Base Of Tongue Research Articles

Clinical application of a self-developed mouth opener with a tongue base retractor in the operation of deep part of tongue base

Objective:To test the application effect of a self-developed mouth opener with a tongue base retractor in the operation of the deep part of tongue base. Methods:The tongue base surgical field was exposed by using a self-developed mouth opener with a tongue base retractor in 8 patients who underwent deep tongue base operation via oral approach, the difficulty of operation, the effect of exposure of operation field, the tear of mucous membrane of the pharynx arch and the risk of tongue paralysis were observed. Results:The self-made mouth opener can expose the deep operative field of the tongue root by using the self-provided tongue root retractor during the operation, and the operation is conducted under the guidance of angle endoscope. The operative field of 8 patients was well exposed during the whole operation, there was no pharyngeal mucosa tearing and postoperative tongue paralysis. Conclusion:The self-made mouth opener has the advantages of simple operation, good exposure effect and less complications, but it needs rigid bending instruments in some operations.

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.

78. Beavertail Modification of the Radial Forearm Free Flap in Primary Parotidectomy Reconstruction: Technique and Outcomes

Head and neck oncologists are often confronted with the difficult challenge of balancing cancer cure with the preservation of function when deciding the patient’s best management. The beavertail modification of the radial forearm free flap (RFFF) has been previously described for tongue base reconstruction only. We describe a new indication for its use for total parotidectomy defects to address the increase risk of Frey’s syndrome, sialocele and associated significant contour deformity.

Segmental mandibular advancement for moderate-to-severe obstructive sleep apnoea: a pilot study

Segmental mandibular advancement (SMA) consists of a combination of bilateral sagittal split osteotomy, anterior subapical osteotomy with extraction of the first premolars, and genioplasty, to allow an extended advancement of the mandible for the improvement of tongue base obstruction in moderate-to-severe obstructive sleep apnoea (OSA) and to minimize any unfavourable aesthetic change due to the large jaw advancement. The aim of this pilot study was to evaluate the surgical outcomes and complications following SMA in OSA patients. Twelve patients (nine male, three female) underwent SMA as part or whole of their skeletal advancement procedure for OSA. The apnoea–hypopnoea index (AHI) improved from a mean± standard deviation 42.4 ± 22.0/hour preoperatively to 9.0 ± 17.4/hour at 1 year postoperative. Surgical success (50% reduction in AHI) was achieved in 11 of the 12 patients (91.7%) at 1 year postoperative, while seven patients (58.3%) attained surgical cure (AHI<5/hour). The lowest oxygen saturation (LSAT) increased from a mean 73.3% preoperatively to 78.7% at 1 year postoperative. The airway volume increased from a mean 2.4 ± 1.7 cm3 at baseline to 6.7 ± 3.5 cm3 at 1 year postoperative (P < 0.001). No major complication occurred. This pilot study showed that SMA appears to be safe and effective as part or whole of the skeletal advancement surgery for moderate-to-severe OSA.

Co-existence of Carcinoma Tongue with Pulmonary Tuberculosis

We present the case of a 45-year-old male diagnosed to have carcinoma base of tongue, whose chest radiograph showed bilateral lung infiltrates and was referred for evaluation of suspected pulmonary metastases. Diagnostic evaluation confirmed the diagnosis of smear-positive pulmonary tuberculosis.

Immunoglobulin High Throughput Sequencing (Ig-HTS) Minimal Residual Disease (MRD) Analysis Is an Effective Surveillance Tool in Patients with Mantle Cell Lymphoma

