Dr. Sung is a laryngologist in the Department of Otolaryngology - Head & Neck Surgery who specializes in voice, swallowing and airway disorders.
Dr. Sung graduated from Harvey Mudd College in Claremont, CA with a bachelor’s of science degree in chemistry with a minor in music. He earned a master’s of science degree in organic chemistry from the University of Pennsylvania. He attended the State University of New York – Downstate Medical Center and obtained his MD in 2004.
He completed his internship in general surgery at Mt. Sinai School of Medicine in New York City in 2005. He continued at Mt. Sinai to finish his residency in otolaryngology – head & neck surgery in 2009. Following residency, he completed a fellowship in laryngology at Harvard Medical School – Massachusetts Eye and Ear Infirmary with Ramon A. Franco, Jr., MD in 2010.
In addition to his medical training, Dr. Sung worked extensively as a professional singer and actor for several years. He attended drama academy in New York City and performed in productions off-Broadway, in regional theaters, and in national and international tours. He has also performed with the Stanford University Symphonic Choir.
Dr. Sung joined the Stanford faculty in 2010 as Assistant Professor. He is also a staff physician at the Veteran’s Administration Palo Alto Health Care System.
His clinical interests include the care of professional voice users; phonomicrosurgery; treatment of vocal fold paralysis with laryngeal framework surgery and injection techniques; diagnosis and Botox treatment of spasmodic dysphonia; office-based laser surgery; treatment of recurrent laryngeal papilloma; treatment of essential laryngeal tremor; and treatment of laryngeal cancer.
- Voice Disorders
- Vocal Cord Paralysis
- Spasmodic Dysphonia
- Laryngeal Cancer
- Laryngeal Laser Thearapy
- Swallowing Disorders
- Airway Disorders
Assistant Professor - Med Center Line, Otolaryngology - Head & Neck Surgery Divisions
Residency Program Director, Stanford University School of Medicine, Dept. of Otolaryngology - Head & Neck Surgery (2019 - Present)
Director of Otolaryngology Medical Student Clerkship, Stanford University School of Medicine, Dept. of Otolaryngology - Head & Neck Surgery (2011 - 2017)
Medical Student Admissions Reviewer, Stanford University School of Medicine (2012 - 2013)
Laryngology & Bronchoesophagology Education Committee, American Academy of Otolaryngology – Head and Neck Surgery (2011 - 2017)
Home Study Course Laryngology & Bronchoesophagology Working Group, American Academy of Otolaryngology – Head and Neck Surgery (2011 - 2017)
Course Director of Otolaryngology - Head & Neck Surgery Grand Rounds, Stanford University School of Medicine, Dept. of Otolaryngology (2011 - 2015)
Honors & Awards
J. Arthur Campbell Award for Chemistry, Harvey Mudd College (1989)
Phi Lambda Upsilon, University of Pennsylvania (1989)
Outstanding Teaching Award, Department of Chemistry, University of Pennsylvania (1990)
Alpha Omega Alpha, SUNY Downstate Medical Center (2003)
Award for Outstanding Academic Achievement, Department of Otolaryngology, SUNY Downstate Medical Center (2004)
Magna Cum Laude, SUNY Downstate Medical Center (2004)
Third Prize, Metropolitan New York Resident Research Day Symposium (2007)
Travel Award, Triological Society (2007, 2009)
First Prize Proffered Paper Session, New York Head and Neck Society (2008)
Boards, Advisory Committees, Professional Organizations
Member, American Academy of Otolaryngology - Head & Neck Surgery (2005 - Present)
Diplomate, American Board of Otolaryngology (2010 - Present)
Member, American Broncho-Esophagological Association (ABEA) (2013 - Present)
Internship: Icahn School of Medicine at Mount Sinai (2005) NY
Fellowship: Massachusetts Eye and Ear Infirmary Ophthalmic Training (2010) MA
Medical Education: SUNY Downstate School of Medicine Registrar (2004) NY
Residency: Mt Sinai School of Medicine (2009) NY
Board Certification: Otolaryngology, American Board of Otolaryngology (2010)
Board Certification, American Board of Otolaryngology, Otolaryngology (2010)
Fellowship, Harvard Medical School - Massachusetts Eye & Ear Infirmary, Laryngology (2010)
Residency, Mt. Sinai School of Medicine, Otolaryngology (2009)
Internship, Mt. Sinai School of Medicine, General Surgery (2005)
MD, State University of New York - Downstate Medical Center, Medicine (2004)
MS, University of Pennsylvania, Organic Chemistry (1992)
BS, Harvey Mudd College, Chemistry (1989)
Current Research and Scholarly Interests
- Development of office-based laryngeal surgical methods and instrumentation.
