Extratympanic Observation of Middle and Inner Ear Structures in Rodents Using Optical Coherence Tomography

Objectives@#. This study aimed to investigate whether optical coherence tomography (OCT) provides useful information about the microstructures of the middle and inner ear via extratympanic approach and thereby could be utilized as an alternative diagnostic technology in ear imaging. @*Methods@#. Five rats and mice were included, and the swept-source OCT system was applied to confirm the extent of visibility of the middle and inner ear and measure the length or thickness of the microstructures in the ear. The cochlea was subsequently dissected following OCT and histologically evaluated to compare with the OCT images. @*Results@#. The middle ear microstructures such as ossicles, stapedial artery and oval window through the tympanic membrane with the OCT could be confirmed in both rats and mice. It was also possible to obtain the inner ear images such as each compartment of the cochlea in the mice, but the bone covering bulla needed to be removed to visualize the inner ear structures in the rats which had thicker bulla. The bony thickness covering the cochlea could be measured, which showed no significant differences between OCT and histologic image at all turns of cochlea. @*Conclusion@#. OCT has been shown a promising technology to assess real-time middle and inner ear microstructures noninvasively with a high-resolution in the animal model. Therefore, OCT could be utilized to provide additional diagnostic information about the diseases of the middle and inner ear.

The Factors Involved in Bilateral Central Lymph Node Metastasis of Isthmus Papillary Thyroid Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aims of this study were to evaluate the rate and risk factors involved in bilateral central lymph node metastasis in patients with papillary thyroid cancer (PTC) found in the isthmus and compared them to tumors located in other thyroid regions, using those findings to establish a surgical strategy for treating these tumors. SUBJECTS AND METHOD: We compared the clinical and pathological data of 48 patients with isthmic PTC and 141 patients with PTC found in other thyroid regions, all of whom underwent total thyroidectomy and bilateral central neck dissection. RESULTS: The rates of bilateral central lymph node metastasis were higher in the isthmus group than in the non-isthmus group (29.2% vs. 9.9%; p=0.001). On multivariate analysis, the isthmic location of the tumor was an independent risk factor for bilateral central lymph node metastasis (OR=3.458; p=0.005). But the positional relationship between the tracheal midline and the nodule was not clear in lymph node metastasis in the isthmus group. CONCLUSION: Bilateral central neck dissection should be considered for isthmic PTC regardless of the relation between nodule and tracheal midline because of the high rate of bilateral central lymph node metastasis.

Post-Processing of High-Speed Video-Laryngoscopic Images to Two-Dimensional Scanning Digital Kymographic Images

BACKGROUND AND OBJECTIVES: High-speed videolaryngoscopy (HSV) is the only technique that captures the true intra-cycle vibratory behavior of the vocal folds by capturing full images of the vocal folds. However, it has problems of no immediate feedback during examination, considerable waiting time for digital kymography (DKG), recording duration limited to a few seconds, and extreme demands for storage space. Herein, we demonstrate a new post-processing method that converts HSV images to two-dimensional digital kymography (2D-DKG) images, which adopts the algorithm of 2D videokymography (2D VKG). MATERIALS AND METHODS: HSV system was used to capture images of vocal folds. HSV images were post-processed in Kay image-process software (KIPS), and conventional DKG images were retrieved. Custom-made post-processing system was used to convert HSV images to 2D-DKG images. The quantitative parameters of the post-processed 2D-DKG images was validated by comparing these parameters with those of the DKG images. RESULTS: Serial HSV images for all phases of vocal fold vibratory movement are included. The images were converted by the scanning method using U-medical image-process software. Similar to conventional DKG, post-processed 2D DKG image from the HSV image can provide quantitative information on vocal fold mucosa vibration, including the various vibratory phases. Differences in amplitude symmetry index, phase symmetry index, open quotient, and close quotient between 2D-DKG and DKG were analyzed. There were no statistical differences between the quantitative parameters of vocal fold vibratory movement in 2D-DKG and DKG. CONCLUSION: The post-processing method of converting HSV images to 2D DKG images could provide clinical information and storage economy.

