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Chow TL. Monitoring Thyroglobulin Following Total Thyroidectomy After Lobectomy. JAMA Otolaryngol Head Neck Surg 2024; 150:357. [PMID: 38421664 DOI: 10.1001/jamaoto.2024.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Tam-Lin Chow
- Head and Neck Division, Department of Surgery, United Christian Hospital, Hong Kong
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Chow TL. Quality Indicators for Primary Hyperparathyroidism. JAMA Otolaryngol Head Neck Surg 2022; 148:696-697. [PMID: 35679020 DOI: 10.1001/jamaoto.2022.0938] [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: 11/14/2022]
Affiliation(s)
- Tam-Lin Chow
- Head and Neck Division, Department of Surgery, United Christian Hospital, Hong Kong
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Chow TL. Intraoperative Parathyroid Hormone in Minimally Invasive Parathyroidectomy. JAMA Otolaryngol Head Neck Surg 2021; 147:922-923. [PMID: 34473225 DOI: 10.1001/jamaoto.2021.2254] [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: 11/14/2022]
Affiliation(s)
- Tam-Lin Chow
- Head and Neck Division, Department of Surgery, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
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Chow TL, Fung KSC, Chan YC. COVID-19 masquerading emergency surgical problems: Lessons learnt from four cases diagnosed in the surgical ward. Surg Pract 2021; 25:114-115. [PMID: 34230831 PMCID: PMC8251229 DOI: 10.1111/1744-1633.12494] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tam-Lin Chow
- Department of Surgery United Christian Hospital Kwun Tong Hong Kong
| | - Kitty S C Fung
- Department of Microbiology United Christian Hospital Kwun Tong Hong Kong
| | - Yiu-Cheung Chan
- Accident and Emergency Department United Christian Hospital Kwun Tong Hong Kong
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Wong DHT, Tang EWH, Njo A, Chu CKL, Chau SKY, Chow TL, Lim HS, Fung KSC, Li KKW. Risk stratification protocol to reduce consumption of personal protective equipment for emergency surgeries during COVID-19 pandemic. Hong Kong Med J 2020; 26:252-254. [PMID: 32366724 DOI: 10.12809/hkmj208533] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- D H T Wong
- Department of Ophthalmology, United Christian Hospital, Hong Kong.,Department of Ophthalmology, Tseung Kwan O Hospital, Hong Kong
| | - E W H Tang
- Department of Ophthalmology, United Christian Hospital, Hong Kong.,Department of Ophthalmology, Tseung Kwan O Hospital, Hong Kong
| | - A Njo
- Department of Anaesthesiology, United Christian Hospital, Hong Kong
| | - C K L Chu
- Department of Anaesthesiology, United Christian Hospital, Hong Kong
| | - S K Y Chau
- Department of Pathology, United Christian Hospital, Hong Kong
| | - T L Chow
- Department of Surgery, United Christian Hospital, Hong Kong
| | - H S Lim
- Department of Anaesthesiology, United Christian Hospital, Hong Kong
| | - K S C Fung
- Department of Pathology, United Christian Hospital, Hong Kong
| | - K K W Li
- Department of Ophthalmology, United Christian Hospital, Hong Kong.,Department of Ophthalmology, Tseung Kwan O Hospital, Hong Kong
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Affiliation(s)
- Tam-Lin Chow
- Head and Neck Division, Department of Surgery, United Christian Hospital, Hong Kong
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Chow TL, Kwan WW, Kwan CK. Treatment of cutaneous angiosarcoma of the scalp and face in Chinese patients: local experience at a regional hospital in Hong Kong. Hong Kong Med J 2018; 24:25-31. [PMID: 29326400 DOI: 10.12809/hkmj176813] [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] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Angiosarcoma is a rare aggressive sarcoma that occurs mostly in the skin of the head and neck in the elderly population. The optimal management is dubious and most studies are from Caucasian populations. We aimed to examine the treatment and outcome of this disease in Chinese patients. METHODS Data of patients with histopathologically verified cutaneous angiosarcoma of the head and neck during December 1997 to September 2016 were retrieved from our hospital cancer registry. The demographic data, clinicopathological information, modality of treatment, and outcomes were reviewed. RESULTS During the study period, 17 Chinese patients were treated. Their median age was 81 years. The tumours were present in the scalp only (n=11), face only (n=4), or both scalp and face (n=2). Only two patients had distant metastases. The modalities of treatment were surgery (n=6), surgery and adjuvant radiotherapy (n=1), palliative radiotherapy (n=5), or palliative chemotherapy (n=3). The remaining two patients refused any treatment initially. Of the seven patients treated surgically, there were four local and two regional recurrences. The median time to relapse was 7.5 months. Overall, 16 patients had died; causes of death were disease-related in 12 whereas four other patients died of inter-current illnesses. One patient was still living with the disease. The median overall survival was 11.1 months and the longest overall survival was 42 months. CONCLUSION The outcome of angiosarcoma in our series is poor. A high index of suspicion is mandatory for prompt diagnosis. Adjuvant radiotherapy is recommended following surgery. The benefit and role of systemic treatment in various combinations with surgery or radiotherapy require further study.
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Affiliation(s)
- T L Chow
- Head and Neck Division, Department of Surgery, United Christian Hospital, Kwun Tong, Hong Kong
| | - W Wy Kwan
- Head and Neck Division, Department of Surgery, United Christian Hospital, Kwun Tong, Hong Kong
| | - C K Kwan
- Department of Oncology, United Christian Hospital, Kwun Tong, Hong Kong
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Chow TL, Tam SWY, Choi CY, Kwan WWY. Hemithyroidectomy for low-risk follicular carcinoma of the thyroid: results from a regional hospital. Singapore Med J 2017; 59:311-315. [PMID: 29214321 DOI: 10.11622/smedj.2017106] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Excellent outcomes after conservative thyroid surgery for low-risk follicular thyroid carcinoma (FTC) have been reported from highly specialised centres. However, it is uncertain whether low-volume hospitals can achieve similar treatment results. METHODS At our institution, 49 patients with FTC were treated during the period 1991-2014. Patients with minimally invasive FTC (MIFTC) were usually treated with hemithyroidectomy. The demographic data, pathology, treatment modality and oncological outcomes of these patients were retrospectively evaluated. RESULTS The tumours were classified as Stage I in 40.8% of patients, Stage II in 32.7%, Stage III in 20.4% and Stage IV in 6.1%, according to the TNM classification system. Only 4 (8.2%) patients had widely invasive FTC (WIFTC). Vascular invasion or capsular invasion alone occurred in 9 (19.1%) and 19 (40.4%) patients, respectively, while 19 (40.4%) patients had simultaneous vascular and capsular invasions. 34 (69.4%) patients with MIFTC initially underwent hemithyroidectomy, while 15 (30.6%) patients underwent total thyroidectomy. Ten patients who underwent total thyroidectomy received radioactive iodine ablation. The mean follow-up duration was 86.9 ± 56.6 months. There was no disease-specific mortality, although two patients with WIFTC remained alive with disease at the end of the study. The five-, ten- and 15-year overall survival rates were 95%, 91% and 84%, respectively. Five patients from the hemithyroidectomy group died due to other illnesses with no evidence of FTC. CONCLUSION Satisfactory disease control and excellent survival for MIFTC is achievable by hemithyroidectomy in community hospitals. Total thyroidectomy should be reserved for WIFTC or aggressive tumours with nodal or distant metastasis.
