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Giotakis AI, Potamianos S, Zachou Z, Giotakis EI, Kyrodimos E. Horizontal pharyngeal closure during total laryngectomy reduces rates of pharyngocutaneous fistula. Eur Arch Otorhinolaryngol 2024; 281:3179-3187. [PMID: 38551697 DOI: 10.1007/s00405-024-08593-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/29/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE Pharyngocutaneous fistula (PCF) is a possible complication following total laryngectomy (TL), with a mean incidence of 17%. We intended to investigate the effect of pharyngeal closure type during TL on the prevention of PCF. METHODS We retrospectively reviewed patients that underwent TL with a horizontal pharyngeal closure over a 10-year period. The frequency of PCF clinically, dysphagia, total oral diet, postoperative dilatation of the neopharynx and voice problems were tabulated. RESULTS Seventy-seven subjects underwent TL due to laryngeal tumor without pharyngeal extension. Of them, 45 underwent a salvage TL. PCF occurred in 1/77 subjects. The rest of the subjects (76/77) did not develop a PCF, neither in the early nor in the late postoperative phase. All subjects (15/77) that underwent implantation of a voice prosthesis were satisfied with their voice. No subject complained about dysphagia. Every subject achieved total oral diet. CONCLUSION The horizontal pharyngeal closure is a safe pharyngeal closure technique during TL, reduces PCF rates (< 2%), results in excellent voice rehabilitation and swallowing function, and can also be used during salvage TL instead of a major pectoral flap. This type of closure should be used only in selected patients with laryngeal disease without pharyngeal extension.
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Affiliation(s)
- Aris I Giotakis
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippocrateion General Hospital Athens, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527, Athens, Greece.
| | - Spyridon Potamianos
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippocrateion General Hospital Athens, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527, Athens, Greece
| | - Zoi Zachou
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippocrateion General Hospital Athens, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527, Athens, Greece
| | - Evangelos I Giotakis
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippocrateion General Hospital Athens, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527, Athens, Greece
| | - Efthymios Kyrodimos
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippocrateion General Hospital Athens, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527, Athens, Greece
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Giotakis AI, Masaoutis C, Delides A, Giotakis EI. Lymphoma presenting as preauricular tumor in unilateral parotid gland agenesis: a case report and review of literature. J Med Case Rep 2024; 18:231. [PMID: 38698413 PMCID: PMC11067121 DOI: 10.1186/s13256-024-04553-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/17/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Parotid gland agenesis is a rare, congenital, usually asymptomatic disorder. Until now, only 24 cases with unilateral, incidentally found, parotid gland agenesis have been described. Here, we present the first reported case of an ipsilateral preauricular neoplasm in a patient with unilateral parotid gland agenesis. During surgery, the position of the greater auricular- and facial nerves was documented. Furthermore, we performed the first sialendoscopy for this rare disorder to assess the number of duct branches, which might be indicative of the abundance of parotid tissue. Moreover, we looked for sialendoscopic characteristic features that could aid in identifying these patients in the ambulatory setting. CASE PRESENTATION A 50-year-old Greek man presented with a painless, slowly enlarging mass in the right parotid space. Magnetic resonance imaging revealed a complete absence of the right parotid gland without accessory parotid tissue. The right parotid gland was replaced by fatty tissue and the radiologist suggested a benign parotid tumor. Fine needle aspiration was indicative of a reactive lymph node. Sialendoscopy revealed only two branches within the right parotid duct. Surgical resection was performed through a conventional lateral parotidectomy. This revealed typical anatomic position of the greater auricular- and facial nerves despite the parotid tissue agenesis. Histopathology revealed a small lymphocytic lymphoma. CONCLUSIONS Surgeons should feel confident to resect tumors of the parotid space in patients with parotid gland agenesis. Reduced branching observed during sialendoscopy might indicate parotid gland agenesis. Physicians should be even more cautious than usual with the watch and wait strategy in patients with tumors of parotid gland agenesis, since the probability of a tumor being a benign salivary gland tumor might be lower than usual.
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Affiliation(s)
- Aris I Giotakis
- First Department of Otorhinolaryngology Head and Neck Surgery, Metropolitan General, Mesogeion 264, 15562, Athens, Greece.
| | - Christos Masaoutis
- Department of Pathology, Metropolitan General, Mesogeion 264, 15562, Athens, Greece
| | - Alexander Delides
- First Department of Otorhinolaryngology Head and Neck Surgery, Metropolitan General, Mesogeion 264, 15562, Athens, Greece
- 2nd Department of Otolaryngology, Attikon University Hospital, National and Kapodistrian University of Athens-Faculty of Medicine, Rimini 1, 12462, Athens, Greece
| | - Evangelos I Giotakis
- First Department of Otorhinolaryngology Head and Neck Surgery, Metropolitan General, Mesogeion 264, 15562, Athens, Greece
- First Department of Otorhinolaryngology, Hippocration Hospital, Medical University of Athens, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527, Athens, Greece
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Giotakis AI, Dudas J, Glueckert R, Buechel E, Riechelmann H. Identification of neutrophils and eosinophils in upper airway mucosa with immunofluorescence multiplex image cytometry. Histochem Cell Biol 2024:10.1007/s00418-024-02284-y. [PMID: 38600336 DOI: 10.1007/s00418-024-02284-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/12/2024]
Abstract
Characterization of inflammation in chronic rhinosinusitis with (CRSwNP) and without nasal polyps (CRSsNP) is an ongoing research process. To overcome limitations of current cytologic techniques, we investigated whether immunofluorescence multiplex image cytometry could quantify intact neutrophils, eosinophils, and other immune cells in solid upper airway mucosa. We used a four-channel immunofluorescence-microscopy technique for the simultaneous detection of the leukocyte marker CD45, the neutrophil marker myeloperoxidase, two eosinophil markers, i.e., major basic protein and eosinophil peroxidase, and DAPI (4',6-diamidin-2-phenylindole), in formalin-fixed paraffin-embedded upper airway tissue samples of patients with CRSwNP and CRSsNP, as well as of patients free of CRS with inferior turbinate hypertrophy (controls). Image acquisition and analysis were performed with TissueFAXS and StrataQuest (TissueGnostics, Vienna, Austria), respectively. Positive and negative immunostaining were differentiated with a specific fluorescence signal/background signal ratio. Isotype controls were used as negative controls. In six controls, nine patients with CRSsNP, and 11 patients with CRSwNP, the median area scanned and median cell count per patient were 14.2 mm2 and 34,356, respectively. In CRSwNP, the number of eosinophils was three times higher (23%) than that of neutrophils (7%). Three times more immune cells were encountered in CRSwNP (33%) compared to CRSsNP (11%). In controls, inflammation was balanced between the epithelial layer and lamina propria, in contrast to CRS (three times more pronounced inflammation in the lamina propria). The quantification of intact neutrophils, eosinophils, and other immune cells in solid tissue with undisrupted architecture seems feasible with immunofluorescence multiplex image cytometry.