Histopathologic Evaluations of the Lingual Artery in Healthy Tongue of Adult Cadaver

OBJECTIVES: To clarify the anatomical distribution of the lingual artery in normal adult subjects through histopathologic evaluations. METHODS: Eighteen healthy cadaveric tongues were used to produce 8 paraffin-embedded tissue sections each. Length from midline raphe, depth from dorsum of tongue and the whole transverse length tongue were measured. The lateral distance, depth, and proportion of lateral distance of deep lingual artery were determined from tip to base of tongue gradually. Lateral distance is length from median raphe to the center of deep lingual artery lumen. Depth is vertical distance from dorsal surface of tongue to the center of deep lingual artery. Proportion of lateral distance is obtained by dividing lateral distance with transverse length from median raphe to lateral border of tongue. The degree of symmetry between right and left sides and the difference between selected spots were evaluated. RESULTS: Right and left sides of the lingual artery were symmetric. The lingual artery was lateralized as it run posterior. The lingual artery runs gradually deeper from the surface as it goes near the base of tongue. Both length and depth of the lingual artery gradually increased between 0%–75% of the mobile tongue, but 75%–100% zone of the lingual artery showed no significant difference. There was no anastomosis between right and left side of the lingual arteries. The lingual artery was located within 50% of the transverse length of tongue from median raphe. CONCLUSION: The present study reveals 3-dimensional information on the anatomical distributions of the lingual artery in normal adult subjects. These findings gives us beneficial information about the handling of the lingual artery during oral and base of tongue-related surgery.

Comparison of two- and three-dimensional sonography for the prediction of the extrathyroidal extension of papillary thyroid carcinomas

BACKGROUND/AIMS: The purpose of this study was to compare the diagnostic validity of two-dimensional (2D) and three-dimensional (3D) ultrasonography (US) when predicting the extrathyroidal extension of papillary thyroid cancer. METHODS: All 2D data were interpreted in real time and 3D data were stored, rendered using tomographic ultrasound imaging (TUI), and then reviewed retrospectively. RESULTS: Extrathyroidal extension was present in 17 papillary thyroid cancers(24.3%) on pathology reports. The presence of contact was significantly associated with extrathyroidal extension on both 2D and 3D US (p = 0.007 and p = 0.003), and the sensitivity and specificity were not significantly different between 2D and 3D US (p = 1.000 and p = 0.754). The coexistence of protrusion and contact was not significantly associated with extrathyroidal extension on either 2D or 3D sonogram. CONCLUSIONS: Three-dimensional images rendered with TUI algorithms alone do not seem to be markedly superior to real-time 2D US in predicting the extrathyroidal extension of papillary thyroid cancer.

The Relationship between the Number of Preserved Parathyroid Glands and Clinical Aspects after Total Thyroidectomy and Central Lymph Node Dissection in Papillary Thyroid Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To identify the relation between the preservation status of the parathyroid glands and the risk of hypoparathyroidism after total thyroidectomy and central lymph node dissection in papillary thyroid carcinoma. SUBJECTS AND METHOD: A retrospective review was carried out for the medical records of 63 patients with papillary thyroid carcinoma (PTC), who satisfied our inclusion criteria and received treatment at the Department of Otolaryngology-Head and Neck Surgery, Hospital from May 2010 to December 2011. Patients with PTC who underwent total thyroidectomy with central lymph node dissection (CLND) were included and grouped according to the number of preserved parathyroid glands as follows: Group 1 (with four intact glands), Group 2 (three intact glands), Group 3 (less than two intact glands). The total and ionized serum calcium and intact parathyroid hormone levels of each group were monitored after the surgery. Patients with postoperative symptomatic hypocalcemia were considered to have postoperative hypoparathyroidism and received calcium/vitamin D therapy. The hypoparathyroidism was considered to be permanent when calcium/vitamin D therapy was still required six months after surgery. RESULTS: Out of 63 cases of total thyroidectomy with CLND, 31 (49.2%) showed postoperative hypoparathyroidism as demonstrated by laboratory findings. Permanent hypoparathyroidism, however, was not observed in these cases. The development of hypoparathyroidism was not significantly related with the number of preserved parathyroid glands. CONCLUSION: To prevent postoperative hypoparathyroidism following total thyroidectomy and CLND, at least two parathyroid glands should be preserved in situ with an intact blood supply in order to prevent permanent hypoparathyroidism after the surgery.