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Affiliation(s)
- Tam-Lin Chow
- Department of Surgery, United Christian Hospital, Kowloon, Hong Kong
| | | | - Chi-Yee Choi
- Department of Surgery, United Christian Hospital, Kowloon, Hong Kong
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Kok ASY, Wong JSW, Chow TL. Use of reversed latissimus dorsi muscle flap for primary oesophageal repair reinforcement in Boerhaave's syndrome. Surg Pract 2017. [DOI: 10.1111/1744-1633.12279] [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: 11/28/2022]
Affiliation(s)
| | | | - Tam-Lin Chow
- Department of Surgery; United Christian Hospital; Hong Kong
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Chow TL, Yuen NW, Kwan WW, Choi CY. Immunoglobulin G4-related disease masquerading as tonsil carcinoma. Hong Kong Med J 2017; 23:537-8. [PMID: 29026051 DOI: 10.12809/hkmj164842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- T L Chow
- Department of Surgery, United Christian Hospital, Kwun Tong, Hong Kong
| | - N Wf Yuen
- Department of Anatomical Pathology, United Christian Hospital, Kwun Tong, Hong Kong
| | - W Wy Kwan
- Department of Surgery, United Christian Hospital, Kwun Tong, Hong Kong
| | - C Y Choi
- Department of Surgery, United Christian Hospital, Kwun Tong, Hong Kong
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Chow TL, Kwan WWY, Fung SC, Ho LI. Prognostic value of lymph node density in buccal squamous cell carcinoma. Am J Otolaryngol 2017; 38:529-532. [PMID: 28554580 DOI: 10.1016/j.amjoto.2017.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/21/2017] [Accepted: 05/05/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Lymph node density(LND) has been shown to be a better prognosticator than conventional nodal classification to predict prognosis for squamous cell carcinoma(SCC) of the oral cavity. However, studies focusing on subsites of oral cancer are meager. The role of LND for buccal SCC was evaluated in this study. METHODS A total of 39 patients with buccal SCC primarily treated surgically with neck dissection were identified. LND was defined as the number of positive nodes over the number of nodal yield. The cut-off of LND was ≤0.07 or >0.07. Patient demographic data and clincopathologic parameters were described. Survival was expressed by Kaplan-Meier method and correlation with survival is analyzed with log-rank test. IBM SPSS Statistics version 22 was used for data computation. RESULTS The median follow-up was 79.0months and median nodes removed was 23 (range 8-93). Positive nodal involvement was found in 19(48.7%) patients. The 5-year and 10-year OS were 67.4% and 42.5% whilst for DSS were 69.2% and 65.5%, respectively. When pT-, pN-, LND-classification and AJCC stage were analyzed for the whole series, only pN- (p=0.006) and LND-classification (p=0.002) were significant factors for OS, while pT-, pN-, LND-classification and AJCC stage were all significant factors for DSS. When only cases with positive nodal spread were considered, the pN-classification (pN1 vs pN2) was not a significant risk factor for either OS (p=0.075, HR 3.10(CI 0.89-10.76)) and DSS (p=0.074, HR 3.58(CI 0.88-14.56)). By contrast, LND-classification (≤0.07 vs >0.07) remained a significant predictor for OS (p=0.03, HR 3.95(CI 1.15-13.63)), but not for the DSS (p=0.112, HR 2.92(CI 0.78-10.99)). CONCLUSION The prognostic value of LND on buccal SCC is supported in this study. The results also suggest that LND is better than the conventional pN-classification to predict OS. Further studies on LND with big sample size for buccal SCC or other subsites of OSCC are worthwhile.
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Affiliation(s)
- Tam-Lin Chow
- Division of Head and Neck Surgery, Department of Surgery, United Christian Hospital, Hong Kong, China.
| | - Wilson W Y Kwan
- Division of Head and Neck Surgery, Department of Surgery, United Christian Hospital, Hong Kong, China
| | - Siu-Chung Fung
- Division of Head and Neck Surgery, Department of Surgery, United Christian Hospital, Hong Kong, China
| | - Lai-In Ho
- Division of Head and Neck Surgery, Department of Surgery, United Christian Hospital, Hong Kong, China
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Kok ASY, Cheung TSH, Lam DCT, Chan WHC, Chan SWW, Chow TL. Mesh erosion to urinary bladder causing fistulation to abdominal wall resulting in necrotizing fasciitis: A case report of late complication of incisional hernia. Int J Surg Case Rep 2017; 39:185-187. [PMID: 28846952 PMCID: PMC5573789 DOI: 10.1016/j.ijscr.2017.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 06/21/2017] [Revised: 08/09/2017] [Accepted: 08/09/2017] [Indexed: 11/17/2022] Open
Abstract
Incisional hernia is not an uncommon complication after abdominal operation. Mesh migration and erosion causing vesico-cutaneous fistula and subsequent necrotizing fasciitis is uncommon. We hereby report a case of abdominal wall necrotizing fasciitis 21 months after laparoscopic incisional hernia repair in lower midline with dual mesh, due to mesh migration and erosion into urinary bladder, resulting in fistulation between bladder and abdominal wall. Mesh erosion to viscera can cause severe complication. Its risk should be balanced and discussed with patient with full consent.
Introduction Incisional hernia is not an uncommon complication after abdominal operation, and laparoscopic ventral hernia repair with mesh is commonly performed nowadays. It is thought to have less complication compare to the traditional open repair, yet late complication is still observed occasionally and can be disastrous. Case report We hereby report a case of abdominal wall necrotizing fasciitis 21 months after laparoscopic incisional hernia repair in lower midline with dual mesh, due to mesh migration and erosion into urinary bladder, resulting in fistulation between bladder and abdominal wall. Repeated debridement and removal of mesh was required for sepsis control and the patient required intensive care support due to multi-organ failure. Subsequent repair of urinary bladder and abdominoplasty was performed after condition stabilized. Conclusion This case was the first reported incident with bladder erosion by dual mesh causing vesico-cutaneous fistula complicated with necrotizing fasciitis. Although dual mesh theoretically reduces the risk of mesh erosion, mesh erosion to viscera can still happen and cause severe complication. Its risk should be balanced and discussed with patient with full consent.
