ABSTRACT
Necrotizing Sialometaplasia (NS) is a benign, self-limiting inflammatory disease of the mucus-secreting glands, and this illness mainly involves the minor salivary glands. The significance of NS resides in its clinical and histopathological resemblance to malignancy. We present here a case of necrotizing sialometaplasia on the soft palate, and this was accompanied by adenoid cystic carcinoma. We report here on this case to draw attention to the difficulty for deciding the extent of resecting a malignancy, and especially when the malignancy is simultaneously accompanied by necrotizing sialometaplasia.
Subject(s)
Adenoids , Carcinoma, Adenoid Cystic , Palate, Soft , Salivary Glands, Minor , Sialometaplasia, NecrotizingABSTRACT
BACKGROUND AND OBJECTIVES: The accurate measure of salivary flow rate requires a variety of clinical and experimental protocols. Several methods have traditionally been used to collect and measure the whole mouth saliva. The objective of this study was to verify usefulness of a newly developed oral Schirmer test for detecting salivary gland hypofunction. SUBJECTS AND METHOD: The control group consisted of 85 healthy patients, while another group consisted of 30 patients with salivary grand resection or post-head and neck irradiation and a third group of 30 patients who suffered from subjective xerostomia caused by other pathologies. Oral Schirmer test was carried out in all subjects. The main outcome was the wetted length after 5 minutes. RESULTS: The mean saliva flow was 59.3+/-16.99 mm/5 min in the control group, 47.0+/-13.50 mm/5 min in the 2nd group and 39.9+/-11.65 mm/ 5 min in the third group. The differences between the control group and the other two groups were statistically different (p<0.001). A cut-off value 40 mm/5 min showed sensitivity of 83.7% and specificity of 62.5%. CONCLUSION: The oral Schirmer test is valid and reliable for identifying subjects with xerostomia.
Subject(s)
Humans , Mouth , Neck , Saliva , Salivary Glands , Sensitivity and Specificity , XerostomiaABSTRACT
Lip cancer is the most common malignancy of the oral cavity and is the second most common cancer in the head and neck. Because lip cancer can be detected early, it is readily curable compared with other head and neck malignancies. In the treatment, surgery is recommended for most patients. After resection, reconstruction is important both aesthetically and functionally, because of it's prominent location of face and essential functions of sphincter to assist in mastication, swallowing, phonation, and expressing emotion. Recently, we performed the reconstruction of lower lip defects after resection of cancer using various methods and achieved good results. So we present the cases with a review of literatures.
Subject(s)
Humans , Carcinoma, Squamous Cell , Deglutition , Head , Lip , Lip Neoplasms , Mastication , Mouth , Neck , Phonation , Plastic Surgery ProceduresABSTRACT
OBJECTIVES: To compare the velopharyngeal function, swallowing and speech of the conventional and modified radial forearm free flap (RFFF) for soft palate reconstruction. METHODS: Retrospective clinical study. Twenty-eight patients who underwent oropharyngeal reconstruction with RFFF were divided into two groups: 10 patients had conventional folded RFFF and 18 patients underwent modified method. RESULTS: The average speech intelligibility score in modified RFFF group was 8.0+/-2.4, and 6.2+/-2.2 in conventional RFFF group (P<0.05). The nasalance was 27.4+/-7.8% in modified group and 38.6+/-2.7% in conventional group during no nasal passage reading and 43.6+/-7.3% in modified group, 55.2+/-7.6% in conventional group during high nasal passage reading (P<0.05). The subjective swallowing functional score was 2.8 in modified group and 2.1 in conventional group. CONCLUSION: The speech assessment and nasalance demonstrate a more favorable outcome in modified group than conventional group.
