Toxoplasmic Lymphadenitis of the Head and Neck Region / 대한이비인후과학회지

Toxoplasmosis is a ubiquitous protozoan infection caused by coccidian Toxoplasma gondii. In an immunocompetent host, the primary infection is generally oligosymptomatic and self-limiting. Fewer than 10% of infected subjects are symptomatic, with lymphadenopathy as the most frequent clinical finding. Here, two cases of Toxoplasmic lymphadenitis are reported for otolaryngologists to consider the clinical findings and natural history aspects of this infection.

Relationship Between Preepiglottic Space Invasion and Lymphatic Metastasis in Supracricoid Partial Laryngectomy With Cricohyoidopexy

OBJECTIVES: The aim of this study was to determine the role of preepiglottic space (PES) invasion in lymph node metastasis and prognosis in patients undergoing supracricoid partial laryngectomy (SCPL) with cricohyoidopexy (CHP). METHODS: A retrospective review of 42 previously untreated patients with squamous cell carcinoma of the larynx that underwent surgery was performed. The mean age of the subjects was 61.3 years, and the male-to-female ratio was 38:4. Regarding their pathological stages, there were 3, 8, 22, and 9 cases of stage T1 to T4, respectively. Concerning the disease stage of the cervical lymph nodes, there were 30, 5, 6, and 1 cases with N0 to N3, respectively. RESULTS: The PES invasion rate was 23.8% (10/42). Significant correlations were found between PES invasion and cervical lymph node metastasis (P=0.002). Seven of the 10 patients (70.0%) with PES invasion had cervical lymph node metastasis, whereas only 5 of the 32 patients (15.6%) without any evidence of PES invasion had lymph node metastasis. There was also a significant correlation of PES invasion with age (P=0.002) and T stage (P=0.030). However, there was no significant relationship between gender, primary tumor site, anterior commissure invasion, subglottic extension, paraglottic space invasion and PES invasion. There was a 5-year disease-specific survival of 70%. PES invasion served as a statistically significant prognostic factor for disease-specific survival (P=0.004). Cervical nodal metastasis (P=0.003) and subglottic extension (P=0.01) were also statistically significant prognostic factors associated with disease-specific survival. CONCLUSION: The PES invasion was significantly related to the cervical lymph node metastasis and prognosis in patients undergoing SCPL with CHP.

Relationships between Tumor Volume and Lymphatic Metastasis and Prognosis in Early Oral Tongue Cancer

OBJECTIVES: Although T stage is an important prognostic tool for oral tongue cancer, it fails to define the depth of invasion and true three-dimensional volume of primary tumors. The purpose of this paper is to determine the relations between tumor volume and lymph node metastasis and survival in early oral tongue cancer. METHODS: Forty-seven patients with T1-2 tongue cancer were included. Tumor volumes were measured by the computerized segmentation of T2-weighted magnetic resonance imaging. RESULTS: The overall average tumor volume was 27.7 cm3 (range, 1.4 to 60.1 cm3). A significant positive correlation was found between tumor volume and pathological T stage, depth of invasion, and cervical lymph node metastasis (P or =20 cm3) and the 5-year disease-specific survival (P=0.046). CONCLUSION: Tumor volume larger than 20 cm3 was associated with greater risk cervical lymph node metastasis and poor 5-year disease-specific survival rate in early oral tongue cancer patients.