Neck circumference correlates with tumor size and lateral lymph node metastasis in men with small papillary thyroid carcinoma

BACKGROUND/AIMS: Obesity is correlated with numerous diseases, including thyroid cancer, but the clinical significance of obesity with regard to the clinical characteristics of thyroid cancer remains unclear. Neck circumference is an index of upper-body adipose tissue distribution. METHODS: In total, 401 patients with papillary thyroid carcinoma (PTC) measuring < or = 2 cm were included. Neck circumference was measured horizontally at the level just below the thyroid cartilage on preoperative neck computed tomographic images. RESULTS: Neck circumference correlated significantly with tumor size in men (p = 0.001) but not in women (p = 0.930). Body mass index (BMI) did not significantly correlate with tumor size in either sex. Neck circumference was significantly larger in men with lateral lymph node (LN) metastasis than in those without (p = 0.004). Neck circumference and BMI did not differ significantly in women according to other factors such as tumor size, multifocality, extrathyroid extension, and LN metastasis. Tumor size and the prevalence of lateral LN metastasis in men tended to increase in the middle/large neck circumference subgroup compared with those in the low neck circumference subgroup. Multivariate logistic regression analysis revealed that neck circumference (p = 0.009) was a predictor for the presence of lateral LN metastasis in men. BMI was not a predictive factor for lateral LN involvement in either sex. CONCLUSIONS: Neck circumference, an indicator of central or visceral obesity but not BMI, may be associated with some prognostic factors in men with small PTC.

Predictive Factors for Incidental Contralateral Carcinoma in Patients with Unilateral Micropapillary Thyroid Carcinoma

BACKGROUND: Whether thyroid lobectomy alone is a sufficient treatment for papillary thyroid microcarcinoma (PTMC) remains controversial. The aim of this study is to evaluate the predictive factors for incidental contralateral carcinoma in patients confirmed of unilateral PTMC preoperatively. METHODS: Between January 2007 and December 2009, 393 patients underwent thyroid surgery for unifocal and unilateral PTMC preoperatively at Pusan National University Hospital. A total thyroidectomy with central neck dissection was routinely performed for these patients during this study period. RESULTS: Among the 393 cases in the cohort, 77 patients (19.6%) had incidental PTMC in the contralateral lobe. In patients with incidental contralateral carcinoma, there was higher prevalence in extrathyroid extension, occult ipsilateral carcinoma, pathologic Hashimoto's thyroiditis, and central lymph node metastasis compared to those without contralateral carcinoma. The mean tumor size also increased in patients with contralateral carcinoma. Multivariate logistic regression showed that extrathyroid extension (P = 0.049), occult ipsilateral carcinoma (P < 0.001), pathologic Hashimoto's thyroiditis (P = 0.038), and central lymph node metastasis (P = 0.002) were predictive factors for incidental contralateral carcinoma. CONCLUSION: In conclusion, multifocality in the ipsilateral lobe, central lymph node metastasis, extrathyroid extension, and Hashimoto's thyroiditis is associated with the presence of contralateral carcinoma. Thus, if these factors are found by preoperative and/or postoperative evaluation, total thyroidectomy or completion thyroidectomy is necessary for the treatment of PTMC.

Growth Inhibitory Effect of Palatine Tonsil-derived Mesenchymal Stem Cells on Head and Neck Squamous Cell Carcinoma Cells