Subject(s)
Humans , Deglutition , Forearm , Free Tissue Flaps , Oropharyngeal Neoplasms , Palate, Soft , Retrospective Studies , Speech IntelligibilityABSTRACT
It is rare to find spontaneous cervical bleedings for which a wide variety of etiologies have been reported. We experienced a case of spontaneous cervical bleeding that caused emergency operation. We present this case with a review of the literature. This case demonstrates a potentially lethal complication in patients with neurofibroma. Neurofibroma is an inherited disease, classified as 'classical (type I, von Recklinghausen, multiple or peripheral neurofibromatosis)', 'central (type II, bilateral acoustic neurofibromatosis)' and other types. The pathognomic features of classical neurofibromatosis are cafe-au-lait spots and neurofibromas. Other clinical features are variably expressed and occurnece of severe hemorrhage is an unusual complication. Conservative management do not stop the hemorrhage. Surgical exploration must be undertaken for cure.
Subject(s)
Humans , Acoustics , Cafe-au-Lait Spots , Emergencies , Hemorrhage , Neck , Neurofibroma , Neurofibromatoses , Neurofibromatosis 1ABSTRACT
BACKGROUND AND OBJECTIVES: Contusions and lacerations of the auricle are common, but reconstructive procedures are difficult because the auricle has an intricate cartilage framework covered with delicate skin. The purpose of this study was to present therapeutic principles of traumatized auricular laceration. SUBJECTS AND METHOD: The study was performed retrospectively and included 35 traumatized auricular laceration patients. Their wound state, degree of laceration, whether or not had exposure of cartilage, methods of reconstruction used and postoperative complications were analyzed. RESULTS: Multiple laceration was found in 11 patients. Eight of 19 patients who had cartilage exposed had been performed cartilage suture method for alignment. Primary reconstruction was performed for two avulsed subtotal injury patients. Pocket principle technique was used for one patient whose auricle was contaminated and amputated. Postoperative complications were noted as paresthesia, color change, delayed healing, deformity and partial loss of auricle. CONCLUSION: Rapid and active management of traumatized auricular lacerations is important to prevent infection and postoperative complications.
Subject(s)
Humans , Cartilage , Congenital Abnormalities , Contusions , Ear, External , Lacerations , Paresthesia , Postoperative Complications , Retrospective Studies , Skin , Sutures , Wounds and InjuriesABSTRACT
BACKGROUND AND OBJECTIVES: 5-Fluorouracil (5-FU) is a commonly used drug in carcinomas of the head and neck. Mucositis and bone marrow toxicity are the two major side effects. Some initial studies showed that the local use of allopurinol as a mouthwash may reduce the oral mucositis caused by the administration of 5-FU. The purposes of this study were to establish the stomatotoxicity of the chemotherapeutic agent in an animal model and to evaluate the effect of allopurinol mouthwashes in treating mucositis objectively. MATERIALS AND METHOD: Young male Golden Syrian hamsters were used. The combination of three intraperitoneal injection of 5-FU at five-day intervals and superficial mechanical mucosal irritation were applied and examined with a gross, light microscope, and a scanning electron microscope. The allopurinol oral mucosal paintings were applied three times everyday, starting with the treatment of 5-FU, only at the right buccal mucosa for one minute. RESULTS: Light microscopic changes were characterized by ulcer and inflammatory cells infiltration. The scanning electron microscopic examination showed irregular microridges and pits. Gross and histopathologic alterations were reliably reduced in the allopurinol mucosal painting group. CONCLUSION: This study suggests an effective animal model for stomatotoxicity of chemotherapeutic agents, and that allopurinol mouthwashes can be effective in treating or protecting the 5-FU induced stomatitis.
Subject(s)
Animals , Cricetinae , Humans , Male , Allopurinol , Bone Marrow , Fluorouracil , Head , Injections, Intraperitoneal , Mesocricetus , Models, Animal , Mouth Mucosa , Mouthwashes , Mucositis , Neck , Paint , Paintings , Stomatitis , UlcerABSTRACT
Lingual thyroid is the most common benign ectopic thyroid tissue but is a rare clinical entity. This developmental anomaly is due to the failure of descent of the gland anlage early in the course of embryogenesis. Patients may have symptoms of dysphagia due to obstruction or even hemorrhage. These symptoms can occur at any time from infancy through adulthood. The clinical findings, laboratory tests, and radiographic imaging studies employed in confirming the diagnosis and in planning appropriate treatment have been evaluated. The primary therapeutic goal is to restore thyroid function but surgical excision of the gland is reserved for more advanced cases of gland enlargement resulting in airway compromise, severe dysphagia that limits oral intake, or hemorrhage. We experienced a case of lingual thyroid that was successfully treated by transcervical approach and summarized the principles of current management for this condition.
