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.

Case Report: Intracapsular Carcinoma Ex Pleomorphic Adenoma of Parotid Gland / 대한두경부종양학회지

Among a variety of malignant types for parotid gland tumors, intracapsular carcinoma ex pleomorphic adenoma which is classified as a non-invasive tumor has been reported rarely. We report a case of a 69-years old patient, who presented with a left parotid mass that was detected 30 years ago. Fine needle aspiration biopsy result of the mass was “suggestive of pleomorphic adenoma”. Superficial partial parotidectomy was performed for the mass and the permanent pathologic finding was “intracapsular carcinoma ex pleomorphic adenoma” which was a salivary ductal carcinoma with well-preserved myoepithelial cells surrounding the malignant epithelial cell clusters. Surgical resection is the main treatment modality for the treatment of intracapsular carcinoma ex pleomorphic adenoma. Herein, we present the case with a review of literature.

Long-Term Oncologic Outcome of Transoral Laser Microsurgery for Early Glottic Cancer / 대한이비인후과학회지

Background and Objectives@#Traditionally, transoral laser microsurgery (TLM) is commonly used to treat early glottic cancer. However, the long-term oncologic results have not been thoroughly investigated. Therefore, this study aimed to analyze long-term oncologic outcomes of TLM for early glottic cancer.Subjects and Method We retrospectively studied 132 patients who underwent TLM for early glottis cancer from January 2001 to August 2020. We assessed overall and disease-free survival according to the T classification and types of cordectomy proposed by the European Laryngological Society in 2007. @*Results@#Of the 132 patients, 125 were male and 7 female. The mean age was 61.6±9.3 years. We found 5 (3.8%), 112 (84.8%), and 15 (11.3%) patients staged as CIS, T1, and T2, respectively. For the cordectomy types, there were 6 in type I, 22 in type II, 83 in type III, 6 in type IV, 13 in type V, and 2 in type VI. Ten-year overall and disease-free survival rates were 99.2% and 87.1%, respectively. Overall and disease-free survival curves were not different according to different T classification and cordectomy types. @*Conclusion@#TLM is an excellent treatment modality for the long-term oncologic control of early glottic cancer.

Introduction of Multidisciplinary Team Approach for Head and Neck Cancer: Patient Satisfaction / 대한이비인후과학회지

Background and Objectives@#The head and neck multidisciplinary team (MDT) approach plays a crucial role in bringing together the ideas of various medical professionals. This study aimed to evaluate the early characteristics of the MDT approach for head and neck cancer and analyzed patients’ satisfaction.Subjects and Method We analyzed 450 head and neck cancer patients who received MDT care from August 2014 to June 2022. Patient satisfaction with MDT care was evaluated by selfadministered questionnaires consisting of 9 questions. @*Results@#Of 450, 298 (66.2%) were male and 152 (33.8%) were female. The mean age was 60.8±14.7 year. The most common primary site was the larynx (17.3%), followed by the oral cavity and oropharynx. A total of 726 cases of the MDT approach were performed in 266 MDT sessions, and the mean number of patients per MDT session was 2.74. The number of medical professionals participating in MDT ranged from a minimum of 3 to a maximum of 9, with a mean of 5.11. The mean running time of MDT meetings per case was 19.51 minutes. The time of the 2nd MDT was significantly shorter than that of the 1st or 3rd MDT. The mean score was close to very satisfactory in each of the 9 patient satisfaction questions. @*Conclusion@#We believe that the MDT approach is feasible and recommend its introduction for the treatment of head and neck cancer as most patients have shown very high satisfaction. Further studies on the role and efficacy of MDT care for head and neck cancer are necessary.

