Tongue Reduction Surgery Improves Mandibular Prognathism in Beckwith-Wiedemann Syndrome Without Compromising Tongue Function

Objectives@#. This study evaluated the surgical outcomes of patients with Beckwith-Wiedemann syndrome who underwent tongue-reduction surgery and analyzed whether the malocclusion and mandibular prognathism caused by macroglossia could be improved. @*Methods@#. A retrospective medical record review was performed for 11 patients with Beckwith-Wiedemann syndrome whose macroglossia was surgically treated. Demographic data, symptoms and signs, and intraoperative and postoperative surgical outcomes were evaluated. Surgery was performed by a single surgeon using the “keyhole” technique, involving midline elliptical excision and anterior wedge resection. Preoperative and postoperative plain skull lateral X-rays were evaluated to assess prognathism improvement. @*Results@#. The median age at the time of surgery was 35.09 months, and the ratio of males to females was 4:7. The median surgical time was 98±31.45 minutes, and the median duration of the postoperative intensive care unit stay was 3.81±2.4 days. There were no airway complications. Two patients (18.2%) had postoperative wound dehiscence; however, there was no nerve damage, recurrence, or other complications. Among the five patients who underwent postoperative speech evaluation, all showed normal speech development, except one patient who had brain dysfunction and developmental delay. Measurements of the A point-nasion-B point (ANB) angles and sella-nasion-B point (SNB) angles (point A is the most concave point of the anterior maxilla; point B is the most concave point on the mandibular symphysis) on plain X-rays showed a significant decrease in the postoperative SNB angle (P <0.001) and a significant increase in the ANB angle (P <0.011). @*Conclusion@#. Tongue-reduction surgery is an effective and safe technique for severe forms of macroglossia associated with Beckwith-Wiedemann syndrome. In addition, it improves mandibular prognathism in young Beckwith-Wiedemann syndrome patients with macroglossia.

Cumulative Sum Analysis of the Learning Curve of Free Flap Reconstruction in Head and Neck Cancer Patients

Objectives@#. Owing to the functional and structural complexity of the head and neck area, the reconstruction of defects in these areas is challenging. Free flap surgery has become standard for the reconstruction of the head and neck with improvements in microvascular surgery. The aim of this study was to use the cumulative sum (CUSUM) method to evaluate the learning curve for free-flap head and neck reconstruction performed by a single surgeon. @*Methods@#. We retrospectively reviewed the medical records of 47 patients who underwent free-flap reconstruction from 2017 to 2021. The clinical demographics and surgical outcomes were analyzed. The total operation time was analyzed using the CUSUM method, which is an analytical approach for visualizing patterns in data by converting raw data into an accumulation of deviations from the average value. @*Results@#. CUSUM analysis showed two phases of the learning curve: phase 1 (cases 1–22) and phase 2 (cases 23–47). The operative time in phase 1 (579.9±128.2 minutes) was significantly longer than that in phase 2 (418.6±80.9 minutes) (P<0.001). The re-exploration rate was higher in phase 1 (31.8%) than in phase 1 (4%) (P=0.018). The flap failure rate was higher in phase 1 (9.1%) than in phase 1 (4%), but this difference was not statistically significant (P=0.593). @*Conclusion@#. The learning curve of free-flap head and neck reconstruction seems to stabilize after approximately 20 cases.

Effectiveness of Intratympanic Dexamethasone Injection for Tinnitus Treatment: A Systematic Review and Meta-Analysis

Objectives@#. Intratympanic dexamethasone injection (ITDI) has been introduced as a treatment option for subjective tinnitus. However, the effects of ITDI on patients with tinnitus remain unclear. In the present systematic review and metaanalysis, we evaluated the effectiveness of ITDI for tinnitus treatment. @*Methods@#. We searched Medline, the Cochrane Central Register of Controlled Trials, and Embase. Four double-blind randomized controlled trials that tested the efficacy of ITDI compared with a placebo were deemed eligible for a quantitative meta-analysis, while four prospective studies and seven retrospective studies reporting the effectiveness of ITDI on tinnitus treatment were included in a qualitative synthesis. @*Results@#. In the four studies included in the quantitative meta-analysis, ITDI did not show evidence of tinnitus improvement compared with placebo (odds ratio [OR], 1.38; 95% confidence interval, 0.53–3.61). In the 11 studies included in the qualitative synthesis, seven retrospective studies without controls reported rates of tinnitus improvement after ITDI ranging from 35.9% to 91.3%. In the four prospective studies with controls, ITDI seemed to be effective when combined with other drugs for tinnitus treatment. @*Conclusion@#. ITDI alone did not show a significant effect for treating tinnitus compared with placebo. However, the potential of combination treatment of ITDI with other drugs for tinnitus therapy should be further studied in more systematic research.

