Impairment mechanism of nasal mucosa after radiotherapy for nasopharyngeal carcinoma

Sudden airway obstruction during emergence from general anesthesia in a post-radiation nasopharyngeal carcinoma patient with lower cranial nerve injury: A case report

This article presents a case study of airway obstruction encountered during the post-anesthetic recovery period in a patient with nasopharyngeal carcinoma who had suffered cranial nerve damage subsequent to radiation therapy. It underscores the necessity for meticulous preoperative preparation during the induction of anesthesia and a comprehensive assessment coupled with careful preparation prior to extubation in the recovery phase. These measures are crucial to guarantee the safety of perioperative anesthesia in such patients. The case report is intended to contribute to the clinical knowledge base for anesthesiologists managing patients with nasopharyngeal carcinoma who have experienced post-radiation cranial nerve impairment. This case report has been meticulously crafted in compliance with the CARE (Case Reports) guideline, ensuring a standardized and rigorous approach to presenting the patient's medical history, diagnosis, treatment, and outcomes.

Impact of Clinical Surveillance on Outcomes of Locally Recurrent Nasopharyngeal Carcinoma

BACKGROUND

Local recurrence of nasopharyngeal carcinoma (NPC) occurs in 10%-20% of patients, with salvage potential in early recurrences. Yet, clear surveillance protocols are lacking. We compare survival outcomes and suitability for salvage in symptomatic and incidentally detected locally recurrent NPC.

METHODS

Locally recurrent NPC patients, initially diagnosed at the National Cancer Center Singapore between October 2003 and November 2009, were identified. Demographics, symptoms, detection modalities, and survival outcomes were analyzed.

RESULTS

Eighty-two patients were studied. Median follow up and time to local recurrence was 5.51 and 2.19 years; 45.1% were symptomatic; 65.9% were diagnosed incidentally; 62.2% were offered salvage treatment. Symptomatic patients (vs. asymptomatic) had lower 5-year overall-survival (39.1% vs. 74.5%, p = 0.011). Nonincidental diagnoses (vs. incidental) had lower 5-year overall-survival (33.6% vs. 71.1%, p = 0.02). Incidentally-detected recurrences (vs. nonincidental) were more likely offered salvage treatment (75.9% vs. 35.7%, p < 0.001).

CONCLUSION

Routine clinical examination, nasoendoscopy, and imaging allow early detection of asymptomatic recurrences, with improved outcomes.

Voice Changes of Patients With Nasopharyngeal Carcinoma in Eleven Years After Radiotherapy: A Cross-Sectional Study

OBJECTIVES

The objective of this study was to assess voice changes in patients with nasopharyngeal carcinoma (NPC) using subjective and objective assessment tools and to make inferences regarding the underlying pathological causes for different phases of radiotherapy (RT).

METHODS

A total of 187 (123 males and 64 females) patients with post-RT NPC with no recurrence of malignancy or other voice diseases and 17 (11 males and 6 females) healthy individuals were included in this study. The patients were equally divided into 11 groups according to the number of years after RT. The acoustic analyses, GRBAS (grade, roughness, breathiness, asthenia, and strain) scales, and Voice Handicap Index (VHI)-10 scores were collected and analyzed.

RESULTS

The fundamental frequency (F0) parameters in years 1 and 2 and year 11 were significantly lower in patients with NPC than in healthy individuals. The maximum phonation times in years 1 and 11 were significantly shorter than those in healthy individuals. The jitter parameters were significantly different between year 1 and from years 8 to 11 and the healthy individuals. The shimmer parameters were significantly different between years 1, from years 9 to 11, and healthy individuals. Hoarseness was the most prominent problem compared to other items of the GRBAS. The VHI-10 scores were significantly different between years 1 and 2 and year 11 after RT in patients with NPC.

CONCLUSIONS

Voice quality was worse in the first 2 years and from years 8 to 11 but remained relatively normal from years 3 to 7 after RT. Patient-reported voice handicaps began during year 3 after RT. The most prominent problem was perceived hoarseness, which was evident in the first 2 years and from years 9 to 11 after RT. The radiation-induced mucous edema, laryngeal intrinsic muscle fibrosis, nerve injuries, upper respiratory tract changes, and decreased lung capacity might be the pathological reasons for voice changes in post-RT patients with NPC.

Impact of long-term nasal airflow deprivation on sinonasal structures and chronic rhinosinusitis in total laryngectomy patients

Objective

Total laryngectomy (TL) patients are good models in which to evaluate the effects of nasal airflow cessation on the sinonasal tract. Here, we evaluated changes in sinonasal structures and association with sinus opacification in the computed tomography (CT) images 3 years post-TL.

Methods

Patients who underwent TL from 2005 to 2017 in a teaching academic center were reviewed retrospectively. Patients with a final follow-up CT taken less than 3 years after TL, tracheoesophageal puncture, inadequate CT image, or history of sinonasal surgery were excluded. The control group included patients who underwent a partial laryngectomy or hypopharyngectomy without requiring a tracheotomy for more than a month. Altogether, 45 TL patients and 38 controls were selected. The volume of all four paranasal sinuses, inferior turbinate soft tissue volume (ITSTV), maxillary sinus natural ostium (MSNO) mucosal width, and Lund-Mackay scores (LMS) were measured on preoperative and postoperative CT scans.

Results

The mean duration between surgery and the final CT scan was 6.3 ± 2.4 and 5.5 ± 2.3 years for the TL and control groups, respectively. Neither group showed significant changes in the four paranasal sinuses' volume or MSNO mucosa width. The ITSTV decreased significantly, from 4.6 ± 1.3 to 2.8 ± 1.1 mL (p < .001), in the TL group, regardless of the presence of nasal septal deviation, showing ITSTV reduction on both concave and convex sides. By contrast, the control group showed no significant changes in ITSTV. Postoperative LMS changes in both groups were insignificant. The number of patients with LMS aggravation or alleviation was the same in both groups, regardless of preoperative sinus opacification.

Conclusions

Paranasal sinus structures and sinus opacification are not affected significantly by nasal airflow cessation; however, the inferior turbinate mucosa is affected by long-term discontinuation of nasal airflow.

Level of Evidence

4 (case-control study).