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Affiliation(s)
- Aris I Giotakis
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - József Dudas
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Rudolf Glueckert
- University Clinics Innsbruck, Tirol Kliniken, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Elias Buechel
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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Heppt H, Widmann G, Riechelmann F, Runge A, Riechelmann H, Giotakis AI. CT comparison of the nasal airway anterior and posterior to the piriform aperture in patients with and without nasal obstruction. Head Face Med 2024; 20:20. [PMID: 38532483 DOI: 10.1186/s13005-024-00420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/10/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Nasal airway stenosis may lie anterior and/or posterior to the piriform aperture. We intended to compare the nasal airway anterior and posterior to the piriform aperture in patients with and without nasal obstruction. METHODS Segmented computed tomography cross-sectional areas of the nasal airway anterior (CT-CSAant) and posterior to the piriform aperture (at the level of the head of the inferior turbinate; CT-CSApost) were compared between patients with nasal obstruction (cases) and trauma controls. CT-CSA were approximately perpendicular to the direction of the nasal airflow. Anterior to the piriform aperture, they were tilted about 30o, 60o and 90o to the nasal floor. Posterior to the piriform aperture, they were tilted about 50o, 80o and 100o to the nasal floor. In cases, we examined the Pearson's correlation of active anterior rhinomanometry with CT-CSAant and CT-CSApost. RESULTS Narrow and bilateral CT-CSApost were similarly large between 56 cases and 56 controls (all p > 0.2). On the contrary, narrow and bilateral CT-CSAant were significantly smaller in cases than in controls (all p < 0.001). The ratio of the size of CT-CSAant-30 to that of CT-CSApost-80 was significantly lower in cases (median: 0.84; lower to upper quartile: 0.55-1.13) than in controls (1.0; 0.88-1.16; Mann-Whitney U test; p = 0.006). Bilateral CT-CSAant correlated significantly with total inspiratory flow (all p < 0.026) in contrast to bilateral CT-CSApost (all p > 0.056). CONCLUSIONS The nasal airway anterior to the piriform aperture was smaller in patients with nasal obstruction due to skeletal nasal stenosis than that in controls. On the contrary, the nasal airway posterior to the piriform aperture was similarly large between patients with and without nasal obstruction. Furthermore, in patients with nasal obstruction, the anterior nasal airway was narrower compared to that located posterior to it. On the contrary, control patients' anterior nasal airway was as large as the posterior one.
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Affiliation(s)
- Helen Heppt
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, +435050423141, Austria
| | - Gerlig Widmann
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Felix Riechelmann
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Annette Runge
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, +435050423141, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, +435050423141, Austria
| | - Aris I Giotakis
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, +435050423141, Austria.
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Giotakis AI, Verius M, Steinbichler TB, Runge A, Kolk A, Hupp LC. Rhinoresistometry as a Cost-Efficient and Time-Saving Alternative to Acoustic Rhinometry for Longitudinal Assessment of Nasal Patency in Orthognathic Surgery. J Craniofac Surg 2024:00001665-990000000-01293. [PMID: 38260959 DOI: 10.1097/scs.0000000000009931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/07/2023] [Indexed: 01/24/2024] Open
Abstract
Rhinoresistometry (RRM) is implemented along with active anterior rhinomanometry (AAR) and can evaluate nasal dimensions [hydraulic diameter (HD)]. As acoustic rhinometry (AR) is time-consuming, the authors investigated if RRM can be an efficient alternative to AR in nasal dimension assessment in orthognathic surgery. In patients undergoing maxillary advancement and impaction (cases) and removal of maxillary cysts (controls), the authors evaluated RRM and AR, before and 1 year after surgery. Furthermore, the authors investigated the correlation of HD with Nasal Obstruction Symptom Evaluation score and volume by computed tomography and AAR. Lastly, the authors measured RMM reproducibility by the Bland-Altman agreement method in controls. In 14 cases, AR and RMM revealed a significant increase on both sides (all P < 0.011) and the right side, respectively (P = 0.028). The authors noted no changes in 14 controls. Hydraulic diameter correlated only with AAR (most P < 0.004). Acoustic rhinometry lasted ~4 minutes before or after decongestion. In controls, HD after surgery was as large (1.05 times larger) as before surgery (up to 39% error rates). Rhinoresistometry can reproducibly assess nasal dimension changes in orthognathic surgery in a way that is different from AR and correlates with nasal function. Rhinoresistometry can help clinicians avoid AR and save significant time, as well as financial and human resources.
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Affiliation(s)
- Aris I Giotakis
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck
| | - Michael Verius
- Department of Radiology, Medical University of Innsbruck
| | - Teresa B Steinbichler
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck
| | - Annette Runge
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck
| | - Andreas Kolk
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Linus C Hupp
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Giotakis AI, Giotakis EI, Kyrodimos E. The Value of the Endoscope-Holding Arm in Transoral Pharyngeal Surgery. J Clin Med 2024; 13:507. [PMID: 38256641 PMCID: PMC10816363 DOI: 10.3390/jcm13020507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/11/2024] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Transoral pharyngeal surgery is mainly feasible with the use of a microscope or robotic systems. Data about alternative methods, with lower costs and easier availability, are sparse. We intended to examine to what extent the endoscope-holding arm is a suitable alternative to the microscope or robotic systems. MATERIAL AND METHODS We retrospectively reviewed subjects who underwent pharyngeal tumor resection with the endoscope-holding arm in our university department. RESULTS We identified 13 subjects who underwent transoral pharyngeal surgery between November 2020 and November 2023. Most subjects presented with an oropharyngeal tumor (6/11 in the lateral wall or tonsil; 4/11 in the tongue base). The oropharyngeal lateral wall or tonsillar tumors were exposed with a standard mouth gag. The tongue-base tumors or hypopharyngeal tumors were exposed with an operating laryngoscope. Advantages over the microscope included an angled view. Advantages over robotic systems included haptic feedback and a faster setup. Advantages over both the microscope and robotic systems included lower costs and easier availability. Visualization with the endoscope was sufficient and similar to that of the microscope. Bimanual action was possible with surgical forceps and a monopolar electrode. CONCLUSIONS Transoral pharyngeal surgery was feasible with the endoscope-holding arm. The endoscope-holding arm could be a cost-efficient alternative to the microscope or robotic systems.
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Affiliation(s)
- Aris I. Giotakis
- First Department of Otorhinolaryngology, Hippocrateion General Hospital, 115 27 Athens, Greece; (E.I.G.); (E.K.)
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Giotakis AI, Mariolis L, Koulentis I, Mpoutris C, Giotakis EI, Apostolopoulou A, Papaefstathiou E. The Benefit of Air Conduction Pure-Tone Audiometry as a Screening Method for Hearing Loss over the VAS Score. Diagnostics (Basel) 2023; 14:79. [PMID: 38201388 PMCID: PMC10802147 DOI: 10.3390/diagnostics14010079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/15/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Hearing loss is commonly encountered by general practitioners. We aimed to evaluate the screening benefit of air conduction pure-tone audiometry over visual analogue scale (VAS) scores for hearing loss. Moreover, we intended to perform the first cross-sectional study in Greece to assess hearing loss with pure-tone audiometry in young adults of the general population. We evaluated Greeks between 15 and 40 years old in a high school in Karditsa, Greece, and a primary health care unit in a nearby community. Subjects filled out a VAS score sheet and underwent pure-tone audiometry in a room without sound isolation, with air conduction only. We named the latter procedure modified pure-tone audiometry (mPTA). Subjects with pathologic results were examined via otoscopy and standardized pure-tone audiometry (sPTA). Of the 286 subjects evaluated, the VAS score revealed 5 subjects (1.7%) with hearing loss. mPTA (100 s duration) doubled this percentage (in total 3.8%; Pearson Chi-Square test; p < 0.001). Based on sPTA, the sensitivity and positive predictive value of the VAS score were 40% and 13%, respectively. For mPTA, they were 100% and 37%, respectively. mPTA filtered out pathologic cases in a proper, rapid, cheap and simple way and may be considered a proper screening method for hearing loss in primary health care.