Feasibility of Surgical Treatment for Laryngomalacia Using the Spontaneous Respiration Technique

Objectives@#. In this study, we review our institutional experience with pediatric laryngomalacia (LM) and report our experiences of patients undergoing supraglottoplasty using the spontaneous respiration using intravenous anesthesia and high-flow nasal oxygen (STRIVE Hi) technique. @*Methods@#. The medical records of 29 children with LM who visited Seoul National University Hospital between January 2017 and March 2019 were retrospectively reviewed. Surgical management was performed using the STRIVE Hi technique. Intraoperative findings and postoperative surgical outcomes, including complications and changes in symptoms and weight, were analyzed. @*Results@#. Of the total study population of 29 subjects, 20 (68.9%) were female. The patients were divided according to the Onley classification as follows: type I (n=13, 44.8%), II (n=10, 34.5%), and III (n=6, 20.7%). Twenty-five patients (86.2%) had comorbidities. Seventeen patients (58.6%) underwent microlaryngobronchoscopy under STRIVE Hi anesthesia. Four patients with several desaturation events required rescue oxygenation by intermittent intubation and mask bagging during the STRIVE Hi technique. However, the procedure was completed in all patients without any severe adverse effects. Overall, 15 children (51.7%) underwent supraglottoplasty, of whom 14 (93.3%) showed symptom improvement, and their postoperative weight percentile significantly increased (P=0.026). One patient required tracheostomy immediately after supraglottoplasty due to associated neurological disease. @*Conclusion@#. The STRIVE Hi technique is feasible for supraglottoplasty in LM patients, while type III LM patients with micrognathia or glossoptosis may have a higher risk of requiring rescue oxygenation during the STRIVE Hi technique.

Head and Neck Surgery for Dysphagia in the COVID-19 Era / 대한연하장애학회지

Treatment of patients with dysphagia has become more complicated due to the worldwide COVID-19 pandemic. A surgical field involving the upper respiratory tract, and the aerosol-generating nature of the surgery implies a higher risk of infection transmission to the surgeon and operating theater (OT) staff. Thus, most guidelines released during the COVID-19 era recommend postponement of surgical treatment for these patients. The surgical treatment for dysphagia can be classified into procedures improving swallowing functions, procedures preventing aspiration, and tracheostomy to preserve the airways. Dysphagia surgeries that improve swallowing functions and prevent aspirations have a lower priority, and therefore, should be delayed until the risk of infection decreases. However, tracheostomy is considered a high priority regardless of the infection risk. As per our experience, a tracheostomy can be conducted safely following strict infection control measures, such as proper personal protective equipment, isolated surgical field, and sterilization of surgical equipment, etc. Other dysphagia surgeries may also be conducted safely if attempted under a strict protocol, although careful assessment of the patient status and the institutional situation should be carried out in advance.

Head and Neck Surgery for Dysphagia in the COVID-19 Era / 대한연하장애학회지

Treatment of patients with dysphagia has become more complicated due to the worldwide COVID-19 pandemic. A surgical field involving the upper respiratory tract, and the aerosol-generating nature of the surgery implies a higher risk of infection transmission to the surgeon and operating theater (OT) staff. Thus, most guidelines released during the COVID-19 era recommend postponement of surgical treatment for these patients. The surgical treatment for dysphagia can be classified into procedures improving swallowing functions, procedures preventing aspiration, and tracheostomy to preserve the airways. Dysphagia surgeries that improve swallowing functions and prevent aspirations have a lower priority, and therefore, should be delayed until the risk of infection decreases. However, tracheostomy is considered a high priority regardless of the infection risk. As per our experience, a tracheostomy can be conducted safely following strict infection control measures, such as proper personal protective equipment, isolated surgical field, and sterilization of surgical equipment, etc. Other dysphagia surgeries may also be conducted safely if attempted under a strict protocol, although careful assessment of the patient status and the institutional situation should be carried out in advance.