OBJECTIVES: Mesenchymal stem cells (MSCs) play an important role in the development and growth of tumor cells. However, the effect of human MSCs on the growth of human tumors is not well understood. The purpose of this study is to confirm the growth effect of palatine tonsil-derived MSCs (TD-MSCs) on head and neck squamous cell carcinoma (HNSCC) cell lines and to elucidate the mechanism of their action. METHODS: TD-MSCs were isolated from patient with chronic tonsillitis and tonsillar hypertrophy. Two human HNSCC cell lines (PNUH-12 and SNU-899) were studied and cocultured with isolated palatine tonsil-derived MSC. The growth inhibitory effect of MSCs on HNSCC cell lines was tested through methylthiazolyldiphenyl-tetrazolium (MTT) assay. The apoptosis induction effect of MSCs on cell lines was assessed with flow cytometry and reverse transcriptase (RT)-PCR. RESULTS: Palatine tonsil-derived MSCs exhibited a growth inhibitory effect on both cell lines. Cell cycle analysis showed an accumulation of tumor cells predominantly in G0/G1 phase with an increase in concentration of TD-MSCs, which was confirmed by increased mRNA expression of cell cycle negative regulator p21. Apoptosis of tumor cells increased significantly as concentration of cocultured TD-MSCs increased. Additionally, mRNA expression of caspase 3 was upregulated with increased concentration of TD-MSCs. CONCLUSION: TD-MSCs have a potential growth inhibitory effect on HNSCC cell lines in vitro by inducing apoptotic cell death and G1 phase arrest of cell lines.

A Case of Spontaneous Massive Pharyngeal Bleeding Caused by Anterior Cervical Osteophytes / 대한이비인후과학회지

Large anterior cervical osteophytes occur in the process of degeneration of the cervical spine or diffuse idiopathic skeletal hyperostosis. Extensive cervical spine osteophytes can produce dysphagia and laryngeal symptoms, including hoarseness, dysphonia, dyspnea and etc. But spontaneous bleeding is rare manifestation. Dysphagia and airway obstruction can be treated by surgical excision of osteophytes if conservative support fails. We present a case of a 76-year-old patient with massive bleeding from posterior hypopharyngeal wall and progressive dysphagia. When angiographic embolization and endoscopic bleeding control failed, the patient died of uncontrolled hemorrhage, and the subsequent disseminated intravascular coagulation and multi-organ failure.

Development of Laser Ruler in Rigid Laryngoscope

OBJECTIVES: The objective of this study was to develop a new device that provides a simple, noninvasive method of measuring accurate lesion size while using an endoscope. METHODS: We developed a rigid laryngoscope with a built-in laser-ruler using a one-light emitting diode and an acrylic plate. The invention incorporates a built-in laser diode that projects an auto-parallel beam into the optical path of the rigid laryngoscope to form two spots in the field of view. RESULTS: While the interspot distance remains consistent despite changes in focal plane, magnification, or viewing angle of the laryngoscope, projection to an uneven surface introduces certain variations in the shape, and size of the spots, and the distance between the two spots. CONCLUSION: The device enables a laryngologist to easily measure the distance between landmarks, as well as the change in real size, and the progressive change of vocal fold lesions in an outpatient setting.

Clinically Related Factors and Features of Central Compartment Neck Lymph Nodes in Thyroid Micropapillary Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Despite the overall excellent prognosis for patients with thyroid papillary microcarcinoma (PMC), PMC is associated with central compartment lymph node metastasis. The aim of this study is to evaluate the effect of clinical and pathological factors affecting the central compartment lymph node metastasis in thyroid PMC. SUBJECTS AND METHOD: We undertook a retrospective study of 161 patients treated between January, 2003 and June, 2007 for papillary thyroid microcarcinoma by total thyroidectomy and central compartment neck dissection (n=161) with or without comprehensive lateral neck dissection. Following factors were included to analyze the relationship of tumor size and central compartment lymph node metastasis; sex, age, extracapsular extension, lymphovascular tumor emboli, multifocality, bilaterality, AMES risk group, lateral cervical lymph node involvement. RESULTS: In 109 of 161 patients (67.7%), tumor size between 5-10 mm was significantly related with extracapsular extension (p=0.027) and also with the AMES high risk group (p=0.007). In 75 of 161 patients (46.6%), central compartment lymph node metastasis were found. By univariate analysis, tumor multifocality, bilaterality, and lateral lymph node involvement were related with central compartment lymph node metastasis. But on multivariate analysis, tumor bilaterality (p=0.008) and lateral lymph node involvement (p=0.018) were significantly related with central compartment lymph node metastasis. CONCLUSION: Prophylactic neck dissection of central compartment lymph nodes in PMC should be recommended as a routine procedure particularly for patients with tumor bilaterality and metastatic lymph nodes in the lateral neck.