Clinical Experience of Rigid Bronchoscopy in Single Center / 결핵및호흡기질환

BACKGROUND: The aim of this study was to analyze clinical situations requiring rigid bronchoscopy and evaluate usefulness of rigid bronchoscopic intervention in benign or malignant airway disorders. METHODS: We retrospectively reviewed 29 patients who underwent rigid bronchoscopy from November 2007 to February 2011 at St. Paul's Hospital, The Catholic University of Korea School of Medicine. RESULTS: Of the 29 patients, the most frequent underlying etiology was benign stenosis of trachea (n=20). Of those 20 patients, 16 had post-intubation tracheal stenosis (PITS), 2 had tracheal stenosis due to inhalation burn (IBTS) and other 2 had obstructive fibrinous tracheal pseudomembrane (OFTP). Other etiologies were airway malignancy (n=6), endobronchial stenosis due to tuberculosis (n=2), and foreign body (n=1). For treatment, silicone stent insertion was done in 16 cases of PITS and IBTS and mechanical removal was performed in 2 cases of OFTP. In 6 cases of malignant airway obstruction mechanical debulking was performed and silicone stents were inserted additionally in 2 cases. Balloon dilatation and electrocautery were used in 2 cases of endobronchial stenosis due to tuberculosis. In all cases of stent, airway obstructive symptom improved immediately. Granulation tissue formation was the most common complication. CONCLUSION: Tracheal stenosis was most common indication and silicone stenting was most common procedure of rigid bronchoscopy in our center. Rigid bronchoscopic procedures, at least tracheal silicone stenting, should be included in pulmonary medicine fellowship programs because it is a very effective and indispensable method to relieve critical airway obstruction which needs training to learn.

CT Evaluation of Vocal Cord Paralysis due to Thoracic Diseases: A 10-Year Retrospective Study

PURPOSE: To discuss computed tomography (CT) evaluation of the etiology of vocal cord paralysis (VCP) due to thoracic diseases. MATERIALS AND METHODS: From records from the past 10 years at our hospital, we retrospectively reviewed 115 cases of VCP that were evaluated with CT. Of these 115 cases, 36 patients (23 M, 13 F) had VCP due to a condition within the thoracic cavity. From these cases, we collected the following information: sex, age distribution, side of paralysis, symptom onset date, date of diagnosis, imaging, and primary disease. The etiology of VCP was determined using both historical information and diagnostic imaging. Imaging procedures included chest radiograph, CT of neck or chest, and esophagography or esophagoscopy. RESULTS: Thirty-three of the 36 patients with thoracic disease had unilateral VCP (21 left, 12 right). Of the primary thoracic diseases, malignancy was the most common (19, 52.8%), with 18 of the 19 malignancies presenting with unilateral VCP. The detected malignant tumors in the chest consisted of thirteen lung cancers, three esophageal cancers, two metastatic tumors, and one mediastinal tumor. We also found other underlying etiologies of VCP, including one aortic arch aneurysm, five iatrogenic, six tuberculosis, one neurofibromatosis, three benign nodes, and one lung collapse. A chest radiograph failed to detect eight of the 19 primary malignancies detected on the CT. Nine patients with lung cancer developed VCP between follow-ups and four of them were diagnosed with a progression of malignancy upon CT evaluation of VCP. CONCLUSION: CT is helpful for the early detection of primary malignancy or progression of malignancy between follow-ups. Moreover, it can reveal various non-malignant causes of VCP.

A Case of Cystic Lymph Node Metastasis from Thyroid Papillary Microcarcinoma / 대한갑상선학회지

Papillary carcinoma is the most common type of thyroid cancer, usually presenting as a thyroid mass. Presentation in cervical nodes alone, with no clinical suspicion of thyroid tumor, also occurs. Lymph node metastasis from papillary carcinoma of the thyroid may undergo cystic transformation. This occurrence is seldom encountered in clinical practice and in cases of microcarcinomas the diagnosis may be difficult, resulting in a delay of the correct diagnosis and of therapy for the primary tumor. We present a rare case of solitary cystic lymph node metastasis of papillary microcarcinoma of the thyroid.