Introduction Mantle cell lymphoma (MCL) accounts for 4-6% of B-cell non-Hodgkin lymphoma (NHL), with historically poor outcomes. With the advent of targeted and cellular therapies, responses and durable remissions have improved although cure remains elusive. As patients experience longer remissions, this raises the question of the optimal surveillance modality. For NHL in general, surveillance imaging surveillance does not improve outcomes and is associated with increased radiation exposure, high costs, and anxiety to patients. Peripheral blood minimal residual disease (MRD) analysis offers a potential alternative to surveillance imaging that is more sensitive, less costly, and eliminates the risk of radiation exposure. The clonoSEQ® assay (Adaptive Biotechnologies) is an FDA-cleared Ig-HTS MRD assay which takes advantage of the fact that B-cell lymphomas nearly always have one or more unique clonal immunoglobulin (Ig) gene rearrangements which can serve as a tumor "marker". These sequences can be detected in the peripheral blood, as circulating tumor DNA (ctDNA), with a sensitivity as low as 1 cell in 1,000,000. Starting in 2015, our group has monitored many of our MCL patients using the clonoSEQ® MRD assay. This has been done in lieu of surveillance imaging, or to minimize its use. We performed a retrospective analysis to summarize our experience with this assay to demonstrate its utility as a surveillance tool for MCL patients. Methods We conducted retrospective data collection and analysis of outcomes in patients who underwent first-line treatment for MCL and were then monitored post-treatment using the clonoSEQ® assay. We captured baseline patient characteristics, as well as every time a surveillance imaging or ctDNA (clonoSEQ®) test was performed. We used swimmer plots to display timelines for individual patients, indicating all ctDNA tests (positive or negative), CT or PET scan results, as well as documented clinical relapse. We used Kaplan-Meier curves to show progression-free survival and overall survival of the entire cohort. We compared ctDNA to radiographic surveillance in terms of ability to detect relapse. Results A total of 31 patients were included. The median age of patients was 59, and the majority had low- or intermediate-risk disease by MIPI score, with 58% having a proliferation index above 30%. The majority (81%) underwent high-dose cytarabine-based induction, 77% underwent autologous transplant in first remission, and 42% received rituximab maintenance (see Table 1). With a median follow up of 5.8 years, overall outcomes with this cohort were excellent, with 69% and 60% progression-free at 5 and 10 years, respectively, and 96% and 92% alive at 5 and 10 years, respectively. Among the 12 patients who ultimately sustained a radiographic relapse, peripheral blood became MRD-positive in 11 patients (92%). The first positive MRD test came with a lead time of between 0-24 months (median 70 days) prior to radiographic relapse. Only one patient had a negative MRD result while being found to have progressive disease on imaging. That patient had a single site of disease at the base of tongue which caused symptoms early, despite a very low overall disease burden. Among the 19 patients who have been in continuous clinical remission, 17 have remained MRD-negative. The other 2 had "molecular relapse” (MRD positive without radiographic relapse), which allowed for pre-emptive rituximab treatment, which converted them back to an MRD-negative state. Several patients were able to enjoy 2-4 year intervals without any surveillance imaging, while still getting reassurance every few months from the negative ctDNA test (see Figure 1). Conclusions Our data suggests that the clonoSEQ® MRD assay is an effective surveillance tool for MCL patients following first-line therapy. In our experience, this MRD assay was predictive of relapse prior to imaging in all but one patient. In addition, the assay allowed for minimization of surveillance imaging, and early detection of MRD allowed for pre-emptive rituximab therapy in select patients. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Chronically Infected Tongue Base Suspension Suture Presenting as Inflamed Submucosal Granuloma and Metaplastic Synovial Cyst Mimicking Malignancy.

Chronically Infected Tongue Base Suspension Suture Presenting as Inflamed Submucosal Granuloma and Metaplastic Synovial Cyst Mimicking Malignancy.

Potential ultrasonic anatomical markers of obstructive sleep apnoea–hypopnoea syndrome

To investigate the potential value of ultrasonography in evaluating the pathophysiology of obstructive sleep apnoea-hypopnoea syndrome (OSAHS) by assessing the correlation of critical ultrasonic anatomical characteristics of the oropharynx with the severity of OSAHS. One hundred and seventy-one patients with suspected OSAHS underwent oropharyngeal sonographic examination and overnight polysomnography. Ultrasonic measurement was compared with the apnoea-hypopnoea index (AHI) and other parameters. An ordinal logistic regression model was used to identify potential ultrasonic anatomical markers for OSAHS. The AHI was significantly correlated with lingual height (r=0.40, p<0.01), maximal width of the tongue (r=0.35, p<0.01), and distance from the symphysis of the mandible to the hyoid bone (M-HB) (r=0.24, p<0.01). A positive relationship between Friedman tongue position (FTP) grades and lingual height (r=0.24, p<0.01), between FTP grades and maximal width of the tongue (r=0.23, p<0.01), and between FTP grades and width of tongue base (TB; r=0.17, p<0.05) was found. Multivariate models adjusted for sex, age, and body mass index (BMI) revealed that lingual height (95% confidence interval [CI]: 1.04-1.24; p=0.004) is independently associated with a higher risk for the severity of OSAHS. Ultrasonography may be a potential imaging method for providing additional useful information about the correlation between ultrasound findings and the severity of OSAHS. Lingual height could be considered an ultrasonic anatomical marker for determining the severity of OSAHS patients independent of age, sex, and BMI.

