Clinical Practice Guidelines for Oropharyngeal Dysphagia / 대한연하장애학회지

Objective@#Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. @*Methods@#Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. @*Results@#Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. @*Conclusion@#This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

Standardization of FEES Evaluation for the Accurate Diagnosis of Dysphagia / 대한연하장애학회지

Objective@#Fiberoptic endoscopic evaluation of swallowing (FEES) is a standard diagnostic tool for swallowing disorders. However, it has not been used frequently in Korea because of the long test time, low cost, and the absence of a standard evaluation system. The purpose of this study was to suggest a standard fill-out form for the FEES result. @*Methods@#From February 2019 to June 2020, a total of 98 FEES tests were performed by an otolaryngologist (JYJ) at the Wonkwang University Hospital. After the exclusion of 68 cases, 30 cases were analyzed twice by 4 raters with over 5 years of experience as otolaryngologists working in various hospitals. The results were measured for the rater’s test-retest reliability and inter-rater consistency. @*Results@#Cohen’s kappa values for measuring the intra-rater consistency of the four raters were 0.984, 0.887, 0.848, and 0.930, respectively, meaning very good alignment of 0.8 or more, respectively. The Fleiss Kappa value for measuring inter-rater consistency was 0.276, meaning ‘fair’ for values of 0.2 or more. To examine consistency, an intraclass correlation coefficient (ICC) analysis conducted by assuming the grading score to be a constant continuous variable gave an ICC value of 0.729 (P＜0.001), showing a very reliable tendency. @*Conclusion@#In this study, all the items of the fill-out form were rated using a three-step grading scale, so the degree of agreement was high when performed twice by the same rater, but the degree of agreement among raters was relatively low. Therefore, our fill-out form for FEES will be useful in evaluating the improvement of a patient over the course of clinical treatment.

Tracheostomy in COVID-19 Pandemic Era / 대한이비인후과학회지

The outbreak of new coronavirus (COVID-19) has emerged as the cause of a severe acute respiratory. The COVID-19 pandemic led to an unexpected increase in the number of patients who are critically ill and required mechanical ventilation for active respiratory support. Tracheostomy is a common surgical procedure performed on patient to provide long-term ventilator support or to manage upper airway obstruction. It could be a critical role in the management of COVID-19 patients. Insertion of a tracheal cannula has become a viable alternative to prolonged endotracheal intubation, with the benefits of decreased airway resistance, improved patient comfort, reduced need for sedation, easier sputum removal. While these interventions could be necessary to provide adequate care, they require special precautions to minimize occupational risk. Because the spread of COVID-19 happened by aerosol and fine droplets, medical staffs are in direct danger of occupational exposure while caring for these patients. The purpose of this article is to review the preoperative preparation and tracheostomy guidelines related to COVID-19 pandemic spread.

Sentinel Lymph Node Centered Selective Neck Dissection Does Not Have Benefits Over Supraomohyoid Neck Dissection in Patients with cT1T2N0 Tongue Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aimed to evaluate the clinical efficacy of sentinel node centered selective neck dissection in patients with early stage tongue cancer (T1T2N0). SUBJECTS AND METHOD: Lymphoscintigraphy was performed for 12 patients, subsequently followed by sentinel node centered selective neck dissection. The location of the sentinel node, pathological confirmation of node metastasis, and follow-up recurrence were analyzed. RESULTS: In total, 19 sentinel lymph nodes were identified. Of these, 18 were located in levels I to III, and one in level IV. After surgery, 3 patients (25%) were diagnosed with neck node metastasis: two experienced sentinel node metastasis and one experienced skipped metastasis. During follow-up, 3 of the 12 patients (25%) experienced recurrence. CONCLUSION: The recurrence of lymph node could be covered with supraomohyoid neck dissection, which indicates that it has superiority over sentinel node centered selective neck dissection in preventing recurrence in T1T2N0 tongue cancer patients.