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Affiliation(s)
- Amy S Y Kok
- Department of Surgery, United Christian Hospital, Hong Kong Address of United Christian Hospital: 130, Hip Wo Street, Kwun Tong, Kowloon, Hong Kong.
| | - Tommy S H Cheung
- Department of Surgery, United Christian Hospital, Hong Kong Address of United Christian Hospital: 130, Hip Wo Street, Kwun Tong, Kowloon, Hong Kong
| | - Dennis C T Lam
- Department of Surgery, United Christian Hospital, Hong Kong Address of United Christian Hospital: 130, Hip Wo Street, Kwun Tong, Kowloon, Hong Kong
| | - Wilson H C Chan
- Department of Surgery, United Christian Hospital, Hong Kong Address of United Christian Hospital: 130, Hip Wo Street, Kwun Tong, Kowloon, Hong Kong
| | - Sharon W W Chan
- Department of Surgery, United Christian Hospital, Hong Kong Address of United Christian Hospital: 130, Hip Wo Street, Kwun Tong, Kowloon, Hong Kong
| | - T L Chow
- Department of Surgery, United Christian Hospital, Hong Kong Address of United Christian Hospital: 130, Hip Wo Street, Kwun Tong, Kowloon, Hong Kong
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Chan PK, Chor JS, Vlantis AC, Chow TL, Fung SC, Lau CH, Ng FY, Wong CS. Smoking, human papillomavirus infection, and p53 mutation as risk factors in oropharyngeal cancer: a case-control study. Hong Kong Med J 2017; 23 Suppl 5:12-16. [PMID: 28943519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Affiliation(s)
- P Ks Chan
- Department of Microbiology, The Chinese University of Hong Kong
| | - J Sy Chor
- School of Public Health and Primary Care, The Chinese University of Hong Kong
| | - A C Vlantis
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong
| | - T L Chow
- Head and Neck Division, Department of Surgery, United Christian Hospital
| | - S C Fung
- Department of Dentistry and Maxillofacial Surgery, United Christian Hospital
| | - C H Lau
- Department of Surgery, Queen Elizabeth Hospital
| | - F Yh Ng
- Department of Surgery, Kwong Wah Hospital
| | - C S Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong
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Affiliation(s)
- Tam-Lin Chow
- Department of Surgery; United Christian Hospital; Hong Kong
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Affiliation(s)
- Kwan-Pok Tsui
- Department of Surgery; United Christian Hospital; Hong Kong China
| | - Wai-Yin Kwan
- Department of Surgery; United Christian Hospital; Hong Kong China
| | - Chi-Yee Choi
- Department of Surgery; United Christian Hospital; Hong Kong China
| | - Tam-Lin Chow
- Department of Surgery; United Christian Hospital; Hong Kong China
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Chow TL, Fung SC, Choi CY, Ho LI, Kwan WW. Maxillary reconstruction with pedicled reverse-flow submental osteocutaneous mandible chimeric flap. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology 2016. [DOI: 10.1016/j.ajoms.2016.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Yeung CKL, Choi CY, Chow TL. Anal reconstruction after a rare complication of routine haemorrhoid treatment. Surg Pract 2016. [DOI: 10.1111/1744-1633.12199] [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: 11/30/2022]
Affiliation(s)
| | - Chi-Yee Choi
- Department of Surgery; United Christian Hospital; Hong Kong
| | - Tam-Lin Chow
- Department of Surgery; United Christian Hospital; Hong Kong
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Chor JSY, Vlantis AC, Chow TL, Fung SC, Ng FYH, Lau CH, Chan ABW, Ho LC, Kwong WH, Fung MNS, Lam EWH, Mak KL, Lam HCY, Kok ASY, Ho WCS, Yeung ACM, Chan PKS. The role of human papillomavirus in head and neck squamous cell carcinoma: A case control study on a southern Chinese population. J Med Virol 2015; 88:877-87. [PMID: 26467027 DOI: 10.1002/jmv.24405] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2015] [Indexed: 12/19/2022]
Abstract
HPV plays a role in the development of a portion of head and neck squamous cell carcinoma (HNSCC), but only limited information on its role in southern Chinese population is available. A multicenter case-control study was conducted. HPV type, viral integration, E6/7 mRNA expression status, and TP53 mutation were determined. A total of 228 HNSCC were recruited including 137 (60.1%) oral SCC, 34 (14.9%) oropharyngeal SCC, 31 (13.6%) laryngeal SCC, 21 (9.2%) hypopharyngeal SCC, and 5 (2.2%) lip and paranasal sinus SCC. High-risk HPV infection was found in 7.5% (17/228) of HNSCC, but only a small proportion of samples had evidence of viral integration (5.3%, 12/228) or E6/7 mRNA expression (4.4%, 10/228). HPV infection with oncogenic phenotype (integration and E6/7 mRNA expression) was significantly more common in oropharyngeal SCC than controls (9/34, 26.5% vs. 0/42, 0.0%, P < 0.001). Smoking showed a significant association with HNSCC, oropharyngeal SCC, and laryngeal SCC. TP53 mutation was associated with HNSCC (P < 0.001). Older age, TP53 mutation, and HPV16 infection with oncogenic phenotypes were independently associated factors for HNSCC with odds ratios of 1.03 (1.02-1.05), 3.38 (1.71-6.66), and 9.19 (1.13-74.68), respectively. High-risk HPV infection of head and neck mucosa is not uncommon in the Hong Kong population. This study found that 26-30% of oropharyngeal carcinoma was associated with HPV infection, mostly HPV16, and that smoking which predisposes to TP53 mutations was another important risk factor.
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Affiliation(s)
- Josette S Y Chor
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Alexander C Vlantis
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Tam-Lin Chow
- Department of Surgery, United Christian Hospital, Hong Kong Special Administrative Region, China
| | - Siu-Chung Fung
- Department of Dentistry, United Christian Hospital, Hong Kong Special Administrative Region, China
| | - Fiona Y H Ng
- Department of Surgery, Kwong Wah Hospital, Hong Kong Special Administrative Region, China
| | - Chi-Hung Lau
- Department of Surgery, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - Amy B W Chan
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Luen-Cheung Ho
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - Wing-Hang Kwong
- Department of Surgery, North District Hospital, Hong Kong Special Administrative Region, China
| | - Mandy N S Fung
- Department of Pathology, United Christian Hospital, Hong Kong Special Administrative Region, China
| | - Eddy W H Lam
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.,Department of Otorhinolaryngology, Head and Neck Surgery, Yan Chai Hospital, Hong Kong Special Administrative Region, China
| | - Kwong-Lin Mak
- Department of Surgery, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Holly C Y Lam
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Amy S Y Kok
- Department of Surgery, United Christian Hospital, Hong Kong Special Administrative Region, China
| | - Wendy C S Ho
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Apple C M Yeung
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Paul K S Chan
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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Chow TL, Choi CY, Chiu ANK. Postoperative PTH monitoring of hypocalcemia expedites discharge after thyroidectomy. Am J Otolaryngol 2014; 35:736-40. [PMID: 25091178 DOI: 10.1016/j.amjoto.2014.07.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 07/02/2014] [Accepted: 07/07/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE Hypocalcemia is the most common complication after total thyroidectomy. Some patients need to stay in the hospital for monitoring of hypocalcemic symptoms and serum calcium levels for several days. We investigated the efficacy and safety of using early postoperative parathyroid hormone (PTH) results for early discharge after thyroidectomy. MATERIALS AND METHODS A retrospective cohort study of 2 sequential groups of patients undergoing total thyroidectomy between January 2010 and March 2013 was undertaken. Patients were divided into 2 groups. In Group 1 (before June 2011), patients had daily monitoring of serum calcium level and hypocalcemic symptoms. They were discharged when calcium level was static and asymptomatic. Postoperative PTH was not utilized for discharge plan. In Group 2 (after June 2011), postoperative PTH and calcium level on day 1 were utilized to dictate subsequent management and discharge plan. RESULTS Of the 107 patients reviewed, 54 (50.5%) were in Group 1 and 53 (49.5%) were in Group 2. A total of 51 (47.7%) patients developed hypocalcemia. The two groups were comparable in demographic data, early postoperative PTH value, rate of hypocalcemia, the need for oral calcium and vitamin D supplements and rate of permanent hypoparathyroidism. Fewer patients in Group 2 experienced hypocalcemic symptoms, p=0.005. None of the patients in Group 2 needed intravenous calcium supplement (p=0.003). The median postoperative hospital stay for Group 1 was 4 days and for Group 2 was 1 day (p<0.0001). CONCLUSIONS Postoperative PTH level after total thyroidectomy facilitates early supplementation therapy and abates symptomatic hypocalcemia. It also allows early and safe patient discharge.