Risk Factors for Tumor Size Increase During Active Surveillance of Papillary Thyroid Cancer: Meta-Analysis and Systematic Review / 대한이비인후과학회지

Background and Objectives@#The purpose of this study was to systematically review literatures on active surveillance for low-risk differentiated thyroid cancer, and to evaluate risk factors for tumor size increase during active surveillance.Subjects and Method We conducted a systematic review and a meta-analysis of studies reporting on tumor growth during active surveillance of papillary thyroid cancer. Using the MEDLINE and EMBASE databases, we searched studies published from the inception of database to December 2020. Studies were included if reported on at least one clinical risk parameter in addition to reporting on the change in tumor size during active surveillance. @*Results@#Out of 33 studies screened, seven were included in the meta-analysis. The odds ratio of a temporal size increase of more than 3 mm in papillary thyroid cancer was 0.011 person-years (95% confidence interval [CI]: 0.009 to 0.013). The odds ratio of lymph node metastasis was 0.002 person-years (95% CI: 0.001 to 0.003). Younger age was a significant risk factor for tumor growth during active surveillance, with a standardized median difference of -0.63 (95% CI: -1.00 to -0.27). In the three studies that evaluated the association of thyroid-stimulating hormone levels and tumor size, the results were contradictory. @*Conclusion@#Active surveillance may be used more cautiously for younger patients.

Feasibility of Brachial Plexus Schwannoma Enucleation With Intraoperative Neuromonitoring

Objectives@#. To evaluate the feasibility of brachial plexus schwannoma enucleation under intraoperative neuromonitoring. @*Methods@#. Five patients who were treated for brachial plexus schwannoma under intraoperative neuromonitoring from 2008 to 2018 were included in this retrospective review. Neuromonitoring was performed with a 100-μV event threshold of the neuromonitoring system (NIM-2 or 3) at the deltoid, biceps brachii, triceps brachii, and brachioradialis muscles. Patient characteristics, tumor size and location, intraoperative neuromonitoring findings, and postoperative function were evaluated. @*Results@#. The intraoperative neuromonitoring findings were in accordance with the preoperative assessment of the included nerve root. Three patients had no postoperative morbidity, one patient had temporary paresthesia of the forearm for 2 months, and one patient mild loss of grip strength for 1 month. @*Conclusion@#. Intraoperative neuromonitoring of the arm and forearm muscles during enucleation of brachial plexus schwannoma promoted confident and successful surgery with minimal postoperative morbidity.

Risk Factors for Positional Vertigo and the Impact of Vertigo on Daily Life: The Korean National Health and Nutrition Examination Survey

BACKGROUND AND OBJECTIVES: This study aimed to analyze risk factors for positional vertigo (PV) and the influence thereof on daily life and subjective quality-of-life (QoL). SUBJECT ANDMETHODS: A cross-sectional study was conducted using data of the 2010 Korea National Health and Nutrition Examination Survey. The study population consisted of 1,274 individuals aged >40 years for whom complete dizziness-related data were available. Blood and urine tests were performed, and nutritional intake, QoL, and subjective health status were measured using a questionnaire. The associations between PV and blood/urine test data and nutritional intake were evaluated via multiple logistic regression analysis. RESULTS: A history of PV within the previous year was reported by 98 individuals (7.7%). Advanced age and female gender were both significantly associated with such a history. Serum hemoglobin, creatinine, and triglyceride levels correlated significantly with a history of PV. Carotene, vitamin A, and vitamin B2 intakes were significantly lower in individuals with PV. Multivariate analysis revealed that only age was significantly associated with a history of PV (p=0.003). Although subjective health status score was not significantly lower in subjects with PV, subjective impairments in mobility, self-care, the performance of usual activities, and anxiety/depression were more prominent in individuals with PV. A fall history and limitations of activity were also significantly higher in individuals with PV (p < 0.001 and p=0.003, respectively). CONCLUSIONS: Age was a risk factor for PV, which affected most QoL parameters, fall frequency, and the performance of normal activities.

