A Clinical Study of Extended-Conservation Surgery in Laryngeal Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The surgical goals of laryngeal cancer should not only be to preserve life but also to preserve laryngeal functions such as airway, aspiration prevention, and voice production. Classic, standard conservation laryngectomy such as horizontal supraglottic laryngectomy and vertical hemilaryngectomy has served well to those purposes but has the limits of resection. And so extended conservation laryngeal surgery was developed to extend surgical resection margin if we carefully select surgical indication. Our study was to determine the best surgical method according to the extent of tumor and evaluate the surgical outcome oncologically and physiologically in extended conservation laryngectomy. MATERIALS AND METHODS: Forty patients were treated with extended conservation surgery in laryngeal cancer at Department of Otorhinolaryngology, Head and Neck Surgery, at the Hallym university hospitals according to surgical algorithm invented by author (Young Min Kim, MD)from 1992 to 1998. They were reviewed retrospectively with respect to age, sex, endoscopic and radiologic evaluation, primary site, extended site, postoperative complications and results. RESULTS: Thirteen patients had glottic cancer, and were treated with extended vertical laryngectomy. Two patients showed recurrence at the primary site or neck nodes, one patient died due to other disease. Ten patients (76.9%)are alive without disease. Twenty-seven patients were supraglottic cancer. They treated with extended horizontal laryngectomy. Twenty patients (74.1%)are alive without disease. Three patients recurred at primary site or neck nodes. CONCLUSION: Extended conservation surgery was oncologically safe in both glottic and supraglottic cancer. Functional outcome was relatively satisfactory and so we could avoid total or near-total laryngectomy with careful evaluation of tumor extent.

A Clinical Study of Head and Neck Tumors Involving the Superior Mediastinum / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Traditionally, approaches to the superior mediastinum for head and neck surgeons are mainly limited to stomal recurrence. Recently, the need to approach to the superior mediastinum is increasing due to increasing thyroid surgery by head and neck surgeon. This study was designed to evaluate the approaches to mediastinum in head and neck tumors involving the superior mediastinum and to analyse the outcome of surgery in terms of morbidity and mortality. MATERIALS AND METHODS: At the department of otolaryngology-head and neck surgery of Hallym university, 15 patients who had been diagnosed as head and neck tumors involving the superior mediastinum from May 1990 to August 1998 were evaluated retrospectively. RESULTS: Of the 15 patients, the tumors involving the superior mediastinum were thyroid cancer (5 cases), hypopharyngeal cancer (4 cases), cervical esophageal cancer (2 cases), laryngeal cancer (1 case), and substernal goiter (3 cases). The surgical techniques used for approach to the superior mediastinum were suprasternal approach, clavicle resection, median sternotomy, and sternal manubrium resection. Eight patients are alive without recurrence, one patient is alive with disease, and six patients died, among them, four patients died of postoperative complication and two died of recurrent cancer. CONCLUSION: The mediastinal approach in itself is not complex and dangerous, however, in the treatment of head and neck cancers involving mediastinum, the surgeon should be careful in choosing the surgical method and approach. The surgeion should also take into consideration morbidity and mortality of the surgery, degree of tumor invasion and others, such as age of the patient.

Changes of the Olfactory Epithelium in Artificially Induced Hypothyroid Rats

BACKGROUND AND OBJECTIVES: This study was performed to investigate, through immunohistochemical analysis, the thyroid hormone's effect on the olfactory receptor neurons of adult rats. MATERIALS AND METHODS: Hypothyroidism was induced by adding reversible goitrogen propylthiouracil (PTU) to the rats' drinking water (30 mg/kg weight). Sprague-Dawly rats aged nine to ten weeks were divided into three groups : control, six weeks or PTU therapy, and 12 weeks of PTU therapy. Light microscopic investigation of the olfactory mucosa was conducted with an immunohistochemical stain to observe for proliferating cell nuclear antigen (PCNA) and protein genepeptide (PGP) 9.5. RESULTS: The rats in the experimental groups gained less weight compared with normal rats of the same age. Light microscopic examination revealed no statistically significant differences in the thicknesses of the olfactory epithelium and the numbers of cells among the three groups in H-E stains, but the ratio of PCNA(+) supporting cells decreased significantly with longer durations of PTU treatment. As PTU therapy continued, immunoreactivities to PGP 9.5 in olfactory receptor cells decreased remarkably. After 12 weeks of PTU treatment, no immunoreactivity was observed in the olfactory receptor cells. CONCLUSION: These results indicate that the thyroid hormone is essential for maturation of the olfactory receptor neuron.

A Case of Basal Cell Adenocarcinoma in the Parotid Gland / 대한이비인후과학회지

Basal cell adenoma of salivary gland is an established variant of monomorphic adenoma. Few cases of malignant basal cell neoplasms have appeared in the literature. Basal cell adenocarcinoma has not only morphologic characteristics of the basal cell adenoma but also infiltrative, perineural and intravascular growth features that indicate a malignant potential. Some cases of these tumors which metastasized to the lymph nodes and lung have been reported. The peak incidence of age is in the fifth decade of life, and there is no gender predilection. The parotid gland is a predominant site of involvement. The authors have experienced such case of basal cell adenocarcinoma, which was presented by a single parotid mass. The tumor was removed by total parotidectomy with preservation of the facial nerve.