Surgical Experience of Primary Hyperparathyroidism: Analysis of Postoperative Outcomes / 대한이비인후과학회지

Background and Objectives@#The standard surgical procedure for primary hyperparathyroidism is the bilateral exploration. However, the unilateral exploration and direct focused parathyroidectomy have been performed to reduce surgical morbidity. The purpose of this study was to report the surgical outcomes and efficacy of the bilateral exploration, unilateral exploration, and direct focused approaches for primary hyperparathyroidism.Subjects and Method We retrospectively analyzed the surgical outcomes of 87 patients with primary hyperparathyroidism from January 2007 to December 2017. We compared the operative time, complication and recurrence rate between the three operative methods. @*Results@#The most common histopathology was parathyroid adenoma, which was found in 73 cases (83.9%), followed by hyperplasia. In terms of complications, there were two cases of transient vocal cord palsy, one case of hematoma, one case of hypocalcemia and one case of hungry bone syndrome. Recurrence occurred in two (2.3%) out of 87 cases. There was no significant difference in the recurrence rate between the three surgical approaches. @*Conclusion@#The success rate of surgery for primary hyperparathyroidism is high. Direct focused parathyroidectomy may be a good option for parathyroid adenoma if the localization tests localize the lesion. The bilateral exploration is effective for parathyroid hyperplasia.

Efficacy of Transcartilaginous Electrodes for Intraoperative Neural Monitoring During Thyroid Surgery

Objectives@#. This study was conducted evaluate the efficacy of electromyography (EMG) using transcartilaginous (TC) electrodes through the thyroid cartilage and perichondrium. @*Methods@#. We prospectively collected EMG data from intraoperative neuromonitoring (IONM) of 54 nerves at risk in 38 patients during thyroidectomy. We followed standardized IONM procedures in all operations. EMG signals from both endotracheal tube (ET) electrodes and TC needle electrodes were recorded simultaneously. We compared the characteristics of the EMG signals and the efficacy of both methods. @*Results@#. Significantly higher mean EMG amplitudes were recorded by TC electrodes than by ET electrodes in all four-step procedures (V1-R1-R2-V2, P<0.001). Loss of signal (LOS) occurred in five patients in ET electrodes, but in only two patients in TC electrodes. Postoperative laryngoscopy revealed recurrent laryngeal nerve palsy in the two patients who showed LOS from both the ET and TC electrodes, and vocal cord movement was intact in the other three patients. Therefore, the positive predictive values of LOS in ET and TC electrodes were 40% and 100%, respectively. @*Conclusion@#. EMG recording using TC needle electrodes is feasible and effective, making it a good alternative technique for IONM.

Guidelines for Tracheostomy From the Korean Bronchoesophagological Society

The Korean Bronchoesophagological Society appointed a task force to develop a clinical practice guideline for tracheostomy. The task force conducted a systematic search of the Embase, Medline, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to key questions. Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. An external expert review and a Delphi questionnaire were conducted to reach a consensus regarding the recommendations. Accordingly, the committee developed 18 evidence-based recommendations, which are grouped into seven categories. These recommendations are intended to assist clinicians in performing tracheostomy and in the management of tracheostomized patients.

A Case of Laryngeal Inflammatory Myofibroblastic Tumor / 대한두경부종양학회지

Inflammatory myofibrolastic tumor (IMT) is a rare borderline neoplasm. It frequently occurs in the lung but occasionally occurs in extrapulmonary sites such as the genitourinary tract, gastrointestinal tract, breast, salivary glands, sinonasal tract, orbit, and the central nervous system. Laryngeal involvement of IMT is very rare.A 61-year-old woman who complained of hoarseness persisting for 3 months visited our hospital. Laryngoscopy showed an elevated lesion in the right true vocal cord. Incisional biopsy was confirmed as larygeal inflammatory myofibrolastic tumor. We performed a transoral excision with CO2 LASER under suspension examination. Regional recurrence or distant metastasis was not observed after 9 months of follow-up. Herein we report a case of larygeal inflammatory myofibrolastic tumor that was treated with surgery alone, with a literature review.