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Affiliation(s)
- Aris I. Giotakis
- First Department of Otorhinolaryngology Head and Neck Surgery, Metropolitan General, 15562 Athens, Greece
| | - Lambros Mariolis
- First Department of Otorhinolaryngology Head and Neck Surgery, Metropolitan General, 15562 Athens, Greece
| | - Ioannis Koulentis
- First Department of Otorhinolaryngology Head and Neck Surgery, Metropolitan General, 15562 Athens, Greece
| | - Christos Mpoutris
- First Department of Otorhinolaryngology Head and Neck Surgery, Metropolitan General, 15562 Athens, Greece
| | - Evangelos I. Giotakis
- First Department of Otorhinolaryngology, Hippocrateion General Hospital, 11527 Athens, Greece
| | - Aikaterini Apostolopoulou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Efstathios Papaefstathiou
- Second Department of Urology, Aristotle University of Thessaloniki, General Hospital ‘Papageorgiou’, 56403 Thessaloniki, Greece;
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Giotakis AI, Runge A, Dudas J, Glueckert R, Gottfried T, Schartinger VH, Klarer J, Randhawa A, Caimmi E, Riechelmann H. Analysis of cells of epithelial, connective tissue and immune differentiation in HPV-positive-, HPV-negative oropharyngeal carcinoma and normal oropharyngeal tissue by immunofluorescence multiplex image cytometry: a preliminary report. BMC Cancer 2023; 23:1154. [PMID: 38012597 PMCID: PMC10683252 DOI: 10.1186/s12885-023-11440-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/24/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Epithelial, connective tissue and immune cells contribute in various ways to the pathophysiology of HPV positive (HPV+) and HPV negative (HPV-) oropharyngeal squamous cell carcinoma (OPSCC). We aimed to investigate the abundance of these cell lineages and their coexpression patterns in patients with HPV + and HPV- OPSCC. METHODS We used a 4-channel immunofluorescence-microscopy technique for the simultaneous detection of three direct-conjugated antibodies (pancytokeratin, vimentin and CD45/CD18) and DAPI (4',6-Diamidin-2-phenylindole) in formalin fixed paraffin-embedded tissue samples (FFPE) of patients with HPV + and HPV- OPSCC, and of control patients. Image acquisition and analysis were performed with TissueFAXS and StrataQuest (TissueGnostics, Vienna, Austria), respectively, in tumor cell clusters/stroma in OPSCC specimens and epithelial layer/lamina propria in control specimens. Cell populations were created based on antibodies' coexpression patterns. Isotype and positive controls were examined for plausibility. RESULTS The proportion of cells of epithelial differentiation in tumor cell clusters was higher in HPV + OPSCC (55%) than in HPV- OPSCC samples (44%). The proportion of connective tissue cells in tumor cell cluster was lower in HPV + OPSCC patients (18%) than in HPV- OPSCC patients (26%). The proportion of immune cells in tumor cell clusters was higher in HPV + OPSCC patients (25%) than in HPV- OPSCC patients (18%). The percentage of anaplastic, potentially de-differentiated cells, was 2% in control patients, and it was higher in HPV- OPSCC (21%) than in HPV + OPSCC samples (6%). CONCLUSIONS This study provided the first quantitative data for the abundance of cells of epithelial, connective tissue and immune differentiation, in patients with OPSCC and control patients. The abundance of these different crucial cell populations was consistently originating from the same tissue sample. De-differentiation of tumor cells was higher in HPV- OPSCC than in HPV + OPSCC. In tumor cells clusters, the antitumoral host immune response was higher in HPV + OPSCC than in HPV- OPSCC, whereas the fibroblast response was higher in HPV- OPSCC than in HPV + OPSCC. This study contributed to the understanding of histopathologic differences between HPV + OPSCC and HPV- OPSCC patients.
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Affiliation(s)
- Aris I Giotakis
- Department of Otorhinolaryngology - Head & Neck Surgery, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Annette Runge
- Department of Otorhinolaryngology - Head & Neck Surgery, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria.
| | - József Dudas
- Department of Otorhinolaryngology - Head & Neck Surgery, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Rudolf Glueckert
- University Clinics Innsbruck, Tirol Kliniken, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Timo Gottfried
- Department of Otorhinolaryngology - Head & Neck Surgery, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Volker H Schartinger
- Department of Otorhinolaryngology - Head & Neck Surgery, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Johanna Klarer
- Department of Otorhinolaryngology - Head & Neck Surgery, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Avneet Randhawa
- Department of Otolaryngology, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Eleonora Caimmi
- Department of Otorhinolaryngology - Head & Neck Surgery, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology - Head & Neck Surgery, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria
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Hupp LC, Verius M, Kolk A, Steinbichler TB, Heppt H, Giotakis AI. The long-term effect of maxillary advancement and impaction on subjective and objective nasal patency: A retrospective case-control study. J Craniomaxillofac Surg 2023:S1010-5182(23)00081-1. [PMID: 37355368 DOI: 10.1016/j.jcms.2023.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/01/2023] [Accepted: 05/21/2023] [Indexed: 06/26/2023] Open
Abstract
The aim of this study was to investigate the change of nasal patency after maxillary advancement and impaction (MAXADV + IMP) in subjects with skeletal class III malocclusion (cases) and after removal of maxillary cysts in close proximity to the nasal floor in subjects that served as controls. NOSE score, volume derived by computed tomography (VOL), and acoustic rhinometry and rhinomanometry were retrospectively evaluated, before and one year after surgery. The movement of specific landmarks was also measured. NOSE score did not change after surgery, neither in 17 cases (p = 0.10) nor in 17 controls (p = 0.14). In cases, VOLpostop (10088 ± 4200 mm3) was significantly higher than VOLpreop (7807 ± 3721 mm3; p = 0.036). Maxillary advancement and inferior displacement of the ventral maxilla were noted by the movement of incisive foramen in the coronal (3.9 ± 5.4; p = 0.011) and Frankfurt Horizontal plane (2.2 ± 2.0; p = 0.001), respectively. In controls, VOLpostop (9749 ± 3654 mm3) was also significantly higher than VOLpreop (8473 ± 2624 mm3; p = 0.050). Cross-sectional areas, nasal flow and nasal resistance changed significantly after surgery in cases (6/30 pairs; p < 0.018), but not in controls (all p > 0.066). MAXADV + IMP increased nasal patency, but did not change the feeling of nasal breathing. Physicians should proceed with caution when informing patients about improvement of nasal breathing after MAXADV + IMP.
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Affiliation(s)
- Linus C Hupp
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Verius
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Kolk
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Teresa B Steinbichler
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Helen Heppt
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Aris I Giotakis
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria.
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Giotakis AI, Yiotakis I, Mellou A, Koufopoulos N, Giotakis EI. Nasal chondrogenic tumors: Case reports of primary chondroma and recurrence of atypical cartilaginous tumor (chondrosarcoma grade I) with review of the literature. Indian J Cancer 2023; 60:248-252. [PMID: 37530248 DOI: 10.4103/ijc.ijc_1341_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Nasal chondromas and nasal atypical cartilaginous tumors (or chondrosarcoma grade 1) are very rare chondrogenic tumors. Approximately 150 cases of nasal chondroma and fewer than 50 cases of nasal atypical cartilaginous tumors have been described. We reported a case with nasal chondroma in the right ethmoid area and a case with a nasal atypical cartilaginous tumor of the anterior septum. No chondroma recurrence was noted for 17 years after endoscopic resection. Recurrence was noted for the nasal atypical cartilaginous tumor 36 months after wide surgical excision via midfacial degloving. Revision surgery was performed again via midfacial degloving. Recurrences of nasal chondroma and atypical cartilaginous tumors are extremely rare. The current data indicate adequate surgical excision, in some cases even radical, as the most important parameter to avoid recurrence. For inoperable recurrent cases of atypical cartilaginous tumors, observation may be followed.
