A Case of Localized Amyloidosis of Tonsil / 대한이비인후과학회지

The term "amyloidosis" is a disease characterized by deposition of altered proteins in the tissue. The amyloid deposit occurs always in the extracellular matrix and presents a fibrillary conformation. Primary localized tonsillar amyloidosis is a very rare disease of unknown cause that occurs in the absence of systemic involvement of amyloidosis or associated chronic inflammatory diseases. We present a case of primary localized amyloidosis in the left tonsil. Histopathologic examination of the mass revealed findings consistent with amyloidosis, which were stained with Congo Red and apple green birefringence under the polarized light fluorescence microscopy. An extensive workup for systemic involvement of amyloidosis was negative and the patient underwent tonsillectomy. The postoperative recovery was uneventful. At present, the patient has no evidence of disease or recurrence.

The Effect on Voice by Strap Muscle Cutting in Thyroidectomy / 대한내분비외과학회지

PURPOSE: Voice change after thyroidectomy has generally been the result of damage to the recurrent or superior laryngeal nerve. But many patients complain voice alteration without laryngeal nerve injury after thyroidectomy. The purpose of this study is to investigate whether strap muscle division results in any subjective or objective functional sequelae in voice, through long-term follow-up prospectively. METHODS: Twenty-two female patients who had undergone thyroid surgery between July 1998 and December 1999, were studied. The patients who were planned for neck dissection, who had benign laryngeal disease or vocal cord paresis, and whose vocal cord paresis were developed after thyroid surgery, were excluded from this study. Twelve patients had undergone thyroidectomy via retraction of strap muscle and ten patients had undergone thyroidectomy via cutting of strap muscle. For evaluation of voice, questionnaires for changes of voice, acoustics (fundamental frequency, jitter, shimmer, signal to noise ratio, noise to harmonic ratio, voice range), and aerodynamic (maximal phonation time) analyses were done. RESULTS: The subjective voice symptoms after thyroidectomy were disturbances of high pitch, singing, loud voice, and easy fatigue at phonation. There were no significant differences in voice parameters on acoustic and aerodynamic analyses between the strap muscle retraction group and the cutting group through long-term follow-up. CONCLUSION: We conclude that strap muscle division does not result in any subjective or objective functional problems in voice. We suggest that surgical division and reconstruction of these muscles should be employed routinely when operating on large, toxic or neoplastic glands.

Clinical Significance of Preoperative Studies in Diagnosis of Thyroid Nodule : FNAC, Ultrasonography, Computed Tomography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is critical to distinguish benign from malignant thyroid nodule and to select a patient for surgery. Fine needle aspiration cytology(FNAC) and various radiologic techniques are used in the evaluation of thyroid nodule. The purpose of this study is to evaluate the diagnostic accuracy of preoperative FNAC, ultrasonography(US) and computed tomography(CT) in thyroid nodule, and to identify the reliable factors of radiologic imaging in the differential diagnosis of thyroid nodule. MATERIALS AND METHOD: Retrospectively, we reviewed 34 patients among 50 patients with thyroid nodule who were evaluated by FNAC, US and CT and operated on at our Department from June 1995 to December 1998. By comparing the preoperative FNAC results, US and CT findings with postoperative pathologic diagnosis, the results were as followed. RESULTS: Overall diagnostic accuracy of FNAC, US, and CT was 84.4%, 88.2%, 79.4%. Solid nature, ill defined margin, calcification, lymphadenopathy on US imaging indicated the possibility of malignancy. Solid nature, ill defined margin, lymphadenopathy on CT imaging indicated the possibility of malignancy. CONCLUSION: This study suggests that FNAC has a high sensitivity(75.0%) and specificity(93.8%) rate and it is therefore a valuable initial diagnostic procedure. US has higher diagnostic accuracy than computued tomography.

