Supraglottic Partial Laryngectomy is Contraindicated in Patients Elder than 70 Years Old? / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Some use age 70 as a cut-off point for supraglottic laryngectomy because of postoperative aspiration and deglutition complications. But the relationship between age and postoperative aspiration and deglutition complications has not been adequately reported. Therefore, we reviewed postoperative aspiration and deglutition complications of supraglottic laryngectomy in patients older than 70 years old and investigated whether age was one of the factors influencing functional outcome in supraglottic laryngectomy. Patients and Method: From 1994 to 2001, the decannulation day and the postoperative day when oral feeding was started were retrospectively investigated on seven patients who underwent supraglottic partial laryngectomies among early (T1, T2) supraglottic squamous cell carcinoma patients elder than 70 years old. RESULTS: There were no cases requiring either a persistent tube feeding and a gastrostomy. Decannulation could be performed in all cases. The average decannulation day was postoperative 20.6 days and the average oral feeding day was 16.3 days. There were no postoperative complications such as aspiration, fistula and dysphagia. There were no differences according to age. CONCLUSION: No differences were found regarding age in the functional outcomes of supraglottic laryngectomy. So, one's chronological age does not necessarily reflect his or her physiological age and therefore cannot be a contraindication of supraglottic laryngectomy.

The Effect on Voice by Strap Muscle Cutting in Thyroidectomy / 대한내분비외과학회지

PURPOSE: Voice change after thyroidectomy has generally been the result of damage to the recurrent or superior laryngeal nerve. But many patients complain voice alteration without laryngeal nerve injury after thyroidectomy. The purpose of this study is to investigate whether strap muscle division results in any subjective or objective functional sequelae in voice, through long-term follow-up prospectively. METHODS: Twenty-two female patients who had undergone thyroid surgery between July 1998 and December 1999, were studied. The patients who were planned for neck dissection, who had benign laryngeal disease or vocal cord paresis, and whose vocal cord paresis were developed after thyroid surgery, were excluded from this study. Twelve patients had undergone thyroidectomy via retraction of strap muscle and ten patients had undergone thyroidectomy via cutting of strap muscle. For evaluation of voice, questionnaires for changes of voice, acoustics (fundamental frequency, jitter, shimmer, signal to noise ratio, noise to harmonic ratio, voice range), and aerodynamic (maximal phonation time) analyses were done. RESULTS: The subjective voice symptoms after thyroidectomy were disturbances of high pitch, singing, loud voice, and easy fatigue at phonation. There were no significant differences in voice parameters on acoustic and aerodynamic analyses between the strap muscle retraction group and the cutting group through long-term follow-up. CONCLUSION: We conclude that strap muscle division does not result in any subjective or objective functional problems in voice. We suggest that surgical division and reconstruction of these muscles should be employed routinely when operating on large, toxic or neoplastic glands.

Mastoid Obliteration with Bone Paste and Fat / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mastoidectomy with canal wall-up technique provides more healthy skin lining conditions of the external ear canal than mastoidectomy with canal wall-down techniques which have several disadvantages. However, in patients who have erosive scutum or posterior wall defects, the canal-wall down procedure is selected for preventing retraction pocket and recurrence of cholesteatoma. We have attempted a new surgical procedure to avoid disadvantages of the canal wall-down procedure in patients with scutum or posterior wall defects. MATERIALS AND METHODS: In 84 patients with chronic otitis media whose scutum or posterior walls have defects, we advocated a new surgical procedure. The posterior wall was kept up, the defected scutum and/or posterior wall was reconstructed with cortical bone paste, and the mastoid cavity was obliterated with abdominal fat. Staged ossiculoplasty was performed for 11 patients. RESULTS: Removal of the bone paste was necessary for only one patient due to infection, but none of the patents had absorption of reconstructed posterior canal wall. In most patients, the wound completely healed within 3 weeks. The mean hearing gain was 21 dB after the staged ossiculoplasty. CONCLUSION: With this procedure, we could avoid disadvantages of the canal wall-down procedure. And in staged ossiculoplasty we found enough middle ear space for ossicle reconstruction.

