A Case of Myxoid Liposarcoma of Neck / 대한두경부종양학회지

Liposarcoma is a very rare malignant tumor affecting the head and neck area. Since it is an invasive and life-threatening disease, active treatments is necessary. However, differential it from lipoma, its corresponding benign counterpart, may be difficult. Herein, we report a rare case of posterior neck myxoid liposarcoma in a 72-year-old man who was initially misdiagnosed with lipoma, including a literature review of differential diagnosis between lipoma and liposarcoma.

Analysis of PD-L1 expression in salivary duct carcinoma with its efficacy as a tumor marker / 대한두경부종양학회지

BACKGROUND/OBJECTIVES: Despite multiple approaches of treatments for salivary duct carcinoma, there has been a need for more successful treatment methods because of its poor prognosis. Treatment options like immunotherapy using new technologies have been attempted. Based on recent study results indicating that targeting programmed death receptors are effective in treating various cancers, this study aimed to identify the frequency of PD-L1 expression and its impact on survival rate in salivary duct carcinoma.MATERIALS #SPCHAR_X0026; METHODS: We studied 33 patients with salivary gland cancer who were available for histologic specimens. We examined the expression of PD-L1 in the tissues and analyzed the association with the survival rate and the association with various clinical parameters.RESULTS: According to this study and review of similar studies, we discovered that the expression of PD-L1 in salivary duct carcinoma was lower than other types of cancers. The impact of PD-L1 on survival rate also showed inconsistency in salivary duct carcinoma.CONCLUSION: Immunotherapy by PD-1/PD-L1 checkpoint blockade in salivary duct carcinoma needs further evaluation for clinical application.

Cervical Sympathetic Chain Schwannoma Mimicking Carotid Body Tumor / 대한이비인후과학회지

Schwannoma arising from cervical sympathetic chain is relatively uncommon and can be occasionally misdiagnosed as carotid body tumor. On MR images, schwannoma shows generally hypointense features on the T1-weighted images and hyperintense features on the T2-weighted images. Occasionally, however, contrast administration, which lets schwannoma show marked enhancement, may make it difficult to differentiate schwannoma from carotid body tumor. A 41-year-old woman presented a neck mass on the left. MR images of the neck and carotid angiography revealed a well-enhancing ovoid tumor, which separated the internal carptod arteries from the external carotid arteries at the level of carotid bifurcation. Complete tumor resection was performed and histopathology findings confirmed a schwannoma originating from the sympathetic chain. Postoperatively, miosis and facial anhydrosis of the left side were noted without ptosis, enophthalmos or other neurologic deficits. We report this case with a review of the literatures.

Change of Voice Quality before and after Treatment of Short-Term Therapy with Proton Pump Inhibitor in Laryngopharyngeal Reflux / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to verify that voice analysis could be an alternate tool for the evaluation of proton pump inhibitor treatment of laryngopharyngeal reflux (LPR). SUBJECTS AND METHOD: Twenty-two patients with LPR symptoms underwent laryngoscopy, stroboscopy and their reflux finding index (RFI) were evaluated. Subjective reflux symptom scores (RSS) and voice handicap index (VHI) were completed at the baseline. All patients underwent voice analysis. Thereafter, patients had short-term proton pump inhibitor therapy for 6 weeks. The RFI, RSS, VHI and voice analysis were repeated during the last week of the treatment. RESULTS: RFI was improved and both RSS and VHI were improved after the treatment. RSS and VHI were significantly correlated. In voice analysis, shimmer significantly improved and harmony to noise ratio (HNR) also improved. CONCLUSION: Voice analysis can be indicators of treatment results of laryngopharyngeal reflux disease.

Larynx-Preserving Partial Pharyngectomy via Lateral Pharyngotomy for the Treatment of Small (T1~2) Hypopharyngeal Squamous Cell Carcinoma

OBJECTIVES: To evaluate the oncologic and functional results of larynx-preserving partial pharyngectomy (LPP) via lateral pharyngotomy approach as a primary treatment for small (T1 or T2) hypopharyngeal squamous cell carcinoma (HPSCC). METHODS: We performed a retrospective review of 23 patients who underwent LPP through lateral pharyngotomy approach for small HPSCC at the our department between January 1991 and June 2007. Fourteen (61%) patients had adjuvant postoperative radiotherapy. RESULTS: The 2-years and 5-years disease specific survival rate was 77% and 61%, respectively. Nine patients (39%) had tumor recurrence. The most common pattern of recurrence was isolated distant failure (n=4, 44%) followed by local (n=2, 22%) and loco-regional (n=3, 34%) recurrence. The ultimate cure rate of the primary tumor was 87% (20 of 23). Twenty-two of the 23 patients (95%) could be decannulated, tolerate an oral diet, and had acceptable postoperative phonatory function. CONCLUSION: LPP via lateral pharyngotomy approach appears to be a feasible procedure for selected small HPSCC patients in terms of both oncologic and functional outcomes.

