Salvage surgery for recurrence of laryngeal and hypopharyngeal squamous cell carcinoma: A retrospective study from 2005 to 2013

ObjectivesSalvage surgery is the gold-standard treatment for locoregional recurrence of laryngeal and hypopharyngeal cancer following radiation therapy. Imperfect oncologic and functional results, however, require patient selection. The main objective of the present study was to determine preoperative factors for survival. Secondary objectives were to study 5-year overall and disease-free survival, general and locoregional complications, and functional results in terms of feeding and tracheotomy closure.Patients and methodA retrospective multicenter study included 52 patients treated by salvage surgery for recurrence of laryngeal or hypopharyngeal squamous cell carcinoma after radiation therapy between 2005 and 2013.ResultsFactors associated with improved 3-year overall survival on univariate analysis comprised laryngeal primary (P = 0.001), laryngeal recurrence (P = 0.026), rT1, rT2 or rT3 rather than rT4 tumor (P = 0.007), previous chemotherapy (P = 0.036), and neck dissection during salvage surgery (P = 0.005), the last of these being confirmed on multivariate analysis. Five-year overall survival was 36.0% (range, 27.6–44.4%), for a median 23.04 months (95% CI, 19.44–26.64). Five-year disease-free survival was 23.5% (range, 16.0–31.0%), for a median 8.04 months (95% CI, 2.04–14.04).ConclusionSalvage surgery for laryngeal or hypopharyngeal cancer is difficult, and survival is not good. Laryngeal primary and recurrence location, moderate tumor volume and extension (< T4), prior chemotherapy and neck dissection during salvage surgery were associated with better overall and disease-free survival, which should enable better patient selection.     

The basaloid variant of squamous cell carcinoma of the larynx

IntroductionBasaloid squamous cell carcinoma (BSCC) is a rare subtype of squamous cell carcinoma (SCC). Because of its rarity, both clinical and prognostic features of this variant are not well known.ObjectiveIn this study, we aimed to determine the frequency of BSCC and other SCC variants among all laryngeal SCC cases, and to determine clinical and prognostic features of BSCC variant. Study design: retrospective cohort study. Evidence level: Level 2b.Material and methodsRecords of the patients who had laryngeal SCC surgically treated at our institute between 2007 and 2013 were retrospectively reviewed.ResultsAmong 198 subjects who had laryngeal SCC surgically treated, the frequency of the variants of SCC other than classical variant was 10.1% (20/198). The most common SCC variant was BSCC (6.6%). Eleven (84.6%) patients with BSCC were at an advanced stage at the presentation (p > 0.05). The 3-year overall survival and disease-free survival rates were 63% and 53% respectively.ConclusionBSCC variant may be more common than previously reported. Since almost the half of patients experiences disease recurrence in the early period, multimodal treatment strategies should be employed at initial treatment, and a close follow-up is strongly recommended for this aggressive SCC variant.     

Prognostic factors and overall survival in a 15-year followup of patients with malignant salivary gland tumors: a retrospective analysis of 193 patients

IntroductionMalignant tumors of the salivary glands are uncommon pathological entities, representing less than 5% of head and neck neoplasms. The prognosis of patients with malignant tumors of the salivary glands is highly variable and certain clinical factors can significantly influence overall survival.ObjectiveTo analyze the clinicopathologic and sociodemographic characteristics that influence survival in patients with malignant tumors of the salivary glandsMethodsThis retrospective study analyzed sex, age, race, education level, tumor location, tumor size, lymph node involvement, distant metastasis, margin status, treatment type, marital status, method of health care access and 15-year overall survival in 193 patients with malignant tumors of the salivary glands. The X², log-rank Mantel-Cox, multinomial regression and Cox logistic regression tests were used (SPSS 20.0,p < 0.05).ResultsThe most common histological types were adenocarcinoma (32.1%), adenoid cystic carcinoma (31.1%) and mucoepidermoid carcinoma (18.7%). The 15-year overall survival rate was 67.4%, with a mean of 116 ± 6 months. The univariate analysis revealed that male sex (p = 0.026), age > 50 years (p  = 0.001), referral origin from the public health system (p  = 0.011), T stage (p =  0.007), M stage (p <  0.001), clinical stage (p <  0.001), compromised surgical margins (p =  0.013), and chemotherapy (p <  0.001) were associated with a poor prognosis. Multivariate analyses also showed that age > 50 years was independently associated with a poor prognosis (p =  0.016). The level of education was the only factor more prevalent in older patients (p =  0.011).ConclusionPatients with malignant tumors of the salivary glands older than 50 years have a worse prognosis and an independent association with a low education level.     