- Clinical outcomes after treatment of glottic insufficiency.
- Clinical outcomes after treatment of benign vocal fold pathology.
- Medical student and resident training curriculum development.
- Introduction to Otolaryngology-Head and Neck Surgery
OTOHNS 200 (Win)
- Independent Studies (4)
Prior Year Courses
- Introduction to Otolaryngology-Head and Neck Surgery
OTOHNS 200 (Win)
- Introduction to Otolaryngology-Head and Neck Surgery
Outcomes in modified transoral resection of diverticula for Zenker's diverticulum.
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
PURPOSE: Transoral resection of Zenker's diverticulum(TORD) was first reported in 2010. We present results for our modified approach to transoral resection (MTORD)-full-thickness cricopharyngeal myectomy, diverticulum sac excision, and suture closure of the pharyngotomy-and evaluate its safety and efficacy compared to endoscopic stapling and open approaches.METHODS: A retrospective study was performed in patients who underwent transoral resection of Zenker's diverticulum using MTORD, endoscopic stapler-assisted diverticulotomy (ESD), or trancervical diverticulectomy (TCD) from July 2009 to August 2017. Pre-operative evaluation included barium swallow and subjective characterization of swallowing dysfunction using the EAT-10 and Reflux Symptom Index (RSI). Complications, length of hospitalization, recurrence, and revision rates were also evaluated.RESULTS: Of 92 patients reviewed, 18 underwent MTORD, 45 underwent ESD and 29 underwent TCD. Major complications were only observed in ESD and TCD. Recurrence which required revision surgery was only observed in ESD. EAT-10 and RSI scores significantly improved and RSI scores normalized post-operatively for all approaches in short-term (<1year) follow-up.CONCLUSIONS: MTORD is a safe and effective option for complete Zenker's diverticulectomy. Complication rates are low. To date, no patient has required reoperation, although more cases and longer term follow-up are needed for more complete comparison to ESD and traditional open excision.
View details for PubMedID 30877422
The Clinical Course of Idiopathic Bilateral Vocal Fold Motion Impairment in Adults: Case Series and Review of the Literature.
Journal of voice : official journal of the Voice Foundation
AIM: Steps for assessment and successful management of bilateral vocal fold motion impairment (VFMI) are (1) recognition of its presence, (2) identifying the etiology and factors restricting vocal fold motion, (3) evaluation of airway patency, and (4) establishing a management plan. No large series documenting the course and outcome of adult idiopathic bilateral VFMI has been published within the past 15 years.METHODS: Retrospective chart review of adult patients with idiopathic bilateral VFMI at a tertiary academic center. A diagnosis was established if history, physical examination with laryngoscopy, and initial imaging excluded a cause. Records were reviewed for demographics, clinical characteristics, surgical intervention details, and length of follow-up.RESULTS: Nine adult patients with idiopathic bilateral VFMI were identified. There were five males and four females with a mean age of 59.6 years. The mean follow-up period was 54.4 months (range, 6-111 months). Upon presentation to our laryngology service, three patients were advised observation, three patients were advised to undergo urgent tracheostomy, and three patients were advised to undergo elective surgery for airway management. By the end of the follow-up period, only four patients (4/9, 44.4%) were tracheostomy dependent, one of them was lost to follow-up after tracheostomy tub downsizing for decannulation.CONCLUSIONS: To our best knowledge, this is the largest series so far of adult patients with idiopathic bilateral VFMI. Conservative treatment can be considered as an alternative to surgery in select cases.
View details for PubMedID 30527967
Early Injection Laryngoplasty After Surgery: 30 Cases and Proposed Aspiration Assessment Protocol.