Clinical Characteristics of Infectious Mononucleosis: A Retrospective Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Infectious mononucleosis is mainly caused by Epstein-Barr virus infection and it presents sore throat, fever, tonsillar enlargement with exudate, cervical lymphadenopathy, hepatosplenomegaly, and etc. Therefore, it is often misdiagnosed with acute tonsillitis. The aim of this study was to evaluate the clinical characteristics of patients with infectious mononucleosis and recent changes.SUBJECTS AND METHOD: From January 2008 to December 2017, we retrospectively studied 83 patients who were diagnosed with infectious mononucleosis. We evaluated the patients' clinical characteristics such as sex, age, onset of disease, the department first visited, period of hospital stay, symptoms, signs, the results of serologic test, and complications.@*RESULTS@#Among 83 patients, 41 were male and 42 were female. The mean age was 16.1±7.28, with the oldest patient being 38 years old and the youngest patient being 2 years old. The proportion of patients older than 25 years was 10.8%. The most common symptom was sore throat (77%), followed by fever (67%), upper respiratory infection symptoms such as cough, sputum, rhinorrhea (37%), abdominal pain (16%), neck mass or neck pain (13%), and headache (4%). The most common sign was tonsillar enlargement (85%), followed by tonsillar white patch (68%), hepatosplenomegaly (67%), and cervical lymphadenopathy (60%). Complication occurred in 2 patients with mild jaundice, and there was no critical complication. The department patients first visited was mostly otolaryngology (61%), followed by pediatrics (21%), gastroenterology (9%), and others (6%).@*CONCLUSION@#Patients with infectious mononucleosis mostly appeared to have fever, pharyngitis or cervical lymphadenitis, and the complication rate was low. The primary infection age of infectious mononucleosis tended to increase in recent years. In adult patients, cervical lymphadenitis was less, and white blood cell count and the proportion of lymphocyte was lower compared to pediatric patients.

Intrathyroidal Parathyroid Carcinoma in Chronic Kidney Disease: A Case Report and Review of Literature / 대한이비인후과학회지

When parathyroid carcinoma occurs in the thyroid gland, it is very difficult to diagnose before surgery because imaging studies and aspiration cytology cannot distinguish parathyroid carcinoma from thyroid nodule or benign parathyroid disease. A 53-year-old male was referred to our hospital for assessment of hypercalcemia. He had suffered from chronic kidney disease for 13 years. A 2.5×1.5 cm hypoechoic nodule was noted in the left thyroid gland on ultrasonography, and it showed increased uptake on the sestamibi scan. Fine needle aspiration biopsy revealed it to be a parathyroid lesion, which was confirmed by surgery as parathyroid carcinoma completely surrounded by normal thyroid parenchyme. Because ultrasonography and aspiration cytology have only a limited role in distinguishing parathyroid carcinoma from thyroid neoplasm, suspicion of parathyroid carcinoma before or during surgery through careful examination can lead to complete resection at the initial surgery.

Safety and Effectiveness of Reza Band in Management of Laryngopharyngeal Reflux Disease: A Preliminary Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The main treatment of laryngopharyngeal reflux disease (LPRD) includes life style modification and proton pump inhibitor (PPI) medication. However, LPRD is sometimes refractory to PPI medication. The Reza band has been developed to exert external pressure on the upper esophageal sphincter thus preventing gastric acid reflux to the larynx and pharynx. The aim of this study was to evaluate safety and efficacy of using the Reza band in patients with LPRD. SUBJECTS AND METHOD: We prospectively enrolled 16 LPRD patients who were refractory to PPI medication and who had agreed to wear the Reza band. Patients were treated with the Reza band and PPI medication simultaneously or only the Reza band. We studied complications related to the Reza band, analyzed Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) before and after the application of the band up to 12 weeks. RESULTS: The Reza band was endured by 15 patients except one patient. One patient (6.25%) ceased wearing the band due to pain and discomfort in the neck. No major complications occurred, except one patient who reported mild neck discomfort when the band was applied. The mean value of RSI before the application of the Reza band was 12.31±6.43, which significantly improved at 8 weeks and 12 weeks (9.17±5.08, p=0.005 and 8.20±5.59, p=0.007, respectively) post-treatment. The mean value of RFS before the application of the Reza band was 13.50±2.97, which significantly improved at 2, 4, 8, and 12 weeks (p < 0.05) post-treatment. CONCLUSION: We conclude that the Reza band is safe and effective for the treatment of LPRD in properly selected patients.

