Endoscopic Thyroidectomy via Axillary Approach / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A hypertrophic scar of the anterior neck is the leading complaint of patients who underwent conventional thyroid surgery. In order to minimize the postoperative scars, endoscopic thyroidectomy via axillary approach was tried. SUBJECTS AND METHOD: Thirty-nine cases (female 37, male two, average age 36.3 yrs) with either benign unilateral thyroid nodule or cyst underwent endoscopic thyroidectomy. Under general anesthesia, less than 7 cm of skin incision was made in the axilla of the same side and subcutaneous tunnel was made over the clavicle. Specially created retractor was placed within the tunnel between platysma and sternocleodomastoid muscle, and under rigid endoscope (4 mm, 5 mm ; 0degrees, 30degrees) thyroidectomy was performed. RESULTS: There were 35 cases of thyroid nodulectomy, one case of isthmusectomy, and three cases of subtotal lobectomy. Complete enucleations with the intact capsule were 13 cases, 24 cases with partial rupture of the capsule, and two cases with incomplete removal of the capsule. The mean operative time was 112.5 minutes. Postoperative complications included one case of postoperative bleeding, two cases of delayed wound healing, three cases of paresthesia of shoulder and arm, and five cases of hypertrophic scar of the axilla. For all cases, hospitalization period was two days. CONCLUSION: Endoscopic thyroidectomy via axillary approach has an excellent cosmetic advantage; however, the procedure requires longer operation time of about three times the conventional method. Operation time can be reduced with the development of more versatile surgical tools. However, limited thyroidectomy surgery can not be avoided.

Clinical Analysis of Cervical Neurilemmoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Neurilemmoma is a benign tumor originating from the spinal nerve root, peripheral nerve and all kinds of cranial nerves except the optic nerve and olfactory nerve. Approximately 25% to 40% of all neurilemmomas are found in the neural structures of the head and neck. We performed this study to analyze the clinical features, diagnosis, treatment and prognosis of neurilemmomas. SUBJECTS AND METHOD: Twenty-one patients who were diagnosed with cervical neurilemmoma and had received treatment at the Department of Otolaryngology-Head and Neck Surgeries from 1994 to 2004 were analyzed retrospectively. RESULTS: The mean age of 21 patients was 41.0 years, with 10 being male and 11 female. The most common symptom was palpable neck mass and the mean duration of symptoms was 28.2 months. The most common location of tumor was level II and the most common nerve of origin was the vagus nerve (23.8%). Preoperative diagnostic tools were FNA, CT and MRI. Operation was most commonly performed via transcervical approach. In 10 cases, nerves of origin were preserved, whereas, in 5 cases, nerves of origin were sacrificed and in 6 cases, nerves of origin were not found. The postoperative complications were vocal cord palsy (14.3%), arm weakness (14.3%), facial weakness (9.5%), Horner's syndrome (9.5%), sensory (4.8%) and motor (4.8%) impairment of tongue. The mean follow-up period was 5.3 years and recurrence was not found during this period. CONCLUSION: CT or MRI is more helpful than FNA in the diagnosis of neurilemmoma. In excising neurilemmoma, the nerve must be preserved as much as possible.

Microscopic Adenoidectomy Using the Electric Adenotome / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The conventional adenoidectomy is performed via the transoral approach and can be accomplished with adenoid curette, adenotome, and adenoid punch. This method has been associated with many complications. We performed an adenoidectomy using an electric adenotome under the operating microscope. The aim of this study was to compare the electric adenotome adenoidectomy with the conventional adenoidectomy and to evaluate the effectiveness and outcome of the electric adenotome surgery. MATERIALS AND METHODS: One hundred cases of microscopic adenoidectomy using the electric adenotome and one hundred cases of conventional methods using curette or punch forceps were examined. RESULTS: There was less incidence of intraoperative and postoperative bleeding in the electric adenotome adenoidectomy group. There were no differences regarding the postoperative outcome and recurrence rate between the electric adenotome method group and the conventional method group. CONCLUSION: Compared to the conventional method, the electric adenotome method has similar postoperativc result but has a lower incidence of intraoperative and postoperative bleeding. We suggest that adenoidectomy using an electric adenotome is an attractive surgical method in children with symptomatic adenoid vegetation,