Comparison between Subjective Scoring and Computer-Based Asymmetry Assessment in Facial Nerve Palsy

BACKGROUND AND OBJECTIVES: The aim of the present study was to assess the feasibility of a PC-based facial asymmetry assessment program (PC-FAAP) and to compare the results of PC-FAAP with subjective regional scoring by raters in acute unilateral peripheral facial nerve paralysis (FNP). SUBJECTS AND METHODS: Participants were divided into 3 groups with 8 participants per group: group I, normal; group II, mild to moderate FNP; and group III, severe FNP. Using the PC-FAAP, the mouth asymmetry ratio (MAR), eyebrow asymmetry ratio (EAR), and complete eye closure asymmetry ratio (CAR) were calculated by comparing the movement of tracking points on both sides. The FNP grading scale (FGS) integrated each score, and the scores were weighted with a ratio of 5:3:2 (MAR:CAR:EAR). Subjective regional scoring was measured on a 0-100 scale score by three otologists. PC-FAAP and subjective scoring were compared in each group regarding the consistency of the results. RESULTS: The mean scores of the MAR, EAR, CAR, and FGS of each group were significantly different. PC-FAAP showed significant differences between the three groups in terms of MAR, EAC, CAR, and FGS. PC-FAAP showed more consistent results than subjective assessment (p < 0.001). The PC-FAAP was significantly more consistent in group I and group III (p < 0.001 and p=0.002, respectively). FGS in group III was the only parameter that showed a more consistent result in PC-FAAP than the subjective scoring (p=0.008). CONCLUSIONS: An FNP grading system using a PC-based program may provide more consistent results, especially for severe forms.

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

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient's treatment goals.

Can Endoscopic Tympanoplasty Be a Good Alternative to Microscopic Tympanoplasty? A Systematic Review and Meta-Analysis

Although efficacies and proportions of tympanoplasty performed via endoscopic ear surgery (EES) have gradually introduced, it remains unclear whether total EES is a good alternative to microscopic ear surgery (MES). Herein, we aimed to compare therapeutic effects of EES and MES in patients receiving tympanoplasty or myringoplasty. A search of MEDLINE, PubMed, and Embase databases was conducted to compare the efficacies of EES and MES. Two investigators independently reviewed all studies and extracted data with a standardized form. We assessed risk of bias and calculated pooled odds ratio (OR) estimates with a 95% confidence interval (CI). Thirteen studies (607 EES patients and 678 MES patients) met inclusion criteria for quantitative meta-analysis. In pooled analysis, those who undergo EES have 0.99 times the OR of graft success compared to those with MES (95% CI, 0.84 to 1.16; P=0.894). In qualitative analysis, comparable hearing improvement was observed between the two groups, despite inconsistent audiometric evaluation. The air-bone gaps (ABGs) improved 2.02 dB less in EES than in MES (mean difference of improvements of ABGs, 2.02; 95% CI, –3.84 to –0.20; P=0.029); however, substantial heterogeneity and publication bias limited the integrity of this analysis. Further, EES significantly decreased canalplasty rate, wound complications, and operation time, compared to MES. Moreover, patients receiving EES reported higher cosmetic satisfaction than patients receiving MES. EES can be a good alternative to MES in terms of comparable graft success rate and hearing outcomes in patients receiving tympanoplasty or myringoplasty. Moreover, EES was less invasive, resulting in higher cosmetic satisfaction, reduced morbidity, and shorter operation time. Our results may affect decision-making and outcome prediction in cases of EES; however, confirmation is needed to clarify potential bias.

A Preliminary Study of Office-Based Transnasal Endoscopic Balloon Dilatation of Pharyngoesophageal Stricture after Total Laryngectomy / 대한연하장애학회지

OBJECTIVE: Pharyngoesophageal stricture formation and dysphagia following total laryngectomy negatively affect quality of life and result in nutritional compromise that can be successfully managed with various techniques. This study was conducted to describe our experiences of office-based balloon dilatation by transnasal endoscopy, which can be performed by an otolaryngologist. METHOD: The present study investigated three patients who underwent transnasal endoscopy guided balloon dilatation of pharyngoesophageal stricture. The assessment was performed based on the number of procedures and recurrences, final subjective outcomes, and complications. RESULT: There were no post-procedural complications. In one patient, a scarric band was found after the procedure; therefore, steroids were injected into the stricture site. There were 2–3 balloon dilatations and the interval between dilatations was 3–6 months. All patients were able to tolerate solid diet after 2 or 3 sessions. CONCLUSION: Transnasal endoscopic balloon dilatation, which can be easily performed by an otolaryngologist in an office setting without sedation or general anesthesia, can be a useful modality for treating pharyngoesophageal stricture after total laryngectomy.