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Abstract
Pyriform sinus fistula is important despite its rarity, as it can induce a recurrent neck abscess. Most of the reported cases occur in children and the majority affect only the left side. We report a patient with a pyriform sinus fistula of the right neck in an adult, which was successfully treated by surgery. The aetiology of this entity is also discussed herein.
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Affiliation(s)
- T L Chow
- Department of Surgery, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong.
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Kwan WYW, Chow TL, Choi CY, Lam SH. Complication rates of central compartment dissection in papillary thyroid cancer. ANZ J Surg 2013; 85:274-8. [PMID: 23890372 DOI: 10.1111/ans.12343] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The benefits of central compartment dissection (CCD) in papillary thyroid carcinoma (PTC) are still debatable and should be weighed against its potential risks. We aim to compare the complication rates in total thyroidectomy with and without CCD for patients with PTC. METHODS This is a retrospective study on prospectively collected data from our cancer registry over a 15-year period. Patients with pathologically proven PTC treated with total thyroidectomy alone or with CCD were included. CCD was performed at the operating surgeon's discretion. A total of 105 patients were included and divided into two groups for analysis: group A - total thyroidectomy alone (51 patients, 49%) and group B - total thyroidectomy with CCD (54 patients, 51%). The operative complications between the two groups were then evaluated. RESULTS Overall, 6.9% and 0.98% patients had transient and permanent recurrent laryngeal nerve palsies, respectively. About 19.0% and 2.9% patients had transient and permanent hypoparathyroidism, respectively and 27.6% patients had parathyroid glands found to be included in the resected specimen. Complication rates in terms of transient or permanent recurrent laryngeal nerve palsy or hypoparathyroidism did not differ significantly between groups A and B. Within group B, 41 patients had unilateral CCD and 12 had bilateral CCD. Transient hypoparathyroidism was more frequent in bilateral CCD (50% versus 12.2%, P = 0.01). CONCLUSIONS Total thyroidectomy with prophylactic unilateral CCD is a safe procedure for PTC without added complication rates compared with total thyroidectomy alone. It is recommended for patients with PTC and clinically negative neck lymph nodes.
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Affiliation(s)
- Wai-Yin Wilson Kwan
- Division of Head and Neck Surgery, Department of Surgery, United Christian Hospital, Hong Kong
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Chow TL, Cheung CY. Amyloidosis: a rare cause of tongue swelling. Hong Kong Med J 2013; 19:88.e3-88.e88004. [PMID: 23378366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Affiliation(s)
- T L Chow
- Department of Surgery, United Christian Hospital, Kwun Tong, Hong Kong.
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Abstract
OBJECTIVE Parotidectomy is usually carried out under general anesthesia. We reported our early experience of performing parotidectomy under local anesthesia. STUDY DESIGN Case series reviewed. SETTING Head and neck services of a regional hospital. PATIENTS, INTERVENTION, AND RESULTS: Seven patients underwent parotidectomy under local anesthesia. The indications were high risk for general anesthesia due to co-morbidity in 2 patients and personal preference for the rest. The operations were performed by retrograde facial nerve dissection after superficial cervical plexus block and incision wound infiltration with local anesthetics. There was no conversion to general anesthesia. Six operations were carried out in the setting of ambulatory procedure and were discharged on the same day. Transient mild facial paresis occurred in 2 patients. CONCLUSION Parotidectomy under local anesthesia can be conducted successfully and avoid the adverse effect of general anesthesia.
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Affiliation(s)
- Tam-Lin Chow
- Division of Head and Neck Surgery, Department of Surgery, United Christian Hospital, Kowloon, Hong Kong SAR.
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Chow TL, Choi CY, Hui JYH. Thyroglossal duct cysts in adults treated by ethanol sclerotherapy: a pilot study of a nonsurgical technique. Laryngoscope 2012; 122:1262-4. [PMID: 22461135 DOI: 10.1002/lary.23254] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 01/09/2012] [Accepted: 01/30/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the effect of ethanol sclerotherapy on the thyroglossal duct cyst (TDC). STUDY DESIGN Prospective case series. METHODS Patients with primary TDC were enrolled. The volume of the TDC was calculated using the following formula: length × width × height × π/6. Under sonographic guidance, ethanol was slowly instilled into the TDC cavity after the cyst fluid was aspirated. The procedure was performed in an outpatient setting. RESULTS A total of eight patients were recruited for this study, but two of them did not receive sclerotherapy. One patient refused treatment after obtaining initial consent, and another patient was not treated due to a technical issue. The median follow-up duration was 21 months. The median cyst volume was 3.5 mL. Of the six patients given sclerotherapy, recurrent TDC occurred in one patient. As expected, the TDC persisted in the two patients who had not undergone sclerotherapy. Two patients experienced moderate pain after the procedure that was well controlled with oral analgesics. No major complications arose, and no patient needed hospitalization because of treatment complications. CONCLUSIONS Percutaneous ethanol sclerotherapy is an effective minimally invasive modality of therapy for TDC. Further studies with longer follow-up are warranted.
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Affiliation(s)
- Tam-Lin Chow
- Department of Surgery, United Christian Hospital, Kowloon, Hong Kong.
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Chow TL, Choi CY, Lam SH. Disease control of differentiated thyroid carcinomas by hemithyroidectomy. Singapore Med J 2010; 51:311-314. [PMID: 20505909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Most differentiated thyroid carcinomas (DTC) are treated by total thyroidectomy in Hong Kong. This study investigates the outcome of tumour control in selected patients treated by hemithyroidectomy, which is beneficial in terms of having a lower operative morbidity. METHODS This is a retrospective study of prospectively collected data from our cancer registry. Patients with pathologically proven differentiated thyroid carcinoma were stratified into risk groups according to the patients' age, tumour size, extrathyroid spread and distant metastasis. Low-risk patients were managed with hemithyroidectomy without postoperative radioactive iodine. Central compartment lymph node dissection was also carried out if the diagnosis was confirmed preoperatively. The oncological outcome and surgical morbidity were evaluated. RESULTS A total of 236 patients with the diagnosis of DTC underwent a thyroidectomy at our institution during a 24-year period. 93 patients were initially treated by hemithyroidectomy. Subsequent evaluation was focused on this subgroup. The mean follow-up period was 63.3 +/- 55.1 months. The mean tumour diameter was 22.1 +/- 20.8 mm. The histopathologic diagnoses were papillary carcinoma (69 cases; 74.2 percent), follicular carcinoma (20 cases; 21.5 percent) and Hurthle cell carcinoma (four cases; 4.3 percent). 23 (24.7 percent) patients underwent hemithyroidectomy coupled with central compartment dissection. Pathologically proven lymph node metastasis was diagnosed in 12 (12.9 percent) patients. Transient vocal cord palsy occurred in six (6.5 percent) patients, while permanent vocal cord palsy occurred in two (2.2 percent). Local tumour recurrence arose in only one (1.1 percent) patient. No patient succumbed to the thyroid cancer. CONCLUSION Hemithyroidectomy coupled with central compartment dissection in selected cases of DTC can achieve excellent tumour control with minimal surgical morbidity.