Subject(s)
Female , Humans , Pregnancy , Deglutition Disorders , Diagnosis , Embryonic Development , Hemorrhage , Hypothyroidism , Lingual Thyroid , Thyroid Dysgenesis , Thyroid GlandABSTRACT
BACKGROUND AND OBJECTIVES: Basal skull fractures are different from cranial vault fractures in several aspects. These fractures are difficult to diagnose by ordinary X-ray, routine head CT and are frequently inferred from clinical signs. It involves more commonly the cranial nerves, makes fistulae of cerebrospinal fluid (CSF) and lead to central nervous system infections. Despite the clinical significance of basal skull fracture in otorhinolaryngology, there have been only a few clinical studies. So we began this research for better treatment of basal skull fracture (BSF). MATERIALS AND METHOD: The authors analyzed 100 cases of basal skull fracture treated in the department of neurosurgery, from January 1998 to December 2000. We reviewed the clinical features, radiologic findings, and rate of delayed diagnosis. RESULTS: The basal skull fractures were more common in men than women. In the decreasing order of cause in basal skull fractures were traffic accidents (64%), fall down and assault. Clinical features were nasal bleeding (42%), ear bleeding (41%) and hearing loss (36%). Most of CSF leakages were noted within 24 hours after injury and had ceased by conservative management. The degree of facial palsy had an influence on the recovery of facial nerve function. The types of hearing loss had a role in the recovery of hearing. Six cases (6%) were delayed in the diagnosis of BSF. CONCLUSION: In the BSF patient's treatment, many parts needed otorhinolaryngological treatment. But in the patient's treatment, otorhinolaryngological problems had been ignored by the neurosurgical concerns. From the otorhinolaryngoloical aspect, BSF patients should be given an active treatment.
Subject(s)
Female , Humans , Male , Accidents, Traffic , Central Nervous System Infections , Cerebrospinal Fluid , Cranial Nerves , Delayed Diagnosis , Diagnosis , Ear , Epistaxis , Facial Nerve , Facial Paralysis , Fistula , Head , Hearing , Hearing Loss , Hemorrhage , Neurosurgery , Otolaryngology , Skull Fractures , SkullABSTRACT
BACKGROUND AND OBJECTIVES: The majority of nasal bone fractures have been managed by using closed reduction and intranasal packing, leaving rooms for many complaints from patients. But the intranasal Kirschner wire (K-wire) splinting described by Chang in 1994 provided rigid intranasal support and increased less complaints from patients. Although the Kirschner wire splinting can be an alternative method for nasal bone packing that accompanies little complaints from patients, literature regarding the efficiency of Kirshcner wire splinting is rare. We studied the efficiency and clinical outcomes between the K-wire splinting and intranasal packing. MATERIALS AND METHOD: Prospectively, we studied 51 patients with nasal bone fracture who have undergone closed reduction. Of these, 30 patients were immobilized with the Kirschner wire splinting and 21 patients were immobilized with intranasal vaseline packing. On the first prospective day, patients were routinely examined by a visual analogue scale. The degree of satisfaction by both doctors and patients was investigated after a minimum 6 months. Complications were studied. All results were statistically confirmed. RESULTS: Complaints from patients were significantly less when the K-wire was used. There was no statistical difference between satisfaction expressed by doctors and patients, and there were no serious complications in using the K-wire. CONCLUSION: The K-wire is a reliable and useful immobilization method for nasal bone fracture.
Subject(s)
Humans , Bone Wires , Immobilization , Nasal Bone , Petrolatum , Prospective Studies , SplintsABSTRACT
Extramedullary plasmacytoma is a rare soft tissue malignancy composed of plasma cells. This tumor may be primary or secondary to the generalized multiple myeloma. The great majority of extramedullary plasmacytoma occurs in the head and neck region, mainly in the upper respiratory tract and oral cavity. The most frequently involved sites are the nasal cavity, paranasal sinus, and nasopharynx, in the decreasing order. However extramedullary plasmacytoma of the larynx is rare. Laryngeal plasmacytomas accounts for between 6 to 18% of all extramedullary plasmacytomas. We report, with a review of literature, a case of extramedullary plasmacytoma of the larynx in a 41 year-old female patient.