Analysis of Recipient Vessel for Microvascular Reconstruction of the Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the relationship between the free flap compromise and the choice of recipient vessels, the method of venous anastomosis, the use of an interposition vein graft, and the number of venous anastomosis for microvascular anastomosis. SUBJECTS AND METHOD: A retrospective review was carried out for 237 patients who underwent 247 microvascular free flap reconstructions after head and neck ablative surgery from October 1993 to July 2009. Flap donor sites included the radial forearm (n=187), anterolateral thigh (n=34), rectus abdominis (n=11), fibula (n=8), and lateral thigh (n=7). RESULTS: The frequently used recipient artery included facial (66.4%), superior thyroid (17.8%), lingual (8.1%), transverse cervical (6.9%), and external carotid (0.8%). The recipient vein included facial (43.7%), external jugular (39.3%), superior thyroid (5.8%), anterior jugular (1.7%), and transverse cervical (0.7%). End-to-end venous anastomoses were completed in 230 flaps and end-to-side anastomoses in 14 flaps. Three patients had one end-to-end and one endto- side anastomoses. The interposition vein grafts were used in 3 cases. Dual venous anastomoses were performed in 48 cases and single anastomosis in 199 cases. Twenty-one (8.5%) cases of free flap compromise due to vascular obstruction were identified and 11 flaps were lost (4.5%) with an overall success rate of 95.5%. There was no relationship between free flap compromise and the choice of recipient artery (p=0.360) or vein (p=0.125), the method of venous anastomosis (p=0.683), the use of an interposition vein graft (p=0.595), and the number of venous anastomosis (p=0.076). CONCLUSION: All vessels in the head and neck are potentially suitable for microvascular anastomoses. Flap compromise was not related to the method of venous anastomosis, the interposition vein graft or the number of venous anastomosis.

A Case of Leukemic Infiltration of Parotid Gland Preceding the Clinical Onset of Acute Lymphoblastic Leukemia / 대한이비인후과학회지

Extramedullary leukemic infiltration rarely occurs in patients with acute lymphoblastic leukemia. An eight-year-old boy presented with a mass lesion of the left parotid gland with several palpable lymph nodes in the ipsilateral neck. The patient did not have any previous medical history. Given the suspicion of a lymphoma, an excisional biopsy of the parotid mass was performed. The preliminary pathologic result indicated myeloid sarcoma. The patient subsequently underwent bone marrow biopsy, and was finally diagnosed as acute lymphoblastic leukemia. Here we report a case of leukemic infiltration of the parotid gland as an extramedullary manifestation preceding the clinical onset of acute lymphoblastic leukemia.

Clinical Outcome of Squamous Cell Carcinoma of the Tongue in Young Patients: A Stage-Matched Comparative Analysis

OBJECTIVES: The reported incidence of tongue cancer in young patients has recently increased. The aim of this study was to analyze the clinical characteristics of tongue cancer in a young group of patients, and to compare them with those of an older group of tongue cancer patients. METHODS: We retrospectively reviewed the records of 85 patients who were diagnosed with squamous cell carcinoma of the tongue. They were divided into two age groups: over 45 years of age and under 45 years. To compare the prognosis of similarly staged patients in the group, each age group was divided into the early (stage I, II) and advanced stage groups (stage III, IV), and then they were compared. The young group consisted of 23 patients and the older group had 62 patients. RESULTS: At the early stage, the clinical prognosis of the patients in both age groups was good, and no significant difference was observed. However, at the advanced stage, the overall and regional recurrence rates were significantly higher in the younger age group as compared to that in the old age group (P=0.007, P=0.001, respectively). The disease-specific survival rate of the patients in the young group was significantly lower than that in the old age group (P=0.025). CONCLUSION: Tongue cancer in young subjects has significantly different clinical outcomes according to the stage. The clinical outcome of the advanced-stage tongue cancer in young subjects was poorer than that in the older subjects. Regional recurrence seemed to be the main cause of the poor prognosis.