Use of VOTE score in predicting outcomes in pediatric obstructive sleep apnea

Obstructive Sleep Apnea (OSA) affects 1-4% of the pediatric population in the U.S. Drug-Induced Sleep Endoscopy (DISE) is widely used to localize the level(s) of obstruction. The VOTE classification system is used to grade obstructions found at the velum, oropharynx, base of tongue, and epiglottis and has been validated in adults. This study aims to determine if the VOTE score has any predictive value in pediatric OSA postoperative outcomes. A retrospective chart review of 129 patients from January 7, 2016 to 05/30/2020 was performed. Included patients were between the ages of 2 and 17, undergoing DISE, and if they had preoperative and postoperative polysomnography (PSG) data. Excluded patients did not meet one of the above or had other comorbidities contributing to their sleep apnea. 53 patients were included. Pearson's Correlation tests compared intraoperative VOTE score to postoperative BMI, AHI, and O2 nadir and their relationships. We found a weakly positive correlation between the VOTE and postoperative AHI with a coefficient of 0.35 and a p-value of 0.01. We found a relationship between postoperative O2 nadir and AHI, with a coefficient of -0.627 and a p-value <0.0001. Finally, a paired, two-tailed t-test compared the mean change between preoperative and postoperative BMIs (+1.6), oAHIs (-23.5), and O2 nadirs (+14), all with p-value <0.0001. We demonstrated a correlation between VOTE and improved postoperative AHI and a relationship between improved postoperative AHI and postoperative O2 nadir. The validity of VOTE may be proven with larger sample size. Alternatively, a different scoring system may be required for pediatric OSA.

Reliability of a pediatric sleep endoscopy scoring system.

The surgical management of Obstructive Sleep Apnea (OSA) may be guided by Drug Induced Sleep Endoscopy (DISE), but there is no universally accepted scoring system for DISE in children. The purpose of this study is to compare a novel system to the more commonly used VOTE (Velum, Oropharynx, Tongue base, Epiglottis) system. A total of thirty pediatric DISE videos were reviewed and scored twice by 5 raters with a range of experience levels. The videos were scored using both the VOTE and the new scoring systems. The raters were also asked to recommend surgical intervention based on the DISE exam alone. Intra-rater test-retest analysis of the responses was conducted using weighted kappa (WK) statistic and percentage agreement (PA), respectively. Inter-rater reliability analysis of responses was evaluated using Krippendorff's alpha reliability coefficient (KA). Using a proportional odds model, a comparison of the weighted kappa statistic for the VOTE and the novel scoring systems was conducted. For the novel scoring system, the intra-rater test-retest WK coefficient was 0.62 and 0.87 and the PA was 64% and 82% at the 25th and 75th percentiles, respectively. For the VOTE system, the intra-rater test-retest WK coefficient was 0.50 and 1.00 and PA was 75% and 100% at the 25th and 75th percentiles, respectively. KA was 0.36 and 0.77at the 25th and 75th percentiles. In addition, responses to the surgical intervention survey analysis yielded a test-retest WK coefficient of 0.40 and 1.00 and a PA 71%-100% at the 25th and 75th percentiles, respectively. KA was 0.40 and 0.61at the 25th and 75th percentiles, respectively. There was no significant difference between the 2 scoring systems on the WK statistic (p=.15), but significant difference on PA (p=.01). Our novel scoring system demonstrated intra-rater test-retest and inter-rater reliability similar to the VOTE system, includes more sites of potential airway obstruction, and has potential for widespread use.

Prevalence of Human Papillomavirus and Co-Infection with Epstein-Barr Virus in Oral and Oropharyngeal Squamous Cell Carcinomas.