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Affiliation(s)
- T L Chow
- Division of Head and Neck Surgery, Department of Surgery, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong SAR.
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Chow TL, Chan T, Law SK, Lam SH. A simple home-made self-retaining retractor for thyroidectomy. Can J Surg 2009; 52:523-524. [PMID: 20011191 PMCID: PMC2792377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2008] [Indexed: 05/28/2023] Open
Affiliation(s)
- Tam-Lin Chow
- Department of Surgery, United Christian Hospital and
| | - Tony Chan
- private practice, Kwun Tong, New Kowloon, Hong Kong
| | - Siu-King Law
- Department of Surgery, United Christian Hospital and
| | - Siu-Ho Lam
- Department of Surgery, United Christian Hospital and
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Chow TL, Lee DTY, Choi CY, Chan TTF, Lam SH. Prediction of Simultaneous Esophageal Lesions in Head and Neck Squamous Cell Carcinoma. ACTA ACUST UNITED AC 2009; 135:882-5. [DOI: 10.1001/archoto.2009.105] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Lam TL, Wong GKY, Chong HC, Cheng PNM, Choi SC, Chow TL, Kwok SY, Poon RTP, Wheatley DN, Lo WH, Leung YC. Recombinant human arginase inhibits proliferation of human hepatocellular carcinoma by inducing cell cycle arrest. Cancer Lett 2009; 277:91-100. [PMID: 19138817 DOI: 10.1016/j.canlet.2008.11.031] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 10/31/2008] [Accepted: 11/22/2008] [Indexed: 12/19/2022]
Abstract
Human hepatocellular carcinoma (HCC) has an elevated requirement for arginine in vitro, and pegylated recombinant human arginase I (rhArg-PEG), an arginine-depleting enzyme, can inhibit the growth of arginine-dependent tumors. While supplementation of the culture medium with ornithine failed to rescue Hep3B cells from growth inhibition induced by rhArg-PEG, citrulline successfully restored cell growth. The data support the roles previously proposed for ornithine transcarbamylase (OTC) in the arginine auxotrophy and rhArg-PEG sensitivity of HCC cells. Expression profiling of argininosuccinate synthetase (ASS), argininosuccinate lyase (ASL) and OTC in 40 HCC tumor biopsy specimens predicted that 16 of the patients would be rhArg-sensitive, compared with 5 who would be sensitive to arginine deiminase (ADI), another arginine-depleting enzyme with anti-tumor activity. Furthermore, rhArg-PEG-mediated deprivation of arginine from the culture medium of different HCC cell lines produced cell cycle arrests at the G(2)/M or S phase, possibly mediated by transcriptional modulation of cyclins and/or cyclin dependent kinases (CDKs). Based on these results, together with further validation of the in vivo efficacy of rhArg-PEG against HCC, we propose that the application of rhArg-PEG alone or in combination with existing chemotherapeutic drugs may represent a specific and effective therapeutic strategy against HCC.
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Affiliation(s)
- T L Lam
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
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Chow TL, Chan TTF, Choi CY, Lam SH. Submandibular sialoadenectomy with local anesthesia in the era of minimally invasive surgery. Otolaryngol Head Neck Surg 2008; 138:752-5. [DOI: 10.1016/j.otohns.2008.03.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Revised: 03/05/2008] [Accepted: 03/20/2008] [Indexed: 11/26/2022]
Abstract
Objective To assess the feasibility and advantages of submandibular sialoadenectomy under local anesthesia. Study Design Retrospective clinical study. Subjects and Methods Twenty patients with benign submandibular masses underwent submandibular sialoadenectomy. The procedure was carried out under local anesthesia (LA) in 12 patients and general anesthesia (GA) in 8 patients. The patient and tumor characteristics, as well as treatment outcome or complications, were compared between the two groups. Results There was no conversion from LA to GA. Nine patients in the LA group could be discharged as day-case surgery versus none in the GA group, P = 0.001. The postoperative hospital stay was also much shorter in the LA group: 0.4 day vs 2.0 days, P < 0.001. Postoperative vomiting occurred in only two of the eight patients of the GA group. Complication rate was similar. Conclusion Submandibular sialoadenectomy under local anesthesia is feasible. It can shorten the hospital stay and facilitate day-case surgery.
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Affiliation(s)
- Tam-Lin Chow
- Division of Head and Neck Surgery, Department of Surgery, United Christian Hospital. Hong Kong
| | - Tony Tung-Fei Chan
- Division of Head and Neck Surgery, Department of Surgery, United Christian Hospital. Hong Kong
| | - Chi-Yee Choi
- Division of Head and Neck Surgery, Department of Surgery, United Christian Hospital. Hong Kong
| | - Siu-Ho Lam
- Division of Head and Neck Surgery, Department of Surgery, United Christian Hospital. Hong Kong
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Chow TL, Chan TTF, Chan SWW, Lam SH. Postmastectomy reconstruction with extended latissimus dorsi myocutaneous flap for Hong Kong Chinese. Surgical Practice 2008. [DOI: 10.1111/j.1744-1633.2008.00394.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chow TL, Chan TTF, Choi CY, Lam SH. Kuttner's tumour (chronic sclerosing sialadenitis) of the submandibular gland: a clinical perspective. Hong Kong Med J 2008; 14:46-49. [PMID: 18239243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVE To study clinical perspectives pertaining to chronic sclerosing sialadenitis, which is also known as Kuttner's tumour. DESIGN Retrospective medical chart review. SETTING Regional hospital, Hong Kong. PATIENTS From February 2005 to February 2007, nine cases with Kuttner's tumour were identified from our hospital electronic database. INTERVENTIONS They underwent submandibular sialadenectomy under either local (n=6) or general (n=3) anaesthesia. MAIN OUTCOME MEASURES The results of preoperative ultrasonography, fine-needle aspiration cytology, and intra-operative frozen section examination were correlated with the final diagnosis. Operative morbidity was also evaluated. RESULTS The mean age of the patients at diagnosis was 61 years; three were females. Three had bilateral submandibular swellings. Following preoperative ultrasonography in six of the patients, tumours were suspected in two, an enlarged lymph node in one, and diffuse enlargement was visualised in the other three. Six patients had preoperative fine-needle aspiration cytology; five yielded scanty acini with normal-looking ductal cells, variable degrees of infiltration by chronic inflammatory cells without granuloma admixing fibrosis. In the sixth patient, only bland-looking epithelial cells, indicative of ductal differentiation suspicious of neoplasm were noted. Intra-operative frozen section examination was conducted in three patients: chronic inflammation without evidence of carcinoma was visualised in each. Operations performed under local anaesthesia were well tolerated; only one patient endured a transient, marginal facial nerve palsy. CONCLUSIONS Kuttner's tumour is by no means rare. When supported by ultrasonography and fine-needle aspiration cytology, an accurate diagnosis can be made preoperatively and surgery can be reserved for symptomatic cases. Submandibular sialadenectomy is a safe and effective means of treating Kuttner's tumour, and can be accomplished under local anaesthesia.