Chondrosarcoma of the Temporal Bone / 대한이비인후과학회지

Chondrosarcoma of the temporal bone is a rare neoplasm constituting only 0.16% of intracranial tumors. Type of cranial nerve involvement in chondrosarcoma of the temporal bone is related to the specific anatomic location of the tumor. Clinically it has been confused with multiple sclerosis, glomus jugulare tumors, meningiomas, and chordomas. Ablative surgical treatment seems to be the procedure of choice and the value of irradiation or chemotherapy is still under debate and long term follow up is necessary. The authors experienced a case of chondrosarcoma of the temporal bone in a 27 year-old female with facial palsy. The patient underwent wide excision via transmastoid and suboccipital approach and then postoperative radiotherapy. She is free of local recurrence or metastasis for postoperative 18 months.

Thyrotracheal Anastomosis for Combined Laryngotracheal Stenosis: Experience in 11 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The combined Laryngotracheal stenosis produces cripling complications of respiratory and phonation difficulty. The area between cricoid cartilage and first tracheal ring is the most common site of stenosis and is the most difficult area to manage, therefore, appropriate selection of surgical method is the important factor determining the success of treatment. The authors treated laryngotracheal stenosis with thyrotracheal anastomosis and here we report the results and problems of thyrotracheal anastomosis to provide aid in the management of laryngotracheal stenosis. MATERIALS AND METHODS: Authors retrospectively studied 11 cases of laryngotracheal resection with thyrotracheal anastomosis patients for clinical characteristics, site and degree of stenosis, operation technique such as granulation tissue removal under bronchoscopy, CO2 laser excision, insertion of T-tube, insertion of laryngeal stent, and its results. RESULTS: 1) Decannulation was possible in seven cases (63.6%). 2) The success rates of patients under the ages of 20years was 80%, patients with normal vocal cord movement was 85.7%. 3) The patients with residual neurologic symptom, or with decreased coughing reflex failed in decannulation. CONCLUSION: Treatment of combined laryngotracheal stenosis is very difficult and our study showed a success rate of 63.6%. Laryngotracheal resection and end to end thyrotracheal anastomosis showed to be the most effective treatment method and in general the patients under the ages of 20 years, or with normal vocal cord movement showed better prognosis. Therefore, a radical treatment planning with efforts to reduce complication at this group may produce satisfactory results in the management of laryngotracheal stenosis.

Expression of Ki-67 and Topoisomerase IIa in Human Middle Ear Cholesteatoma Epithelium / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cholesteatoma is a destructive lesion of the middle ear or mastoid process. The development of human cholesteatoma is due to the altered control of cellular proliferation in part, which tilts the balance toward the aggressive, invasive growth of squamous epithelium within the middle ear. Many efforts were performed to prove overproliferative characteristics of cholesteatoma using various proliferation markers. Nonetheless, trigger site of overproliferation within the overgrowing epithelium of cholesteatoma is still ill defined. MATERIALS AND METHODS: In this study, we used the monoclonal antibody Ki-67 and Topoisomerase II, a marker of active proliferation, on frozen sections obtained from 12 cholesteatoma samples and observed expression of these markers in three different regions, from normal meatal skin, transitional zone and cholesteatoma sac. RESULTS: The results were interpreted on the basis of nuclear staining and percentage of positively stained cells (labeling index). We found that labeling indices of cholesteatoma and transitional zone were significantly increased compared with that of normal meatal skin. CONCLUSION: This result suggested that initiating of overproliliferation of cholesteatoma epithelium started from the transitional zone.