Head and neck squamous cell carcinoma is one of the most important malignancies, worldwide. Oncogenic viruses, such as human papilloma virus (HPV) and Epstein-Barr virus (EBV), are linked to these cancers and studies suggest a possible interaction between HPV and EBV during co-infections to promote oncogenesis. Nonetheless, these reports are controversial and demand more investigations in this regard. The present work to assessed the prevalence of HPV and co-infection with EBV in oral and oropharyngeal squamous cell carcinomas. Formalin-fixed paraffin-embedded tissues were collected from 166 archived oral and oropharyngeal squamous cell carcinoma samples from Ahvaz Imam Khomeini hospital, Ahvaz, Iran, from March 2013 and December 2019. Nested-PCR was used to detect the viruses and type-specific PCR/nested-PCR and sequencing were performed for virus genotyping. Out of the 166 specimens, 84.33% and 16.42% were from oral cavity and oropharynx, respectively; of which, 32 cases (19.3%) were HPV-positive (16.42% of oral cavity and 34.6% of oropharynx). HPV was detected in 36.36%, 25%, and 16.42% of base of tongue, tonsil, and oral tongue tumors, respectively. HPV was more associated with well differentiated tumors (24;18.04%) in compared to moderately and poorly differentiated ones. Regarding HPV-16 genotyping, 7 (21.8%) out of the 32 samples were found to be HPV-16 (4/26 (15.38%) for oropharynx and 3/140 (2.14%) for oral cavity). Moreover, 90 samples were evaluated for EBV infection and co-infection; of which, 4 (4.4%) subjects tested positive for EBV, including two cases with HPV co-infection. All the positive cases were EBV type B, from oral cavity, and histologically well differentiated. HPV was more associated with oropharyngeal cancer. This association has been linked to various factors such as repeated oral and oropharyngeal exposure to HPV due to change in patterns of sexual behaviors; a phenomenon that may demand routine HPV vaccination.

Safety of tongue base procedures for sleep apnoea in adults: A systematic review and metanalysis from the YO-IFOS study group

Tongue base and hypopharynx are the major sites of obstruction in OSA patients with failed palatal surgery. In recent years, several minimally invasive procedures have been developed to address tongue base obstruction. However, the research focus has consistently been on the effectiveness of surgery in reducing obstructive sleep apnoea rather than on postoperative complications. In this systematic review and metanalysis we aim to review the complication rate of minimally invasive base of tongue procedures for OSAS in adults. PubMed (Medline), the Cochrane Library, EMBASE, Scopus, SciELO and Trip Database. Data sources were checked by three authors of the YO-IFOS sleep apnoea study group. Three authors extracted the data. Main outcome was expressed as the complication rate and 95% confidence interval for each surgical technique. 20 studies (542 patients) met the inclusion criteria. The mean complication rate is 12.79%; 4.65% for minor complications, 6.42% if they are moderate, and 1.77% if severe. The most reported complication overall is infection, in 1.95% of cases, followed by transient swallowing disorder, occurring in 1.30% of the total sample. The heterogeneity amongst the included studies prevents us from obtaining solid conclusions. The available evidence suggests that minimally invasive base of tongue procedures may present a wide spectrum of complication rates, ranging from 4.4% in tongue base radiofrequency to up to 42.42% in tongue base ablation. La base de la lengua y la hipofaringe son los principales sitios de obstrucción en pacientes con AOS persistente tras una faringoplastia. En los últimos años se han desarrollado numerosas técnicas de cirugía mínimamente invasiva con el objetivo de tratar la obstrucción en este nivel. Sin embargo, el foco de los investigadores se ha situado habitualmente en la efectividad de la técnica para reducir el número de eventos obstructivos, más que en sus complicaciones. En esta revisión sistemática y metaanálisis se evalúa la incidencia de complicaciones de procedimientos mínimamente invasivos para la base de la lengua en pacientes adultos con AOS. PubMed (Medline), Cochrane Library, EMBASE, Scopus, SciELO y Trip Database. Las bases de datos fueron evaluadas por 3 autores del grupo de investigación en apnea YO-IFOS. Tres autores extrajeron la información. Los resultados principales se expresaron como porcentaje de complicación e intervalo de confianza al 95% para cada técnica quirúrgica. Veinte estudios (542 pacientes) cumplieron los criterios de inclusión. La incidencia media de complicaciones fue del 12,79%; un 4,65% fueron menores, un 6,42% moderadas y un 1,77% severas. La complicación más habitual fue infección en el 1,95% de los casos, seguida por alteración transitoria de la deglución en un 1,30%. La heterogeneidad de los artículos incluidos no permite obtener conclusiones firmes. La evidencia disponible muestra que la cirugía mínimamente invasiva de la base de la lengua presenta un intervalo amplio de complicaciones que varía entre el 4,4% en la radiofrecuencia de la base de la lengua y el 42,42% en la ablación de la base de la lengua.

