A case report of a carotid space abscess due to extraluminal migration of a fishbone into the deep cervical space / 고신대학교의과대학학술지

Laryngopharyngeal foreign bodies are among the cases most frequently encountered by otolaryngologists. Most foreign bodies can be easily removed without any complications. However, surgical removal is required in some cases. Therefore, a delayed diagnosis or misdiagnosis could cause fatal complications for patients who need a surgical approach. We report a rare case of extraluminal migration of a foreign body to the deep cervical space. The foreign body (a fishbone) was removed by a surgical approach. With a literature review, we also propose an algorithm for the management of suspicious foreign bodies in the neck.

Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma Arising from the Tongue: case report / 고신대학교의과대학학술지

Liposarcomas are common mesenchymal malignant tumors arising from adipose tissue. Although liposarcomas are the most frequent type of soft tissue sarcomas, accounting for approximately 20% of all soft tissue sarcomas, they are rare in the head and neck, particularly in the oral cavity. Oral liposarcomas have been reported to occur mainly on the buccal mucosa, with other sites including the floor of the mouth, tongue, palate, and mandible. This report describes a 76-yearold male patient with an atypical lipomatous tumor/well-differentiated liposarcoma of the tongue that underwent surgical excision. This report also reviews published data on these rare tumors.

Calcium Hydroxylapatite Pulmonary Embolism after Percutaneous Injection Laryngoplasty

Injection medialization laryngoplasty is a procedure that has many advantages in treating vocal fold paralysis; however, undesired complications can occur. We experienced a case of a pulmonary embolism, suspected in a patient who had undergone an injection laryngoplasty with calcium hydroxylapatite (CaHA). The patient suffered dyspnea after undergoing the injection laryngoplasty. Chest embolism computed tomography (CT) scan revealed a new lesion of enhancing materials at the pulmonary vasculature in the right upper lobe. The CaHA embolism was suspected, and the patient was treated with warfarin for 12 months. The patient's symptom of dyspnea nearly disappeared and a follow up chest embolism CT scan revealed no signs of the previous lesion. Thus, we would like to report this rare case along with a review of the literature.

Comparison of Voice Outcomes between Medialization Thyroplasty and Arytenoid Adduction with or without Injection Laryngoplasty in Unilateral Vocal Fold Paralysis Patients

BACKGROUND AND OBJECTIVES: In unilateral vocal fold paralysis (VFP), medialization thyroplasty (MT), arytenoid adduction (AA) and injection layrngoplasty (IL) are the most common procedures to correct phonatory problems. There is no consensus that which procedure is superior to the other for correcting the glottal insufficiency. The purpose of this study was to compare the phonatory parameters between MT, AA and AA with IL (AA+IL) in patients with unilateral VFP. MATERIALS AND METHODS: This retrospective study enrolled patients from 2005 to 2016. Total 72 patients (49 male, 23 female, mean age 54.5 years) were classified into three groups ; MT (n=28), AA (n=12), and AA+IL (n=32). GRBAS scales, maximum phonation time (MPT), jitter, shimmer, noise to harmonic ratio (NHR), and voice handicap index (VHI)-10 and VHI-30 were preoperatively and postoperatively collected and compared between the three groups. RESULTS: Age, gender and cause of VFP were not significantly different between the three groups. In MT and AA groups, MPT, VHI, G (overall grade) and B (breathiness) were significantly improved. In AA+IL group, jitter, shimmer, NHR, MPT, VHI, G and B were significantly improved. In analysis of differences (pre-postoperative values), Δ jitter (p < 0.001), Δ shimmer (p=0.031), and Δ NHR (p=0.002) were significantly different and AA+IL group showed the greatest improvement. CONCLUSION: Analysis of voice parameters showed that all the three procedures for patients with unilateral VFP are effective in the improvement of voice ; especially in MPT, VHI-10, G and B scales. Compared to the others, AA+IL provided the better acoustic values including jitter, shimmer and NHR.

A Case of Schwannoma of the Tongue Base / 대한이비인후과학회지

Schwannomas are benign peripheral nerve sheath tumors. It is found rarely in the oral cavity but most commonly in the tongue followed by the palate, floor of mouth, buccal mucosa, and mandible. Because schwannoma of the base of tongue is exceedingly rare, it is often not immediately included in the differential diagnosis, causing delay in identification and treatment. We report here, with a review of the literature, a case of schwannoma of the base of tongue, which was misdiagnosed as a lingual thyroid. A 28-year-old man presented with a base of tongue mass, which was first detected a month ago. The preoperative diagnosis was lingual thyroid on the basis of the physical findings and computerized tomographic findings. The permanent pathologic report of the mass was schwannoma. Postoperatively, the patient showed no problem with tongue function and wound healing.