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Affiliation(s)
- T L Chow
- Division of Head and Neck Surgery, Department of Surgery, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
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Chow TL, Chan SWW, Lam SH. Ranula successfully treated by botulinum toxin type A: report of 3 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 105:41-2. [PMID: 17764989 DOI: 10.1016/j.tripleo.2007.04.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Revised: 03/07/2007] [Accepted: 04/09/2007] [Indexed: 05/17/2023]
Abstract
The conventional treatment of ranula is surgical procedure. We report an innovative method for ranula by using botulinum toxin type A on 3 patients. All 3 cases of ranula resolved after this minimally invasive therapy. The treatment complication was minimal.
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Affiliation(s)
- Tam-Lin Chow
- Division of Head and Neck Surgery, Department of Surgery, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong Special Administrative Region.
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Abstract
BACKGROUND The submental flap was described for head and neck reconstruction more than a decade ago. Its application is confined mainly to nonmalignant diseases or low-grade malignancies, as the submental flap resides in the level I lymphatic drainage region of the neck. The authors report the use of the submental flap for soft-tissue reconstruction in a selected group of patients with aggressive orofacial cancer. METHODS From March of 2003 to September of 2005, 10 patients (nine with intraoral squamous cell carcinoma and one with facial angiosarcoma) underwent submental flap reconstruction after surgical extirpation of aggressive orofacial malignancies. The indications were severe comorbidity, old age, the presence of another incurable cancer, and/or the patient's skepticism about undergoing a free flap operation. RESULTS Of the surviving patients, the median follow-up was 21 months (range, 2 to 37 months). There were no cases of total flap failure, but partial necrosis occurred in two cases. Three patients experienced tumor recurrence, but only one case might have been related to use of the submental flap. Postoperative oral function, in terms of swallowing and speech, was well preserved; conventional dentures were fabricated for four patients. CONCLUSIONS In selected patients with aggressive orofacial cancer, the submental flap is an expedient alternative to free tissue transfer for reconstruction. Nonetheless, indiscriminate use might compromise the oncological outcome, so it cannot be regarded as a standard method of treatment.
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Affiliation(s)
- Tam-Lin Chow
- Hong Kong, S.A.R. From the Divisions of Head and Neck Surgery, Breast Surgery, Reconstructive Surgery, and Maxillofacial and Dental Surgery, United Christian Hospital
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Chow TL, Chan TTF, Ho YW, Lam SH. Improvement of Anemia After Parathyroidectomy in Chinese Patients With Renal Failure Undergoing Long-term Dialysis. ACTA ACUST UNITED AC 2007; 142:644-8. [PMID: 17638802 DOI: 10.1001/archsurg.142.7.644] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
HYPOTHESIS Most patients undergoing long-term dialysis are anemic because of underproduction of erythropoietin and its inhibition by high parathyroid hormone levels due to secondary hyperparathyroidism. Renal anemia can be improved by parathyroidectomy. DESIGN Retrospective cohort study. SETTING Regional hospital. PATIENTS Twenty-three Chinese patients without a previous functioning renal transplant underwent parathyroidectomy for severe secondary hyperparathyroidism in a 3-year period. INTERVENTION Total parathyroidectomy with or without parathyroid autograft at the forearm. MAIN OUTCOME MEASURES The preoperative and 6-month postoperative hematological and biochemical variables were compared for any differences by means of a paired t test. RESULTS The mean +/- SD follow-up duration was 17.7 +/- 8.1 (range, 6-34) months. Three patients (13%) developed persistent or recurrent hyperparathyroidism and 2 patients (9%) were biochemically hypoparathyroid. The other 18 patients (78%) were euparathyroid. Surgical morbidity was minimal; only 1 patient had complications, consisting of a postoperative fever of unknown origin that resolved with conservative treatment. The mean +/- SD hemoglobin level (8.6 +/- 2.1 vs 9.4 +/- 2.1 g/dL) but not the mean platelet level was significantly (P = .04) increased 6 months postoperatively. Likewise, the following other mean +/- SD biochemical values improved after surgery: parathyroid hormone (2235 +/- 500 vs 151 +/- 312 pg/mL; P<.001), alkaline phosphatase (645 +/- 349 vs 123 +/- 82 U/L; P<.001), calcium (10.8 +/- 4.0 vs 9.3 +/- 1.0 mg/dL; P<.001), phosphate (1.93 +/- 0.73 vs 1.50 +/- 0.51 mmol/L; P = .02), and albumin (3.5 +/- 0.5 vs 3.8 +/- 0.6 g/dL; P = .006). CONCLUSIONS Parathyroidectomy is highly effective to control secondary hyperparathyroidism with an exceedingly low complication rate. The hemoglobin level was significantly elevated 6 months postoperatively. The long-term effect warrants future trials.
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Affiliation(s)
- Tam-Lin Chow
- Division of Head and Neck, Reconstructive and Breast Surgery, Department of Surgery, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
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Suen DTK, Chow TL, Lam CYW, Wong ESW, Lam SH. SENSATION RECOVERY IMPROVED BY GREAT AURICULAR NERVE PRESERVATION IN PAROTIDECTOMY: A PROSPECTIVE DOUBLE-BLIND STUDY. ANZ J Surg 2007; 77:374-6. [PMID: 17497980 DOI: 10.1111/j.1445-2197.2007.04064.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The great auricular nerve (GAN) is frequently sacrificed during parotidectomy and causes sensory disturbance of the auricle. Our study is to investigate whether GAN preservation can improve the sensory recovery. METHODS Patients undergoing superficial or total conservative parotidectomy for benign tumours were recruited consecutively from November 1998 to September 2001. Different sensory methods (light touch, two-point discrimination and sharp pain) of the auricle were evaluated by a designated physiotherapist preoperatively as well as at 1, 3, 6 and 12 months postoperatively. The patients and the physiotherapist were blinded to the integrity of the GAN. Long-term subjective assessment was also carried out beyond 2 years postoperatively. RESULTS A total of 21 patients were recruited for the study. GAN were preserved in 10 patients. The mean follow up was 16 months (12-42 months). There was no difference in sex distribution, type of operation and pathology of parotid tumour between the two groups. No postoperative mortality occurred and postoperative morbidity did not differ between the two groups. Patients with GAN preserved had significantly better light touch and sharp pain recovery at 1 year postoperatively. Subjective assessment of sensory dysfunction also favoured GAN preservation. CONCLUSION Great auricular nerve preservation minimizes the postoperative sensory disturbance and should be considered whenever tumour clearance is not compromised.
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Affiliation(s)
- Dacita T K Suen
- Division of Head and Neck Surgery, Department of Surgery, United Christian Hospital, Hong Kong SAR, China.
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Leung VKS, Chan WH, Chow TL, Luk ISC, Chau TN, Loke TKL. Oesophageal tuberculosis mimicking oesophageal carcinoma. Hong Kong Med J 2006; 12:473-6. [PMID: 17148804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
Tuberculous involvement of the oesophagus is rare, and is usually caused by direct spread from adjacent afflicted structures. We report an 83-year-old male patient with oesophageal tuberculosis secondary to tuberculous mediastinal lymphadenitis who presented with non-specific symptoms of anorexia and lethargy. Upper gastro-intestinal endoscopy revealed an ulcerative tumour-like lesion in the mid-oesophagus suggesting oesophageal carcinoma. Repeated endoscopic biopsies revealed a non-specific acute-on-chronic inflammation consisting of non-caseating granulomas, with no evidence of malignancy. Endoscopic ultrasonography demonstrated that the oesophageal lesion was secondary to direct extension of mediastinal lymphadenopathy. The diagnosis of tuberculosis was eventually confirmed by histological and microbiological analysis of a surgically excised cervical lymph node. The patient responded promptly to treatment with antituberculous drugs. We suggest that oesophageal tuberculosis has to be kept in mind in the differential diagnosis of oesophageal ulcerohypertrophic lesions.