Gastrostomy Tube Use in Head and Neck Cancer Survivors, Pre-Treatment Factors Supersede Treatment Intensification: A Second Analysis of RTOG 0129, RTOG 0522, and NRG/RTOG 1016

<h3>Purpose/Objective(s)</h3> Clinical and treatment factors that engender long-term gastrostomy tube (g-tube) dependence are poorly defined. We attempted to identify potential predictors. <h3>Materials/Methods</h3> All eligible patients treated on RTOG 0129, RTOG 0522, and NRG/RTOG 1016 were grouped according to treatment received: standard fractionation RT (3DSFX) + cisplatin (C), accelerated fractionation RT (3DAFX) + C, accelerated IMRT (AFX) + C, AFX + C + cetuximab (cetux) and AFX + cetux. G-tube rates were compared at baseline (pre-treatment), 6-months after radiation completion, and annually from years 1 to 9 post treatment. Time to g- tube placement was analyzed using Cox proportional hazards models for variables of interest. Additionally, a separate review was performed for patients with no g-tube at 3 years' post-treatment (survivors with acceptable post-treatment swallowing) to evaluate late g-tube placement. <h3>Results</h3> 2389 patients were identified, 1839 of which had oropharynx cancer (OPC). AFX+C was the most common management (n=843, 35%). The G-tube rate at treatment initiation was 14%. At one-year post-treatment the rate was 19% and at 9 years the number was 8%. The RTOG 0129 g-tube rate was significantly higher than that of later studies (RTOG 0522 HR 0.7, 0.6-0.8; NRG/RTOG1016 HR 0.85 (0.72-0.99). Patients treated with 3D regimens had significantly higher feeding tube rate at baseline, 6 months, 1 year, and 2 years post-treatment (3DSFX + C: 25%/45%/29%/13% and 3DAFX + C: 22%/41%/26%/17%, respectively) when compared to accelerated IMRT regimens (all time points p < 0.001). There was no difference in feeding tube rate between treatment groups from years 3 – 9. Among OPC patients the predictors of feeding tube placement were older age (HR 1.01, 1.00-1.02), T4 primary (1.3, 1.1-1.6) and >10 pack year smoking history (HR 1.2, 1.0-1.4). Treatment regimen, tumor location, and p16-status did not affect g-tube placement. Among all patients, predictors of g-tube placement were older age (HR 1.01, 1.01-1.02); T4 primary (HR 1.3, 1.2-1.5), AJCC 7^th ed N2c/N3 (1.3, 1.1-1.6); and >10 pack year smoking history (HR 1.2, 1.0-1.3). At 3 years there were 989 patients alive with follow-up who never required a gastrostomy tube. Of the 249 of these patients with 9 years' follow-up the g-tube rate was 6%. From univariable model predictors of feeding tubes placed more than 5 years after treatment completion were T3 category, T4 category, >10 pack years smoking, non-tonsil or tongue base primary, and p16-negative tumors. <h3>Conclusion</h3> G-tube rates were highest in patients managed with 3DCRT on RTOG 0129; utilization has significantly decreased over time. Radiation acceleration treatment intensification does not increase g-tube use during treatment or survivorship. Predictors of feeding tube use are increasing age, T4 primary tumors and >10 pack year smoking history.

The Effect of Pharyngeal Surgery on Positive Airway Pressure Therapy in Obstructive Sleep Apnea: A Meta-Analysis.

