The Connectivity–Based Parcellation of The Angular Gyrus: Fiber Dissection And MR Tractography Study

The angular gyrus (AG) wraps the posterior end of the superior temporal sulcus (STS), so it is considered as a continuation of the superior/middle temporal gyrus and forms the inferior parietal lobule (IPL) with the supramarginal gyrus (SMG). The AG was functionally divided in the literature, but there is no fiber dissection study in this context. This study divided AG into superior (sAG) and inferior (iAG) parts by focusing on STS. Red blue silicone injected eight human cadaveric cerebrums were dissected via the Klingler method focusing on the AG. White matter (WM) tracts identified during dissection were then reconstructed on the Human Connectome Project 1065 individual template for validation. According to this study, superior longitudinal fasciculus (SLF) II and middle longitudinal fasciculus (MdLF) are associated with sAG; the anterior commissure (AC), optic radiation (OR) with iAG; the arcuate fasciculus (AF), inferior frontooccipital fasciculus (IFOF), and tapetum (Tp) with both parts. In cortical parcellation of AG based on STS, sAG and iAG were found to be associated with different fiber tracts. Although it has been shown in previous studies that there are functionally different subunits with AG parcellation, here, for the first time, different functions of the subunits have been revealed with cadaveric dissection and tractography images.

Ứng dụng nội soi dải ánh sáng hẹp kết hợp nội soi vi phẫu bằng laser CO2 trong chẩn đoán và điều trị ung thư hạ họng, thanh quản giai đoạn sớm

TÓM TẮT Mục tiêu: Đánh giá kết quả ứng dụng nội soi dải ánh sáng hẹp kết hợp nội soi vi phẫu bằng Laser CO2 trong chẩn đoán và điều trị ung thư hạ họng và ung thư thanh quản giai đoạn sớm. Phương pháp nghiên cứu: Nghiên cứu tiến cứu, có can thiệp lâm sàng trên 18 bệnh nhân ung thư hạ họng, ung thư thanh quản ở giai đoạn sớm, được phát hiện tổn thương ác tính bằng nội soi dải ánh sáng hẹp, điều trị phẫu thuật nội soi vi phẫu bằng Laser CO2. Kết quả: Tuổi trung bình mắc bệnh là 63,8 ± 12,6; bệnh nhân có hút thuốc lá chiếm 61,1%; triệu chứng khàn tiếng chiếm 72%, ung thư giai đoạn T1a có tỷ lệ 72,2%; IPCL type V-1 là 72,2%; khả năng kiểm soát bờ rìa là 83,3%, không có tai biến trong phẫu thuật 17/18 trường hợp và di chứng sau phẫu thuật tháng thứ 1 là tăng sinh mô hạt (77,8%), tháng thứ 3 là dính mép trước dây thanh (27,8%). Kết luận: Nội soi dải ánh sáng hẹp có giá trị phát hiện sớm ung thư hạ họng, ung thư thanh quản. Phẫu thuật nội soi vi phẫu bằng Laser CO2 ung thư hạ họng, ung thư thanh quản ở giai đoạn sớm mang lại kết quả tốt, tỷ lệ tai biến và biến chứng sau phẫu thuật thấp, bảo tồn được tối đa chức năng phát âm, hô hấp và nuốt. ABSTRACT UTILITY OF NARROW - BAND IMAGING ENDOSCOPY COMBINED WITH CO2 LASER ENDOSCOPIC MICROSURGERY IN DIAGNOSIS AND TREATMENT OF EARLYSTAGE HYPOPHARYNGEAL AND LARYNGEAL CARCINOMA Objective: To evaluate the results of applying narrow band imaging endoscopy combined with CO2 laser endoscopic microsurgery to diagnose and treat early stage hypopharyngeal and laryngeal carcinoma. Methods: A prospective study was conducted on 18 patients with early stage hypopharyngeal and laryngeal carcinoma. Results: The mean age was 63.8 ± 12.6; smoker was 61.1%, the rate of hoarseness was 72%, T1a tumor stage was 72.2%, IPCL type V-1 was 72,2%, marginal tumor control was 83.3%. There were of 17/18 case with no complication during operation. The rate of extensive granuloma was 77.8% in the first month, and of anterior commissure adhesion was 27.8% in the third month post - surgery. Conclusion: Narrow band imaging endoscopy was a valuable tool in screening for early stage hypopharyngeal and laryngeal carcinoma. CO2 laser endoscopic microsurgery was an effective method. The rate of complication during and after surgery was low. This method restores the maximum function of speech, breathing and swallowing. Keywords: Early - stage pharyngeal cancer, early - stage laryngeal cancer, narrow - band imaging endoscopy, CO2 laser endoscopic microsurgery.