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Affiliation(s)
- Aris I Giotakis
- Department of Otorhinolaryngology, Metropolitan Hospital Athens, Athens
| | - Ioannis Yiotakis
- Department of Otorhinolaryngology, Metropolitan Hospital Athens, Athens
| | - Argiro Mellou
- First Department of Pathology, National and Kapodistrian University of Athens Medical School, Hippokration Hospital, Athens
| | - Nektarios Koufopoulos
- Second Department of Pathology, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
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Giotakis AI, Widmann G, Mallien E, Riechelmann F, Heppt H, Riechelmann H. CT analysis of the anterior nasal airway based on the direction of nasal airflow in patients with nasal obstruction and trauma controls. Eur Arch Otorhinolaryngol 2023; 280:1765-1774. [PMID: 36242609 DOI: 10.1007/s00405-022-07703-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/12/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The anterior nose is the nasal segment with the highest resistance to airflow. In a hospital-based case-control study, we compared cross-sectional areas of the nasal cavities anterior to the piriform aperture determined by computed tomography (CT-CSA) in patients with nasal obstruction (cases) and unselected patients with trauma unrelated to the head and face (controls). METHODS CT-CSA could be reproducibly identified at angles of 0o, 30°, 60°, and 90° to the nasal floor approximately perpendicular to the arcuate direction of nasal airflow using bony landmarks. CT-CSA were manually segmented and compared in cases and controls. In cases, we compared CT-CSA at 30° (CT-CSA30-narrow) with the minimum cross-sectional area determined by acoustic rhinometry (AR-MCA1-narrow), each on the narrower side. RESULTS CT-CSA ranged from 7 to 250 mm2 with an average of 100 mm2 per nasal side. Side differences of the nasal airways indicating asymmetry of the nasal airways were greater in 40 cases than in 44 controls (p < 0.003). Moreover, bilateral CT-CSA were significantly smaller in cases than in controls (p < 0.001). CT-CSA30-narrow did not significantly correlate with AR-MCA1-narrow (r = 0.33; p = 0.07) and on average was 58% smaller than AR-MCA1-narrow. CONCLUSIONS Cross-sectional areas of the anterior nose perpendicular to the direction of nasal airflow, which is considered relevant in terms of flow physics, can be reliably measured using CT. Anterior nasal cavities in patients with nasal obstruction were more asymmetric and, as a whole, narrower than in controls, the latter of which is not corrected by routine septoplasty.
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Affiliation(s)
- Aris I Giotakis
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Gerlig Widmann
- Department of Radiology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Erik Mallien
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Felix Riechelmann
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Helen Heppt
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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Giotakis AI, Fischlechner R, Dejaco D, Gottfried T, Riechelmann H. [Prognostic factors for successful outcome in sialendoscopy for sialolithiasis]. Laryngorhinootologie 2021; 101:228-237. [PMID: 34058775 PMCID: PMC8885298 DOI: 10.1055/a-1510-9548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Hintergrund
Der Erfolg der Sialendoskopie hängt von mehreren Faktoren ab. Im Jahr 2008 wurde die Lithiasis-Stenosis-Dilatation (LSD) -Klassifikation zur genaueren Beschreibung des Stein-Gang-Verhältnisses eingeführt. Neben dem Nutzen der LSD-Klassifikation untersuchten wir weitere prä- und intraoperativ erhobene Einflussfaktoren auf den Erfolg der Sialendoskopie bei Sialolithiasis.
Methode
PatientInnen mit Sialolithiasis der Glandula submandibularis und Glandula parotis, die zwischen September 2018 und März 2020 eine primäre Sialendoskopie erhielten, wurden retrospektiv untersucht. Die Steingröße, Steinlokalisation und LSD-Klassifikation wurden unter anderem als prognostische Einflussfaktoren untersucht.
Ergebnisse
Insgesamt wurden 37 PatientInnen retrospektiv untersucht. Eine erfolgreiche Steinextraktion wurde bei 12/37 (32 %) PatientInnen durchgeführt. Bei Erfolg betrug die mediane Steingröße 3,7 mm, verglichen mit 10 mm bei Misserfolg (Mann-Whitney-Test; p < 0,0001). Bei Erfolg waren 11/12 Steine distal lokalisiert, verglichen mit 13/25 proximal lokalisierten Steinen bei Misserfolg (Pearson-Chi-Quadrat-Test; p = 0,010). Bei Erfolg wurden 10/12 Steine als L1S0D0 klassifiziert, während 15/25 bei Misserfolg als L3aS0D0-Steine klassifiziert wurden (Pearson-Chi-Quadrat-Test; p = 0,001). Für distal lokalisierte Steine, die kleiner als 5 mm waren, lag die Erfolgsrate bei 100 %. Für proximal lokalisierte Steine, die größer als 4 mm waren, lag die Erfolgsrate bei 0 %. Für die als L1S0D0 klassifizierten Steine betrug die Erfolgsrate 60–100 %.
Schlussfolgerung
Distal lokalisierte Steine und Steine kleiner als 5 mm in einem ansonsten unauffälligen Gangsystem können als prognostisch günstige Faktoren angesehen werden. Zukünftige Studien sollten anhand größerer Datenmengen die LSD-Klassifikation, das Volumen der Steine und deren Gangorientierung bzw. deren Abstand von der Papille untersuchen.
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Affiliation(s)
- Aris I Giotakis
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Medizinische Universität Innsbruck, Austria
| | - Rene Fischlechner
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Medizinische Universität Innsbruck, Austria
| | - Daniel Dejaco
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Medizinische Universität Innsbruck, Austria
| | - Timo Gottfried
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Medizinische Universität Innsbruck, Austria
| | - Herbert Riechelmann
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Medizinische Universität Innsbruck, Austria
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Berger M, Giotakis AI, Pillei M, Mehrle A, Kraxner M, Kral F, Recheis W, Riechelmann H, Freysinger W. Agreement between rhinomanometry and computed tomography-based computational fluid dynamics. Int J Comput Assist Radiol Surg 2021; 16:629-638. [PMID: 33677758 PMCID: PMC8052237 DOI: 10.1007/s11548-021-02332-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/23/2021] [Indexed: 11/21/2022]
Abstract
Purpose Active anterior rhinomanometry (AAR) and computed tomography (CT) are standardized methods for the evaluation of nasal obstruction. Recent attempts to correlate AAR with CT-based computational fluid dynamics (CFD) have been controversial. We aimed to investigate this correlation and agreement based on an in-house developed procedure. Methods In a pilot study, we retrospectively examined five subjects scheduled for septoplasty, along with preoperative digital volume tomography and AAR. The simulation was performed with Sailfish CFD, a lattice Boltzmann code. We examined the correlation and agreement of pressure derived from AAR (RhinoPress) and simulation (SimPress) and these of resistance during inspiration by 150 Pa pressure drop derived from AAR (RhinoRes150) and simulation (SimRes150). For investigation of correlation between pressures and between resistances, a univariate analysis of variance and a Pearson’s correlation were performed, respectively. For investigation of agreement, the Bland–Altman method was used. Results The correlation coefficient between RhinoPress and SimPress was r = 0.93 (p < 0.001). RhinoPress was similar to SimPress in the less obstructed nasal side and two times greater than SimPress in the more obstructed nasal side. A moderate correlation was found between RhinoRes150 and SimRes150 (r = 0.65; p = 0.041). Conclusion The simulation of rhinomanometry pressure by CT-based CFD seems more feasible with the lattice Boltzmann code in the less obstructed nasal side. In the more obstructed nasal side, error rates of up to 100% were encountered. Our results imply that the pressure and resistance derived from CT-based CFD and AAR were similar, yet not same. Supplementary Information The online version contains supplementary material available at 10.1007/s11548-021-02332-1.