Number of Metastatic Lymph Nodes and Ratio of Metastatic Lymph Nodes to Total Number of Retrieved Lymph Nodes Are Risk Factors for Recurrence in Patients With Clinically Node Negative Papillary Thyroid Carcinoma

OBJECTIVES: The number of metastatic lymph nodes (LNs) and the ratio between the number of metastatic LNs and the total number of retrieved LNs (the LN ratio [LNR]) have been proposed as risk factors for recurrence of papillary thyroid carcinoma (PTC). However, the significance of the number of LNs and the LNR in patients with clinically node negative PTC has not been clearly determined. The purpose of this study is to evaluate their significance. METHODS: We retrospectively analyzed 382 patients with PTC who had undergone total thyroidectomy with prophylactic central neck dissection (CND) between January 2000 and December 2010. We excluded patients with lobectomy, concurrent lateral compartment neck dissection, a follow-up period less than at least 2 years, number of harvested central LNs less than or equal to one, clinically positive LN, distant metastasis, recurrent cancer or other types of malignancy. The correlations between recurrence and various clinicopathologic characteristics including tumor size, extrathyroidal extension (ETE), stage, number of metastatic central LNs, and the LNR were investigated. RESULTS: After a mean follow-up period of 82.2±26.4 months, recurrence occurred in 14 patients (3.7%). Tumor size ≥20 mm, maximal ETE, presence of central LN metastasis, number of metastatic LNs ≥2, and LNR ≥0.31 correlated with recurrence in the univariate analysis. However, tumor size ≥20 mm, maximal ETE, number of metastatic LNs ≥2, and LNR ≥0.31 were significantly associated with recurrence in the multivariate analysis (hazard ratio=6.61, 7.17, 3.43, and 11.23, respectively). CONCLUSION: The LNR and the number of metastatic LNs are independent prognostic risk factors for recurrence in patients with clinically node negative PTC, and these factors can be used to guide postoperative adjuvant therapy and follow-up strategy after prophylactic CND.

Long-Term Effects of Adenotonsillectomy on Growth and Symptoms in Childhood / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was performed to evaluate the long-term effect of adenotonsillectomy on childhood growth by examining preoperative growth status and presenting symptoms. SUBJECTS AND METHOD: One hundred and four patients who underwent adenotonsillectomy from January to December 2009 were enrolled in this study. Clinical data were collected from medical record reviews and through the administered questionnaire. We investigated symptoms and growth changes during 5 years following the surgery. RESULTS: The mean age of patients was 6.0±1.94 years (range, 3–10), with the male to female ratio of 62:42. Pre-operative symptoms were significantly improved after the surgery. The mean pre-operative height and weight percentiles were 53.6±27.4 and 59.6±29.2 at initial evaluation, and 67.1±26.4 and 59.6±28.6 at 5 years post adenotonsillectomy (p < 0.001, p=0.989), respectively. An increase in height percentile was more prominent in patients whose pre-operative height percentile was less than 50 compared to those with a percentile of 50 or more (p < 0.001). Weight percentile was significantly increased in those with the pre-operative weight percentile of less than 50 and decreased in patients with a percentile of 50 or more. CONCLUSION: Adenotonsillectomy has a positive effect on height growth in children with adenotonsillar hypertrophy, especially in patients whose height percentile is less than 50. Weight gain also can be expected in preoperative low-weight children.