A Case of Localized Amyloidosis of Tonsil / 대한이비인후과학회지

The term "amyloidosis" is a disease characterized by deposition of altered proteins in the tissue. The amyloid deposit occurs always in the extracellular matrix and presents a fibrillary conformation. Primary localized tonsillar amyloidosis is a very rare disease of unknown cause that occurs in the absence of systemic involvement of amyloidosis or associated chronic inflammatory diseases. We present a case of primary localized amyloidosis in the left tonsil. Histopathologic examination of the mass revealed findings consistent with amyloidosis, which were stained with Congo Red and apple green birefringence under the polarized light fluorescence microscopy. An extensive workup for systemic involvement of amyloidosis was negative and the patient underwent tonsillectomy. The postoperative recovery was uneventful. At present, the patient has no evidence of disease or recurrence.

F-18-FDG Imaging Using Dual-Head Coincidence Positron Emission Tomography in Patients with Head and Neck Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: An accurate, preoperative assessment of tumor extent and lymph node involvement is necessary to plan and tailor therapy for patients with head and neck cancer. Metabolic imaging with tluorine-18-fluorodeoxyglucose (FDG) is a good method to detect primary cancers in the head and neck and to assess the involvement of lymph nodes, but it is not widely available because of high cost of positron emission tomography (PET). Recently, an alternative method for using FDG was developed: the coincidence detection PET (CoDe PET) using a gamma camera. The aim of this study was to evaluate the clinical utility of FDG CoDe PET using a gamma camera in patients with head and neck cancer. MATERIALS AND METHODS: Thirty FDG CoDe PET studies were performed in 7 patients before therapy and 19 patients after therapy with various head and neck cancers (Age : 25- 79 years, mean age : 50+/-13 years, 18 men, 8 women). All patients had fasted for 6 to 12 hours and were injected 1 1 l to 370 MRq of F-18-FDG 1 hour before imaging. With the exception of the physiological FDG uptake, all visually detectable focal FDC uptake in the primary cancer site or in the neck was considered positive. FDG CoDe PET studies were correlated with CT/MRI. The standard procedure for detecting the presence of disease was the combinations of repeated MRIs, 3 months of follow-up clinical evaluation and the result of a needle aspiration cytology or biopsy. RESULTS: FDG CoDe PET had a detcction rate that was comparable to that of CT/MRI in the pre-therapy group. However, in the post-therapy group, FDG CoDe PET could differentiate residual/recurrence of tumor from radiation change more accurately than could MRI. But, it had a less accurate detection rate for cervical metastases because of asymmetric neck muscle uptake. CONCLUSION: FDG CoDe PET is a sensitive and cost-effective method to detect primary tumor and lymph node involvement in primary head and neck cancers. It is also useful in differentiating residual tumor or tumor recurrence from post-therapy changes in patients with head and neck cancers.

Analysis of Lymph Nodes Number according to Various Modifications of Neck Dissection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The type of neck dissection performed for head and neck cancers depends on the experience of the surgeon and the status of the neck metastasis. The purpose of this study was to quantify the extent of lymphadenectomy achieved according to the various modifications of neck dissection based on microscopic pathologic analysis and to analyze the difference in the number of lymph nodes between the types of neck dissection. MATERIALS AND METHODS: Charts and pathologic finding of patients who underwent neck dissection from June 1994 to October 1999 were reviewed. Patients who received selective neck dissection or preoperative radiotherapy to the neck were excluded. The samples were 65 necks and were divided into four groups based on Medina's classification: radical neck dissection (group 1), Type I modified radical neck dissection (group 2), Type II modified radical neck dissection (group 3), and Type III modified neck dissection (group 4). The number of lymph nodes was counted by a pathologic microscopic examination for each region of specimens. The intergroup difference was analyzed by a one-way between-group analysis of variance (ANOVA). RESULTS: The mean number of dissected lymph nodes per specimen was 43.6 in group 1, 38.8 in both groups of 2 and 3, and 30.3 in group 4. Group 4 was significantly different from group 1 (p<0.05). Especially, the number of dissected lymph nodes from level II, III, IV of group 4 was significantly different from those of group 1 (p<0.05). There was no significant difference between other groups. CONCLUSIONS: The number of dissected lymph nodes decreases as the number of preserved non-lymphatic tissue structures increases. Level II, III, IV are less completely operated regions in functional neck dissection.