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Affiliation(s)
- Manuel Berger
- Department of Environmental, Process and Energy Engineering, MCI, The Entrepreneurial School, Innsbruck, Austria
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Aris I Giotakis
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Martin Pillei
- Department of Environmental, Process and Energy Engineering, MCI, The Entrepreneurial School, Innsbruck, Austria
- Department of Fluid Mechanics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Andreas Mehrle
- Department of Mechatronics, MCI, The Entrepreneurial School, Innsbruck, Austria
| | - Michael Kraxner
- Department of Environmental, Process and Energy Engineering, MCI, The Entrepreneurial School, Innsbruck, Austria
| | - Florian Kral
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Recheis
- University Hospital of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Freysinger
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
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Giotakis AI, Dudas J, Glueckert R, Dejaco D, Ingruber J, Fleischer F, Innerhofer V, Pinggera L, Bektic-Tadic L, Gabriel SAM, Riechelmann H. Characterization of epithelial cells, connective tissue cells and immune cells in human upper airway mucosa by immunofluorescence multichannel image cytometry: a pilot study. Histochem Cell Biol 2021; 155:405-421. [PMID: 33251550 PMCID: PMC8021535 DOI: 10.1007/s00418-020-01945-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2020] [Indexed: 12/30/2022]
Abstract
Epithelial, connective tissue and immune cells contribute in various ways to the pathophysiology of chronic rhinosinusitis (CRS). However, data of their distribution in upper airway mucosa are sparse. We aimed to provide quantitative, purely informative data on the distribution of these cell lineages and their coexpression patterns, which might help identifying, e.g., cells in the epithelium undergoing through epithelial-mesenchymal transition (EMT). For this purpose, we used immunofluorescence multichannel image cytometry (IMIC). We examined fixed paraffin-embedded tissue samples (FFPE) of six patients with chronic rhinosinusitis (CRS) and of three patients without CRS (controls). The direct-conjugated antibodies pancytokeratin, vimentin and CD45/CD18 were used for coexpression analysis in epithelial layer and lamina propria. Image acquisition and analysis were performed with TissueFAXS and StrataQuest, respectively. To distinguish positive from negative expression, a ratio between cell-specific immunostaining intensity and background was developed. Isotype controls were used as negative controls. Per patient, a 4.5-mm2 tissue area was scanned and a median of 14,875 cells was recognized. The most common cell types were cytokeratin-single-positive (26%), vimentin-single-positive (13%) and CD45/CD18-single-positive with CD45/CD18-vimentin-double-positive cells (29%). In the patients with CRS, CD45/CD18-single-positive cells were 3-6 times higher compared to the control patients. In the epithelial layer, cytokeratin-vimentin-double-positive EMT cells were observed 3-5 times higher in the patients with CRS than in the control patients. This study provided quantitative data for the distribution of crucial cell types in CRS. Future studies may focus on the distribution and coexpression patterns of different immune cells in CRS or even cancer tissue.
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Affiliation(s)
- Aris I Giotakis
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Jozsef Dudas
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Rudolf Glueckert
- University Clinics Innsbruck, Tirol Kliniken, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Daniel Dejaco
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Julia Ingruber
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Felix Fleischer
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Veronika Innerhofer
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Leyla Pinggera
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ljilja Bektic-Tadic
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sarah A M Gabriel
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
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15
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Riedl D, Dejaco D, Steinbichler TB, Innerhofer V, Gottfried T, Bektic-Tadic L, Giotakis AI, Rumpold G, Riechelmann H. Assessment of health-related quality-of-life in patients with chronic Rhinosinusitis - Validation of the German Sino-Nasal Outcome Test-22 (German-SNOT-22). J Psychosom Res 2021; 140:110316. [PMID: 33271403 DOI: 10.1016/j.jpsychores.2020.110316] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/16/2020] [Accepted: 11/22/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The Sino-Nasal-Outcome-Test-22 (SNOT-22) represents the reference questionnaire to assess symptoms, health-related quality-of-life (HRQOL) and treatment-response in patients with chronic rhinosinusitis (CRS). The SNOT-22 has been validated for various languages, yet no validation is available for the German version. Thus, we provide a validation of the SNOT-22 for German. METHODS In this prospective observational study 139 CRS-patients and 36 control-participants were included. CRS-patients completed the German-SNOT-22 before treatment (T0) and four (T1), twelve (T2) and 48 weeks after inclusion (T3). At T0, Mackay-Naclerio-, Lund-Mackay- and Brief-Symptom-Inventory-18 (BSI-18) scores were collected as external reference for the German-SNOT-22 and its subscales. At T1, T2, and T3 health-transition-items (HTIs) were raised to explore responsivity. Control-participants completed the German-SNOT-22 at T0. Reliability (internal consistency, item-total correlation), validity (concurrent validity, discriminatory validity) and responsiveness (distribution- and anchor-based) were explored for the German-SNOT-22. RESULTS At T0, the mean German-SNOT-22 total-score for CRS patients was 38.0 (± 20.9) and responded to treatment (T1 = 26.3 ± 19.1; T2 = 25.8 ± 20.6; T3 = 20.5 ± 16.3). For control-participants, the mean total-score at T0 was 15.1 (±10.9). The German-SNOT-22 was reliable (excellent internal consistency α = 0.93; good overall item-total correlations r = 0.39-0.85), valid (significant correlations between Mackay-Naclerio-, Lund-Mackay- and BSI-18 scores, all r > 0.39, p < 0.01) and responsive (significant correlations between HTIs and mean change in German-SNOT-22 total-score F = 9.57, p < 0.001). CONCLUSION The German-SNOT-22 validated here matches the original SNOT-22. It is a reliable, valid and responsive questionnaire to assess symptoms, HRQOL and treatment-response in CRS-patients. Good psychometric properties were observed.
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Affiliation(s)
- D Riedl
- Department of Medical Psychology, Medical University of Innsbruck, Schöpfstr. 23a, 6020 Innsbruck, Tyrol, Austria
| | - D Dejaco
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Tyrol, Austria.
| | - T B Steinbichler
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Tyrol, Austria
| | - V Innerhofer
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Tyrol, Austria
| | - T Gottfried
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Tyrol, Austria
| | - L Bektic-Tadic
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Tyrol, Austria
| | - A I Giotakis
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Tyrol, Austria
| | - G Rumpold
- Department of Medical Psychology, Medical University of Innsbruck, Schöpfstr. 23a, 6020 Innsbruck, Tyrol, Austria
| | - H Riechelmann
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Tyrol, Austria
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Pantazis TL, Giotakis AI, Karamagkiolas S, Giotakis I, Konstantoulakis M, Liakea A, Misiakos EP. Low expression of miR-20b-5p indicates favorable prognosis in laryngeal squamous cell carcinoma, especially in patients with non-infiltrated regional lymph nodes. Am J Otolaryngol 2020; 41:102563. [PMID: 32521298 DOI: 10.1016/j.amjoto.2020.102563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/24/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Tumor recurrence and distant metastasis are very common in laryngeal squamous cell carcinoma (LSCC). In this study, we examined the potential prognostic value of microRNA-20b-5p (miR-20b-5p), a component of the tumor-related miR-106a/363 cluster. MATERIALS AND METHODS Total RNA was purified from 105 tissue specimens resected from patients having undergone surgical treatment for primary LSCC. After in vitro polyadenylation and reverse transcription, a sensitive real-time quantitative polymerase chain reaction (qPCR) methodology was applied for the relative quantification of miR-20b-5p levels. Then, we proceeded with biostatistical analysis, seeking to assess the prognostic value of miR-20b-5p expression in LSCC. RESULTS miR-20b-5p positivity constitutes a predictor of inferior DFS and OS in LSCC (P < 0.001 and P = 0.002, respectively). The significant prognostic value of miR-20b-5p expression status seems to be independent of tumor size, histological grade, and TNM stage, as revealed by the multivariate bootstrap Cox regression analysis. Kaplan-Meier survival analysis showed also that miR-20b-5p expression status can stratify LSCC patients with non-infiltrated regional lymph nodes (N0) into two subgroups with distinct prognosis (P = 0.004 and P = 0.004, respectively). CONCLUSIONS The miR-20b-5p expression status is a promising molecular tissue biomarker in LSCC, with an independent prognostic value, and thus merits further validation in larger cohorts of patients.