Postoperative Hypoparathyroidism and the Viability of the Parathyroid Glands During Thyroidectomy

OBJECTIVES: To prevent hypoparathyroidism after thyroidectomy, preservation of the parathyroid glands and their vascularity are essential. The aim of this study was to determine the association between postoperative parathyroid function and the viability of the parathyroid glands during thyroidectomy. METHODS: We prospectively analyzed 111 patients who underwent total thyroidectomy and in whom all 4 parathyroid glands were preserved in situ during the operation. The surgeons scored the viability of each parathyroid gland from 0 (normal) to 3 (severely compromised viability) based on its gross appearance and vascularity intraoperatively. The index of parathyroid viability score (IPVS) was defined as the sum of the viability scores of the 4 parathyroid glands. We evaluated the relationship between postoperative parathyroid function and IPVS. RESULTS: Transient hypoparathyroidism occurred in 25 patients (22.5%), and permanent hypoparathyroidism in 4 patients (3.6%). The IPVS were significantly different in the three groups: 2.87±1.46 in the normal group, 3.68±1.41 in the transient hypoparathyroidism group and 7.50±1.00 in the permanent hypoparathyroidism group. The rates of transient hypoparathyroidism were 13.6% in patients with IPVS 0–2, 23.8% in patients with IPVS 3–4, and 42.9% in patients with IPVS 5–6. All the patients with IPVS of 7 or more had permanent hypoparathyroidism. CONCLUSION: IPVS is correlated with the incidence of hypoparathyroidism. It could be a good quantitative indicator of the probability of hypoparathyroidism after thyroidectomy.

Acoustic Outcomes After Laryngomicrosurgery for Reinke's Edema

BACKGROUND AND OBJECTIVES: The management of Reinke's edema includes usually medical treatment and voice therapy. Laryngomicrosurgery (LMS) is also necessary, especially to improve airway obstruction. However, voice outcome after LMS has not been determined well. The aim of this study was to evaluate effectiveness of LMS for Reinke's edema and analyze the voice outcomes after LMS. MATERIALS AND METHODS: Twenty-five patients with Reinke's edema who underwent LMS from September 2007 to December 2016 were enrolled in this study. We analyzed reflux finding score (RFS), reflux symptom index (RSI), and acoustic parameters before and after surgery. RESULTS: Male was 15 (60%) and female was 10 (40%), and mean age was 49.6 years. Preoperative mean value of RFS decreased significantly up to 3 months after LMS (18.3±2.2 and 10.0±2.2 at preoperative and 3 months postoperatively, respectively). The mean value of Jitter decreased significantly before and after surgery (2.71±2.81% and 1.06±1.21% before and after LMS, p=0.041). The mean value of Shimmer also decreased significantly before and after surgery (7.97±3.63% and 4.83±1.85%, respectively, p=0.006). CONCLUSION: LMS is effective in the treatment of Reinke's edema. It results in favorable acoustic outcomes and laryngoscopic findings in properly selected patients.

Effectiveness of Proton Pump Inhibitor in the Treatment of Contact Granuloma

BACKGROUND AND OBJECTIVES: Contact granuloma is granulation tissue that occurs mainly in the vocal process of arytenoid cartilage. Among several etiological factors, gastric acid reflux is known to be an important cause. The aim of this study was to evaluate clinical characteristics of contact granuloma and analyze the effectiveness of proton pump inhibitor in the treatment of contact granuloma. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 40 patients who were treated with proton pump inhibitor (PPI) for contact granuloma from January 2011 to December 2015. Reflux finding score (RFS), reflux symptom index (RSI) and size of granuloma were evaluated before and after treatment serially to assess the effectiveness of proton pump inhibitor. RESULTS: Of 40 patients, 25 patients (62.5%) and 10 patients (25%) showed improvement and partial improvement of granuloma, respectively. Five patients showed no response. The mean times of partial improvement and improvement were 2.08±2.23 months and 4.60±2.77 months, respectively and mean duration of PPI treatment was 6.8±5.2 months. CONCLUSION: Proton pump inhibitors is effective in the treatment of contact granuloma.