Journal of voice : official journal of the Voice Foundation
Vocal fold movement impairment may significantly compromise postoperative recovery and quality of life of patients following thoracic or cardiothoracic surgery or prolonged intubation. The literature is limited and there is no standard screening protocol for the optimal postoperative swallowing and aspiration evaluations. We performed retrospective review of adult patients undergoing early vocal fold (VF) injection laryngoplasty for acute postoperative Vocal fold movement impairment (<30 days) that had both pre- and postinjection speech language pathologist (SLP) performed swallowing/aspiration evaluations. Records were reviewed for demographics, clinical characteristics, procedural details, and short-term outcome measures of oral intake. In total, 30 patients were included, and had data on swallowing/aspiration studies before and after the VF injection laryngoplasty. Most of the patients were injected within 5 days following the laryngologist evaluation and within 14 days following the iatrogenic recurrent laryngeal nerve injury (23/30, 76.7%). The majority of patients were injected at the bedside by awake transcutaneous injection (22/30, 73.3%), six patients were injected in the operating room under general anesthesia, and two at the outpatient clinic. Pre- and postinjection SLP evaluations included clinical bedside assessment or instrumental evaluation. Following VF injection laryngoplasty, oral diet advancement was noted in 81.8% of the patients that were nil per os before the injection (18/22). No complications were noted. In conclusions, acute VFMI following surgery requires immediate diagnosis and therapeutic strategy to minimize postoperative complications and to overcome impairments in the voice, swallow, and cough. Otolaryngology-SLP interdisciplinary aspiration and swallowing assessment protocol is proposed based on our experience and an extensive literature review.
View details for PubMedID 30340927
Improvement in the Reflux Symptom Index Following Surgery for Cricopharyngeal Dysfunction
JOURNAL OF VOICE
2017; 31 (1): 86-89
Gastroesophageal reflux may contribute to the development of cricopharyngeal dysfunction and Zenker's diverticulum. Common dictum suggests that if upper esophageal sphincter tone is reduced through cricopharyngeal myotomy, symptoms of laryngopharyngeal reflux may worsen. We hypothesized that patients who undergo myotomy should show decreased dysphagia symptoms with concurrent worsening of reflux symptomatology and that these changes would be greater in those patients undergoing complete versus partial myotomy.A retrospective chart review was performed for patients who underwent endoscopic or open cricopharyngeal myotomy, with or without Zenker's diverticulectomy. Preoperative and postoperative reflux symptomatology was subjectively measured with the Reflux Symptom Index (RSI), and dysphagia symptomatology was measured with the Eating Assessment Tool 10 (EAT-10). Patients who underwent partial myotomy via endoscopic stapling of Zenker's diverticulum were compared with patients who underwent complete myotomy (either endoscopic laser-assisted or via an open transcervical approach). The patients were further subdivided into three groups for data analysis: endoscopic staple diverticulotomy, laser cricopharyngeal myotomy, and open approach.A total of 41 patient charts were reviewed. Of these 41 patients, 17 underwent endoscopic stapler-assisted diverticulotomy, 4 underwent endosopic laser-assisted cricopharyngeal myotomy, and 20 underwent open transcervical cricopharyngeal myotomy, with diverticulectomy as indicated. Mean pre- and postoperative RSIs were 21.8 and 8.9, respectively (P < 0.001). Mean pre- and postoperative EAT-10 scores were 19.1 and 5.0, respectively (P < 0.001).Patients' reflux symptoms significantly improved after cricopharyngeal myotomy, with significant improvement in dysphagia symptoms. Concern for worsening of reflux symptoms following surgery does not appear to be clinically common.
View details for DOI 10.1016/j.jvoice.2016.02.006
View details for PubMedID 27049450
Surgical Management of Supraglottic Stenosis Using Intubationless Optiflow.
The Annals of otology, rhinology, and laryngology
2017; 126 (9): 669–72
Airway management during endoscopic surgical treatment of supraglottic and pharyngeal stenosis is often challenging and can be accomplished by various means, including tracheostomy, jet ventilation, or direct laryngoscopy. We describe CO2 laser excision of supraglottic-pharyngeal stenosis using intubationless Optiflow high-flow nasal cannula (HFNC).A 55-year-old male presented with dyspnea and dysphagia secondary to severe supraglottic-pharyngeal stenosis in the setting of previous chemoradiation for a T0N2aM0 squamous cell carcinoma. Laryngoscopy revealed severe supraglottic-pharyngeal stenosis with tethering of the epiglottis to the lateral pharyngeal walls. Optiflow HFNC was used to deliver 70 L/min of oxygen. After anesthetic induction, CO2 laser microlaryngoscopy was utilized to release scar tissue along the lateral epiglottic border, opening up the supraglottic airway sufficiently for endotracheal intubation and further laser resection.Airway management with Optiflow HFNC allowed initial endoscopic surgical access, partial stenotic release, and intubation. From anesthetic induction to intubation, the patient remained apneic for 26 minutes. The patient's stenosis was successfully addressed, and 10-month follow-up demonstrated stable patency of the airway.Optiflow is an important new tool in the management of severe supraglottic stenosis. It provides sufficient oxygenation to perform extended apneic surgery and improves endoscopic surgical access in a limited airway.