Subject(s)
Adult , Female , Humans , Head , Larynx , Mouth , Multiple Myeloma , Nasal Cavity , Nasopharynx , Neck , Plasma Cells , Plasmacytoma , Respiratory SystemABSTRACT
Anterior or lateral neck mass that appears on straining should be differentiated from laryngocele, jugular phlebectasia and superior mediastinal cysts or masses. The most common cause of aneck masses which that appears on straining is alaryngocele. The jugular phlebectasia may present itself in a similar manner, although it occurs rarely. The cause of the jugular phlebectasia is unclear. The diagnosis is made on a clinical basis and confirmed by the less invasive radiological technique. No treatment is indicated because of its self-limiting, benign condition. However, the surgical removal is needed for cosmetic purposes by a unilateral excision of the jugular vein. We experienced two cases of jugular phlebectasia, one anterior and the other internal. One case of The anterior jugular phlebectasia was successfully treated by surgical excision, and the other case of internal jugular phlebectasia was treated conservatively.
Subject(s)
Diagnosis , Jugular Veins , Laryngocele , Mediastinal Cyst , NeckABSTRACT
BACKGROUND AND OBJECTIVES: Conventional tonsillectomy with the naked eye has posed problems in obtaining a good surgical field and in minimizing damage to the adjacent tissue. Tonsillectomy using an operating microscope offers outstanding illumination and visualization of the surgical field, thereby reducing the incidence of complications associated with tonsillectomy. The objective of this study was to compare the surgical methods of the conventional and the microscopic tonsillectomies, and to evaluate the usefulness and effectiveness of the microscopic tonsillectomy. MATERIALS AND METHODS: Two hundred children between the ages of five and ten who received tonsillectomy between June 1995 and August 1998 at Korea University Hospital were divided into two groups,' one group underwent tonsillectomy using an operating microscope (Group 1, n=100) and the other group underwent tonsillectomy using the conventional dissection and snare technique (Group 2, n = 100). Duration of surgery, post-operative healing period, amount of intra and post-operative hemorrhage, post- operative pain score, and the incidence of post-operative cicatrical pharyngeal stenosis were compared between the two groups. RESULTS: There was no statistically significant diference in operating time and post-operative healing period between the two groups, but cicatrical pharyngeal stenosis due to post-operative scarring was more common in the group that underwent conventional tonsillectomy. The amount of hemorrhage both intra and post-operatively, and post-operative pain was significantly decreased in the microscopic tonsillectomy group. CONCLUSION: The widespread use of operating microscope in otolaryngological surgeries allows this technique to be applied to tonsillectomy with few problems. This technique affords decreased intra-operative bleeding, less post-operative complications, and decreased post-operative pain compared with conventional techniques. We believe that microscopic tonsillectomy is a safe, elegant and effective procedure that represents a new concept in tonsil surgery.
Subject(s)
Child , Humans , Cicatrix , Constriction, Pathologic , Hemorrhage , Incidence , Korea , Lighting , Palatine Tonsil , SNARE Proteins , TonsillectomyABSTRACT
BACKGROUND AND OBJECTIVES: Chronic recurrent parotitis has been considered as an ascending infection from the oral cavity, but its causes remain unknown. Although conservative mechanical and medical measures are usually effective in controlling the acute exacerbations of this disease, surgical treatment may become necessary when the infection become too frequent or severe for episodic treatment. This study was designed to evaluate the etiology and pathology, and to analyse the outcome of surgery. MATERIALS AND METHODS: A retrospective study was conducted on nine patients who were managed by surgery(seven patients: superficial parotidectomy, two patients: total parotidectomy) after failure with all conservative measures. The age distribution was from 25 to 72 years, with the mean of 44 years. RESULTS: Of nine patients, the numbers of recurrence were 1-5 times (with the average of three times). Duration of illness ranged from one to 42 years, with a mean of 12 years. Conservative treatments preceding surgery included parotid gland massage, sialogogues, repeated use of antibiotics, and Stensens duct probing in all patients. The disease persisted in all the patients despite these measures, but following parotidectomy (superficial: 7 patients, total: 2 patients), all had complete resolution of the disease. Two patients developed transient facial weakness (House-Brackmann grade II) postoperatively without permanent sequelae. Other complications included seroma in two patients, facial deformity in two patients, Freys' syndrome in one patient, and salivary fistula in one patient. CONCLUSION: Chronic recurrent parotitis, when deeply severe, causes significant. When all the conservative medical management fail, parotidectomy can be offered as the last resolution.
