Reconstruction of Head and Neck Defects with Anterolateral Thigh Free Flap / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Anterolateral thigh flap (ALTF) has been reported to be very versatile and reliable for the head and neck reconstruction. The great concern in its operative technique is the anatomic variation of the perforators of the flap. The aim of study is to present our clinical experience using ALTF for the reconstruction of head and neck defects and to describe the anatomic variations of perforators among Korean patients. SUBJECTS AND METHOD: A retrospective study was conducted on patients who underwent ALTF reconstruction for their head and neck defects between April 2002 and April 2004. A total of 13 subjects (M: F=11: 2, mean age: 62 years) were considered for reconstruction after a wide surgical ablation of malignant tumors of the head and neck. The authors analyzed several items such as success rate, associated complications, characteristics of the flap, and morbidity of the donor site. RESULTS: All flaps were successfully transferred without any intraoperative complications. Partial necrosis occurred in 2 of 13 subjects, which were managed with conservative debridement and/or skin graft. As for vascular pedicles, musculocutaneous perforators from the descending branch of lateral circumflex femoral artery (LCFA) were found in 84.6% (11 of 13). In two cases (15.4%), the septocutaneous perforator from the descending branch of LCFA was the dominant supplier. The size of ALTF ranged from 8.0 to 16.0 cm in length, 4.0 to 8.0 cm in width, and 0.4 to 1.2 cm in thickness. Donor site complications were acceptable in all patients. CONCLUSION: Various types of head and neck defects were effectively managed with ALTF. We could overcome the anatomic variation of the perforators and most flaps were transferred without major complications and donor site morbidity. Further study on the anatomy of pedicles and refinements of surgical technique may make ALTF the workhorse of head and neck reconstruction.

The Patterns of Lymphatic Metastasis and the Surgical Treatment of Malignant Tumors in the Periorbital Area / 대한이비인후과학회지

OBJECTIVES: Malignant tumors rarely develop in the perioirbital area. Few studies have been reported on the patterns of lymphatic metastasis in these malignant tumors. The objectives of this study were to analyze the patterns of lymphatic metastasis in the malignant tumor arising in the periorbital area according to the primary site to assess the optimal surgical management of these tumors. MATERIALS AND METHODS: We retrospectively reviewed the medical records of eight patients with malignant tumors in the periorbital area from January 1997 to June 2002. The mean duration of follow up was 25.8 months. Five patients had tumors in the medial wall of the perioirbital area: one in the lateral wall and two in the medial and the lateral wall. There were three squamous cell carcinomas, two adenoid cystic carcinomas, two sebaceous carcinomas and one basal cell carcinoma. RESULTS: The Lymphatic metastasis was observed in 4 of 8 patients who had relatively large size (> or =4 cm) or poorly differentiated tumor. Four of 7 tumors involving the medial wall of the periorbital area had the lymphatic spread to the periparotid lymph node and level II lymph node groups. CONCLUSION: The results of this study suggest that more aggressive management of the parotid area should be necessary in the malignant tumors developing in the perioirbital area even in the medial portion.