Multidimensional Rehabilitation in Patients with Aspiration Following Head and Neck Cancer Treatment

Patients who have the head and neck cancer are usually treated by surgery, radiation therapy, chemotherapy, or combinations of them. These treatments can induce variable degree of aspiration with dysphagia. The type and severity of aspiration depends on the size and location of the original tumor, the structures involved, and the treatment modality used for treatment. The management of aspiration after the head and neck cancer's treatment begins with an accurate evaluation for the cause and mechanism of aspiration through modified barium swallow (MBS) and fiberoptic endoscopic examination of swallowing (FEES). Then, the clinician can use postures, maneuvers, and exercises to treat the swallow disorder and to help the patient achieve optimal function. To achieve optimal swallowing without aspiration, multidimensional rehabilitation by various medical personnel is definitely necessary.

Exploratory Study on Guide Wire-Guided Tongue Resection under Ultrasonography for Adequate Safe Margins in Tongue Cancer Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The adequate safety margin in tongue cancer is the most important prognostic factor for local recurrence and survival. This study aimed to evaluate the resection margins using a new technique of tongue resection under the guidance of guide wire under ultrasonography in patients with tongue cancer. SUBJECTS AND METHOD: In this prospective study, 10 patients with presurgical, biopsy-proven, clinical T1 or T2 tongue squamous cell carcinomas underwent resection under the guidance of guide wire inserted using ultrasonography. The data of resection margins of 37 patients who underwent partial glossectomy using the conventional method of palpation were used as control data. RESULTS: The mean safety margins (mm) of the experimental group were 7.59±4.30 (anterior), 8.56±4.69 (posterior), 5.25±3.01 (superior), 5.93±3.66 (inferior), 13.00±13.29 (medial), 5.78±2.64 (deep), and 6.67±3.06 (lateral). There were no differences in the safety margins between the two groups. CONCLUSION: Using guide wire under ultrasonography was not superior to the conventional method for partial glossectomy for having adequate resection margins.

Clinical Features and Outcomes of a Rare Nasal Cavity Tumor Glomangiopericytoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Glomangiopericytoma falls within the category of borderline low-malignant-potential soft tissue tumors of the nose and paranasal sinuses. It is a rare tumor arising from the pericytes surrounding capillaries, and accounts for less than 0.5% of all sinonasal tumors. The aim of this study was to analyze the clinical manifestation and surgical outcomes of the glomangiopericytoma in the nasal cavity. SUBJECTS AND METHOD: Medical records of eight patients who were surgically managed for glomangiopericytoma of the nose and paranasal sinuses from 2000 to 2015 were retrospectively reviewed. Clinical features, size, Immunohistochemical staining, extent of surgery, adjuvant treatment, and recurrence were evaluated. RESULTS: Eight patients, 3 males and 5 females, were enrolled, with the mean age of 54.7 years old. The most common symptom of glomangiopericytoma was ipsilateral nasal obstruction. All patients got surgical treatment, and one patient received radiation to the surgical site, whose margin of resection was positive. The mean follow-up period was 39.5 months (3-176 months). During the follow-up period, one patient was found to have a positive resection margin. CONCLUSION: The surgical outcome shows that complete initial excision is important to prevent recurrence. Furthermore, adjuvant radiation therapy may also be a reasonable option for some patients with margin involvement.

A Case of Rhabdomyosarcoma Presenting a Rapidly Growing Thyroid Mass Showing Cytological Features Mimic Anaplastic Thyroid Carcinoma / 대한갑상선학회지

This is a case of a 30-year-old man who was referred to our hospital for evaluation of a rapidly growing tumor in the left thyroid gland. It was palpated 2 weeks ago. But it was growing fast. A 4x3 cm mass was palpated in the left thyroid gland. Our impression was anaplastic thyroid carcinoma. Computed tomography finding indicated a thyroid malignant tumor and cytology result suggested spindle cell neoplasm. A lower anterior neck mass was resected and final histopathological result turns out to be a rhabdomyosarcoma (RMS). Although cervical RMS is very rare in adults, it has to be included for the differential diagnosis for the rapidly growing mass at thyroid gland.

A Case of Aconite Intoxication and Recurrent Ventricular Arrhythmia without Apparent Myocardial Damage after 20,680 Joules DC Shock

The aconite root has been used in oriental medicine to improve metabolism of debilitated patient and to cure acute dysuria, cardiac weakness, gout, neuralgias and rheumatism. The crude drug "bu-shi" or "cho-oh", which is obtained from the Aconitum roots, contains the potent poisons aconitine, mesaconitine, jesaconitine, and hypaconitine, which are C