F-18-FDG Imaging Using Dual-Head Coincidence Positron Emission Tomography in Patients with Head and Neck Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: An accurate, preoperative assessment of tumor extent and lymph node involvement is necessary to plan and tailor therapy for patients with head and neck cancer. Metabolic imaging with tluorine-18-fluorodeoxyglucose (FDG) is a good method to detect primary cancers in the head and neck and to assess the involvement of lymph nodes, but it is not widely available because of high cost of positron emission tomography (PET). Recently, an alternative method for using FDG was developed: the coincidence detection PET (CoDe PET) using a gamma camera. The aim of this study was to evaluate the clinical utility of FDG CoDe PET using a gamma camera in patients with head and neck cancer. MATERIALS AND METHODS: Thirty FDG CoDe PET studies were performed in 7 patients before therapy and 19 patients after therapy with various head and neck cancers (Age : 25- 79 years, mean age : 50+/-13 years, 18 men, 8 women). All patients had fasted for 6 to 12 hours and were injected 1 1 l to 370 MRq of F-18-FDG 1 hour before imaging. With the exception of the physiological FDG uptake, all visually detectable focal FDC uptake in the primary cancer site or in the neck was considered positive. FDG CoDe PET studies were correlated with CT/MRI. The standard procedure for detecting the presence of disease was the combinations of repeated MRIs, 3 months of follow-up clinical evaluation and the result of a needle aspiration cytology or biopsy. RESULTS: FDG CoDe PET had a detcction rate that was comparable to that of CT/MRI in the pre-therapy group. However, in the post-therapy group, FDG CoDe PET could differentiate residual/recurrence of tumor from radiation change more accurately than could MRI. But, it had a less accurate detection rate for cervical metastases because of asymmetric neck muscle uptake. CONCLUSION: FDG CoDe PET is a sensitive and cost-effective method to detect primary tumor and lymph node involvement in primary head and neck cancers. It is also useful in differentiating residual tumor or tumor recurrence from post-therapy changes in patients with head and neck cancers.

Analysis of Lymph Nodes Number according to Various Modifications of Neck Dissection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The type of neck dissection performed for head and neck cancers depends on the experience of the surgeon and the status of the neck metastasis. The purpose of this study was to quantify the extent of lymphadenectomy achieved according to the various modifications of neck dissection based on microscopic pathologic analysis and to analyze the difference in the number of lymph nodes between the types of neck dissection. MATERIALS AND METHODS: Charts and pathologic finding of patients who underwent neck dissection from June 1994 to October 1999 were reviewed. Patients who received selective neck dissection or preoperative radiotherapy to the neck were excluded. The samples were 65 necks and were divided into four groups based on Medina's classification: radical neck dissection (group 1), Type I modified radical neck dissection (group 2), Type II modified radical neck dissection (group 3), and Type III modified neck dissection (group 4). The number of lymph nodes was counted by a pathologic microscopic examination for each region of specimens. The intergroup difference was analyzed by a one-way between-group analysis of variance (ANOVA). RESULTS: The mean number of dissected lymph nodes per specimen was 43.6 in group 1, 38.8 in both groups of 2 and 3, and 30.3 in group 4. Group 4 was significantly different from group 1 (p<0.05). Especially, the number of dissected lymph nodes from level II, III, IV of group 4 was significantly different from those of group 1 (p<0.05). There was no significant difference between other groups. CONCLUSIONS: The number of dissected lymph nodes decreases as the number of preserved non-lymphatic tissue structures increases. Level II, III, IV are less completely operated regions in functional neck dissection.

Primary Ewing's Sarcoma Arising from the Mandible: A Case Report / 대한이비인후과학회지

Ewing's sarcoma is an uncommon malignancy that usually occurs in children. It is composed of monotonous population of small cells with large nuclei and little cytoplasm. These cells fall into the category of the "small, round, blue cell tumors of children". Based on cytogenetic studies, Ewing's sarcoma appears to be of neuroectodermal origin and shares the same reciprocal 11:22 translocation as primitive neuroectodermal tumor. Long bones and pelvis are the preferential sites. The incidence of Ewing's sarcoma in all primary malignant bone tumors is four-seven percent. Only seven percent of Ewing's sarcoma occurs in the mandible either as primary or metastatic disease. The rarity is due to the paucity of hematopoietic marrow of the mandible. Soft tissue swelling and pain are the most common presenting symptoms. Differential diagnosis of Ewing's sarcoma of the mandible includes other mass lesions of the jaw such as osteosarcoma, Burkitt's lymphoma, retinoblastoma and neuroblastoma. Treatment for mandibular Ewing's sarcoma consists of various single and combination modalities including radiation, chemotherapy, and surgery. We report a case of a 24-year-old male with mandibular Ewing's sarcoma who was treated with chemotherapy (vincristine, adriamycin, cyclophosphamide and ifosfamide, etoposide) and concurrent radiation therapy (6MV, 180-200 cGy/d, 32 fractination, total dose: 5900 cGy).

Case Report: Intramasseteric Vascular Anomaly-Misdiagnosed to Parotid Sialolithiasis / 대한이비인후과학회지

Intramuscular hemangiomas are benign vascular lesions of skeletal muscle and constitutes less than 1% of all hemangiomas. Of all intramuscular hemangiomas, 13-25% occur in the head and neck, presenting lesions of enlarging soft tissue mass associated with pain. Usually they do not exhibit cutaneous changes, such as bluish skin discoloration as seen in cutaneous and superficial subcutaneous lesions. Because of their infrequency, deep location and unfamiliar presentation, intramuscular hemangomas are seldom correctly diagnosed clinically. We encountered a case of intramasseteric hemangioma in a 14-year-old female. She presented intermittent painful swelling on the right preauricular area. Sialography showed a multiple calcified lesion of the soft tissue, while CT scan and MRI showed a tumor mass lying in the masseter muscle. Angiography showed blush lesion but no tumor feeding arteries. After 6 months of intra-lesional sclerosing therapy with alcohol, total regression of tumor was obtained. As we experienced in this case, percutaneous sclerotherapy with alcohol could be the first therapeutic alternative.