A Case of Embolotherapy Using Coils, Stents for Ruptured Carotid Artery in Rucurred Hypopharyngeal Cancer / 대한이비인후과학회지

Carotid artery rupture in patients with squamous cell carcinoma of the head and neck is one of the most devastating complications associated with head and neck surgery. The reported incidence of carotid rupture in patients who have had a neck dissection or radiation therapy is 3-4%. Because of the 40% mortality associated with this complication, many researchers have written about the methods of management regarding this problem. Carotid rupture tends to occur in patients with associated conditions such as pharyngocutaneous fistula, recurrent tumor, or radiation necrosis. Management of carotid artery rupture includes surgical ligation and endovascular treatment of ruptured artery. Many authors reported that results of endovascular therapy is better than one of exploration of the neck and ligation. We reported a case of endovascular therapy using coils, stents, and graft-stent for ruptured carotid artery in patients with recurrent hypopharyngeal cancer.

Effect of Botulinum Toxin Type A on a Rat Surgical Wound Model

\ OBJECTIVES: The tension on a wound is one of the important factors that determine the degree of fibrosis and scar formation. We hypothesized that local botulinum toxin type A (Botox) induced paralysis of the musculature subjacent to a surgical wound with a skin defect would minimize the repetitive tensile forces on the surgical wound's edges, and this will result in a decreased fibroplastic response and fibrosis of the wound. METHODS: This is a prospective randomized experimental study. Two distinct surgical wounds were made to the dorsum of 15 adult rats, respectively. One of the 2 wounds was injected with Botox, and the other wound was used as a control, and this was done for all the rats' wounds. We evaluated the wound size, the degree of fibrosis and inflammation, the blood vessel proliferation, the thickness of the wound and the expression of transforming growth factor (TGF)-beta1 in the wounds. RESULTS: There were significant differences of wound size at the 3rd and 4th week between the Botox and control groups (P<0.05). The Botox group showed less infiltration of inflammatory cells than the control group at the 2nd week (P<0.05). The Botox group showed a smaller number of fibroblasts and less fibrosis than the control group at the 4th week (P<0.05). The Botox group showed much strong collagen density than the control group at the 8th week (P<0.05). For the immunohistochemical staining, there was a lower transforming growth factor (TGF)-beta1 expression in the Botox group than that of the control group at the 4th week (P<0.05). CONCLUSION: The wounds of the Botox-treated group showed a larger wound size, less infiltration of inflammatory cells and less fibrosis, a much greater amount of collagen and a lower expression of TGF-beta1 than did the control group. Botox might be used to decrease the fibrosis of a surgical wound without damaging the epithelial growth in situations for which decreased fibrosis is necessary, such as for treating laryngeal, tracheal and nasal stenosis.

Expression of VEGF, HGF, IL-6, IL-8, MMP-9, Telomerase in Peripheral Blood of Patients with Head and Neck Squamous Cell Carcinoma

OBJECTIVES: This study investigated the telomerase expression in peripheral blood mononuclear cells (PBMCs) and the relationship between the serum level of several soluble factors such as vascular endothelial growth factor (VEGF), hepatocyte growth factor, interleukin (IL)-6, IL-8, and matrix metallopeptidase-9 and the clinicopathological features of patients with head and neck squamous cell carcinoma (HNSCC). METHODS: Peripheral blood samples were collected from 50 HNSCC patients and 15 normal controls. The telomerase activity in the PBMCs was measured by Telomere Repeat Amplification Protocols. The serum levels of the soluble factors were analyzed by enzyme-linked immunosorbent assay. RESULTS: The expression of telomerase in the PBMCs of HNSCC patients was significantly correlated with the N and American Joint Committee on Cancer (AJCC) stages. The serum VEGF level was significantly higher in the patients with an advanced T stage, N stage and AJCC stage. Serum VEGF was significantly related with the expression of telomerase in the PBMCs. The telomerase expression and the VEGF expression were shown to be independent factors associated with poor survival. CONCLUSION: The telomerase expression in the PBMCs and the serum VEGF level of HNSCC patients were significantly correlated with the N stage, the AJCC stage and the prognosis.