Comparación de pacientes con laringectomía total primaria y de rescate

Introduction and objectivesTotal laryngectomy (TL) is one of the treatments available in locally advanced laryngeal carcinomas or as a salvage therapy when organ preservation fails, achieving high survival rates and few complications. The aim of this study was to analyse the oncological outcomes, comparing the data obtained with the current literature and analysing complications and survival.MethodsThe study included 62 patients with primary carcinoma of the larynx treated by primary or salvage TL between 2003 and 2019. We analysed the demographic, clinical and pathological characteristics, tumour stage, complementary treatments, postoperative complications, locoregional recurrences, metastases, and causes of death.ResultsThe mean age was 64 years, 90.3% were men, 96.8% were smokers, 43.5% had multiple pathologies and 82.3% had a locally advanced stage. Of all TL 71% were primary and 29% salvage. Neck dissection was performed in 59.6%. Lymphovascular invasion was present in 30.6%, perineural invasion in 30.6% and margin involvement in 14.5%. During the follow-up, 17.7% presented locoregional recurrence and 11.3% distant metastases. Regarding complementary treatments, 56.4% of the patients received adjuvant therapy. The incidence of haemorrhage was 11.3%, infection 14.5%, and pharyngocutaneous fistula 21%. There was a statistically significant correlation between fistula and haemorrhage (P = .000) and between fistula and infection (P = .000). No statistically significant differences were found between the studied factors of primary and salvage TL. The 3-year overall survival was 92% and 5-year overall survival was 88%, finding statistical significance with the locally advanced stage (P = .038), T4 (P = .026), lymphovascular invasion (P = .019) and the involvement of more than 3 lymph nodes in the pathological anatomy (P = .005). On the multivariate analysis, the only variable that showed a significant relationship with survival was lymphovascular invasion (P = .026).ConclusionsAlthough organ preservation is a primary objective, TL remains a leading treatment in locally advanced carcinomas and as salvage in case of failure of medical therapy or partial surgery.     

Sinonasal adenocarcinomas: Retrospective analysis from an oncology center

Introduction and objectivesSinonasal adenocarcinomas are rare and heterogeneous tumors and for this reason remain understudied. Our purpose is to analyze clinical presentation, outcomes and factors affecting survival of patients with sinonasal adenocarcinomas, treated at our institution.Material and methodsRetrospective review of clinical records of patients with sinonasal adenocarcinoma, treated at a tertiary oncology institution (January 2010 to December 2019).ResultsSixty patients diagnosed with adenocarcinoma were included, with male preponderance (54.90%) and a mean age of 57.5 ± 14.9 years. Adenocarcinoma was the most frequent type of sinonasal cancer, contrary to previous reports from our institution. In most patients, it was detected at an advanced disease stage, significantly decreasing their survival rate when compared to patients diagnosed at initial stages (p < 0.029). Intestinal type adenocarcinoma was established in 47 patients, the most frequent being the colonic subtype (24%). Tumors with good/moderate histologic differentiation presented a survival advantage over those that were poorly differentiated (p = 0.043). The most common treatment modality was surgery followed by radiotherapy. Endoscopic resection was performed in 53% of the patients and an external approach was used in 40% of the patients. Estimated overall survival rates at 3 and 5-years were 64% and 53%, respectively, and cancer specific survival 72% and 65%, for the same period. Recurrence rate was 32% and occurred mainly locally. Disease Free Survival rate was 71% at 3 years and 65% at 5 years.ConclusionsDespite being the most common sinonasal malignancy in our sample, in contrast to other series, sinonasal adenocarcinomas are still rare tumors with a substantial local failure rate of around 30%. Advanced stage at diagnosis and histologic differentiation grade negatively affected prognosis of these tumors.     