Surgical Treatment of Posterior Hypopharyngeal Wall Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Posterior hypopharyngeal wall cancer is rarely encountered. There are diverse surgical approa-ches for this lesion. MATERIALS AND METHODS: We have reviewed our 5-year experience with 12 patients treated for squamous carcinoma of the posterior hypopharyngeal wall. Surgery was the definitive therapy for the primary tumor in all patients. All but one were previously untreated. Seven patients had limited resections that preserved the larynx, involving suprahyoid pharyngotomy (1 patient), transoral and suprahyoid pharyngotomy (1 patient), lateral pharyngotomy (1 patient), suprahyoid and lateral pharyngotomy (2 patients), mandibular swing and lateral pharyngotomy (2 patients). The second group consisted of 5 patients with more extensive tumors who required a laryngectomy and complex reconstruction. All in this group required flap reconstruction. RESULTS: Eight were NED, one was lost postoperatively and three patients developed local recurrence. CONCLUSION: Our experience highlights the variety of treatment approaches available in patients with pharyngeal carcinoma confined to the posterior wall.

Hypocalcemia Followed by Total Thyroidectomy with Central Neck Dissection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are many controversies about the extent of thyroidectomy and neck dissection in cases of thyroid cancer. Hypocalcemia is one of serious complications after total thyroidectomy. The on-set of hypocalcemia depends on many factors and different literature cites variable incidence. This study was performed to evaluate the incidence of postoperative hypocalcemia and the safety of total thyroidectomy with central neck dissection in thyroid cancer. MATERIALS AND METHODS: We conducted a retrospective chart review of 17 patients who underwent total thyroidectomy for thyroid malignancies from June 1995 to December 1998. Routine central neck dissection was performed and modified radical neck dissection was done in cases with positive neck node. We analyzed the onset-time of hypocalcemia, serum albumin level, hypocalcemic incidence according to the number of identified and autotransplanted parathyroid glands, lowest calcium level, clinical features and duration of calcium replacement in hypocalcemic patients. RESULTS: The incidence of postoperative hypocalcemia was 76.5% (13/17)and most cases (58.9%)occurred on the first postoperative day. The serum albumin level was lower on the first postoperative day than on the third postoperative day. The average number of identified parathyroid glands was three, and the more parathyroid glands there are, the less hypocalcemia we found. Parathyroid gland autotransplantation were performed in 12 cases. Symptomatic transient hypocalcemia occurred in 6 cases (35.2%). Asymptomatic transient hypocalcemia occurred in 6 cases (35.2%). Permanent hypocalcemia occurred in 1 case (5.9%). CONCLUSION: The incidence of postoperative hypocalcemia was relatively high but half of them were asymptomatic. There are no need for thyroid hormone replacement in asymptomatic transient hypocalcemic patients and that we found total thyroidectomy with central neck dissection is a safe procedure in most of thyroid malignancies.

Primary Neuroblastoma Arising in Parapharyngeal Space: A Case Report / 대한이비인후과학회지

Although neuroblastoma is a relatively common malignancy of childhood, it is rare in the head and neck area. While less than 5% of neuroblastoma arise from the cervical sympathetic chain, the head and neck is mostly manifested with a metastatic disease. We encountered a case of primary neuroblastoma arising in the parapharyngeal space in an infant. The patient, a 7-month-old male, presented with multiple neck masses without any other symptoms. Urine VMA and HVA, the magnetic resonance image, an abdominal and chest computed tomogram, and a Tc(99m) MIBI tumor scan were performed. The diagnosis of differentiating neuroblastoma was made by a fine needle aspiration cytology. Complete surgical excision was performed at the expense of sacrificing the sympathetic nerve trunk. No recurrence was noted during the 1-year follow-up period, although the right-sided Horner's syndrome persisted. An accurate preoperative cytologic diagnosis and proper surgical intervention can result in a good prognosis for a low stage cervical neruoblastoma; however, a long term follow-up is indicated.