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Affiliation(s)
- Theodwros-Leonidas Pantazis
- First Department of Otolaryngology, Athens General Hospital "Hippokration", Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Aris I Giotakis
- First Department of Otolaryngology, Athens General Hospital "Hippokration", Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Karamagkiolas
- First Department of Otolaryngology, Athens General Hospital "Hippokration", Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Giotakis
- First Department of Otolaryngology, Athens General Hospital "Hippokration", Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Manousos Konstantoulakis
- First Department of Propaedeutic Surgery, Athens General Hospital "Hippokration", Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aliki Liakea
- First Department of Pathology, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
| | - Evangelos P Misiakos
- Third Department of Surgery, University General Hospital "Attikon", Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Riechelmann H, Widmann G, Kofler B, Arminger R, Url C, Giotakis AI. Nasal Floor Asymmetry Is Associated With Nasal Obstruction. J Oral Maxillofac Surg 2020; 78:1833.e1-1833.e9. [PMID: 32544472 DOI: 10.1016/j.joms.2020.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The role of morphologic characteristics of the nasal cavity in nasal obstruction is not yet sufficiently understood. The aim of this study was to determine which morphometric parameters of the nasal cavity severely impair nasal breathing and when. PATIENTS AND METHODS In a hospital-based, computed tomography-morphometric cross-sectional study, we evaluated computed tomography coronal scans of patients with known nasal obstruction scheduled to undergo functional nasal surgical procedures (cases) and trauma patients without facial involvement or known nasal obstruction (controls). The primary predictor variable was case versus control. In both groups, we measured and compared the piriform aperture width; nasal floor canting; piriform aperture vertical height, height-width ratio, and total cross-sectional area; height difference between the right and left nasal floors; and nasal septal thickness; as well as age and gender differences. Metric data means, standard deviations, and 95% confidence intervals were calculated and analyzed. RESULTS The sample was composed of 60 patients evenly divided between cases and controls. Of these, 30 were men. The average age of the cases and controls was 27.4 ± 7.8 years and 38.5 ± 18.6 years, respectively (P < .001). The differences in piriform aperture width were not statistically significant between cases and controls (23.3 ± 1.9 mm and 23.8 ± 1.7 mm, respectively; P > .2). In contrast, we noted statistically significant differences between cases and controls in nasal floor canting (5.4° ± 4.6° and 1.8° ± 1.5°, respectively; P < .001) and height difference between the right and left nasal floors (1.8 ± 1.2 mm and 1.0 ± 0.7 mm, respectively; P = .002). CONCLUSIONS Nasal floor canting of 3° or greater and a height difference between the right and left nasal floors of 1.5 mm or greater may contribute to the etiology of clinically relevant nasal obstruction. A piriform aperture width of 22 mm or less may be considered narrow. Future studies can determine when and how exactly to surgically address a clinically relevant narrow piriform aperture and nasal floor canting.
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Affiliation(s)
- Herbert Riechelmann
- Department Head, Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerlig Widmann
- Private Dozent Consultant, Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara Kofler
- Consultant, Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Roman Arminger
- Medical Student, Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Url
- Consultant, Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Aris I Giotakis
- Consultant, Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria.
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Giotakis EI, Giotakis AI. Modified facelift incision and superficial musculoaponeurotic system flap in parotid malignancy: a retrospective study and review of the literature. World J Surg Oncol 2020; 18:8. [PMID: 31918725 PMCID: PMC6953144 DOI: 10.1186/s12957-020-1785-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/05/2020] [Indexed: 11/18/2022] Open
Abstract
Background Data reporting the use of modified facelift incision (MFI) approach with or without superficial musculoaponeurotic system (SMAS) reconstruction in parotid malignancy are limited. To enhance the limited knowledge in this subject, the authors of the current study report quality data of MFI in patients with parotid malignancy with or without SMAS reconstruction. Methods We performed a retrospective review of parotid malignancy patients treated with the MFI over a 5-year period (2015–2019) in the 1st ENT University Department, University of Athens, Greece. Results We identified five patients with parotid malignancy. We performed MFI parotidectomy in 5/5 patients and SMAS reconstruction in 2/5 patients. All tumors were classified as T1N0M0. After a mean follow-up of 43.6 months (minimum, 36; maximum, 55), we noted no recurrence. The patients reported no Frey’s syndrome. Conclusions The authors of the current study suggest consideration of the MFI approach in parotid malignancy. A MFI approach should at least favor small parotid tumors without neck metastatic disease (T1cN0). Surgeons could also address larger tumors with a MFI approach. Surgeons should reconstruct the parotid lodge with a SMAS advancement flap in tumors not in proximity with the SMAS.
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Affiliation(s)
- Evangelos I Giotakis
- First Department of Otorhinolaryngology, Hippocration Hospital, Medical University of Athens, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527, Athens, Greece
| | - Aris I Giotakis
- First Department of Otorhinolaryngology, Hippocration Hospital, Medical University of Athens, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527, Athens, Greece.
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Giotakis AI, Lazaris AC, Kataki A, Kontos CK, Giotakis EI. Positive BCL2L12 expression predicts favorable prognosis in patients with laryngeal squamous cell carcinoma. Cancer Biomark 2019; 25:141-149. [PMID: 31104007 DOI: 10.3233/cbm-181772] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Laryngeal squamous cell carcinoma (LSCC) constitutes the third most frequent head and neck cancer. Several tissue biomarkers have been studied for their prognostic significance in LSCC. OBJECTIVE To investigate the prognostic significance of BCL2L12, a new member of the BCL2 family, in primary LSCC along with well-examined biomarkers such as BCL2 and BAX. METHODS Cancerous tissue specimens of patients with primary LSCC were collected during 2005 and 2012 as pretreatment tissue biopsy. The specimens were immunohistochemically evaluated for the protein expression of BCL2L12, BCL2 and BAX. Kaplan-Meier survival curves and Cox proportional hazard regression models were performed to evaluate prognosis. RESULTS In the study cohort of 78 patients with primary LSCC, Kaplan-Meier survival curves demonstrated that advanced-stage LSCC patients with BCL2L12-positive tumors had significantly higher OS time in comparison with advanced-stage LSCC patients with BCL2L12-negative tumors (p= 0.014). Also, advanced-stage LSCC patients with BCL2L12-positive tumors had significantly lower risk of death from LSCC compared to advanced-stage LSCC patients with BCL2L12-negative tumors (HR = 0.228, 95%CI = 0.063-0.833, p= 0.025). CONCLUSIONS BCL2L12 protein expression could be used as a favorable prognostic tissue biomarker in patients with primary advanced-stage LSCC. On the contrary, BCL2 and BAX did not correlate with prognosis in patients with primary LSCC.