Analysis of Influencing Factors on Cervical Lymph Node Metastasis in Early Oral Tongue Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The status of cervical lymph node metastasis has a greatinfluence on the prognosis of patients with early oral tongue cancer. We evaluated various clinical, histopathological, lymphangiogenic parameters and their association with cervical lymph node metastasis in early oral squamous cell carcinoma of the tongue. SUBJECTS AND METHOD: Fifty-one patients with squamous cell carcinoma of the early oral tongue were classified as their tumor stage, lymph node metastasis, histopathological grade, tumor depth of invasion and their paraffin-embedded surgical specimens were investigated by immunohistochemical analysis using VEGF and E-cadherin antibody. RESULTS: Cervical lymph node metastases were present in 18 of the 51 cases (35.3%). Regarding tumor cell differentiation, there were 28 (54.9%), 19 (37.3%), and 4 (7.8%) well-, moderate-, and poorly-differentiated cases, respectively. The depth of invasion varied from 1 to 25 mm and averaged 9.69+/-5.83 mm, and there was a significant correlation between the tumor depth ofinvasion and cervical lymph node metastasis (p<0.001) and primary tumor size (p<0.001). Immunohistochemical analysis showed the expression rates of VEGF, E-cadherin as 46.9% and 52.9%, respectively. There was significant correlation between the expressions of VEGF and lymph node metastasis (p=0.009). Patients who were followed up for more than 12 months had a 5-year overall survival of 82%. Primary tumor size and VEGF expression was associated with the overall survival. CONCLUSION: The analysis of these clinical, histological, and immunohistochemical parameters may help to identify patients who would benefit from a neck dissection by predicting the likelihood of cervical lymph node metastasis.

A Case of Fibro-Osseous Hamartoma Originated from Nasal Cavity / 대한이비인후과학회지

Hamartoma occurs in all areas of the body, especially in the liver, spleen, kidney and lung. However, it was rarely reported in the nasal cavity, paranasal sinuses, or nasopharynx. The histopathological and clinical differential diagnosis of fibro-osseous hamartoma of the sinonasal tract includes ossifying fibroma, fibrous dysplasia and osteoma. We present the case of a 57-year-old man with nasal obstruction in right side, which was treated with complete resection by endoscopic approach. A combination of clinical, radiographic and histological information permitted a diagnosis of a benign fibro-osseous hamartoma in this case.

Therapeutic Nanoparticles for Drug Delivery in Cancer / 대한이비인후과학회지

No Abstract available.

A Case of Enchondral Pseudocyst of the Auricle / 대한이비인후과학회지

Endochondral pseudocyst of the ear is considered to be a benign, asymptomatic condition seen infrequently in clinical practice. It is an intracartilaginous cyst devoid of epithelial lining and filled with a sterile, viscous, straw-colored fluid. It is important to remove the pseudocyst to prevent recurrence and good esthetic outcome. We experienced a case of a 59-years-old man with an endochondral pseudocyst of his right auricle. To our knowledge, this is the first report in Korea, so we report this case with a review of the literature.

Soft Palate Reconstruction in Oral Cavity and Oropharyngeal Cancers / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various kinds of flaps are used for reconstruction of defected soft palate, and with these, physiologic functions can be preserved. We report the clinical results of our 44 consecutive soft palate reconstructions in oral and oropharyngeal cancers. SUBJECTS AND METHOD: We reviewed the medical records of patients who were offered soft palate reconstruction with various kinds of flaps after ablative surgery of oral and oropharyngeal cancer from July 1997 to July 2004 and analyzed primary site, resection area of soft palate, reconstruction methods and postoperative functions using Modified barium swallow (MBS), articulation and resonance test. RESULTS: Various kinds of flaps were used according to the resected area of soft palate. In cases of resection area less than 1/3 (63.6%), the reconstruction methods were local flap (7.1%), rectus abdominis myocutaneous flap (3.6%), lateral thigh free flap (LTFF)(3.6%), and radial forearm free flap (RFFF)(85.7%). In cases of resection area that is more than 1/3 of the total resection, all cases were reconstructed with RFFF, combining more complex techniques such as double folding, palmaris longus tendon, and superiorly-based pharyngeal flap. Velopharyngeal insufficiency (VPI) was examined in only 2 (11.8%) patients, and in residue after swallowing was examined in 10 (41.2%) patients. Postoperative pronunciation was 'good' in 15 (68.2%) patients. CONCLUSION: In oral and oropharyngeal cancer, reconstruction of resected soft palate using various kinds of flaps is very useful and effective in postoperative physiologic functions such as in swallowing and pronunciation.