There is controversy about the effect of pharyngeal surgery for obstructive sleep apnea (OSA) on positive airway pressure (PAP) adherence, and the related results of meta-analysis have not yet been available. Therefore, the purpose of this meta-analysis was to assess the effect of pharyngeal OSA surgery on PAP therapy parameters such as optimal pressure levels and usage time. We selected studies investigating optimal PAP levels or usage time before and after pharyngeal OSA surgery, regardless of the study design. Pharyngeal OSA surgery included uvulopalatopharyngoplasty and its variants, tonsillectomy, Pillar implants, radiofrequency ablation, tongue base surgery and its variants, and genioglossus advancement. Studies in which isolated nasal surgery was performed were excluded. The random-effects model was used due to significant heterogeneity among the studies. Nine studies were included in the meta-analysis of optimal PAP levels, and five studies in the meta-analysis of PAP usage time. After pharyngeal OSA surgery, the summed optimal PAP level was significantly decreased (standardized mean difference (SMD), -1.113; 95% confidence interval (CI), -1.667 to -0.559)), and the summed usage time of PAP was significantly increased (SMD, 0.794; 95% CI, 0.259 to 1.329). This study illustrated that pharyngeal OSA surgery lowered optimal PAP levels and enhanced PAP usage time. The results of the meta-analysis contribute to our understanding of the role of pharyngeal OSA surgery in patients with PAP intolerance.

Mucoepidermoid carcinoma may be devoid of squamoid cells by immunohistochemistry: expanding the histologic and immunohistochemical spectrum of MAML2- rearranged salivary gland tumours.

Mucoepidermoid carcinoma (MEC) is historically defined by a mix of squamoid, intermediate, and mucous cells, but we have recently encountered several cases lacking immunoreactivity for squamous markers p40, p63, and CK5/6 despite MAML2 fusions. This study will characterise these unique tumours. Ten MEC were collected arising from the parotid gland (n=4), submandibular gland (n=2), nasopharynx (n=1), base of tongue (n=1), bronchus (n=1), and trachea (n=1). Six tumours were low-grade, two intermediate-grade, one high-grade, and one demonstrated low-grade areas with high-grade transformation. Four cases were oncocytic, four had clear-cell features, two had spindle cell features, and one high-grade MEC had prominent solid, cord-like, and micropapillary features. The tumours were negative for p40 (10/10), p63 (10/10), and CK5/6 (9/9). Targeted RNA sequencing demonstrated CRTC1::MAML2 in five cases, CRTC3::MAML2 in two, and a novel MAML2::CEP126 in the unusual high-grade case. In two cases with insufficient RNA, MAML2 fluorescence insitu hybridisation (FISH) showed rearrangement. Genetically-confirmed MEC may lack overt squamous differentiation by histology and immunohistochemistry. While most cases harboured canonical fusions and fit within the spectra of MEC variants with oncocytic, clear cell, and/or spindle cell features, one had a novel MAML2::CEP126 fusion and unusual morphology. In MEC without squamoid cells, the use of immunohistochemistry may hinder, rather than aid, the correct diagnosis. In such cases, MAML2 analysis is most useful. The historical definition of MEC as a carcinoma with squamoid, intermediate and mucous cells should be revisited.

The effect of surgical weight loss on upper airway fat in obstructive sleep apnoea.

Obesity is a reversible risk factor for obstructive sleep apnoea (OSA). Weight loss can potentially improve OSA by reducing fat around and within tissues surrounding the upper airway, but imaging studies are limited. Our aim was to study the effects of large amounts of weight loss on the upper airway and volume and fat content of multiple surrounding soft tissues. Participants undergoing bariatric surgery were recruited. Magnetic resonance imaging (MRI) was performed at baseline and six-months after surgery. Volumetric analysis of the airway space, tongue, pharyngeal lateral walls, and soft palate were performed as well as calculation of intra-tissue fat content from Dixon imaging sequences. Among 18participants(89% women), the group experienced 27.4 ± 4.7% reduction in body weight. Velopharyngeal airway volume increased (large effect; Cohen's d [95% CI], 0.8 [0.1, 1.4]) and tongue (large effect; Cohen's d [95% CI], - 1.4 [- 2.1, - 0.7]) and pharyngeal lateral wall (Cohen's d [95% CI], - 0.7 [- 1.2, - 0.1]) volumes decreased. Intra-tissue fat decreased following weight loss in the tongue, tongue base, lateral walls, and soft palate. There was a greater effect of weight loss on intra-tissue fat than parapharyngeal fat pad volume (medium effect; Cohen's d [95% CI], - 0.5 [- 1.2, 0.1], p = 0.083). The study showed an increase in velopharyngeal volume, reduction in tongue volume, and reduced intra-tissue fat in multiple upper airway soft tissues following weight loss in OSA. Further studies are needed to assess the effect of these anatomical changes on upper airway function and its relationship to OSA improvement.