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Affiliation(s)
- Aris I Giotakis
- First Department of Otorhinolaryngology, Hippocration Hospital, Medical University of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas C Lazaris
- Department of Pathology, Medical University of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Agapi Kataki
- Laboratory of Surgical Research, 1st Department of Propaedeutic Surgery, Hippocration Hospital, Medical University of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos K Kontos
- Department of Biochemistry and Molecular Biology, University of Athens, Athens, Greece
| | - Evangelos I Giotakis
- First Department of Otorhinolaryngology, Hippocration Hospital, Medical University of Athens, National and Kapodistrian University of Athens, Athens, Greece
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Giotakis AI, Innerhofer V, Vent J, Tomazic PV, Riechelmann H. [Messverfahren zur objektiven Beurteilung der nasalen Durchgängigkeit]. Laryngorhinootologie 2019; 98:312-324. [PMID: 31090051 DOI: 10.1055/a-0865-2163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The need for objective assessment of nasal patency in the fields of rhinosurgery and allergy has led to the development of various methods for the evaluation of nasal patency. These methods include active anterior rhinomanometry, PNIF, acoustic rhinometry, rhinostereometry, optical rhinometry, minimal cross-sectional area endoscopy, nasal sound spectral analysis, magnetic resonance imaging and numerical flow simulation. This article provides a brief overview of currently common procedures.
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Affiliation(s)
- Aris I Giotakis
- Department of Otorhinolaryngology, Medical University of Innsbruck
| | | | - Julia Vent
- Department of Otorhinolaryngology, University of Heidelberg - Medical Center of Mannheim, and Department of Otorhinolaryngology, University of Cologne/Köln
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Giotakis AI, Kral F, Freysinger W, Markart S, Riechelmann H. Missed paranasal sinus compartments in sinus surgery with and without image-guidance systems: a pilot feasibility study. Int J Comput Assist Radiol Surg 2019; 14:895-902. [PMID: 30840184 DOI: 10.1007/s11548-019-01930-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/28/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Image-guidance systems (IGS) have gained widespread use in endoscopic sinus surgery (ESS) and have been thoroughly analysed. In this study, we looked for a new parameter to determine if patients could directly benefit from the use of IGS during primary ESS. We questioned if IGS could improve the quality of ESS in chronic rhinosinusitis (CRS) patients via allowing a more comprehensive treatment of all involved sinus compartments. METHODS In a pilot feasibility study, we evaluated uncomplicated CRS patients following primary ESS with and without IGS between January 2011 and June 2012 using preoperative and postoperative CT scans. The preoperative CT scans identified the sinus compartments requiring surgery. The postoperative CT scans were used to evaluate the treatment effect in these compartments. From these data, we calculated a missing ratio (missed compartments/compartments requiring surgery) for each patient. RESULTS Of the 169 ESS patients who were treated, ten patients were retrospectively identified as complying with the inclusion and exclusion criteria following ESS with IGS. Ten patients treated without IGS were then randomly chosen. The median missing ratio for non-IGS patients was 36%, and for IGS patients, the median missing ratio was 0% (p = 0.046). However, the missing ratio was depended on the number of compartments requiring surgery. Stratification of the number of compartments requiring surgery resulted in an exact p value of 0.13. CONCLUSIONS IGS could help the surgeon to more completely address diseased sinus compartments. For better scientific merit, a comparative study of ESS with and without IGS seems feasible, using the proposed failing score missed compartments/compartments requiring surgery as the primary outcome parameter.
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Affiliation(s)
- Aris I Giotakis
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
| | - Florian Kral
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.,Division of Otolaryngology, Hospital Kardinal Schwarzenberg, Schwarzach, Austria
| | - Wolfgang Freysinger
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Stefan Markart
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.,Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Herbert Riechelmann
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
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22
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Giotakis AI, Pototschnig C. Use of erbium laser in the treatment of persistent post-radiotherapy laryngeal edema: a case report and review of the literature. World J Surg Oncol 2018; 16:176. [PMID: 30149805 PMCID: PMC6112140 DOI: 10.1186/s12957-018-1480-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/21/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Post-radiotherapy laryngeal edema may affect the patients' quality of life, leading to repeated treatment attempts, which include massage/physical therapy, inhalations, and/or tracheostomy. CASE PRESENTATION We report the surgical treatment approach of a 69-year-old patient with severe persistent post-radiotherapy laryngeal edema. After multiple inpatient admissions and failed conservative therapy, we used the erbium laser to treat the arytenoid edema. After repeated procedures, no complications were observed. The patient remained free of symptoms after 30 months of follow-up. CONCLUSIONS The authors provide an easy-to-perform, safe, and quick surgical technique without non-severe or severe complications. Using this technique repeatedly, complications from excessive thermal damage with CO2 laser or unpleasant solutions such as tracheostomy can be avoided.
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Affiliation(s)
- Aris I Giotakis
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Claus Pototschnig
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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Giotakis AI, Karow EM, Scheithauer MO, Weber R, Riechelmann H. Saline irrigations following sinus surgery - a controlled, single blinded, randomized trial. Rhinology 2017; 54:302-310. [PMID: 27556896 DOI: 10.4193/rhino16.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a common health problem. If medical treatment fails, endonasal sinus surgery is a valuable treatment option. A thorough postsurgical treatment is needed including, among others, nasal saline irrigations (NSI). In this prospective, controlled, single blinded, randomized trial, we aimed to evaluate efficacy of nasal saline irrigations following endonasal sinus surgery in CRS-patients with nasal polyps. METHODOLOGY We examined patient's nasal symptoms, general quality of life and postoperative condition of the mucosa. We also investigated whether or not NSI reduced the number of missed workdays after surgery (MWD). Patients were randomized into an irrigation and non-irrigation arm. RESULTS Following treatment, mean nasal sum-score in the irrigation arm was 4.4 and in the non-irrigation arm it was 6.3. Accordingly, mean general sum-score in the irrigation arm was 2.5 and in the non-irrigation arm 4.8. Thus, nasal irrigation led to a more pronounced improvement of nasal and general symptoms than in the non-irrigation arm. No differences were observed in postoperative condition of mucosa or number of MWD. CONCLUSIONS Nasal irrigation improves symptoms score after ESS in patients with CRSwNP.
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Affiliation(s)
- A I Giotakis
- Department of Otorhinolaryngology, Medical University of Innsbruck, Austria
| | - E M Karow
- Siemens and Co, Arzbacher Str. 78, 56130 Bad Ems, Germany
| | - M O Scheithauer
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Ulm, Germany
| | - R Weber
- Department of Otorhinolaryngology, Clinical Centre Karlsruhe, Germany
| | - H Riechelmann
- Department of Otorhinolaryngology, Medical University of Innsbruck, Austria
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Giotakis AI, Bender B, Pototschnig C. [Infant Oral Tumor]. Laryngorhinootologie 2016; 95:849-850. [PMID: 27832677 DOI: 10.1055/s-0042-111511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A I Giotakis
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Medizinische Universitat Innsbruck, Innsbruck, Austria
| | - B Bender
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Medizinische Universitat Innsbruck, Innsbruck, Austria
| | - C Pototschnig
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Medizinische Universitat Innsbruck, Innsbruck, Austria
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Giotakis AI, Kontos CK, Manolopoulos LD, Sismanis A, Konstadoulakis MM, Scorilas A. High BAX/BCL2 mRNA ratio predicts favorable prognosis in laryngeal squamous cell carcinoma, particularly in patients with negative lymph nodes at the time of diagnosis. Clin Biochem 2016; 49:890-6. [PMID: 27129795 DOI: 10.1016/j.clinbiochem.2016.04.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 03/06/2016] [Accepted: 04/22/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Laryngeal squamous cell carcinoma (LSCC), a common type of head and neck cancer, is associated with high rates of metastasis and recurrence. Therefore, accurate prognostic stratification of LSCC patients based on molecular prognostic tumor biomarkers would definitely lead to a better clinical management of this malignancy. The aim of this study was the investigation of the potential combinatorial prognostic value of BCL2 and BAX mRNA expression in LSCC. DESIGN AND METHODS Total RNA was isolated from 105 cancerous laryngeal tissue specimens obtained from patients having undergone surgical treatment for primary LSCC. After cDNA preparation, a low-cost, in-house developed, sensitive and accurate real-time quantitative PCR (qPCR) methodology was applied for the quantification of BCL2 and BAX mRNA levels. Then, we carried out a biostatistical analysis to assess the prognostic value of the BAX/BCL2 mRNA expression ratio. RESULTS High BAX/BCL2 mRNA expression constitutes a favorable prognosticator in LSCC, predicting significantly longer disease-free survival (P=0.011) and overall survival (P=0.014) of patients. More importantly, the significant prognostic value of the BAX/BCL2 mRNA expression appeared to be independent of the histological grade and size of the malignant laryngeal tumor as well as TNM stage, as revealed by the multivariate bootstrap Cox regression analysis. Kaplan-Meier survival analysis demonstrated also that the BAX/BCL2 ratio can stratify node-negative (N0) LSCC patients into two subgroups with significantly different DFS and OS (P=0.021 and P=0.009, respectively). CONCLUSIONS The BAX/BCL2 mRNA ratio is a putative molecular tissue biomarker in CLL and hence deserves further validation in larger cohorts of LSCC patients.