View details for PubMedID 28766977
Phonomicrosurgery simulation: A low-cost teaching model using easily accessible materials.
2016; 126 (11): 2528-2533
To introduce the use of a new phonomicrosurgical trainer using easily accessible materials, and to establish the effectiveness of the model.The model uses a grape imbedded in gelatin, a microscope, and microlaryngeal instruments. The study was designed to test baseline differences in training levels, as well as improvement in performance after training with the simulation model.Thirty subjects enrolled in the Stanford University School of Medicine otolaryngology training program performed microlaryngeal surgery tasks on a grape. Tasks were designed to model both excision of a vocal fold lesion and vocal fold injection. Anonymized video recordings comparing presimulation and postsimulation training were collected and graded by an expert laryngologist. Both objective comparison of skills and subjective participant surveys were analyzed.Objectively, trainees in all groups made statistically significant improvements across all tested variables, including microscope positioning, creation of a linear incision, elevation of epithelial flaps, excision of a crescent of tissue, vocal fold injection, preservation of remaining tissue, and time to complete all tasks. Subjectively, 100% of participants felt that they had increased comfort with microlaryngeal instruments and decreased intimidation of microlaryngeal surgery after completing the simulation training. This appreciation of skills was most notable and statistically significant in the intern trainees.Microlaryngeal surgical simulation is a tool that can be used to train residents to prepare them for phonomicrosurgical procedures at all levels of training. Our low-cost model with accessible materials can be easily duplicated and used to introduce trainees to microlaryngeal surgery or improve skills of more senior trainees.1B. Laryngoscope, 2016.
View details for DOI 10.1002/lary.25940
View details for PubMedID 27107403
Consultation via telemedicine and access to operative care for patients with head and neck cancer in a Veterans Health Administration population
HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK
2016; 38 (6): 925-929
The purpose of this study was to evaluate a telemedicine model that utilizes an audiovisual teleconference as a preoperative visit.Veterans Health Administration (VHA) patients with head and neck cancer at 2 remote locations were provided access to the Palo Alto Veterans Affairs (PAVA) Health Care System otolaryngology department via the telemedicine protocol: tissue diagnosis and imaging at the patient site; data review at PAVA; and a preoperative teleconference connecting the patient to PAVA. Operative care occurred at PAVA. Follow-up care was provided remotely via teleconference.Fifteen patients were evaluated. Eleven underwent surgery, 4 with high-grade neoplasms (carcinoma). Average time from referral to operation was 28 days (range, 17-36 days) and 72 (range, 31-108 days), respectively, for high-grade and low-grade groups. The average patient was spared 28 hours traveling time and $900/patient was saved on travel-related costs.A telemedicine model enables timely access to surgical care and permits considerable savings among select VHA patients with head and neck cancer. © 2016 Wiley Periodicals, Inc. Head Neck 38: 925-929, 2016.
View details for DOI 10.1002/hed.24386
View details for PubMedID 26899939
Tracheal Stenosis Because of Wegener Granulomatosis Misdiagnosed as Asthma.
A & A case reports
2016; 6 (10): 311-312
We describe a patient with Wegener granulomatosis whose complaint of wheezing was incorrectly attributed to asthma. Anesthesiologists must recognize that tracheal stenosis is extremely common in Wegener granulomatosis and can mimic other causes of wheezing.
View details for DOI 10.1213/XAA.0000000000000307
View details for PubMedID 27075424
Symptomatic Anterior Cervical Osteophyte Causing Dysphagia: Case Report, Imaging, and Review of the Literature.