The Extent of Chromosomal Losses and the Status of CpG Methylation in Squamous Cell Carcinoma of the Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Carcinogenesis is known to arise as a result of the accumulation of genetic alterations including unilateral chromosomal losses and epigenetic modification. In this study, we investigated the extent of chromosomal losses and the status of CpG methylation in squamous cell carcinoma of the head and neck in relation to the clinicopathologic factors. SUBJECTS AND METHOD: A total of 20 tumor foci from 12 cases were examined wtih PCR-based loss of heterozygosity (LOH) analysis using a panel of 41 microsatellite markers on 8 chromosomes and a total of 10 tumor foci from 5 cases were examined with methylation-specific PCR on 2 extragenic regions of the 3 cancer-linked genes. RESULTS: In 20 tumor foci, LOH was found most frequently on the chromosome 8p. Multiple tumor foci of a given case had the same or a similar extent of chromosomal losses and yielded an overall mean value of 5.5 per tumor focus. Even though the tumor foci showed histological homogeneity, they revealed genetical heterogeneity. The relation between methylation changes between the paired normal mucosa and tumor site was variable and 10 tumor sites examined for the methylation status of 6 extragenic regions showed 21 (35%) hypomethylation changes, 6 (10%) hypermethylation changes, and 33 (55%) no methylation changes. The degree of methylation changes indicated the tendency to cluster in the range of U1 and M1 low-grade changes. With respect to relationship between bet methylation changes and clinicopathologic factors, hypomethylation changes were dominant in those cases with increased depth of invasion. CONCLUSION: These results showed that multiple intratumoral foci of the head and neck cancer patients were generally under the influence of a similar level of chromosomal losses and hypomethylation changes.

The Analysis of Maxillary Sinus Aeration Dependent on Aging Process: Volume Assessment by Three Dimensional Reconstruction by High Resolutional CT Scanning / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the maxillary sinus volume in human depending on age and sex by using 3-dimensional reconstruction of computed tomography (3DR-CT). SUBJECTS AND METHOD: One hundred seventy three people (238 maxillary sinuses), who had taken paranasal sinus high resolution CT between December 2000 and November 2003, and had no evidence of inflammation or hypoplasia in CT finding, and had no specific history of surgery of paranasal sinus or maxillofacial trauma, were retrospectively analyzed. 3-dimensional reconstruction images were obtained using the surfacerendering technique with images by high-resolution CT on a personal computer. A software used for 3-dimensional reconstruction was Vwork 4.0 (CyberMedTM, Korea) used. The mean volume of maxillary sinus were evaluated in both sex. The ratio of maximal horizontal and half horizontal extension and the degree of descent of sinus below the nasal floor were evaluated. RESULTS: The development of maxillary sinus were found in males in their twenties and in teen females. The mean volume of maxillary sinus in an early adult were 24043 mm3 (Male) and 15859.5 mm3 (Female). There was a significant difference observed in the sinus volume (p<0.05) according to sex and the significant difference in the volume of maxillary sinus according to age groups between sex before reaching maximal volume. But there were no significant correlation among aging process, aeration of maxillay sinus after its maximal growth and the descent below the nasal floor. CONCLUSION: The growth of maxillary sinus is continued until the age of twenties in male and teens in female. Therefore, maxillay sinus operation affecting bony structures before those age may affect the sinus development; inferior meatal antrostomy also should be done after confirming the level of inferior extension of maxillary sinus below the nasal floor.