Evaluation of degree of upper aerodigestive tract obstruction in patients with snoring and obstructive sleep apnea syndrome

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Objectives of the study were to evaluate the degree of obstruction of upper aerodigestive tract in patients with snoring and obstructive sleep apnea syndrome (OSAS) by nasopharyngolaryngoscopy assisted Muller’s maneuver; to evaluate the degree of obstruction of upper aerodigestive tract in patients with snoring and OSAS with imaging technique magnetic resonance imaging (MRI); and to find the association between fibroptic nasopharyngolaryngoscopy assisted Muller’s maneuver (NMM) and sleep MRI.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Study design was&lt;strong&gt; &lt;/strong&gt;open prospective observational study&lt;strong&gt;. &lt;/strong&gt;30 patients diagnosed with snoring and OSA were included in the study at department of ear, nose and throat (ENT), Command Hospital, Air Force, Bangalore. They underwent detailed clinical evaluation and polysomnography followed by assessment of levels and degree of obstruction of upper aerodigestive tract by flexible fiber optic laryngoscopy (FOL) assisted Mullers maneuver and functional (f) sleep MRI. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 20 patients (66.7%) were diagnosed as obstructive sleep apnea syndrome, 10 patients (33.3%) were snorers by Polysomnography. 27 (90%) patients show moderate to severe collapse at level of the base of tongue, 25 (83.3) patients show moderate to severe collapse at the level of soft palate by flexible FOL assisted Mullers maneuver. 22 (73.4%) patients show a collapse the level of the soft palate, 20 (66.6%) patients show a collapse at the level of the base of tongue by f sleep MRI. In this study, on applying Chi square test there was significant association between soft palate Flexible nasopharyngoscopy with muller’s method and soft palate MRI with Chi square value 35.690, p value &amp;lt;0.001. There was significant association between base of tongue flexible nasopharyngoscopy with Muller’s method and base of tongue sleep MRI with Chi-square value 14.511, and p value &amp;lt;0.005.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Polysomnography is gold standard test to diagnose OSA. Flexible nasopharyngoscopy with Muller’s method and sleep MRI shows the most common site of upper airway collapse is at the level of the soft palate and the base of tongue.&lt;/p&gt;

Potential Utility of the Mallampati Score for Prediction of Treatment Compliance and Safety Profiles of Patients With Head and Neck Cancer Undergoing Definitive Concurrent Chemoradiotherapy.

Restriction of mouth opening (RMO) is a common manifestation of head and neck cancer (HNC) and a poor prognostic factor following concurrent chemoradiotherapy (CCRT) of patients. This study aimed to explore whether the Mallampati score, a visual assessment of the distance from the tongue base to the roof of the mouth, can be used as a surrogate for RMO in predicting treatment outcomes in patients with HNC undergoing CCRT. A total of 461 consecutive patients who received definitive CCRT for the treatment of locally advanced HNC between August 2016 and December 2017 at Chang Gung Memorial Hospital in Taiwan (Linkou, Keelung, and Kaohsiung branches) were enrolled in this prospective study. Patients were allocated by the pre-treatment Mallampati score of 1 or 2 (n=24) vs. 3 or 4 (n=207) to compare treatment compliance and treatment-related complications. Patients in the Mallampati score of 3 or 4 group had a higher prevalence of betel quid chewing, oral cavity and oropharynx cancers, advanced tumor stage, poorer performance status, and were more likely to receive platinum monotherapy during CCRT. Patients in the Mallampati score of 3 or 4 group had a 2.08-fold (p=0.002) hazard ratio (HR) for overall survival compared to those in the score of 1 or 2 group in the univariate analysis, the difference remained significant in multivariate analysis (adjusted HR=1.61; 95% CI=1.02-2.61; p=0.047). Patients in the Mallampati score 3 or 4 group had a 2.36-fold (95% CI=1.07-5.19; p=0.033) increased likelihood of incomplete chemotherapy, 2.44-fold (95% CI=1.17-5.06; p=0.017) increased likelihood of incomplete radiotherapy, and 1.84-fold (95% CI=1.18-2.87; p=0.007) risk of unexpected hospitalization compared to those with a Mallampati score of 1 or 2 in multivariate analysis. Patients with HNC with higher pre-treatment Mallampati scores had poorer survival outcomes and were at a higher risk of treatment incompletion and treatment-related toxicities when undergoing CCRT. Our results support the utility of Mallampati score as a surrogate for measuring RMO to predict survival outcomes, treatment compliance, and safety profiles in patients with HNC undergoing CCRT.