Initial Treatment and Conservation Salvage Surgery of Early Glottic Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Surgery or radiation therapy is most widely employed in the treatment of early glottic cancer with no significant difference in the survival rate. Various treatment modalities including surgery, radiation therapy or combined therapy can also be adopted for recurring early glottic cancer. Nowadays, conservation salvage surgery presents as an excellent alternative to the traditional total laryngectomy with favorable results. The objective of this study is to compare the outcome of each treatment modality for early glottic cancer and evaluate the role of conservation salvage surgery for recurring cases. SUBJECTS AND METHOD: Seventy-three patients with early glottic cancer (stage Tis, T1, T2 N0M0) were treated between January 1995 and December 2001, and followed up for at least over an year. They were divided into two groups with the standards of whether they had surgery or radiation therapy as an initial treatment. Then, both groups were analyzed for local control and recurrence rate after initial treatment and conservation salvage surgery for recurrent case, respectively. RESULTS: Twenty-four patients had conservation surgery and 49 had radiation therapy as an initial treatment. Local control rate was 100% for conservation surgery, 93.9% for radiation therapy and there was no significant difference between groups. Recurrence rate for each group was 8.3% and 15.3%, respectively, but no statistical difference was found. Twelve patients showed recurreence or had remnant cancer. Conservation salvage surgery including laser cordectomy, hemilaryngectomy, frontolateral hemilaryngectomy, and supracricoid partial laryngectomy had been performed in 10 cases. In all cases, laryngeal preservation was possible and there was no recurrence of tumor during follow up periods. CONCLUSION: As an initial treatment modality, conservation surgery and radiation therapy was proven to be equally effective for early glottic cancer with no significant difference in local control and recurrence rate. For the recurrent cases, conservation salvage surgery including supracricoid partial laryngectomy was shown to be a very useful treatment modality with good oncological results and excellent laryngeal preservation.

Salivary Duct Carcinoma: A Clinicopathologic Analysis and Treatment Outcome / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Salivary duct carcinoma (SDC) is a rare but highly malignant tumor of the salivary glands. Authors aimed to assess the current treatment outcome and to estimate the prognostic factors in the patients with SDC. MATERIALS AND METHODS: We reviewed the medical records of 11 patients with SDC, who were treated between Jan. 1995 and Jun. 2002 at the Department of Otolaryngology, Samsung Medical Center. Follow-up duration ranged from 10 to 76 months with a mean of 29.6. RESULTS: The parotid glands were more frequently involved (9 patients) than the submandibular glands (2 patients). Most patients were diagnosed to have an advanced stage of the disease. Curative surgical resections and/or postoperative radiation were the mainstay of the treatment. The adjusted 3-year survival rate was 64.9% and the disease-free 3-year survival rate was 34.1%. Four patients died of the disease at a mean interval of 22 months after the initial diagnosis. Presentation with the facial nerve paralysis, positive surgical resection margins and pathological vascular invasion had a tendency to result in poor survivals. Treatment failures due to distant metastasis were common (54.5%). CONCLUSION: We reconfirmed the aggressive clinical natures of SDC: frequent distant metastasis and poor survival rates. These findings strongly suggest that additional treatment modalities such as an adjunctive systemic treatment need to be considered in the patients with SDC especially when they have high risk factors or an advanced disease, which need further investigation.

Effects of Medical Treatment on Meniere's disease

OBJECTIVES: In Meniere's disease, medical treatment using diuretics has been the mainstream of management. But the effects of medical treatment are very difficult to evaluate because of many variables. Authors tried to investigate the effects of diuretics on Meniere's disease through the change of symptoms. MATERIALS AND METHOD: From January, 1995 to December, 2000, the twenty patients with definite Meniere's disease who has been followed up over 24 months were retrospectively reviewed. They had no history of previous medication, and were managed with diuretics for the first time. The change of frequency of vertigo, the threshold of pure tone audiometry, type of audiogram were analyzed at each period during 6 month before treatment, during 6 month at 1, 2 and 4 years after treatment. RESULTS: The ratio of sex was 1:1(male 10, female 10), the average age of diagnosis was 53.9 year old, and the average follow up duration was 39.3 month. By medical treatment, vertigo symptom was significantly controlled in 56.2% at 2 year after treatment. Among 20 patients, 5 patients failed to medical treatment and underwent the sac decompression (N=1) and intratympanic gentamicin injection (N=4). The change of pure tone audiometry was from 34.5 dB before treatment to 38 dB at 24 months and 44.2 dB at 48 months after treatment. The most type of audiometry was flat type and flat type was increased with time. CONCLUSION: In Meniere's disease, the medical treatment controlled significantly the vertigo frequency in 50~60%. But the hearing threshold was aggravated with time after treatment despite of medical treatment.