The Clinical Feasibility of Functional 3-Dimensional Laryngeal CT as a New Technique: Preliminary Study in Unilateral Vocal Fold Paralysis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are many clinical procedures that are related to the evaluation of kinematic events concerning vocal fold vibration. However, many of these procedures are hardly applicable for precise analyses of physiological and morphological changes in vocal folds with respect to the pitch control, and vocal fold volume changes from the phonatory aspect of larynx. The purpose of this study was to examine the clinical feasibility of a new 3 dimensional image method, the functional laryngeal CT, which can provide a clear sagittal image of the vocal fold in each of the anteroposterior directions during phonation and resting state. SUBJECTS AND METHOD: Functional laryngeal CT was performed in 4 normal control and 2 cases of unilateral vocal fold paralysis. The subjects were instructed at resting position to produce sustained vowel phonation of three different kinds of pitch. Three-dimensional endoscopic images were reconstructed through segmentation and surface-rendering algorithm on personal computer, using the DICOM (Digital Image and Communication in Medicine) file of axial images. RESULTS: The dynamic vocal fold 3D image that was reconstructed by serial section image during phonation showed that the vocal fold became thin and volume was decreased in relation to the increase in pitch. Typical subglottic shoulder formation and ventricular widening was noted in the high pitched tone. CONCLUSION: Functional 3D laryngeal CT (F3DLxCT) is an informative tool for visualizing the active changes in length, tension and mass of the vocal folds for pitch control. Furthermore, the volume defect and the level difference in the paralysed vocal fold are easily detectable with this new techinque.

Hypermethylation of TIG1 in Head and Neck Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Decreased expression and growth suppression of Tazarotene-Induced Gene 1 (TIG1) were reported in prostate cancer. In this study, we examined the possibility of TIG1 transcriptional silencing by hypermethylation in head and neck cancer. SUBJECTS AND METHOD: We extracted DNA and total RNA from five head and neck cell lines (O11, O12, O19, O22 and O28), and three prostate cell lines (PC3, LNCap and DU145). We checked the methylation status of TIG1 by methylation-specific PCR (MSP) and RT-PCR. We also examined primary cancer tissues of 32 head and neck cancer, 31 prostate cancer and 10 normal samples. RESULTS: We found that all of five head and neck (100%) cell lines and two of three prostate (66.7%) cell lines were methylated. RT-PCR analysis confirmed the absence of TIG1 expression in six cell lines with methylation. We checked primary cancer by MSP and found TIG1 methylation in 16 of 32 (50%) head and neck cancers, and 17 of 31 (54.8%) prostate cancers. Normal head and neck and prostate tissues were free of methylation. CONCLUSION: Our results support the notion that methylation might be an important mechanism of TIG1 inactivation and a target event in head and neck cancer.

A Case of Extramedullary Plasmacytoma of the Nasopharynx / 대한이비인후과학회지

Multiple myeloma, solitary bone plasmacytoma, extramedullary plasmacytoma, plasmablastic sarcoma, and multifocal form of multiple myeloma belong to plasma cell tumors. Among them, extramedullary plasmacytoma consists of 4% of all plasma cell tumors and is found predominantly in the head and neck region. This tumor is a solitary tumor consisting of monoclonal plasma cell proliferation that occurs in soft tissues other than bone. The frequent sites in the upper aerodigestive tract are the paranasal sinus and the nasal cavity. Because the diagnosis is based on immunophenotypical finding of monoclonal plasma cells and there are many differential diagnoses, the exact diagnosis is difficult. To our knowledge, extramedullary plasmacytoma originating in the nasopharynx has rarely been reported. We experienced a case of nasopharyngeal extramedullary plasmacytoma which was treated with combined therapy. So we report this case with a review of literatures.

A Case of Esophageal Foreign Body Resulting in Unilateral Vocal Cord Paralysis in an Infant / 대한이비인후과학회지

Esophageal foreign bodies in infants are frequently obscured because of the non-specific symptoms and signs and the lack of historical clues. Infants in such cases often present vomiting, odynophagia, dysphagia or ptyalism without a history of foreign body ingestion. Recently we encountered a case of the vocal cord palsy caused by an esophageal foreign body which was found when studying the vocal cord palsy in an infant. We report this case with review of literature.