Usefulness of Brain Protection and Compressed Spectral Array Monitoring in Carotid Artery Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Detection and prevention of cerebral ischemia are some of the most important aspects in the surgical manipulation of the carotid artery. During the last several decades, various methods including analog EEG had been tried, but none of them proved to be satisfactory. MATERIALS AND METHODS: A new intraoperative EEG monitoring technique with compressed spectral array (CSA) monitoring was applied. With brain protection, patient's EEG was continuously monitored before and after carotid clamping. RESULTS: Each case of carotid endarterectomy, rupture of carotid and innominate artery, and carotid artery resection with vein graft was successfully managed without any neurological complication during and after the surgery. Average carotid clamping time was 59 minutes. Neither carotid bypass nor shunt was used in any cases. CONCLUSION: EEG monitoring with CSA technique was easy to read, easily applicable in the operating room, convenient to compare data before and after the carotid clamping, and it showed data continuously for 9-18 minutes on a window. This technique was also very useful in emergency carotid surgery cases where no preoperative information about cerebral circulation were available.

A Case of Congenital Vestibular Anomaly with Direction Changing Positional Nystagmus / 대한이비인후과학회지

Direction changing positional nystagmus (DCPN) is defined as a nystagmus that changes its direction with different head and body positions. In the past, it was usually thought that DCPN was the sign of central vestibular system lesion. But recently, there have been some reports that DCPN definitely does not localize the site of lesion in the central vestibular pathway, and that it more often indicates a peripheral vestibular site. However, congenital vestibular dys- or hypoplasia was not reported as a cause of DCPN. Recently, we experienced a 17-year-old patient who had a vestibular dys- or hypoplasia and showed a transient geotrophic DCPN with a normal cochlea. We report that congenital vestibular dys- or hypoplasia can be one of the causes of DCPN and present its possible mechanism.

The Efficacy of Stellate Ganglion Block in the Treatment of Idiopathic Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A stellate ganglion block (SGB) induces vasodilatation in the head, neck, and upper extremities. Based on this principle, SGB has been widely used as one of the treatment modalities in sudden idiopathic sensorineural hearing loss (S-SNHL). However, until now, published data establishing the statistical significance of the effect of SGB has been slim. We conducted this study to find out the effect of SGB in the treatment of idiopathic S-SNHL and to find out the factors influencing the prognosis of the disease. MATERIALS AND METHODS: We reviewed the records of 221 patients seen in the past eight years between 1990 to 1997 who had an initial diagnosis of idiopathic S-SNHL and was admitted for treatment. One hundred twenty patients were treated with SGB and the other 101 patients were treated without SGB to use as a control group. RESULTS: The therapeutic result of SGB group was better than that of the control group. Especially, statistical difference was found in the following two subgroups; one in which the interval between the onset of disease and the initiation of treatment was from 8 to 28 days, and the other when the initial hearing loss was below 90 dB. CONCLUSION: We suggest that this study could be utilized as a standard of clinical treatment when SGB is performed.

Inferior Meatal Fenestration Operation of the Postoperative Maxillary Cysts / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Among the postoperative complications of Caldwell-Luc operation, maxillary cysts are sometimes difficult to manage properly by conventional revision Caldwell-Luc procedure. However, with the advent of endoscopic procedures, the technique of intranasal fenestration operation through the inferior meatus has been improved. This study evaluate the surgical results of inferior meatal fenestration operation and examines the clinical indication of this technique. The authors also review surgical cases of postoperative maxillary cyst. MATERIALS AND METHOD: We reviewed 58 cases of postoperative maxillary cyst which were treated surgically in the last 10 years. We analyzed their chief complaints such as sex, age, duration between the initial surgery and the presentation of the symptoms, symptom relief after revision surgery, and the recurrence rate of each surgical techniques. Sites of the cyst in the maxillary sinus and the existence of the septa were analysed radiologically by using computed tomograms of paranasal sinuses. Fourty-eight cases received inferior meatal fenestration operation and 12 cases received revision Caldwell-Luc operation. RESULTS: Inferior meatal fenestration operation could be best indicated in the patients with bulging cysts in the inferior meatus. However, the non-bulging cysts which tare in contact with the inferior metus and those with the inferior metus and those with incomplete septa were also treated with the inferior meatal fenestration operation without recurrence. Comparing with the revision Caldwel-Luc procedure, the inferior meatal fenestration operation was less time consuming and provided less postoperative discomfort for the patients. Also, since the operation is carried out under the direct endoscopic control, fine procedures and the removal of septa in the cysts were possible. CONCLUSIONS: For inferior meatal fenesration operation, the need for a pre-operative endoscopic nasal examination and an evaluation of comography should be emphasized before selecting the suitable method of treatment. Inferior meatal fenestration operations appear to be the most suitable treatment for cases where cysts bulge into the inferior meatus.