Air-bone gap in ears with a well-repaired tympanic membrane after Type III and Type IV tympanoplasty

ObjectiveTo investigate the air-bone conduction hearing gap (A–B gap) after Type III and Type IV stapes columella tympanoplasty in ears with mobile stapes and a well repaired tympanic membrane (TM).MethodsThose patients who underwent tympanoplasty in our hospital between 2003 and 2009 and satisfied the following criteria were eligible: (1) good stapes mobility, confirmed intraoperatively; (2) postoperative TM and/or computed tomography (CT) findings that showed a well-aerated tympanic cavity without TM perforation, otorrhea, or middle ear effusion; and (3) measurable air and bone conduction hearing thresholds 1 year postoperatively at all test frequencies (250 Hz, 500 Hz, 1 kHz, 2 kHz, and 4 kHz).ResultsHearing results were better after Type III tympanoplasty than after Type IV tympanoplasty. After Type III (n = 70) and Type IV (n = 24) tympanoplasty, the respective mean A–B gaps were 16.4 ± 7.2 dB and 20.1 ± 5.6 dB, respectively. The mean A–B gap was significantly smaller after Type III tympanoplasty than after Type IV tympanoplasty (p < 0.05). Regardless of the type of tympanoplasty, the postoperative A–B gap was greatest at 4 kHz.ConclusionThe mean A–B gap was smaller after Type III tympanoplasty than after Type IV tympanoplasty. The magnitude of the A–B gap was greatest at 4 kHz in both procedures.     

Melanoma of the external ear: A population-based study

Background

Primary melanoma of the external ear (PMEE) is rare and therefore well-suited for large population-based registry analysis. The objective of this study was to utilize the Surveillance, Epidemiology, and End Results (SEER) set of cancer registries to determine the incidence, treatment, and survival characteristics of PMEE.

Tinnitus characteristics in patients with hyperacusis and vertigo (including Ménière's disease) vs. hyperacusis alone

Introduction and objectivesTo compare clinical and psychoacoustic tinnitus characteristics in patients with the comorbidity of hyperacusis, hyperacusis and vertigo, and with Ménière's disease (MD).Materials and methodsThree hundred and twenty-nine tinnitus patients underwent audiological and otoneurological evaluation. Records of 94 individuals younger than 65 years, 40 women and 54 men (mean age 41.8, range 24–64 years), who complained of tinnitus and hyperacusis, were analyzed. One hundred and thirty-one ears with tinnitus were identified: 67 in the group of patients with tinnitus and hyperacusis (group 1; 41 patients); 28 in the group fulfilling criteria of MD diagnosis (group 2; 28); and 36 in the group with tinnitus, hyperacusis and typical symptoms of vertigo (group 3; 25).Results and conclusionsMean value of interaural difference in canal paresis in group 1 was 6.3%; in group 2: 23.7%; and in group 3: 25.9%; p < .001. Mean tinnitus pitch value was significantly lower in group 3 (1679 Hz; SD = 1139) and group 2 (2250 Hz; SD = 1162) compared to group 1 (4538 Hz; SD = 3123; p = .012). Values of tinnitus intensity and other characteristics did not significantly differ between the groups. Tinnitus and hyperacusis were most frequently preceded by acoustic trauma. Tinnitus coinciding with hyperacusis and vertigo was observed in patients after head trauma.Mean tinnitus pitch was lower in the groups of patients with hyperacusis and peripheral labyrinthine lesion than in tinnitus sufferers with hyperacusis alone. Tinnitus sufferers with low tinnitus pitch should undergo vestibular system evaluation. Hyperacusis and vertigo are likely comorbidities in tinnitus patients after head trauma. Hyperacusis may coincide in tinnitus patients after head trauma.     

Squamous cell carcinoma of the retromolar trigone: Treatment outcomes

Objective

Squamous cell carcinoma (SCC) of the retromolar trigone is uncommon, accounting for 1.4% of all oral cancer cases in Japan. Few studies have examined the optimal treatment for this cancer. The aim of this study was to evaluate the outcome of treatment for primary SCC of the retromolar area.

Brainstem auditory evoked potentials in children with lead exposure

IntroductionEarlier studies have demonstrated an auditory effect of lead exposure in children, but information on the effects of low chronic exposures needs to be further elucidated.ObjectiveTo investigate the effect of low chronic exposures of the auditory system in children with a history of low blood lead levels, using an auditory electrophysiological test.MethodsContemporary cross-sectional cohort. Study participants underwent tympanometry, pure tone and speech audiometry, transient evoked otoacoustic emissions, and brainstem auditory evoked potentials, with blood lead monitoring over a period of 35.5 months. The study included 130 children, with ages ranging from 18 months to 14 years, 5 months (mean age 6 years, 8 months ± 3 years, 2 months).ResultsThe mean time-integrated cumulative blood lead index was 12 μg/dL (SD ± 5.7, range: 2.433). All participants had hearing thresholds equal to or below 20 dBHL and normal amplitudes of transient evoked otoacoustic emissions. No association was found between the absolute latencies of waves I, III, and V, the interpeak latencies I–III, III–V, and I–V, and the cumulative lead values.ConclusionNo evidence of toxic effects from chronic low lead exposures was observed on the auditory function of children living in a lead contaminated area.     

