Complications Following Thyroid Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Despite the fact that the rate of complications is constantly decreasing, the immediate and severe complications of thyroid surgery emphasize the need for precise surgical techniques and to provide patients with the most benefical treatment that results in lower morbidity. To clarify the safety of thyroid surgery, 147 thyroidectomy cases were reviewed. MATERIALS AND METHODS: From April 1998 through March 2000, 147 thyroidectomies were performed at the otolaryngologic department. The risk of recurrent laryngeal nerve lesion is based on the number of nerves at risk, and the risk of hypocalcemia is based on the number of patients undergoing bilateral procedures, or contralateral surgery in patients previously operated on. The risk of superior laryngeal nerve injury is based on the number of all thyroidectomies. RESULTS: The number of nerves at risk was 210. The rate of postoperative permanent recurrent laryngeal nerve palsy was 1.4% (3/210), which is iatrogenic. Four recurrent nerves (1.9%) invaded by cancer were sacrificed intentionally. Transient paralysis was found in 1.4% of the cases (3/210). Transient superior laryngeal nerve injury was found in 0.7% (1/147), all within one month of recovery. Of 89 patients undergoing dissection of both thyroid lobes, 1.1% (1/89) developed postoperative permanent hypocalcemia. Transient postoperative hypocalcemia was found in 7 patients (7.9%), with a recovery period ranging from one to two weeks. Postoperative bleeding, infection, and seroma were not noted in this study. CONCLUSION: The data strongly indicate that careful surgical techniques, understanding of anatomic variation and surgical experiences hold the clue for a low rate of complications following thyroid surgery.

A Case of Metastatic Hepatocellular Carcinoma of the Ethmoid Sinus / 대한이비인후과학회지

Hepatocellular carcinoma usually metastasizes to lung, breast, lymph node, GI tract, bone, kindey, and adrenal gland. Up to now, only few cases of hepatocellular carcinoma presenting as a metastatic ethmoid sinus tumor could be found in the literature. If a patient with hepatocellular carcinoma complains epistaxis, and if expansile, osteolytic, and hypervascular lesions are observed in a radiologic examination, nasal cavity and sinus tumor should be confirmed through biopsy. We report, along with the review of appropriate literature, a case of histollogically confirmed metastatic hepatocellular carcinoma of the ethmoid sinus of a 56 year old man.

Imaging and Acoustic Study of Laryngectomees after the Amatsu Tracheoesophageal Shunt Operation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The two most important methods for voice rehabilitation after total laryngectomy are tracheoesophageal speech and esophageal speech. The former can be obtained in several ways, for example, by the primary Amatsu tracheoesophageal (T-E) shunt operation or by the use of a low-resistance valve such as the Provox prosthesis. The purpose of this investigation was to study the anatomy and physiology of the neoglottis and to evaluate the vocal quality of tracheoesophageal speech. MATERIALS AND METHODS: A total of 12 patients, who had undergone the Amatsu T-E shunt operation after total laryngectomy, were analyzed using the stroboscopy, laryngofiberscopy, videofluoroscopy, and computerized speech lab. RESULTS: With stroboscopy, the neoglottis was split from left to right in 3 patients and in 9 patients, the direction of opening and closure of rheeoglottis was anterior-posterior. The regular vibratory features were observed in patients with a shortened visible vibratorvsegment. The results of videofluoroscopy indicate that the location of the vibration was mostly situated between C3 and C5. The cervical esophagus closure during tracheoesophageal phonation was located at a level between C7-T2. CONCLUSION: The anatomical and morphological characteristics of the neoglottis was related to the healing process after operation. The neoglottis was considered to be formed by the thyropharyngeal muscle, and concentric contraction under subneoglottic extension was formed by the contraction of the cervical esophagus.