A domain knowledge enhanced yield based deep learning classifier identifies perineural invasion in oral cavity squamous cell carcinoma.

Perineural invasion (PNI), a form of local invasion defined as the ability of cancer cells to invade in, around, and through nerves, has a negative prognostic impact in oral cavity squamous cell carcinoma (OCSCC). Unfortunately, the diagnosis of PNI suffers from a significant degree of intra- and interobserver variability. The aim of this pilot study was to develop a deep learning-based human-enhanced tool, termed domain knowledge enhanced yield (Domain-KEY) algorithm, for identifying PNI in digital slides. Hematoxylin and eosin (H&E)-stained whole-slide images (WSIs, n = 85) were obtained from 80 patients with OCSCC. The model structure consisted of two parts to simulate human decision-making skills in diagnostic pathology. To this aim, two semantic segmentation models were constructed (i.e., identification of nerve fibers followed by the diagnosis of PNI). The inferred results were subsequently subjected to post-processing of generated decision rules for diagnostic labeling. Ten H&E-stained WSIs not previously used in the study were read and labeled by the Domain-KEY algorithm. Thereafter, labeling correctness was visually inspected by two independent pathologists. The Domain-KEY algorithm was found to outperform the ResnetV2_50 classifier for the detection of PNI (diagnostic accuracy: 89.01% and 61.94%, respectively). On analyzing WSIs, the algorithm achieved a mean diagnostic accuracy as high as 97.50% versus traditional pathology. The observed accuracy in a validation dataset of 25 WSIs obtained from seven patients with oropharyngeal (cancer of the tongue base, n = 1; tonsil cancer, n = 1; soft palate cancer, n = 1) and hypopharyngeal (cancer of posterior wall, n = 2; pyriform sinus cancer, n = 2) malignancies was 96%. Notably, the algorithm was successfully applied in the analysis of WSIs to shorten the time required to reach a diagnosis. The addition of the hybrid intelligence model decreased the mean time required to reach a diagnosis by 15.0% and 23.7% for the first and second pathologists, respectively. On analyzing digital slides, the tool was effective in supporting human diagnostic thinking. The Domain-KEY algorithm successfully mimicked human decision-making skills and supported expert pathologists in the routine diagnosis of PNI.

Automated deep neural network analysis of lateral cephalogram data can aid in detecting obstructive sleep apnea.

Information on obstructive sleep apnea (OSA) is often latently detected in diagnostic tests conducted for other purposes, providing opportunities for maximizing value. This study aimed to develop a convolutional neural network (CNN) to identify the risk of OSA using lateral cephalograms. The lateral cephalograms of 5,648 individuals (mean age, 49.0 ± 15.8 years; men, 62.3%) with or without OSA were collected and divided into training, validation, and internal test datasets in a 5:2:3 ratio. A separate external test dataset (n = 378) was used. A densely connected CNN was trained to diagnose OSA using a cephalogram. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC). Gradient-weighted class activation mapping (Grad-CAM) was used to evaluate the region of focus, and the relationships between the model outputs, anthropometric characteristics, and OSA severity were evaluated. The AUROC of the model for the presence of OSA was 0.82 (95% confidence interval, 0.80-0.84) and 0.73 (95% confidence interval, 0.65-0.81) in the internal and external test datasets, respectively. Grad-CAM demonstrated that the model focused on the area of the tongue base and oropharynx in the cephalogram. Sigmoid output values were positively correlated with OSA severity, body mass index, and neck and waist circumference. Deep learning may help develop a model that classifies OSA using a cephalogram, which may be clinically useful in the appropriate context. The definition of ground truth was the main limitation of this study. Jeong H-G, Kim T, Hong JE, etal. Automated deep neural network analysis of lateral cephalogram data can aid in detecting obstructive sleep apnea. J Clin Sleep Med. 2023;19(2):327-337.