Leukoplakia: An Invasive Cancer Hidden within the Vocal Folds. A Multivariate Analysis of Risk Factors

IntroductionDiscerning the preoperative nature of vocal fold leukoplakia (VFL) with a substantial degree of certainty is fundamental, seeing that the histological diagnosis of VFL includes a wide spectrum of pathology and there is no consensus on an appropriate treatment strategy or frequency of surveillance. The goal of our study was to establish a clear schedule of the diagnostics and decision-making in which the timing and necessity of surgical intervention are crucial to not miss this cancer hidden underneath the white plaque.Material and MethodsWe define a schedule as a combination of procedures (white light and Narrow Band Imaging diagnostic tools), methods of evaluating the results (a combination of multiple image classifications in white light and Narrow Band Imaging), and taking into account patient-related risk factors, precise lesion location, and morphology. A total number of 259 patients with 296 vocal folds affected by leukoplakia were enrolled in the study. All patients were assessed for three classifications, in detail according to Ni 2019 and ELS 2015 for Narrow Band Imaging and according to Chen 2019 for white light. In 41 of the 296 folds (13.9%), the VFL specimens in the final histology revealed invasive cancer. We compared the results from the classifications to the final histology results.ResultsThe results showed that the classifications and evaluations of the involvement of anterior commissure improve the clinical utility of these classifications and showed improved diagnostic performance. The AUC of this model was the highest (0.973) with the highest sensitivity, specificity, PPV, and NPV (90.2%, 89%, 56.9%, and 98.3%, respectively).ConclusionThe schedule that combines white light and Narrow Band Imaging, with a combination of the two classifications, improves the specificity and predictive value, especially of anterior commissure involvement.

Oncological Outcomes of Transoral Laryngeal Microsurgery with Fiber-Optic Diode Laser for Early Glottic Cancer: A Single-Center Experience

<b><i>Backgroud/Objectives:</i></b> Transoral laser laryngeal microsurgery (_LTLM) has been widely used in the treatment of early-stage glottic laryngeal squamous cell carcinoma (LSCC) for the past few decades. Although T stage, tumor grade, anterior commissure involvement, type of cordectomy, positive surgical margin, and postoperative additional therapies were accused as the prognostic factors for recurrence, there is still controversy about these data in the literature. The purpose of this study was to evaluate the oncological results of our patients with early glottic LSCC treated with _LTLM as a single-modality therapy in a single-center study. <b><i>Methods:</i></b> Patients with early-stage (T_is-1–2/N₀) glottic LSCC who underwent _LTLM as a primary treatment from 2011 to 2019 were retrospectively reviewed. The clinicopathological factors and oncologic outcomes were analyzed. <b><i>Results:</i></b> One hundred and sixty-one patients were enrolled in this study. The 5-year overall (OS), disease-specific (DSS), disease-free (DFS), and laryngectomy-free survival rates were 84.5%, 97.9%, 79.2%, and 93.5%, respectively. The most common stage, histopathological type, and type of endoscopic cordectomy were T₁ stage, well-differentiated cancer, and type 2 cordectomy, respectively. A positive surgical margin was defined in 20 (12.4%) patients. There was a significant relationship between histopathological grade and positive surgical margins (<i>p</i> = 0.038). OS and DSS rates of “wait and see” modality were lower, while DFS of radiotherapy was lower than that of other treatment modalities in patients with positive surgical margins, but the differences were not statistically significant. Nineteen (11.8%) patients had a recurrence. DSS was statistically significantly lower in patients with recurrence (<i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> The results of our study showed that anterior commissure involvement, surgical margin positivity, and higher T stage statistically did not reduce survival rates in early-stage LSCC patients treated with _LTLM. As the histopathological grade of the tumor worsens, the risk of surgical margin positivity increases. RT may have a negative effect on recurrence and organ preservation in the additional treatment of patient with positive surgical margins.

Case Report: Ultrasound Guided Mucosal Fold Lateralization for Laryngeal Webs

The surgical management of Laryngeal webs is challenging and is associated with a high recurrence rate due the presence of opposing raw mucosal surfaces of the vocal cords, especially near the anterior commissure which causes re-scarring. We describe an endoscopic technique of mucosal flap lateralization (MFL) with ultrasound guidance, which prevents the apposition of the anterior raw surfaces of the vocal cords after web incision, thus avoiding recurrence.