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Affiliation(s)
- V K S Leung
- United Christian Hospital, Hong Kong: Department of Medicine and Geriatrics.
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Chow TL, Chan TTF, Suen DTK, Chu DW, Lam SH. Surgical management of substernal goitre: local experience. Hong Kong Med J 2005; 11:360-5. [PMID: 16219955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES To examine the presentation, workup, and surgical complications of substernal goitre. DESIGN Retrospective study. SETTING Regional hospital, Hong Kong. PATIENTS Twenty-four mostly elderly patients (mean age, 60.1 years) who underwent thyroidectomy for substernal goitres between 2000 and 2003 (substernal goitres were defined as those having either a caudal mass transgressing the fourth thoracic vertebra or having more than 50% of their overall mass residing within the thorax). MAIN OUTCOME MEASURES Symptoms, histopathological diagnoses, morbidities, and complications. RESULTS Dyspnoea was the most common symptom (n=8, 33%). Three (12.5%) patients presented with acute airway obstruction; however, 13 (54.2%) were asymptomatic apart from the presence of cervical masses. Computed tomographic scans were performed on all but two patients. Malignancy was present in 12.6% of patients, or 16.8% if occult papillary carcinoma is included. Partial or full sternotomies were performed in two (8.3%) patients. Complications included recurrent laryngeal nerve injury (n=1, 2.7% of nerves at risk), transient hypoparathyroidism (n=2, 13.3% of patients at risk), haematoma (n=1, 2.7%), pneumonia (n=1, 2.7%), and wound infection (n=1, 2.7%). There was no operative mortality or permanent hypoparathyroidism. The complication rate was significantly lower in the asymptomatic patients (P=0.033 by Fisher's exact test); clinicopathological parameters were otherwise statistically comparable between the two groups. CONCLUSIONS There is rarely any mortality in thyroidectomy for substernal goitre, and the morbidity is also very low, especially in asymptomatic patients. In the absence of contra-indications, substernal goitre should be treated with early surgery rather than having it run the risk of acute airway distress or cancer.
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Affiliation(s)
- T L Chow
- Department of Surgery, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
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Abstract
BACKGROUND The aim of this study was to determine the predictive risk factors for complications resulting from foreign body ingestion. METHODS A consecutive series of 1338 patients with suspected foreign body ingestion presenting from 1996 to 2000 were studied retrospectively. The potential risk factors for complications after foreign body ingestion were analysed by multivariate logistic regression and included concurrent medical illness, age, duration and types of symptoms, types of foreign body ingested, positive cervical radiographic findings and the level of foreign body impaction. RESULTS Fish bone (62.7 per cent) was the commonest type of foreign body ingested. Most of the objects were impacted at or above the cricopharyngeus, the commonest site being the valleculae (31.4 per cent). Multivariate analysis showed that presentation delayed for more than 2 days (P < 0.001), positive cervical radiographic findings (P < 0.001) and foreign body impacted at the cricopharyngeus (P = 0.009) or upper oesophagus (P = 0.005) were significant independent risk factors associated with the development of complications after foreign body ingestion. CONCLUSION In patients with a foreign body seen on plain cervical radiography, presentation delayed for more than 2 days after ingestion, and foreign body impacted at the level of the cricopharyngeus or oesophagus there is a high degree of correlation with the occurrence of complications. Awareness should be raised when these risk factors are present.
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Affiliation(s)
- A T Y Lai
- Department of Surgery, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong, China.
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Abstract
BACKGROUND Occult lymph node (LN) metastasis is common in papillary thyroid carcinoma. Sentinel lymph node (SLN) biopsy has been proven to be successful and accurate to predict the nodal status in melanoma and breast cancer. We investigate the use of SLN in papillary thyroid carcinoma. METHODS Patients of previously untreated papillary thyroid carcinoma, diagnosed preoperatively by fine-needle cytology without any palpable cervical LN are prospectively studied. Blue dye injection was utilized for the SLN biopsy followed by central compartment lymphadenectomy. The histopathological results of the SLN and lymphadenectomy specimens were compared. RESULTS Fifteen consecutive patients underwent surgery including SLN biopsy for papillary thyroid carcinoma. Occult nodal metastases were identified in 10 patients (67%). The other five cases had no nodal metastasis. SLN were found in 10 cases. One, two and three SLN were present in three, three and four patients, respectively. SLN were located in the central compartment in eight cases. The SLN were found in the lateral compartment in one case. In the remaining one case, the SLN were found in both the central and lateral compartments. Of the group with found SLN, false negative occurred in one case. The overall accuracy of the SLN in predicting the nodal status was 90%. The sensitivity, specificity, positive predictive value and negative predictive value were 88%, 100%, 100% and 67%, respectively. No complications were directly related to SLN biopsy. CONCLUSION Occult nodal spread is frequently encountered in papillary thyroid carcinoma. SLN biopsy is safe and feasible in papillary thyroid cancer, however further studies are necessary to improve the diagnostic accuracy prior to routine clinical use.
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Affiliation(s)
- Tam-Lin Chow
- Division of Head & Neck, Breast and Reconstruction Surgery, Department of Surgery, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong SAR, China
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Chow TL, Kwok SPY. Use of botulinum toxin type A in a case of persistent parotid sialocele. Hong Kong Med J 2003; 9:293-4. [PMID: 12904619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Sialocele is an uncommon complication of parotidectomy. Most cases resolve after conservative therapy consisting of repeated aspiration and pressure dressing. The condition is, however, occasionally resistant to such therapy. We report on a 52-year-old Chinese man who had a 10-year history of right parotid swelling. Following fine-needle aspiration cytology, Warthin's tumour was diagnosed, but after elective parotidectomy, a swelling developed and parotid sialocele was diagnosed. Botulinum toxin type A was given after the sialocele had persisted for almost 3 weeks after surgery, and after conservative management had been tried; the sialocele disappeared after two doses of treatment. Botulinum toxin therapy was thus an effective method of treating persistent sialocele.
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Affiliation(s)
- T L Chow
- Division of Head and Neck, Breast and Reconstructive Surgery, Department of Surgery, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Hong Kong
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Abstract
BACKGROUND The present study was undertaken to evaluate the efficacy of acupuncture anaesthesia in inguinal hernia repair. METHODS Twelve patients with non-recurrent inguinal hernia had Lichtenstein mesh repair under acupuncture anaesthesia. Selected acupuncture loci were stimulated with fine needles connected to low frequency current. Supplementary local anaesthetic was given when required. RESULTS Four (33%) patients reported satisfactory analgesic effect throughout the operation without need for additional medication, eight (67%) patients experienced mild discomfort during the operation requiring 1-4 mL of 1% lignocaine injection. Blood pressure and heart rate were stable during the procedure. All patients were able to sit up and resume their diet immediately post-operatively. All but one patient were discharged on day one after the procedure, with no early or late complications reported. Most patients were satisfied with the analgesic effect of acupuncture anaesthesia. CONCLUSIONS Acupuncture anaesthesia is a feasible anaesthetic option. It reduces the amount of local anaesthetic required, and thus the associated potential complications. It is effective in pain relief and inhibiting gastrointestinal upset. Postoperative recovery was rapid and complication free.