Significance of Sublingual Gland Excision in Surgical Treatment of Ranula / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Ranulas, pseudo cysts found on the floor of mouth, develop from the retention or extravasation of saliva from the sublingual gland. The main treatment of ranula is surgical excision but the extent of surgery is controversial. The aim of this study was to evaluate the significance of sublingual gland excision in the surgical treatment of ranula. SUBJECTS AND METHOD: We retrospectively reviewed 112 patients with ranula who had undergone surgical excision from January 2004 to April 2016. Those who underwent any previous treatment such as sclerotherapy, marsupialization, or excision of cyst were excluded in the study. Surgical outcomes including complications and recurrence were compared between the group that went through simple cyst excision and the group that went through cyst and sublingual gland excision. RESULTS: Of 112 patients, 94 were simple ranula and 18 were plunging ranula. Thirty-seven (33%) were male and 75 (67%) were female. Of the 94 simple ranula patients, 23 underwent excision of cyst only; the remaining 71 patients and all other patients with plunging ranula underwent excision of cyst and sublingual gland together. The recurrence rate was significantly lower for the cyst and sublingual gland excision group than for the simple cyst excision group (2.2% vs. 17.4%, p=0.004). The complication rate did not differ between the two groups (4.3% vs. 1.1%, p=0.298). CONCLUSION: The excision of sublingual glands as well as cysts is an important option to reduce recurrence in the surgical treatment of ranula.

Accuracy of Diagnostic Methods for Detection of Head and Neck Primary Origin in Metastatic Neck Mass / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is important to localize the primary site when cervical lymph node metastasis is detected. The purpose of this study was to evaluate the accuracy of diagnostic methods to detect the head and neck primary site in patients with metastatic neck mass. SUBJECTS AND METHOD: Sixty-six patients who had presented with neck mass and were confirmed to have metastatic carcinoma by fine needle aspiration cytology from January 1998 to June 2016 were enrolled. We analyzed the accuracy of diagnostic modalities that inluded physical and endoscopic examination, CT, MRI, PET/CT, and guided biopsy. RESULTS: The mean age of patients was 58.7±12.6 years with the male to female ratio of 55:11. The metastatic lymph nodes were most common at level II (60/66, 90.9%) followed by levels III, IV, I and V. The most common primary site was tonsil (45.5%), followed by the nasopharynx, base of tongue and hypopharynx, and eight patients (12.1%) were diagnosed as metastatic carcinoma of unknown origin. The primary sites were detected by: physical and endoscopic examination in 36/66 (54.5%), CT in 41/66 (62.1%), MRI in 39/52 (75%) and PET/CT in 46/63 (73.1%). The primary sites were additionally detected using PET/CT for nine cases of the 20 cases, where primary sites were not found using physical and endoscopic examination, CT or MRI. Guided biopsy was done in 11 cases, where primary sites were not detected by all of the methods; hence, primary sites for 3 cases were additionally revealed. CONCLUSION: PET/CT is a useful method when physical examination, CT and MRI cannot reveal the primary site of metastatic neck mass. Guided biopsy can be performed when primary site is not founded by any of the physical and imaging examinations.

Deep Neck Infection with Mediastinal Abscess Treated by Modified Vacuum-Assisted Closure Application

Deep neck infection is a surgical emergency that can result in life threatening complications such as airway obstruction, aspiration, thrombosis of major vessels and mediastinitis by spread of infection along fascial planes. Although appropriate surgical intervention and prompt antibiotics are given, revision surgeries are often required. We report a patient with mediastinal abscess caused by a deep neck infection that was initially intractable with usual surgical drainage but was eventually successfully treated with the modified application of a vacuum-assisted closure (VAC) device (InfoV.A.C. Therapy Unit; Kinetic Concept Inc., USA). We inserted silastic drain tubes into paratracheal area. It was difficult to pack the VAC foams, so they were prone to fail, with complete debridement. With modified VAC therapy assisted by silastic drain tube, the deeply located mediastinal abscess that had been unresponsive to conventional surgical drainage was successfully treated.

Guidelines for the Surgical Management of Laryngeal Cancer: Korean Society of Thyroid-Head and Neck Surgery

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.