2016; 8 (2)
Anterior cervical osteophytes are found in 20-30% of elderly patients. Rarely, severe osteophytes can cause dysphagia, dysphonia, and dyspnea. Here, we illustrate a case of severe dysphagia caused by a large post-traumatic osteophyte with oropharyngeal swallow study showing a significant mass effect on the pharynx and resolution following osteophytectomy. We also review the literature regarding the etiology, diagnosis, and treatment of symptomatic anterior cervical osteophytes.
View details for DOI 10.7759/cureus.473
View details for PubMedID 27004150
View details for PubMedCentralID PMC4779080
Deep brain stimulation for vocal tremor: a comprehensive, multidisciplinary methodology
2015; 38 (6)
Tremulous voice is a characteristic feature of a multitude of movement disorders, but when it occurs in individuals diagnosed with essential tremor, it is referred to as essential vocal tremor (EVT). For individuals with EVT, their tremulous voice is associated with significant social embarrassment and in severe cases may result in the discontinuation of employment and hobbies. Management of EVT is extremely difficult, and current behavioral and medical interventions for vocal tremor result in suboptimal outcomes. Deep brain stimulation (DBS) has been proposed as a potential therapeutic avenue for EVT, but few studies can be identified that have systematically examined improvements in EVT following DBS. The authors describe a case of awake bilateral DBS targeting the ventral intermediate nucleus for a patient suffering from severe voice and arm tremor. They also present their comprehensive, multidisciplinary methodology for definitive treatment of EVT via DBS. To the authors' knowledge, this is the first time comprehensive intraoperative voice evaluation has been used to guide microelectrode/stimulator placement, as well as the first time that standard pre- and post-DBS assessments have been conducted, demonstrating the efficacy of this tailored DBS approach.
View details for DOI 10.3171/2015.3.FOCUS1537
View details for Web of Science ID 000355539900006
View details for PubMedID 26030706
Deep Brain Stimulation for Essential Vocal Tremor: A Technical Report.
2015; 7 (3)
Essential vocal tremor (EVT) is the presence of a tremulous voice that is commonly associated with essential tremor. Patients with EVT often report a necessary increase in vocal effort that significantly worsens with stress and anxiety and can significantly impact quality of life despite optimal medical and behavioral treatment options. Deep brain stimulation (DBS) has been proposed as an effective therapy for vocal tremor, but very few studies exist in the literature that comprehensively evaluate the efficacy of DBS for specifically addressing EVT. We present a technical report on our multidisciplinary, comprehensive operative methodology for treatment of EVT with frameless, awake deep brain stimulation (DBS).
View details for DOI 10.7759/cureus.256
View details for PubMedID 26180680
Endoscopic suture retriever for endolaryngeal keel placement in treatment of anterior glottic webs.
The Annals of otology, rhinology, and laryngology
2015; 124 (3): 240-243
Endoscopic placement of a laryngeal keel has traditionally required the use of a Lichtenberger endo-extralaryngeal needle passer, which is not universally available. We discuss a safe and technically simple alternate technique using an endoscopic suture retriever through a percutaneously placed angiocatheter that obviates the need for the Lichtenberger instrument.Case series.Two 14-gauge angiocatheters were passed through the anterior neck under telescopic visualization of the larynx. The suture retriever was inserted through the catheter and deployed within the larynx to withdraw a Prolene suture that was threaded through a Silastic keel. The keel was then tied in position over a sterile button on the anterior neck.This procedure was performed on 2 patients with excellent outcomes in both cases.Endoscopic keel placement is a widely used procedure for treating anterior glottic webs and requires suture passage from within the larynx to the anterior neck to secure the keel into position. This is the first report of an exo-endolaryngeal suture retriever for placement of a laryngeal keel. This technique provides a safe, reliable, and efficient alternative to endo-extralaryngeal needle puncture and uses materials that are available in many operating room settings.