Using craniofacial characteristics to predict optimum airway pressure in obstructive sleep apnea treatment

IntroductionManual titration is the gold standard to determinate optimal continuous positive airway pressure, and the prediction of the optimal pressure is important to avoid delays in prescribing a continuous positive airway pressure treatment.ObjectiveTo verify whether anthropometric, polysomnographic, cephalometric, and upper airway clinical assessments can predict the optimal continuous positive airway pressure setting for obstructive sleep apnea patients.MethodsFifty men between 25 and 65 years, with body mass indexes of less than or equal to 35 kg/m² were selected. All patients had baseline polysomnography followed by cephalometric and otolaryngological clinical assessments. On a second night, titration polysomnography was carried out to establish the optimal pressure.ResultsThe average age of the patients was 43 ± 12.3 years, with a mean body mass index of 27.1 ± 3.4 kg/m² and an apnea–hypopnea index of 17.8 ± 10.5 events per hour. Smaller mandibular length (p = 0.03), smaller atlas–jaw distance (p = 0.03), and the presence of a Mallampati III and IV (p = 0.02) were predictors for higher continuous positive airway pressure. The formula for the optimal continuous positive airway pressure was: 17.244 − (0.133 × jaw length) + (0.969 × Mallampati III and IV classification) − (0.926 × atlas–jaw distance).ConclusionIn a sample of male patients with mild-to-moderate obstructive sleep apnea, the optimal continuous positive airway pressure was predicted using the mandibular length, atlas–jaw distance and Mallampati classification.     

An investigation into hearing loss among patients of 50 years or older

Objects To investigate the extent of hearing loss in an elderly sample population to estimate hearing disorders among the age-equivalent population in China and to study primary clinical characteristic...     

The effect of age on ossiculoplasty results: A retrospective evaluation of 60 cases

ObjectiveThere are only a few studies evaluating ossiculoplasty results in the pediatric age group. Although the effect of different factors on the results of ossiculoplasty is investigated, the effect of age on ossiculoplasty results is not known. In this study, the effect of age on ossiculoplasty results has been investigated.MethodsThis retrospective clinical study was performed in 60 patients (30 female, 30 male; mean age 15.5 ± 14.3 years, range 9–57 years) who underwent ossiculoplasty. The cases were divided into two groups according to their age. Group A consisted of pediatric cases younger than 18 years of age and group B consisted of adult subjects (>18 years). The comparison of the groups was made by taking into consideration the air-bone gap in the 3rd and 12th weeks of the pre- and postoperative period.ResultsThere was no statistically significant difference between preoperative air-bone gaps of the groups (p = 0.086). In the third postoperative month, the air-bone gap gain of group A was statistically significantly higher than group B (p = 0.0001). The air-bone gap gain of group A was significantly higher than group B in the postoperative 12th month (p = 0.026). The air-bone gap gain of the patients with malleus in group A and group B was higher in the postoperative 3rd month than in the patients without malleus (all p values <0.05). There was no statistically significant difference between the air-bone gap gain in patients with the stapes suprastructure and the air-bone gap gain of the patients without stapes suprastructure in group A and group B in the postoperative 3rd month (p values >0.05).ConclusionThe results of ossiculoplasty were found better in the pediatric age group. We think that ossiculoplasty should be carried out without delay in the pediatric age group.     

Difference of antrochoanal polyp between children and adults

ObjectiveThe purpose of this study was to review the clinical characteristics of the antrochoanal polyp (ACP) and to compare the differences between children and adults.Patients and methodsThis study was performed in 56 patients who underwent endoscopic surgery for ACP between 2004 and 2014. The study population was subdivided into children (≤8 years old) and adults (>18 years old). Clinical findings of ACP, including symptoms, CT stages, and surgical outcomes were retrospectively analyzed.ResultsCT Stage II and III lesions were more common than CT stage I lesions in children (p < 0.001). Accompanying maxillary sinus diseases were more common in adults (p < 0.005). Purely endoscopic surgery for ACPs was performed in all children and 25 (86.2%) adults. The combined approach, endoscopic and canine fossa approach, was applied in 4 (13.8%) adults. The success rate was 88.9% in children and 93.1% in adults. According to the approach method, the success rate was 90.4% for the purely endoscopic approach and 100% for the combined approach.ConclusionHigh incidence of CT stage II and III lesions in the child group with ACP in our study suggests that children with ACP present at a more advanced state because of late diagnosis. Accompanying maxillary sinus diseases can be present in patients with ACP, especially adults, which should be considered preoperatively and treated appropriately.     