Efficacy of Calcium Hydroxyapatite in Vocal Fold Augmentation for Unilateral Vocal Fold Paralysis in Asian

BACKGROUND AND OBJECTIVES: This study aimed to evaluate efficacy and complication of injection laryngoplasty using calcium hydroxyapatite (CaHA) for unilateral vocal fold paralysis in Asian. MATERIALS AND METHODS: A prospective study was conducted on the adult patients with unilateral vocal fold paralysis from May 2015 through January 2016. Injection laryngoplasty was performed by one laryngologist. All patients underwent prospective voice evaluation using the subjective and objective comprehensive battery of assessments, before the procedure and after the procedure at 3 months, and 6 months. RESULTS: A total of 7 patients (5 males and 2 females) were included in this study. VHI-10 was significantly decreased after injection laryngoplasty, at postoperative 6 months (p=0.031), while VAS score and MDADI showed no difference. GRBAS scale gradually decreased in 3 months and 6 months follow-up without statistical significance. Acoustic analysis revealed that jitter, shimmer, and noise-to-harmonic ratio continuously decreased from the baseline at 3 months and 6 months, although statistical significance was not attained. In the aerodynamic analysis, maximal phonation time was gradually increased at 3months and 6 months with significant difference (p=0.016, 0.031, respectively). There was no side effect associated with the procedure. CONCLUSION: CaHA can be safely used in Asian patients and the onset of maximal efficacy seems to be slow than other studies with Caucasian patients.

Urine Cotinine Should Be Involved in Initial Evaluation of Tinnitus in Adolescents

OBJECTIVES: Smoking is associated with hearing loss, while the correlation between tinnitus and smoking is not fully elucidated. This study aimed to evaluate risk factors of tinnitus in adolescents in terms of smoking, and we identified a rectifiable parameter that can be serially monitored. METHODS: A cross-sectional study was conducted using data from the Korea National Health and Nutrition Examination Survey, with 2,782 participants aged 12 to 18 years, from 2008 through 2011. Participants with history of ear disease, hearing loss, and inadequate responses to questionnaires were excluded. We investigated the prevalence of tinnitus and tinnitus-related annoyance by questionnaire and sought potential risk factors in blood and urine tests and smoking history. RESULTS: The prevalence of tinnitus in the 12- to 18-year-old population was 17.5%, with 3.3% reporting tinnitus-related annoyance. On univariate analysis, the prevalence of tinnitus increased with age (P < 0.001) and was higher among girls (P=0.012). Blood tests and urinalysis showed significant correlation between tinnitus and red blood cell count, alkaline phosphatase levels, and urine cotinine (P=0.002, P < 0.001, P=0.018, respectively). In multivariate analysis, the urine cotinine level was the only parameter associated with tinnitus (odds ratio, 1.000; 95% confidence interval, 0.999 to 1.000; P=0.038). Smoking was also significantly correlated with tinnitus (P=0.043), and amount of smoking with tinnitus-related annoyance (P=0.045). However, current smoking and past smoking were not correlated with tinnitus. CONCLUSION: Urine cotinine may be a rectifiable marker for management of tinnitus in adolescents. This suggests that smoking cessation should be incorporated in the management of tinnitus in adolescents.

Relationship Between Diet and Tinnitus: Korea National Health and Nutrition Examination Survey

OBJECTIVES: This study aimed to analyze the association between nutritional intake and tinnitus prevalence by evaluating a large cross-sectional cohort. METHODS: Data from the Korea National Health and Nutrition Examination Survey collected between 2013 and 2015 were analyzed. The study population consisted of 7,621 individuals aged 40 to 80 years with complete tinnitus-related data. Individuals with inadequate responses to tinnitus history, noise exposure in the work place, or subjective hearing loss were excluded. Prevalence of tinnitus and tinnitus-related annoyance, and nutrition intake were measured using this questionnaire, and associations between tinnitus and nutritional data were evaluated by binary logistic regression analysis. RESULTS: Subjective tinnitus was reported by 1,435 individuals with subjective normal hearing (18.8%). Prevalence of tinnitus increased with age. However, among individuals with tinnitus, the proportion of individuals with tinnitus-related annoyance was similar across age groups. Older age, female sex, lower body mass index (BMI), and less vitamin B2 intake were significantly associated with tinnitus (P < 0.001, P=0.002, P=0.041, P=0.013, respectively). Vitamin B2 intake was significantly less in individuals with tinnitus who were middle-aged (ages 51–55 and 56–60 years, P=0.012 and P=0.020, respectively). Less intake of water, protein, and vitamin B3 were associated with tinnitus-related annoyance (P=0.038, P=0.009, and P=0.005, respectively). Prevalence of annoyance was significantly associated with less water intake in younger ages (age 45–55 years) but with less protein and vitamin B3 intake in older ages (age 66–80 years). CONCLUSION: Reduced intake of vitamin B2 and B3, water, and protein may be associated with tinnitus and tinnitus-related annoyance, and further studies regarding the importance of adequate nutritional intake in the tinnitus management need to be performed.