View details for DOI 10.1177/0003489414549577
View details for PubMedID 25204710
Single-Operator Flexible Nasolaryngoscopy-Guided Transthyrohyoid Vocal Fold Injections
Meeting of the American-Broncho-Esophagological-Association
ANNALS PUBL CO. 2013: 9–14
A number of laryngeal injection techniques have been described for performing vocal fold medialization or delivery of medications, including peroral and percutaneous approaches. Although flexible nasolaryngoscopy-guided injection (FNGI) improves visualization and patient tolerance over rigid endoscopy, the technique requires an assistant to manipulate the laryngoscope. The efficacy and patient tolerance of a novel, single-operator technique for FNGI are evaluated.Patients who required laryngeal injection for vocal fold medialization or for administration of cidofovir or steroids were included in this study. Indications included vocal fold paresis or paralysis, sulcus deformities, recurrent respiratory papillomatosis, vocal fold polyps, and laryngeal granulomas. All procedures were performed in the office setting with topical and local anesthesia with the patient awake. The surgeon performed flexible nasolaryngoscopy with the nondominant hand while using the dominant hand to perform transthyrohyoid injection with a 25-gauge needle with proximal and distal bends.Twenty-six patients underwent a total of 42 single-operator FNGI procedures; 19 unilateral and 23 bilateral injections were performed. All but 1 of the procedures were completed with adequate visualization and placement of injectant and good patient tolerance.Single-operator FNGI via a transthyrohyoid approach is a viable and versatile laryngeal injection technique for a variety of indications. It provides access to the anterior, middle, and posterior parts of the larynx. It eliminates the need for an assistant experienced in nasolaryngoscopy and allows the surgeon to adjust and optimize visualization in a fashion analogous to endoscopic sinus surgery.
View details for Web of Science ID 000313851400003
View details for PubMedID 23472310
- Office-Based Laser Laryngeal Surgery Op Tech in Otolaryngol 2012; 23 (2): 102-105
- Management of Recurrent Laryngeal Nerve Paralysis Surgery of the Thyroid and Parathyroid Glands 2011
- Airway and respiratory complications: Tracheal Stenosis Spinal Cord Injury: Rehabilitation Medicine Quick Reference 2010
- Airway and respiratory interventions: Tracheostomies. Spinal Cord Injury: Rehabilitation Medicine Quick Reference 2010
TRANSORAL ROBOTIC SURGERY FOR THE MANAGEMENT OF HEAD AND NECK CANCER: A PRELIMINARY EXPERIENCE
HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK
2009; 31 (3): 283-289
The aim of this prospective study was to determine the technical feasibility, safety, and efficacy of transoral robotic surgery (TORS) for a variety of malignant head and neck lesions.From April 2007 to November 2007, 20 patients were enrolled in an institutional review board-approved prospective trial using the daVinci surgical robot. Inclusion criteria for the study consisted of adults with early head and neck cancer involving the oral cavity, oropharynx, hypopharynx, and larynx.Twenty patients were included in this study. In 2 cases, access to the tumor was inadequate and the procedure was terminated. In all 18 cases, negative resection margins were achieved. Intraoral reconstruction was performed in 8 patients. Fifteen of 18 patients underwent concomitant unilateral (n = 10) or bilateral (n = 5) selective neck dissections. None of the patients required tracheotomy and there were no intraoperative or postoperative complications. The average setup time was 54.6 minutes (range, 140-20 minutes), with a precipitous decrease in the setup time as the study progressed.TORS is a safe, feasible, and minimally invasive alternative to classic open surgery or endoscopic transoral laser surgery in patients with early cancer of the head and neck. With increasing experience, surgical setup as well as operative time will continue to decrease.
View details for DOI 10.1002/hed.20972
View details for Web of Science ID 000264011500001
View details for PubMedID 18972413
- Transoral robotic assisted free flap reconstruction OTOLARYNGOLOGY-HEAD AND NECK SURGERY 2009; 140 (1): 124-125
Transoral Robotic Surgery Using a Carbon Dioxide Flexible Laser for Tumors of the Upper Aerodigestive Tract
2008; 118 (12): 2187-2189
To determine the safety, feasibility, and efficacy of coupling transoral robotic technology with the flexible carbon dioxide (CO2) laser for various tumors of the oropharynx and supraglottic larynx.Prospective, pilot trial.Eight patients were enrolled in an IRB-approved prospective trial for transoral robotic surgery with the aid of the flexible CO2 laser.Seven male patients with early carcinoma of the oropharynx or larynx successfully underwent tumor extirpation with the transoral robot and the flexible CO2 laser. We were unable to gain access to the supraglottic larynx in one female patient. The final pathology revealed seven patients with squamous cell carcinoma and one patient with adenoid cystic carcinoma. The flexible CO2 laser provided fine incisions with excellent hemostasis and minimal peripheral tissue injury. Additionally, the laser provided an excellent tool for raising pharyngeal flaps for reconstruction of the oropharynx.The flexible CO2 laser offers a unique advantage of precise incisions and may provide a valuable tool for both tumor extirpation and the creation of flaps for transoral robotic reconstruction.