Otorhinolaryngologists’ personal treatment preferences (total laryngectomy or laryngeal preservation) when faced with advanced stage laryngeal cancer

ObjectiveTo analyse the treatment options that otorhinolaryngologists would consider if faced with advanced stage laryngeal cancer amenable to total laryngectomy or an organ preservation protocol.Material and methodsProspective study conducted in a French Teaching Hospital based on questionnaires filled in by 163 otorhinolaryngologists in 2012, studying the percentage chance of cure that they would be prepared to trade-off to preserve their larynx, defining the additional information that they would like to receive and identifying any statistical associations between these parameters and various medical and socioeconomic variables.ResultsA total of 42.3% of otorhinolaryngologists would not consider the slightest trade-off to preserve their larynx and preferred to undergo total laryngectomy. In the group of otorhinolaryngologists who would consider a larynx preservation protocol (57.6%), the percentage chance of cure that they would be willing to trade-off to preserve their larynx ranged between 5 to 100% (median: 15%) and 4.2% of them were willing to trade-off all chances of cure (100%) to avoid total laryngectomy. The percentage of otorhinolaryngologists who would not consider trading off the slightest chance of survival to preserve their larynx increased from 29.3 to 49.5% (P = 0.01) when they participated in multidisciplinary consultation meetings. In the group of otorhinolaryngologists who would consider a larynx preservation protocol, the median percentage survival trade-off that they would consider in order to preserve their larynx (i) decreased from 20 to 10% (P = 0.004) when they participated in multidisciplinary consultation meetings and (ii) increased regularly with their number of years of practice (P = 0.03) and their age (P = 0.025). Finally, 25.1% of otorhinolaryngologists wanted to receive additional information, although none of the variables analysed affected this desire for more information.ConclusionTreatment options considered by otorhinolaryngologists faced with advanced stage laryngeal cancer were almost equally divided between total laryngectomy and larynx preservation. Number of years of practice and regular participation in head and neck cancer multidisciplinary consultation meetings were variables that significantly influenced this choice.     

Laryngeal preservation by treatment with induction chemotherapy and radiotherapy protocol for stage III & IV carcinoma larynx--results of a pilot study.

Total laryngectomy for advanced carcinoma of the larynx is effective but functionally disabling. In an effort at laryngeal preservation, 33 patients of stage III/IV carcinoma larynx were treated between 1987 and 1991 with induction chemotherapy followed by definitive radiation. Two chemotherapy protocols were administered. Group I patients received one to three cycles of cisplatin 100 mg/m2 (day 1), bleomycin 15 U/m2 (day 1), and 5-fluorouracil 1000 mg/m2/day (day 2 to 5) at three weekly intervals. This was then followed by radiotherapy. Group II received one to six weekly injections of single agent methotrexate 50 mg/m2 with or without leucocovorin rescue followed by radiotherapy. Any recurrence was salvaged by surgery. Midway through the study, Group II protocol was discontinued as the initial results were not comparable with Group I or standard treatment. The Group I protocol, however, yielded an initial locoregional control rate of 83.3 per cent With the addition of surgical salvage the locoregional control rate was 94.4 per cent and the control rate with laryngeal preservation was 88.8 per cent. The Kaplan-Meier probability of two years and five years disease-free survival was 81.9 per cent and 61.4 per cent respectively. For disease-free survival with laryngeal preservation the corresponding figures for two years and five years were 58.3 per cent and 41.7 per cent. The control group of 51 patients treated with radical surgery followed by radiotherapy yielded survival figures at two years and five years of 64.3 per cent and 57.2 per cent. The difference in the survival of Group I and the control group was not statistically significant (p value = 0.280). These initial results indicate that for stage III and for surgically resectable stage IV laryngeal carcinomas, a protocol of induction combination chemotherapy consisting of cisplatin, bleomycin and 5-fluorouracil followed by radiotherapy and combined with surgical salvage whenever required, can lead to comparable cure rates. In addition, a large proportion of patients are spared the morbidity of a total laryngectomy.     