Manometric Characteristics of the Pharynx and upper Esophageal Sphincter in theTotal Laryngectomized Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Total laryngectomy is usually used for patients with advanced laryngeal cancer, and causes injuries to hypopharyngeal mucosa, cricopharyngeal muscle, pharyngeal constrictor muscle. These damages induce postoperative swallowing difficulties, although accurate and objective data have not been reported. The purpose of this study is to evaluate the changes and functional difficulties of swallowing mechanism in patients with total laryngectomy by manometric analysis. MATERIALS AND METHODS: We used station pull-through technique in two groups. The study group consisted of 11 total laryngectomized patients, and the control group consisted of 10 cases. We measured resting pressure, length, pressure after relaxation of UES (upper esophageal sphincter), and pharyngeal pressure. And 5 parameters were analyzed for coordination of hypopharynx and UES during swallowing. RESULTS: In the study group, the resting pressure, the maximal pressure after relaxation, and the length of UES was 36.3+/-10.5 mmHg, 149.8+/-14.6 mmHg, and 3.4+/-0.8 cm respectively. In the control group, the results was 34.9+/-9.6 mmHg, 85.5+/-12.3 mmHg, 2.2+/-0.6 cm respectively. The pharyngeal pressure was 81.8+/-10.1 mmHg in the study group, and 67.1+/-12.3 mmHg in the control group. The interval of pharyngeal constriction was 3.0+/-0.23 sec in the study group and 0.49+/-0.04 sec in the control group. The interval of UES relaxation was 2.43+/-0.14 sec in the study group and 0.99+/-0.03 sec in the control group. CONCLUSION: Manometric analysis showed higher pressure of the pharynx and UES in the total laryngectomized patients than in the normal adults. And there was a failure in the coordination between pharyngeal constriction and UES relaxation.

Rectus Abdominis Free Flap Reconstruction for Orbital-Maxillary Defect in Advanced Maxillary Sinus Cancer / 대한이비인후과학회지

In the management of advanced maxillary sinus cancer, sometimes it requires an extensive ablation and orbital exenteration that results in large and full defects of the cheek and orbital regions. Reconstruction of large orbital-maxillary defects can be accomplished in one stage by microsurgical free transfer of rectus abdominis myocutaneous flap. The muscle component is suitable to fill the orbital and maxillary cavities, and the skin components are used for cheek, palate and lateral nasal cavity wall reconstruction as a three-dimentional folded free flap. Major problems with this flap are the bulkiness, the possibility of abdominal hernia and muscle weakness following the removal of the rectus abdominis muscle. Free deep inferior epigastric artery skin flap without rectus abdominis muscle is available in the reconstruction of large orbital-maxillary defect without the problems of the rectus abdominis myocutaneous free flap. We experienced one case of rectus abdominis myocutaneous free flap, and one other case of inferior rectus abdominis free flap for the reconstruction of huge surgical defects due to radical maxillectomy with orbital excenteration. Both of the patients were satisfied and there have been no severe complication associated with these technique.

Clinical Features of Cholesterol Granuloma in Temporal Bone / 대한이비인후과학회지

Cholesterol granuloma is not a clinically or pathologically independent entity. It may develop in any portion of the pneumatic system of the temporal bone and can be associated with a variety of middle ear disorders. Three factors are considered to play an important role in its development: 1) interference with drainage 2) hemorrhage and 3) obstruction of ventilation. We reviewed 20 cases of cholesterol granuloma in the temporal bone by analysing findings of myringoscopy, temporal bone CT and/or MRI and operation, and concluded that cholesterol granuloma appeared clinically in three forms ; 1) in association with chronic otitis media, especially cholesteatoma 2) idiopathic blue eardrum 3) localized lesion in the middle ear, mastoid antrum, external auditory canal and petrous apex.

Facial Translocation Approach for Nasopharyngeal Angiofibroma / 대한이비인후과학회지

Angiofibroma is a benign tumor that predominantly affects male adolescent and the most common benign tumor of nasopharynx. These tumors are highly vascular and usually with extension to the nose, paranasal sinus, pterygomaxillary fossa, infratemporal fossa, cranium, and the neck. There are many therapeutic approaches to huge sized angiofibroma with intracranial extension. Recently we experienced two cases of nasopharyngeal angiofibroma invading cranial base that was resected by facial translocation approach after superselective embolization and direct intratumoral embolization with good results. So, we report these with the review of literature.

A Case of Familial Medullary Thyroid Carcinoma / 대한이비인후과학회지

Medullary thyroid carcinoma(MTC) is a malignancy of the thyroid C-cells, and it compromises 5-10% of all thyroid cancers. MTC occurs in both sporadic and hereditary types, the latter making up 25% of all MTCs and being compromised of three distinct syndromesmultiple endocrine neoplasia type IIa(MEN IIa), multiple endocrine neoplasia type IIb(MEN IIb), and familial medullary thyroid carcinoma(FMTC). To date, screening for MTC subtype is important for proper diagnosis and treatment. Recently, the authors experienced a case of FMTC. So, we report this case with the review of the literatures.

Effect of stimulus parameters on auditory brainstem response / 대한이비인후과학회지

No abstract available.

A case of adenomatous tumor of the middle ear / 대한이비인후과학회지

No abstract available.