The Usefullness of Gastric Pull-Up Reconstruction in Advanced Hypopharyngeal Cancer Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various methods of reconstruction have been used after resection of hypopharynx. This study is aimed to evaluate the results and usefullness of gastric pull-up reconstruction. SUBJECTS AND METHOD: The clinical data of 12 hypopharyngeal cancer patients, who were treated with gastric pull-up primary surgery (9 patients, 75.0%) or with salvage surgery (3 patients, 25.0%) after radiotherapy with or without chemotherapy, were studiedfrom 1987 to 2002. This study was a retrospective review of 12 patients (8 males and 4 females, mean age 57.3 years). RESULTS: Nine (75.0%) patients were stage IV and 3 (25.0%) patients were stage III. Total pharyngolaryngoesophagectomies were performed and reconstructed by gastric pullup. Five year survival rate was 57.7%. Five patients died of locoregional recurrence or distant metastasis and 3 patients were lost. The mean time forthe initiation of oral feeding was 32.2 days (range 23 to 58 days). Postoperative complications were hemothorax (1), fistula (2), stenosis (1), hypocalcemia (1), and regurgitation (2). There was no flap failure. CONCLUSION: Although gastric pull-up after resection of advanced hypopharyngeal and cervical esophageal lesions has morbidity and mortality of a combined abdominal, thoracic and cervical operation, flap failure rate is relatively low compared with free flap reconstructions such as jejunal free flap, myocutaneous free flap (radial forearm free flap or anterolateral thigh free flap). Gastric transposition constitutes relatively safe and effective method of restoring the continuity of the upper digestive tract following surgery of extensive carcinoma of the hypopharynx, larynx, and cervical esophagus.

Clinical Characteristics of Multifocal Papillary Thyroid Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Papillary thyroid cancers (PTCs) often present as multifocal tumors. Whether multifocal tumors are associated with increased risk of recurrence and mortality is still the subject of controversy. The aim of current study was to individualize factors associated with multifocality of papillary thyroid cancer and determine the clinical significance of multifocal thyroid cancer. SUBJECTS AND METHOD: We undertook a retrospective study of 403 patients treated between January, 2003 and June, 2007 for papillary thyroid carcinoma by total thyroidectomy and central compartment neck dissection (n=403) with or without comprehensive lateral neck dissection. There were 342 women and 61 men whose mean age was 47.3 years old. Following criteria were used to study the pattern of and factors related with multifocality : sex, age, extracapsular extension, central compartment lymph node metastasis, the involvement of lateral neck lymph node, AMES risk group, distant metastasis. RESULTS: Of those factors, sex (p=0.0481), central compartment lymph node metastasis (p=0.0007), the involvement of lateral neck lymph node (p=0.0001) were significantly related factors for multifocality of papillary thyroid cancer. Age, primary tumor size, AMES risk group were not significantly related with multifocality. Bilateral or contralateral central compartment lymph node metastasis occurred more frequently in multifocal PTCs (64.0%) than solitary PTCs (46.9)(p=0.012). CONCLUSION: Our data suggest that the multifocal tumors in patients with papillary thyroid carcinoma are associated with increased risk of bilateral central compartment and lateral cervical lymph node metastasis. Therefore, total thyroidectomy and bilateral central compartment lymph node dissection should be recommended as a routine procedure in multifocal papillary carcinoma