Peritumoral infiltrate in the prognosis of epidermoid carcinoma of the oral cavity

IntroductionPatients with squamous cell carcinoma of the oral cavity present deficits in their cellular immunity that contribute to neoplastic growth. Thus, the inflammatory activity, such as the immunological response to the tumor, can be used as a prognostic factor.ObjectivesTo evaluate the correlation between peritumoral inflammation and clinical characteristics of the patients, survival, and the disease-free interval.MethodsThe study sample consisted of a retrospective hospital-based cohort of patients undergoing surgery for resection of oral cavity tumor. The inflammatory infiltrate on the slides was evaluated semi-quantitatively, and were divided into minor and major inflammatory processes.ResultsThis study included 57 tumor samples, with infiltration of lymphocytes, plasma cells, and histiocytes. The log-rank test showed no significance for the survival curves and recurrence of the “minor inflammatory” and “major inflammatory” processes, with p = 0.14 and p = 0.24, respectively. A direct association between age and inflammation (p = 0.04) was observed, as well as an indirect association between the degree of tumor differentiation and inflammation (p = 0.01).ConclusionAlthough associated with histological differentiation, the peritumoral inflammatory process cannot be considered a prognostic factor in squamous cell carcinoma of the oral cavity, as it is not related to survival and disease-free interval.     

Idiopathic unilateral vocal-fold paralysis in the adult

GoalTo analyze the characteristics of adult idiopathic unilateral vocal-fold paralysis.Material and methodsRetrospective study of diagnostic problems, clinical data and recovery in an inception cohort of 100 adult patients with idiopathic unilateral vocal-fold paralysis (Group A) and comparison with a cohort of 211 patients with isolated non-idiopathic non-traumatic unilateral vocal-fold paralysis (Group B).ResultsDiagnostic problems were noted in 24% of cases in Group A: eight patients with concomitant common upper aerodigestive tract infection, five patients with a concomitant condition liable to induce immunodepression and 11 patients in whom a malignant tumor occurred along the path of the ipsilateral vagus and inferior laryngeal nerves or in the ipsilateral paralyzed larynx. There was no recovery of vocal-fold motion beyond 51 months after onset of paralysis. The 5-year actuarial estimate for recovery differed significantly (P < 0.0001): 53.2% in Group A versus 17.9% in Group B. In Group A, recovery occurred before the end of the second year following paralysis onset in 93% of cases. On univariate analysis, recovery in Group A was associated with younger age (P = 0.0033), shorter time to consultation (P < 0.0001), and absence of oncologic history (P < 0.028). In case of non-recovery in Group A, malignant tumor along the ipsilateral vagus or inferior laryngeal nerve was found in 17.2% of cases, 81% of which manifesting during the 30 months following the onset of vocal-fold paralysis.ConclusionIn non-traumatic vocal-fold paralysis in adult patients, without recovery of vocal-fold motion, a minimum three years’ regular follow-up is recommended.     

New clinical staging for pharyngeal surgery in obstructive sleep apnea patients

IntroductionThe success of pharyngeal surgery in the treatment of obstructive sleep apnea syndrome depends on the appropriate selection of patients.ObjectiveTo propose a new staging for indication of pharyngeal surgery in obstructive sleep apnea syndrome.MethodsA total of 54 patients undergoing extended tonsillectomy were retrospectively included, divided into six stages. Stage I: patients with palatine tonsils grade 3/4 and modified Mallampati index 1/2; stage II: palatine tonsils 3/4 and modified Mallampati index 3/4; stage III: palatine tonsils 1/2 and modified Mallampati index 1/2; stage IV: palatine tonsils 1/2 and modified Mallampati index 3/4; stage V: body mass index ≥40 kg/m² with palatine tonsils 3/4 and modified Mallampati index 1, 2, 3, or 4. Stage VI: body mass index ≥40 with palatine tonsils 1/2 and modified Mallampati index 1, 2, 3, or 4.ResultsThe surgical success rates were 88.9%, 75.0%, 35.7%, 38.5%, and 100.0% in stages I–V.ConclusionThe presence of hypertrophic palatine tonsils was the anatomical factor in common in the most successful stages (I, II, and V), regardless of body mass index. Although the modified Mallampati index classes 3 and 4 reduced the success rate of surgery in patients with hypertrophic tonsils (stage II), the presence of modified Mallampati index classes 1 and 2 did not favor surgical success in patients with normal tonsils (stage III).