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Affiliation(s)
- Aris I Giotakis
- First Department of Otorhinolaryngology, Athens General Hospital "Hippokration", National and Kapodistrian University of Athens, Athens GR-11527, Greece
| | - Christos K Kontos
- Department of Biochemistry and Molecular Biology, National and Kapodistrian University of Athens, Athens GR-15701, Greece
| | - Leonidas D Manolopoulos
- First Department of Otorhinolaryngology, Athens General Hospital "Hippokration", National and Kapodistrian University of Athens, Athens GR-11527, Greece
| | - Aristides Sismanis
- First Department of Otorhinolaryngology, Athens General Hospital "Hippokration", National and Kapodistrian University of Athens, Athens GR-11527, Greece
| | - Manousos M Konstadoulakis
- First Department of Propaedeutic Surgery, Athens General Hospital "Hippokration", National and Kapodistrian University of Athens, Athens GR-11527, Greece
| | - Andreas Scorilas
- Department of Biochemistry and Molecular Biology, National and Kapodistrian University of Athens, Athens GR-15701, Greece.
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Vassilakopoulou M, Avgeris M, Velcheti V, Kotoula V, Rampias T, Chatzopoulos K, Perisanidis C, Kontos CK, Giotakis AI, Scorilas A, Rimm D, Sasaki C, Fountzilas G, Psyrri A. Evaluation of PD-L1 Expression and Associated Tumor-Infiltrating Lymphocytes in Laryngeal Squamous Cell Carcinoma. Clin Cancer Res 2015; 22:704-13. [PMID: 26408403 DOI: 10.1158/1078-0432.ccr-15-1543] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/02/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Programmed death-ligand 1 (PD-L1; also known as CD274 or B7-H1) expression represents a mechanism of immune escape for cancer. Our purpose was to characterize tumor PD-L1 expression and associated T-cell infiltration in primary laryngeal squamous cell carcinomas (SCC). EXPERIMENTAL DESIGN A well-annotated cohort of 260 operable primary laryngeal SCCs [formalin-fixed paraffin-embedded (FFPE) specimens] was morphologically characterized for stromal tumor-infiltrating lymphocytes (TIL), on hematoxylin/eosin-stained whole sections and for PD-L1 mRNA expression by qRT-PCR in FFPE specimens. For PD-L1 protein expression, automated quantitative protein analysis (AQUA) was applied on tissue microarrays consisting of two cores from these tumors. In addition, PD-L1 mRNA expression in fresh-frozen tumors and normal adjacent tissue specimens was assessed in a second independent cohort of 89 patients with primary laryngeal SCC. RESULTS PD-L1 mRNA levels were upregulated in tumors compared with surrounding normal tissue (P = 0.009). TILs density correlated with tumor PD-L1 AQUA levels (P = 0.021). Both high TILs density and high PD-L1 AQUA levels were significantly associated with superior disease-free survival (DFS; TILs: P = 0.009 and PD-L1: P = 0.044) and overall survival (OS; TILs: P = 0.015 and PD-L1: P = 0.059) of the patients and retained significance in multivariate analysis. CONCLUSIONS Increased TILs density and PD-L1 levels are associated with better outcome in laryngeal squamous cell cancer. Assessment of TILs and PD-L1 expression could be useful to predict response to immune checkpoint inhibitors.
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Affiliation(s)
| | - Margaritis Avgeris
- Department of Biochemistry and Molecular Biology, Faculty of Biology, University of Athens, Athens, Greece
| | - Vamsidhar Velcheti
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Vassiliki Kotoula
- Department of Pathology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece. Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Thessaloniki, Greece
| | - Theodore Rampias
- Department of Surgery (Otolaryngology), Yale University School of Medicine, New Haven, Connecticut
| | - Kyriakos Chatzopoulos
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Thessaloniki, Greece
| | - Christos Perisanidis
- Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria
| | - Christos K Kontos
- Department of Biochemistry and Molecular Biology, Faculty of Biology, University of Athens, Athens, Greece
| | - Aris I Giotakis
- First Ear, Nose and Throat Clinics, Athens General Hospital "Hippokration," University of Athens, Athens, Greece
| | - Andreas Scorilas
- Department of Biochemistry and Molecular Biology, Faculty of Biology, University of Athens, Athens, Greece
| | - David Rimm
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Clarence Sasaki
- Department of Surgery (Otolaryngology), Yale University School of Medicine, New Haven, Connecticut
| | - George Fountzilas
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Thessaloniki, Greece
| | - Amanda Psyrri
- Second Department of Internal Medicine, Section of Medical Oncology, "Attikon" University Hospital, University of Athens, Athens, Greece.
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Foteinou E, Kontos CK, Giotakis AI, Scorilas A. Low mRNA expression levels of kallikrein-related peptidase 4 (KLK4) predict short-term relapse in patients with laryngeal squamous cell carcinoma. Biol Chem 2015; 395:1051-62. [PMID: 24854539 DOI: 10.1515/hsz-2014-0139] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 04/08/2014] [Indexed: 12/21/2022]
Abstract
Several members of the family of tissue kallikrein and kallikrein-related peptidases have been suggested as promising tumor biomarkers with important prognostic significance. However, only one (KLK11) has already been studied in laryngeal squamous cell carcinoma (LSCC) as a potential biomarker for LSCC diagnosis and/or prognosis. Our study investigated the prognostic value of kallikrein-related peptidase-4 (KLK4) mRNA expression as a molecular tissue biomarker in LSCC. For this purpose, KLK4 mRNA expression analysis was performed in 116 cancerous and 74 paired non-cancerous laryngeal tissue specimens obtained from patients that had undergone surgical treatment for primary LSCC. A remarkable downregulation of KLK4 mRNA expression was discovered in laryngeal tumors, compared to non-cancerous laryngeal tissue specimens. KLK4 mRNA expression was also shown to distinguish LSCC from non-cancerous laryngeal tissues. Furthermore, low KLK4 mRNA expression was shown to predict poor disease-free survival, independently of the histological grade and size of the malignant tumor as well as patient TNM stage. According to Kaplan-Meier survival analysis, low KLK4 mRNA expression predicts short-term relapse even among patients with well-differentiated tumors or those at an early TNM stage. Thus, KLK4 mRNA positivity could be regarded as a novel independent indicator of favorable prognosis for the disease-free survival of LSCC patients.
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