Correlation between Tumor Markers and Clinicopathologic Factors in Peripheral Blood of Papillary Thyroid Cancer Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Vascular endothelial growth factor (VEGF), matrix metalloproteinase-9 (MMP-9), hepatocyte growth factor (HGF) and epidermal growth factor (EGF) are involved in the pathogenesis and development of thyroid cancer. The purpose of this study was to find the correlation between serum VEGF, VEGF-C, MMP-9, EGF, HGF and clinicopathologic factors. SUBJECTS AND METHOD: Using enzyme linked immunosorbent assay (ELISA) kit, 64 patients with thyroid papillary cancer, 15 benign thyroid mass patients and 14 healthy normal control were analyzed to investigate the expression of human VEGF, VEGF-C, MMP-9, EGF and HGF. RESULTS: There were no significant differences in the serum levels of VEGF, VEGFC, MMP-9, TGF, EGF between papillary thyroid cancer group and the benign thyroid tumor group. Levels of VEGF and MMP-9 appeared higher in lateral cervical lymph node metastasis than N0 lymph node metastasis or only cervical component lymph node metastasis. But, the serum VEGF-C level was significantly related with tumor size, T stage, extrathyroidal extension and lateral cervical lymph node metastasis (p=0.043). CONCLUSION: VEGF, VEGF-C, MMP-9, HGF and EGF could not be used as a diagnostic tool for differentiating malignancy from benign thyroid disease. Serum VEGF, VEGF-C and MMP-9 levels were correlated with lateral cervical lymph node metastasis of papillary thyroid cancer. Consequently, this results suggests that they may serve as preoperative supplementary marker for determining the extent of papillary thyroid cancer surgery. Also, serum VEGF-C levels were correlated with some prognostic factors of papillary thyroid cancer.

Differential Diagnosis and Treatment of Neck Masses

Neck mass is a common clinical finding in all age groups. Although most neck masses have the nature of benign processes, malignant diseases must ruled out. Careful medical history, such as the duration of the mass, the presence of pain, history of upper airway infection, contact history of animals, and travel, should be obtained. Thorough physical examination should be also performed. The patients' age and the location, size, and duration of the neck masses are important pieces of information. Neck masses in children (0 to 15 years) are more commonly inflammatory than congenital or developmental and those in young adult (16~ 40 years) are more commonly congenital than neoplastic. However, the first consideration in elderly adults (>40 years) should be neoplasia. The location of the mass is particularly important with respect to the differentiation between congenital and developmental masses because such lesions are consistent in their location. For metastatic neck masses, their location may be the key to the identification of the primary tumor. Inflammatory and infectious causes of neck masses, such as cervical adenitis and cat-scratch disease, are common in young adults. The progressively increasing size of the mass indicates malignancy, however, a rapid change of size usually suggests an infectious mass. Congenital masses, such as branchial anomalies and thyroglossal duct cysts, should be considered in the differential diagnosis. Neoplasms (benign and malignant) are more likely to be present in older adults. Ultrasonography-guided biopsy is the best diagnostic method for evaluating neck masses. Panendoscopy (nasopharyx, palatine tonsil, base of tongue, piriform sinus, esophagus, stomach, trachea, and lungs) must be performed in all patients of malignant disease. The Open biopsy should be performed only in case of the neck masses which persist beyond four to six weeks after a single course of a broad-spectrum antibiotic or suspects the malignat lymphoma.

Clinical Analysis of First Bite Syndrome after Surgery of the Parapharyngeal Space Tumor / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: First bite syndrome is the development of pain in the parotid region after the first bite of each meal and can be seen after surgery of the parapharyngeal space tumor. The purpose of this study is to report the incidence and clinical courses of first bite syndrome after surgery of parapharyngeal space tumor. SUBJECTS AND METHOD: A retrospective review was done on 22 patients diagnosed and surgically treated for tumors of the parapharyngeal space from May 2001 to September 2005. RESULTS: Seven of 22 patients were diagnosed with the first bite syndrome after the operation of the parapharyngeal space tumor. In postoperative pathology, three were pleomorphic adenoma of parotid gland, three were paraganglioma of carotid body, and remaining one was schwannoma originated from sympathetic nerve chain. The first bite syndrome developed in 1 out of 5 patients with Horner's syndrome, 2 out of 4 patients with ligation of external carotid artery above branching point of facial artery, and all three patients with paraganglioma, originated from carotid body. The pain subsided in one patient 3 months after the development of first bite syndrome, although the pain persisted in remaining 6 patients during follow-up period. CONCLUSION: First bite syndrome is a minor complication of surgery involving the parapharyngeal space. But symptoms are often mild but can be severe enough to hinder a patient's quality of life and ability to eat. Therefore, surgeons who operate in the parapharyngeal space should be aware of first bite syndrome and counsel patients regarding this potential complication.