Background and Objectives: Percutaneous dilatational tracheostomy (PDT) is an easy and fast technique that can replace surgical tracheostomy (ST). Less bleeding, easy technique and short procedure time are the main advantages of this tecunique. This study is to evaluate the feasibility of PDT during the head and neck cancer surgery.Subjects and Method The medical records of 12 patients who underwent PDT during a head and neck cancer surgery in the period of September 2019 to September 2021 were reviewed retrospectively. Another medical records of 12 patients who underwent ST during the head and neck cancer surgery were acquired for comparison. PDT was performed using Ciglia Percutaneous Tracheostomy Set® (Cook Critical Care). Parameters of blood loss, procedure time, wound communication between the cervical and tracheostomy incision and complications were compared between the PDT group and the ST group. Results: The PDT group showed less blood loss, shorter procedure time and showed fewer incidences of wound communication. As for complications, there was one case of conversion to ST due to procedure failure in the PDT group. The complication rate was not different between the two groups. Conclusion PDT can be used as a safe and effective procedure during the head and neck cancer surgery for selected patients.

Percutaneous dilatational tracheostomy (PDT) is an increasingly popular method with several advantages, such as being able to perform at bedside with a simple kit, with a less number of medical staff and less amount of time. PDT is easier to perform, offers less bleeding risks and post-operative infection rates compared to conventional surgical tracheotomy. However, PDT is being performed more in the pulmonology and intensive care medicine than in otolaryngology. Herein, we introduce PDT and share our experiences, hoping otolaryngologists use our procedure more.

Purpose: The incidence of human papillomavirus (HPV)-related oropharyngeal cancer (OPC) has increased, and staging and optimal therapeutic approaches are challenging. A questionnaire survey was conducted to investigate the controversial treatment policy of stage T2 OPC according to the N category and determine the opinions of multidisciplinary experts in Korea. Materials and Methods: Five OPC scenarios were developed by the Subcommittee on Oropharyngeal Treatment Guidelines of the Korean Society for Head and Neck Oncology and distributed to experts of multidisciplinary treatment hospitals. Results: Sixty-five experts from 45 institutions responded. For the HPV-positive T2N0M0 scenario, 67.7% of respondents selected surgery followed by definitive concurrent chemoradiotherapy (CCRT) or radiotherapy alone. For the T2N1M0 HPV-positive scenario, there was a notable difference in the selection of primary treatment by expert specialty; 53.9% of respondents selected surgery and 39.8% selected definitive CCRT as the primary treatment. For the T2N3M0 advanced HPV-positive scenario, 50.0% of respondents selected CCRT and 33.3% considered induction chemotherapy (IC) as the primary treatment. CCRT and IC were significantly more frequently selected for the HPV-related OPC cases (p=0.010). The interdepartmental variability showed that the head and neck surgeons and medical oncologists favored surgery, whereas the radiation oncologists preferably selected definitive CCRT (p < 0.001). Conclusion In this study, surgery was preferred for lymph node-negative OPC, and as lymph node metastasis progressed, CCRT tended to be preferred, and IC was administered. Clinical practice patterns by stage and HPV status showed differences according to expert specialty. Multidisciplinary consensus guidelines will be essential in the future.

An acquired tracheoesophageal fistula (TEF) is a rare complication that can occur in the treatment of laryngeal cancer. Explosive coughing from the tracheostomy-opening site after swallowing is a warning sign of the TEF. A 68-year old male laryngeal cancer patient showed delayed TEF after chemoradiotherapy with a total laryngectomy.The clinicians carrying out a videofluoroscopic swallowing study should be familiar with the total laryngectomy state, as well as the findings and initial general management of TEF. This report discusses the pathophysiology and management of TEF and the needs for dysphagia care team after chemoradiation in laryngeal cancer patients.

The Korean Bronchoesophagological Society appointed a task force to develop a clinical practice guideline for tracheostomy. The task force conducted a systematic search of the Embase, Medline, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to key questions. Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. An external expert review and a Delphi questionnaire were conducted to reach a consensus regarding the recommendations. Accordingly, the committee developed 18 evidence-based recommendations, which are grouped into seven categories. These recommendations are intended to assist clinicians in performing tracheostomy and in the management of tracheostomized patients.

BACKGROUND AND OBJECTIVES: Percutaneous dilatational tracheostomy (PDT) has become an increasingly popular method of establishing an airway for patients in need of chronic ventilator assistance. The aim of this study is to assess and compare two main strategies for doing tracheostomy: traditional open surgical tracheostomy (ST) and PDT. MATERIALS AND METHOD: We retrospectively reviewed medical records of 43 patients who underwent tracheostomy between the years 2016 and 2017. All patients were under intensive care unit (ICU) care and referred to the department of otolaryngology for tracheostomy. All tracheostomies were performed at the bedside using either percutaneous dilatational technique or open surgical technique by a single surgeon. In cases of PDT, either blind puncture technique without any guidance or laryngoscopy-guided puncture technique was used. Demographic and procedural variables and complications were compared between the two groups. RESULTS: PDT was performed in 29 patients and ST in 14 patients. Of those who underwent PDT, 15 patients received the blind puncture technique and 14 patients laryngoscopy-guided puncture technique. The cricosternal distance was longer and the amount of blood loss and duration of the procedure was lesser in the PDT group. In the PDT group, there was no difference in blood loss nor in the duration of the procedure according to the puncture technique, whereas critical complications occurred more frequently when the blind technique was used. Subjective difficulty of the procedure is predictive of complications. CONCLUSION: The study show that PDT is a useful and safe procedure for ICU patients. Also, guidance on using the flexible laryngoscopy during PDT can prevent severe complications.
Critical Care ; Humans ; Intensive Care Units ; Laryngoscopy ; Medical Records ; Methods ; Otolaryngology ; Punctures ; Retrospective Studies ; Tracheostomy ; Ventilators, Mechanical