Clinical Features and Outcomes of Patients in Neonatal Intensive Care Requiring Laryngologic Consultation for Airway Disorders / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Airway problems frequently occur in neonatal patients requiring intensive care due to high prevalence of intubation history and congenital conditions that are linked to craniofacial or upper aerodigestive tract anomalies. However, many investigations on airway disorders have examined large populations of hospitalized children without focusing on those treated in the intensive care unit (ICU). Here we present the clinical features and outcomes in infants hospitalized with airway-related problems at the neonatal ICU. SUBJECTS AND METHOD: A total 69 patients were studied from May 2005 to December 2012, with each examined by an otolaryngologist while in neonatal ICU (NICU) for possible airway problems. Descriptive analysis was used in evaluating illnesses suffered and subsequent upper airway treatments. Factors associated with tracheostomy were identified by multivariate analysis. RESULTS: The median age of infants was 30 days (range, 1-237 days), with a male-to-female ratio of 1.38. The median gestational age was 35⁺³ weeks, and the mean birth weight was 2.35±0.89 kg. Overall, 40 patients had histories of intubation (median duration, 36 days; range, 1-204 days). The most common diagnosis in the upper airway exam was laryngomalacia (n=12), followed by subglottic stenosis (n=10) and micrognathia (n=8). Tracheostomy was performed in 38 patients (55.1%). In multivariate analysis, intubation history was identified as the only variable demonstrating a significant independent association with tracheostomy (p=0.006). CONCLUSION: Upper airway problems in NICU patients are due to a variety of disorders. Precise diagnosis and treatment is achievable through bedside and intraoperative assessments. Patients with a history of intubation are at increased risk of tracheostomy.

Predicting Extrathyroidal Extension in Patients With Papillary Thyroid Microcarcinoma According to a BRAF Mutation

OBJECTIVES: The aim of this study was to evaluate the association between preoperative parameters and extrathyroidal extension (ETE) of papillary thyroid microcarcinoma (PTMC) according to the BRAF mutation and to evaluate the preoperative predictability of ETE. METHODS: We analyzed the medical records of 332 patients with PTMC (140 in the BRAF– group and 192 in the BRAF+ group). The presence of ETE was subjected to a correlation analysis with age, sex, tumor size, clinical nodal status, and ultrasonography (US) findings. Among the US findings, the correlation between tumors and the thyroid capsule was categorized into four groups; US group A, intraparechymal; US group B, tumor abutting the capsule 50% of diameter; and US group D, tumor destroyed the capsule. The predictive value of ETE, including sensitivity, specificity, and positive and negative predictive values were evaluated. RESULTS: Tumor size and US group were significantly correlated with gross ETE in the BRAF– and BRAF+ groups. Tumor size of 0.5 cm and US groups B and C in the BRAF– group were cutoff values for gross ETE, with a negative predictive value of 100%, whereas tumor size of 0.7 cm and US groups A and B in the BRAF+ group had negative predictive values of 92.4% and 100%, respectively. CONCLUSION: Excluding of ETE by US was categorized according to tumor size and US findings. A different categorization to exclude ETE is needed according to the BRAF mutation.

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.

Glottic Infection by Herpes Simplex Virus in an Irradiated Patient / 대한이비인후과학회지

Herpetic laryngitis is extremely rare in healthy adults. The local factors that increase susceptibility to herpes simplex virus include irradiation on the head and neck area. A 66-year-old man who had history of supraglottic cancer had voice change 4 years after the radiotherapy. On laryngscopic examination, the erosive mucosal lesion was found on his left vocal fold. A pathologic examination of the lesion by suspension laryngoscopy revealed that the lesion was herpetic laryngitis, which was confirmed by immunohistochemical stain as herpes simplex virus. Herpetic laryngitis should be in the index of differential diagnosis in patients with laryngitis who have the history of irradiation on the neck.