View details for DOI 10.1097/MLG.0b013e31818379e4
View details for Web of Science ID 000263200900019
View details for PubMedID 19029867
Transoral Robotic Surgery Using an Image Guidance System
2008; 118 (11): 2003-2005
To describe a novel technique using the image guidance system for transoral robotic surgery of the pharyngeal and parapharyngeal spaces.Case series presentation.Three cases of oropharyngeal and pharyngeal space lesions are reviewed for presentation, workup, and original management.Final pathology of a vascular malformation, an acinic cell adenocarcinoma, and a squamous cell carcinoma were located and minimally invasively removed by a transoral robotic approach with the aid of image guidance. No complications or recurrences were observed on an average of 7 month follow-up.Transoral robotic surgery using an image guidance system seems safe and effective in assisting dissection.
View details for DOI 10.1097/MLG.0b013e3181818784
View details for Web of Science ID 000260874700017
View details for PubMedID 18849862
The administration of IL-12/GM-CSF and Ig-4-1BB ligand markedly decreases murine floor of mouth squamous cell cancer
OTOLARYNGOLOGY-HEAD AND NECK SURGERY
2008; 139 (3): 442-448
To assess immune-based gene therapy in a murine floor of mouth (FOM) squamous cell carcinoma (SCC) model.In vitro and in vivo testing of immune therapy for SCC.Multiple SCC lines were infected by using advRSV-interleukin-12 (IL-12) and advCMV-interleukin-12/granulocyte macrophage colony-stimulating factor (IL-12/GM-CSF) and monitored for production of IL-12 and GM-CSF. Intratumoral injections of viral vectors were administered with systemic Ig-4-1BB ligand in an orthotopic murine FOM SCC model and followed for tumor size and survival.In vitro, all cell lines produced substantial levels of IL-12 and GM-CSF. In vivo, tumors treated with advCMV-IL-12/GM-CSF and Ig-4-1BBL showed a striking reduction in tumor volume (vs control P<0.0001) and improved median survival (38 days vs 19 days for control, P<0.0001).Combination immune-based therapies effectively improve survival in mice bearing FOM SCC over single-modality therapy.
View details for DOI 10.1016/j.otohns.2008.05.001
View details for Web of Science ID 000258858400020
View details for PubMedID 18722228
Combined VSV Oncolytic Virus and Chemotherapy for Squamous Cell Carcinoma
110th Annual Meeting of the Triological-Society
WILEY-BLACKWELL. 2008: 237–42
Vesicular stomatitis virus (VSV) is a negative-strand ribonucleic acid (RNA) virus that replicates specifically in tumor cells and has oncolytic effects in a variety of malignant tumors. We previously demonstrated recombinant VSV vectors incorporating viral fusion protein (rVSV-F) and interleukin 12 (rVSV-IL12) to have significant antitumor effects against squamous cell carcinoma (SCC) in a murine model. Here we evaluate the potential to combine a potent chemotherapeutic agent for SCC (cisplatin) with rVSV-F and rVSV-IL12 to improve efficacy.In vitro, three SCC cell lines were tested using rVSV-F and rVSV-IL12 with cisplatin, monitoring viral replication and cell survival. In an orthotopic floor of mouth murine SCC model, intratumoral injections of virus combined with systemic cisplatin were tested for tumor control and animal survival.In vitro, virus and cisplatin combination demonstrated rapid replication and enhanced tumor cell kill. Human keratinocytes were unaffected by virus and cisplatin. In vivo, combined rVSV-F with cisplatin reduced tumor burden and improved survival (P = .2 for both), while rVSV-IL12 monotherapy had better tumor control (P = .06) and survival (P = .024) than combination therapy.Addition of cisplatin did not affect the ability of either virus to replicate in or kill murine SCC cells in vitro. In vivo, combination therapy enhancedrVSV-F antitumor activity, but diminished rVSV-IL12 antitumor activity. Combination therapy may provide useful treatment for SCC with the development of more efficient viral vectors in combination with different chemotherapy agents or immunostimulatory agents.
View details for DOI 10.1097/MLG.0b013e3181581977
View details for Web of Science ID 000260661500008
View details for PubMedID 18043494