Subject(s)
Humans , Age Distribution , Anti-Bacterial Agents , Congenital Abnormalities , Fistula , Massage , Mouth , Parotid Gland , Parotitis , Pathology , Recurrence , Retrospective Studies , Salivary Ducts , SeromaABSTRACT
BACKGROUND AND OBJECTIVES: The management of early glottic, tongue and tongue base cancer remains controversial and the trends in the treatment rationale can be influenced by the clinician and/or the patient factors. This study assesses the current treatment trend in the management of glottic, tongue and tongue base cancer among the Korean Society of Head and Neck Surgeons membership. We want this data to give more information in regards to better selection of treatment against specific individual factors. MATERIALS AND METHODS: A survey instrument in the form of a questionnaire was designed by authors. The questionnaire was distributed to 91 members with 46 responses. After the data from these surveys were computerized, the analysis was performed using SAS software. RESULTS: The two most frequently used treatment regimens of T2N0 glottic cancers were conservation laryngeal surgery (45.7%) and radiation therapy alone (19.6%). T2N0 tongue cancer was usually treated with surgery (56.5%) and surgery with radiation therapy (26.1%). The treatment patterns for tongue base cancer were varied as follows: surgery, 23.9%; radiation therapy only, 21.7%; combined therapy, 30.4%; and patient choice, 23.9%. In situations where an unclear resection margin is found, participants usually underwent adjuvant postoperative radiotherapy. A trend toward lower application rates was noted from positive margin (82.6%) to close margin (67.4%) and the difference was statistically significant (p<0.020). Important factors to determine which patient should be entered into a combined therapy program after neck dissection were the N-staging system and the histological extracapsular spread of lymph node metastases. Examination of treatment rationale demonstrated that the most preferred form of treatment was based on the perception of superior oncologic outcomes (87.0%). Treatment recommendations were usually decided by the operator (52.3%) and the tumor board (25.0%). CONCLUSIONS: Treatment modalities were not significantly influenced by varied individual factors of participants. But a standard therapy has never been well defined. These varied factors in the management of early glottic, tongue and tongue base cancer and treatment rationale reflect that there are multiple influencing factors.
Subject(s)
Humans , Head , Korea , Lymph Nodes , Neck , Neck Dissection , Neoplasm Metastasis , Surveys and Questionnaires , Radiotherapy , Tongue Neoplasms , TongueABSTRACT
BACKGROUND AND OBJECTIVES: The Warthin's tumor is characterized by its frequent occurrence in the parotid tail and multifocal presentation. Superficial or total parotidectomy was advocated by many surgeons due to its multifocal nature. Recently, with the advancement of various radiologic diagnostic methods, more conservative surgical management with low morbidities can be considered since an accurate pattern and site of the tumor can be determined. MATERIALS AND METHODS: Authors retrospectively studied 20 cases of pathologically diagnosed Warthin's tumor for clinical pattern, tumor site in parotid gland, recurrence and complication rate according to different surgical methods. Patients were divided into two groups: Group II received enucleation and Group II received either superficial parotidectomy or total parotidectomy. RESULTS: Post operative complication rate was low in enucleation group, compared with parotidectomy. There was no difference in the recurrence between the two groups. CONCLUSION: Enucleation is an effective method in treatment of solitary or multifocal Warthin's tumors.