BACKGROUND AND OBJECTIVES: Percutaneous dilatational tracheostomy (PDT) has become an increasingly popular method of establishing an airway for patients in need of chronic ventilator assistance. The aim of this study is to assess and compare two main strategies for doing tracheostomy: traditional open surgical tracheostomy (ST) and PDT.MATERIALS AND METHOD: We retrospectively reviewed medical records of 43 patients who underwent tracheostomy between the years 2016 and 2017. All patients were under intensive care unit (ICU) care and referred to the department of otolaryngology for tracheostomy. All tracheostomies were performed at the bedside using either percutaneous dilatational technique or open surgical technique by a single surgeon. In cases of PDT, either blind puncture technique without any guidance or laryngoscopy-guided puncture technique was used. Demographic and procedural variables and complications were compared between the two groups. RESULTS: PDT was performed in 29 patients and ST in 14 patients. Of those who underwent PDT, 15 patients received the blind puncture technique and 14 patients laryngoscopy-guided puncture technique. The cricosternal distance was longer and the amount of blood loss and duration of the procedure was lesser in the PDT group. In the PDT group, there was no difference in blood loss nor in the duration of the procedure according to the puncture technique, whereas critical complications occurred more frequently when the blind technique was used. Subjective difficulty of the procedure is predictive of complications. CONCLUSION The study show that PDT is a useful and safe procedure for ICU patients. Also, guidance on using the flexible laryngoscopy during PDT can prevent severe complications.

A nasal hemangioma is a rare lesion that causes intranasal bleeding. When endoscopically removing an endonasal hemangioma, the minimization of bleeding is imperative to optimize visualization and decrease complications. Many methods can be used to decrease bleeding during endoscopic removal, including cautery and embolization. We treated one patient with a hemangioma arising from the mucosa of the right inferior turbinate, which was removed successfully using a minimally invasive endoscopic endonasal technique with radiofrequency coblation to minimize bleeding. Herein we report this case and review the literature.
Cautery ; Endoscopy ; Hemangioma* ; Hemorrhage ; Humans ; Mucous Membrane ; Turbinates

Percutaneous dilatational tracheostomy (PDT) has become an increasingly popular method of establishing an airway for patients in need of chronic ventilator assistance. We report a rare case of a 42-year-old female who developed extensive subcutaneous emphysema, bilateral pneumothoraces, pneumomediastinum, and pneumoperitoneum after percutaneous dilatational tracheostomy. The patient suffered from amyotrophic lateral sclerosis, and underwent PDT after a period of mechanical ventilation. During PDT, tracheostomy tube was inserted into the paratracheal space. Follow-up chest radiography and computed tomography of chest and abdomen revealed extensive subcutaneous emphysema, bilateral pneumothoraces, pneumomediastinum, and pneumoperitoneum. The patient was treated successfully with insertion of the thoracostomy tube and conservative care.
Abdomen ; Adult ; Amyotrophic Lateral Sclerosis ; Female ; Follow-Up Studies ; Humans ; Mediastinal Emphysema ; Methods ; Pneumoperitoneum ; Radiography ; Respiration, Artificial ; Subcutaneous Emphysema ; Thoracostomy ; Thorax ; Tracheostomy* ; Ventilators, Mechanical

OBJECTIVE: We examined the difference in responses to donepezil between carriers and non-carriers of the A allele at the +4 position of the choline acetyltransferase (ChAT) gene in Koreans. METHODS: Patients who met the criteria for probable Alzheimer's disease (AD) (n=199) were recruited. Among these, 145 completed the 12-week follow-up evaluation and 135 completed the 26-week scheduled course. Differences and changes in the Korean version of the mini-mental state examination (MMSE-KC) score, Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery (CERAD-K[N]) wordlist subtest score (WSS), CERAD-K(N) total score (TS), and the Korean version of geriatric depression scale (GDS-K) score between baseline and 12 weeks or 26 weeks were assessed by the Student's t-test. RESULTS: At 12 weeks, the changes in the MMSE-KC score, CERAD-K(N) WSS, and CERAD-K(N) TS from baseline were not significant between ChAT A allele carriers and non-carriers; however, at 26 weeks, these changes were significantly larger in ChAT A allele carriers than in non-carriers (p=0.02 for MMSE-KC and p=0.03 for CERAD-K(N) WSS respectively). CONCLUSION: Our findings in this study suggested that presence of the A allele at the +4 position of ChAT might positively influence the treatment effect of donepezil in the early stages of AD in Koreans.
Alleles ; Alzheimer Disease* ; Choline O-Acetyltransferase* ; Choline* ; Depression ; Follow-Up Studies ; Genotype* ; Humans ; Polymorphism, Single Nucleotide