Complicated Paediatric Bronchial Foreign Body: A Novel Extraction Technique

A paediatric bronchoscopy procedure for foreign body inhalation is indeed a highly challenging procedure due to multiple risk factors such as lower physiological functional residual capacity and adverse pulmonary function effects by anaesthetic agents in addition to concurrent active lungs infection. Here we elucidate a novel technique of foreign body removal located at the distal airway in a paediatric patient and in a situation where a paediatric flexible bronchoscopy with built-in working channel is not available. A 1-year 7-months-old boy presented with acute respiratory distress syndrome following a one-week history of active respiratory infection. On examination, he was tachypnoeic with audible soft inspiratory stridor and intermittent barking cough despite being supplemented with 3 liters /minute oxygen mask. Chest x-ray showed right upper lobe collapse. He was referred to the otorhinolaryngology team after a suspicious history of foreign body aspiration obtained from his mother. Bedside flexible nasopharyngolaryngoscopy showed granulation tissue at the junction of laryngeal surface of epiglottis and anterior commissure. He underwent emergency direct laryngoscopy, tracheoscopy, bronchoscopy, excision of granulation tissue and removal of foreign body under general anaesthesia. Herein, some of complicated bronchoscopy demand critical thinking of alternative or modified techniques to achieve a successful and safe surgery. Bangladesh J Otorhinolaryngol 2021; 27(2): 177-183

Evaluation of Ultrasound Guided Measurement of Anterior Neck Soft Tissue Thickness in Predicting Difficult Laryngoscopy in Obese Patients

Background: The incidence of unanticipated difficult airway is 14.3-17.5% in obese. Preoperative difficult airway prediction is important to avoid postoperative morbidity and mortality. USG guided measurement of anterior neck soft tissue thickness can be used to predict difficult laryngoscopy in obese patients and we thus undertook this study to determine the role of USG guided measurement of anterior neck thickness at the level of vocal cords in difficult laryngoscopy prediction. Methods: Sixty obese patients (BMI≥30kg/m2), 18-70 years of age of either sex, were included. Anterior neck soft tissue thickness was measured by ultrasound as the distance from the skin to the anterior commissure of vocal cord. Neck circumference was measured at mid neck just below the laryngeal prominence with the subjects standing upright and facing forward with shoulders relaxed. Thyromental distance, sternomental distance, Mallampatti score and neck circumference were also recorded. Results: The cut off values of BMI (46.94 kg/m2), neck circumference (41.5 cm) and anterior neck soft tissue thickness (22.1mm). Four patients in the morbidly obese and 80% of the superobese patients had a difficult laryngoscopy. Sixteen (26.67%) patients had an anterior neck soft tissue thickness of >22.1mm. Of these, 11 (91.67%) patients had difficult laryngoscopy while one (8.33%) patient with anterior neck soft tissue thickness ≤ 22.1mm had difficult laryngoscopy (P<0.05). There was also significant association between neck circumference and BMI. Conclusion: The USG guided measurement of anterior neck soft tissue thickness, BMI and neck circumference can reliably predict difficult laryngoscopy in obese patients.

Association Between Anatomical Location of Surgically Induced Lesions and Postoperative Seizure Outcome in Temporal Lobe Epilepsy

Objective:To determine the association between surgical lesions of distinct grey and white structures and connections with favorable post-operative seizure outcomes.Methods:Patients with drug-resistant temporal lobe epilepsy (TLE) from three epilepsy centers were included. We employed a voxel-based and connectome-based mapping approach to determine the association between favorable outcomes and surgery-induced temporal lesions. Analyses were conducted controlling for multiple confounders, including total surgical resection/ablation volume, hippocampal volumes, side of surgery, and site where the patient was treated.Results:The cohort included 113 patients with TLE [54 women; 86 right-handed; 16.5 (SD = 11.9) age at seizure onset, 54.9% left] who were 61.1% free of disabling seizures (Engel class 1) at follow-up. Postoperative seizure freedom in TLE was associated with 1) surgical lesions that targeted the hippocampus as well as the amygdala-piriform cortex complex and entorhinal cortices; 2) disconnection of temporal, frontal, and limbic regions through loss of white matter tracts within the uncinate fasciculus, anterior commissure, and fornix; and 3) functional disconnection of the frontal (superior and middle frontal gyri, orbitofrontal region) and temporal (superior and middle pole) lobes.Conclusions:Better postoperative seizure freedom are associated with surgical lesions of specific structures and connections throughout the temporal lobes. These findings shed light on the key components of epileptogenic networks in TLE and constitute a promising source of new evidence for future improvements in surgical interventions.Classification of Evidence:This study provides Class II evidence that for patients with temporal lobe epilepsy, postoperative seizure freedom is associated with surgical lesions of specific temporal lobe structures and connections.