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Affiliation(s)
- David Wa Chu
- Department of Surgery, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
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Chow TL, Chow TK, Lui YH, Sze WM, Yuen NWF, Kwok SPY. Lymphoepithelioma-like carcinoma of oral cavity: report of three cases and literature review. Int J Oral Maxillofac Surg 2002; 31:212-8. [PMID: 12102423 DOI: 10.1054/ijom.2001.0148] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Lymphoepithelioma-like carcinoma is a rare tumour in the oral cavity and is characterized histologically by non-keratinizing, undifferentiated squamous cell carcinoma with lymphocytic infiltration. Three consecutive cases of intraoral lymphoepithelioma-like carcinoma are reported. A review of the literature reveals a similar biological behaviour to that of nasopharyngeal lymphoepithelioma: a high incidence of cervical nodal spread and remarkable radiosensitivity. Chemotherapy should be considered when nodal or distant metastases are present. The association of the Epstein-Barr virus with this tumour remains unclear but our experience suggests a positive correlation in Chinese individuals.
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Affiliation(s)
- T L Chow
- Department of Surgery, United Christian Hospital, Kowloon, Hong Kong
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Abstract
BACKGROUND Acute diverticulitis of the caecum and ascending colon is uncommon. Controversies abound as regards the optimal surgical treatment, ranging from appendectomy, diverticulectomy to right hemicolectomy. The aim of the present paper was to review treatment strategy followed by a critical appraisal. METHODS The case notes of 30 patients with acute diverticulitis of the right colon who were treated at the United Christian Hospital, Hong Kong from 1992 to 1998 were systematically reviewed. The data were subjected to statistical analysis. RESULTS The median age was 34 years, with a male:female ratio of 1:1.15. All patients presented with acute right lower abdominal pain and localized rebound tenderness. All were diagnosed preoperatively as having appendicitis. The mean duration of symptoms was 2 days (range: 1-6 days). Two treatment groups were identified. Group A (n = 16; 53%) received appendicectomy alone, while group B (n = 14; 47%) underwent diverticulectomy in addition to appendicectomy, including one patient with perforated diverticulitis. Overall, there was no procedure-related morbidity or mortality. Both groups received a similar duration of broad-spectrum antibiotics. All the patients were interviewed by phone after operation to detect any recurrence of symptoms, with a median follow-up interval of 34 months (range: 11-78 months). There was no recurrence of symptoms in group A, which received appendicectomy and antibiotics. The only difference was operative time. CONCLUSION For non-perforated diverticulitis of the right colon, appendicectomy and intravenous antibiotics without diverticulectomy is the preferred treatment strategy.
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Affiliation(s)
- P W Chiu
- Department of Surgery, United Christian Hospital, Hong Kong
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Chow TL, Chu W, Lim BH, Kwok SP. Outcomes and complications of thyroid surgery: retrospective study. Hong Kong Med J 2001; 7:261-5. [PMID: 11590267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
OBJECTIVE To study the outcome and complications of thyroid surgery. DESIGN Retrospective study. SETTING Regional hospital, Hong Kong. PATIENTS Three hundred and twelve patients (266 women and 46 men) underwent thyroid surgery between January 1994 and December 1999. MAIN OUTCOME MEASURES Complications of thyroidectomy for various thyroid diseases according to surgical technique used. RESULTS Capsular dissection gradually became a more popular surgical technique: 33% and 58% in the first and second halves of the study period respectively (P<0.001). The overall rate of permanent vocal cord palsy was 2%. Near-total thyroidectomy became the preferred surgical treatment for toxic goitre over the study period. The incidence of recurrent hyperthyroidism was reduced from 21% to 7% (P>0.1, not significant). The incidence of hypoparathyroidism was approximately 30% after thyroidectomy for cancer. CONCLUSION Capsular dissection is increasingly utilised in thyroid surgery. Low complication rates can be achieved after thyroidectomy for benign diseases. Hypoparathyroidism, however, is a relatively common complication after surgery for thyroid cancer.
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Affiliation(s)
- T L Chow
- Department of Surgery, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
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Chow TL, Lam CY, Chiu PW, Lim BH, Kwok SP. Sternomastoid-muscle transposition improves the cosmetic outcome of superficial parotidectomy. Br J Plast Surg 2001; 54:409-11. [PMID: 11428772 DOI: 10.1054/bjps.2001.3586] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A facial depressed deformity subsequent to superficial parotidectomy is unsightly. Although a facelift incision can improve the cosmetic outcome by concealing the scar, the hollow contour around the angle of the mandible remains conspicuous. We have attempted to mitigate this problem by transposition of the sternomastoid muscle. Transposition of the sternomastoid muscle to cover the parotid bed after superficial parotidectomy for benign tumour was performed in eight consecutive patients. The histopathology and postoperative results, including complications and patient satisfaction, were analysed. The depressed deformity was considerably alleviated in all eight patients. All patients except one, who had a wound infection, were satisfied with the cosmetic outcome postoperatively. The extra operative time required for sternomastoid-muscle transposition was only 10 min. There was no morbidity related to this additional procedure. By combining this simple method with a facelift incision, an appealing cosmetic outcome can be achieved after superficial parotidectomy.
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Affiliation(s)
- T L Chow
- Division of Head and Neck, Breast and Reconstructive Surgery, Department of Surgery, United Christian Hospital, Kowloon, Hong Kong
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Yuen AP, Lam KY, Wei WI, Lam KY, Ho CM, Chow TL, Yuen WF. A comparison of the prognostic significance of tumor diameter, length, width, thickness, area, volume, and clinicopathological features of oral tongue carcinoma. Am J Surg 2000; 180:139-43. [PMID: 11044531 DOI: 10.1016/s0002-9610(00)00433-5] [Citation(s) in RCA: 166] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The present study aims at evaluation of the prognostic value of tumor size including diameter, length, thickness, width, area, and volume in the prediction of nodal metastasis, local recurrence, and survival of oral tongue carcinoma. The results will have important implications for the management of patients. METHODS Eighty-five glossectomy specimens of oral tongue carcinoma were serially sectioned in 3 mm thickness for the tumor size evaluation with computer image analyzer. RESULTS Among all the tumor size parameters being evaluated, tumor thickness was the only significant factor for the prediction of local recurrence, nodal metastasis, and survival. With the use of 3 mm and 9 mm division, tumor of up to 3 mm thickness has 10% nodal metastasis, 0% local recurrence, and 100% 5-year actuarial disease-free survival; tumor thickness of more than 3 mm and up to 9 mm has 50% nodal metastasis, 11% local recurrence, and 77% 5-year actuarial disease free survival; tumor of more than 9 mm has 65% nodal metastasis, 26% local recurrence, and 60% 5-year actuarial disease-free survival. CONCLUSIONS Tumor thickness should be considered in the management of patients with oral tongue carcinoma.
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Affiliation(s)
- A P Yuen
- Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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Affiliation(s)
- W K Mak
- Department of Surgery, United Christian Hospital, Kwun Tong, Hong Kong
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