The Analysis of Changes of Tonsillectomy after Diagnosis Related Group Based Payment System: Review of the Data Given by the Health Insurance Review & Assessment Service / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Diagnosis by Related Groups (DRG), a system forcibly implemented in all medical institutions from July 2013, was applied to tonsillectomy and adenoidectomy in the field of Otorhinolaryngology. We analyzed the changes in medical costs and evaluated the efficiency of the DRG system by analyzing the data collected before and after the DRG implementation. SUBJECTS AND METHOD: We analyzed the total number of cases, total medical costs and per charge for tonsillectomy and adenoidectomy using the data from the Korean National Health Insurance from 2011 to 2014. We compared the number and cost of tonsillectomy and adenoidectomy by hospital type, region, and patient age. RESULTS: The total number of tonsillectomy and adenoidectomy after the application of DRG systems in July 2013 in all medical institutions was reduced, but the total costs showed a tendancy to increase, resulting in an increase per charge of case. The number of tonsillectomy and adenoidectomy was decreased in general and specialized hospitals, but the costs were increased after DRG systems. CONCLUSION: Medical costs per charge of case related to tonsillectomy and adenoidectomy was higher in the DRG system than in the 'fee for service' system. Increased medical costs, considered to be the most likely cause of patient copayments, are recognized in the DRG system. The results showed that saving effect of medical costs was not significant in the DRG system; it may appear to relieve patient burden in the short term, but the financial state of national health insurance is worsening.

Epstein-Barr Virus Positive Primary Lymphoepithelial Carcinoma of the Parotid Gland with Hot Uptake of the Nasopharynx at Positron Emission Tomography-Computed Tomography / 대한이비인후과학회지

Lymphoepithelial carcinoma (LEC) is a rare histological type of cancer of the salivary glands. LEC is characterized histologically as non-keratinizing, undifferentiated squamous cell carcinoma with lymphocytic infiltration. According to several in-situ hybridization studies, LEC is strongly associated with Epstein-Barr virus (EBV) infection. We report, along with a review of literature, a rare case of EBV positive primary LEC of the parotid that excluded the possibility of coexisting or metastatic nasopharyngeal carcinoma.

A Case of the Ex Utero Intrapartum Treatment in Congenital Fetal Oral Teratoma / 대한이비인후과학회지

The ex utero intrapartum treatment (EXIT) is used for unborn fetuses in cases of predictable complications of postpartum airway obstruction. The delivered fetus is maintained on placental circulation while airway is established and this is carried out by a multidisciplinary team. Teratomas arising from the palate or pharynx may cause immediate life-threatening airway obstruction to the newborn. In our case, congenital oral teratoma was detected via prenatal ultrasound. The treating team determined that this may induce airway occlusion at birth and decided to perform an EXIT to secure an airway. On the day of birth, debulking of the tumor was performed and the fetus was successfully delivered. Vital signs were stable without intubation management.

Comparison of Natural Drainage Group and Negative Drainage Groups after Total Thyroidectomy: Prospective Randomized Controlled Study

PURPOSE: The aim of this study was to compare a negative pressure drain with a natural drain in order to determine whether a negative pressure drainage tube causes an increase in the drainage volume. MATERIALS AND METHODS: Sixty-two patients who underwent total thyroidectomy for papillary thyroid carcinoma (PTC) were enrolled in the study between March 2010 and August 2010 at Gyeongsang National University Hospital. The patients were prospectively and randomly assigned to two groups, a negative pressure drainage group (n=32) and natural drainage group (n=30). Every 3 hours, the volume of drainage was checked in the two groups until the tube was removed. RESULTS: The amount of drainage during the first 24 hours postoperatively was 41.68+/-3.93 mL in the negative drain group and 25.3+/-2.68 mL in the natural drain group (p<0.001). After 24 additional hours, the negative drain group was 35.19+/-4.26 mL and natural drain groups 21.53+/-2.90 mL (p<0.001). However, the drainage at postoperative day 3 was not statistically different between the two groups. In addition, the vocal cord palsy and temporary and permanent hypocalcemia were not different between the two groups. CONCLUSION: These results indicate that a negative pressure drain may increase the amount of drainage during the first 24-48 hours postoperatively. Therefore, it is not necessary to place a closed suction drain when only a total thyroidectomy is done.