data and videolaryngostroboscopic findings for 33 patients. The mean follow-up time was 18 months. Thirty-three (80.4%) patients displayed excellent results; 4 (9.8%) experienced improvement, and 4 (9.8%) postprocedure failure. Patient phonatory functions showed significant improvements in shimmer, harmonic-to-noise ratio, phonation time (p < 0.05), grade, roughness and breathiness (p < 0.001). The videolaryngostroboscopic rating showed significant improvements in vocal fold edge linearity, vocal fold vibration amplitude, and mucosal wave excursion (p < 0.001). Improvements observed through long-term follow-up tended to be less dramatic in patients with recurrent VN than those with nonrecurrent VN. FAMSR is an easy, safe, and fast procedure which should be considered as an option in treating VN patients who either require surgery or do not have the time or perseverance to complete a lengthy program of speech therapy.

ObjectiveTo provide an anatomical basis for mandibulotomy.

ObjectivesAutogenous fat augmentation has been used as a treatment for glottic insufficiency. However, no information is available on the effectiveness of fat injection in patients with vocal nodules or recurrent vocal nodules after surgery.

Cranial nerve palsy is a rare complication after patients with nasopharyngeal carcinoma (NPC) receive radiotherapy using a technique that delivers 180–200 centigrays (cGy) per day. Cranial neuropathy is of particular clinical interest in terms of making a differential diagnosis, because it is also a common presenting manifestation in patients with NPC. Cranial neuropathy may lead to distressing signs and symptoms in these patients, and their treatment has not been addressed in previous reports. This article presents the authors' experience with radiotherapy-related cranial nerve palsy in patients with NPC. Nineteen patients were diagnosed with radiation-related neuropathy. Patients with recurrent tumors or with a suspicion of persistent or recurrent tumors were excluded. Most patients were treated using 180 cGy or 200 cGy per fraction per day. The total dose was 7000–13,000 cGy to the nasopharynx and 5000–9000 cGy to the neck. Unilateral vocal cord paralysis alone and hearing loss were not included in the analysis. There were 15 male patients and 4 female patients. The latency before palsy occurred was 12–240 months. Single nerve palsy developed in four patients, including two patients with hypoglossal palsy and two patients with recurrent laryngeal palsy. Two patients had three nerve palsies each. The other 13 patients presented with 2 nerve palsies each. Vagus and hypoglossal palsy appeared to be a frequent combination and occurred in 11 patients. Overall, there were 17 patients with hypoglossal palsy (7 bilateral, 8 left-sided, and 2 right-sided), 11 patients with vagus palsy (2 bilateral, 7 left-sided, and 2 right-sided), 6 patients with recurrent laryngeal nerve palsy (5 bilateral), and 2 patients with accessory palsies (all bilateral). Marked neck fibrosis was present in 12 patients. Patients who had vocal cord paralysis suffered from easy choking and hoarseness. Severe respiratory difficulty occurred in two patients who had bilateral vocal cord palsy. Surgical procedures included laryngoplasty, tracheostomy, and gastrostomy. Quality of life improved considerably after patients underwent surgery. Radiotherapy-related cranial nerve palsy may occur in patients with NPC after they receive conventional radiotherapy. Hypoglossal nerve palsy was found the most frequently in this series, followed by vagus nerve palsy and recurrent laryngeal nerve palsy. Neck fibrosis and the course of the three nerves through the neck may be important risk factors for the development of palsy. The diagnosis must be made only after the possibilities of tumor-induced palsy and idiopathic palsy are excluded. Surgery is helpful in improving the quality of life in many patients. Cancer 2002;95:404–9. © 2002 American Cancer Society. DOI 10.1002/cncr.10668

Purpose:To report our observation of excessive temporal lobe necrosis in nasopharyngeal carcinoma (NPC) patients treated with 160 cGy b.i.d. radiotherapy technique. During the same period, patients treated with 120 cGy b.i.d. have not shown a similar tendency. Our experience may be useful for designing unconventional radiotherapy regimens for NPC patients.

Vocal cord immobility is a rare presentation of an impacted fishbone in the pharynx. The mechanisms can be classified into either mechanical articular fixation or direct/indirect neuropathy of the recurrent laryngeal nerve. We report a case of vocal cord immobility secondary to long‐standing impaction of a fishbone in the hypopharynx for at least 9 months. The diagnosis was made by computed tomography (CT) and rigid laryngoscopy because no reliable history was available. The cricoarytenoid joint was not fixed and the function of the vocal cords returned one month after removal of the fishbone. The mechanism of the vocal cord immobility was an injury to the recurrent laryngeal nerve due to the chronic inflammatory reaction in the paraglottic space. Laryngoscope, 119:228–230, 2009

Unilateral vocal cord paralysis (VCP) is a frequent complication of a variety of cancers. It is easy to diagnose and not fatal. Bilateral VCP is rare and it is fatal if not appropriately managed. We encountered a patient with nasopharyngeal carcinoma who developed bilateral VCP with hoarseness and respiratory distress 2 years after initial diagnosis. A tracheostomy was performed to restore airway patency.