Larynx-Preserving Partial Pharyngectomy via Lateral Pharyngotomy for the Treatment of Small (T1~2) Hypopharyngeal Squamous Cell Carcinoma

OBJECTIVES: To evaluate the oncologic and functional results of larynx-preserving partial pharyngectomy (LPP) via lateral pharyngotomy approach as a primary treatment for small (T1 or T2) hypopharyngeal squamous cell carcinoma (HPSCC). METHODS: We performed a retrospective review of 23 patients who underwent LPP through lateral pharyngotomy approach for small HPSCC at the our department between January 1991 and June 2007. Fourteen (61%) patients had adjuvant postoperative radiotherapy. RESULTS: The 2-years and 5-years disease specific survival rate was 77% and 61%, respectively. Nine patients (39%) had tumor recurrence. The most common pattern of recurrence was isolated distant failure (n=4, 44%) followed by local (n=2, 22%) and loco-regional (n=3, 34%) recurrence. The ultimate cure rate of the primary tumor was 87% (20 of 23). Twenty-two of the 23 patients (95%) could be decannulated, tolerate an oral diet, and had acceptable postoperative phonatory function. CONCLUSION: LPP via lateral pharyngotomy approach appears to be a feasible procedure for selected small HPSCC patients in terms of both oncologic and functional outcomes.

A Case of Primary Chondrosarcoma of the Cricoid Cartilage / 대한이비인후과학회지

Laryngeal chondrosarcoma is a cartilaginous malignant tumor which is rarely encountered in the head and neck. They occur most often in the paranasal sinus, mandibule, and larynx. The cricoid cartilage is the most common site of the laryngeal chondrosarcoma. Complete surgical resection and postoperative radiotherapy are generally recommended. Almost all cases of the laryngeal chondrosarcoma are detected early because of the rapid development of symptoms such as dyspnea, dysphagia and hoarseness, which are caused by the anatomic location. Authors experienced a case of laryngeal chondrosarcoma that originated from the cricoid cartilage in a 67 year-old male without any symptoms. The mass was found on a routine esophagogastroduodenoscopy examination. Hemicricoidectomy with complete excision of tumor was performed via laryngofissure approach. The patient did not undergo radiotherapy, since all margins of the resected mass were tumor-free. There was no evidence of recurrence or metastasis 12 months after surgery.

A Case of Huge Substernal Goiter Causing Acute Respiratory Failure / 대한이비인후과학회지

Substernal goiter is defined as a thyroid mass of which more than half is located below the thoracic inlet. As substernal goiter enlarges within the bony thoracic cavity, and vascular and visceral structures may slowly become compressed and compromised. Airway obstruction can occur due to the compression or the displacement of the trachea. Tracheal compression may rarely lead to severe respiratory compromise. Recently, we experienced a case of huge substernal goiter causing acute respiratory failure in a 63-year old female. We present this case with a review of the literature.

A Case of Multifocal MALT Lymphoma in Salivary Glands / 대한이비인후과학회지

Primary malignant lymphomas of the salivary glands are uncommon. The parotid gland was most frequently involved, followed by the submandibular gland, minor salivary glands and sublingual gland. The most common subtype is mucosa-associated lymphoid tissue (MALT) lymphoma. MALT lymphoma is a relatively indolent disease and tends to remain localized for prolonged period of time. But, we experienced a case of a multifocal salivary MALT lymphoma involving both parotid glands and right submandibular gland during its progression of disease. We report a case with a review of the literature.

Prevalence of Frontal Recess Cells in Koreans / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This research aimed to evaluate the prevalence of specific frontal recess cells in Koreans using the classification developed by Lee, et al. SUBJECTS AND METHOD: Frontal recess was studied using high resolution CT scans of normal 60 Koreans. RESULTS: Three volunteers were found to have sinusitis around frontal recess in CT and therefore were excluded from this study. Agger nasi cells were observed in 107 sides (94.0%), frontal cell type 1 in 26 sides (22.8%), type 2 in 16 sides (14,0%), type 3 in 9 sides (7.9%) and type 4 in 0 side (0.0%). Frontal bullar cells were observed in 16 sides (14.0%), suprabullar cells in 45 sides (39.5%) and supraorbital ethmoid cells in 3 sides (2.6%). Intersinus septal cells were observed in 10 sides (8.8%) and terminal recess in 76 sides (66.7%). CONCLUSION: This is the first study conducted about the Korean prevalence of frontal recess cells using the new classification.

Changes of VEMP Responses by the Strength of SCM Muscles Contraction and Stimulation Intensities / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the effect of the strength of SCM muscle contraction and the intensity of the sound stimulation on the VEMP parameters (amplitude, latency and threshold). SUBJECTS AND METHOD: Twenty normal subjects were included. Subjects pushed with their jaw against the hand-held inflated cuff to generate cuff pressures of 20, 40 and 60 mmHg and sequential stimulation intensities were applied. Variances of each parameter were analyzed. RESULTS: There was no significant difference in terms of threshold according to the side and strength of SCM contraction. P1-N1 amplitude demonstrated no significant differences according to the side ; however, the amplitude increased significantly as the cuff pressure and stimulation intensity increased. Interaural amplitude difference ratios showed an increased difference at 20 mmHg when compared to those at 60 mmHg. There was neither a cuff pressure effect, nor stimulation intensity effect when considering the P1 latencies. As for the N1 values, there was no stimulation intensity effect but there was a delayed latency at 20 mmHg when compared to those at 40 or 60 mmHg. Interaural latency difference of N1 latencies did not differ significantly according to the cuff pressure ; however, there was an increased difference at 20 mmHg when compared to those at 40 or 60 mmHg. CONCLUSION: This study shows that VEMP response is influenced by the cuff pressure and stimulation intensity, and we recommend to get each VEMP parameter using this feedback method in the clinical setting.

Clinical Manifestations of Patients with Migraine-associated Vertigo / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The clinical association between migraine and vestibular symptoms has been indicated in many studies and it is believed that migraine-associated vertigo is one of the most common causes of spontaneous recurrent vertigo. SUBJECTS AND METHOD: We investigated the nature of vestibular and migrainous symptoms of 26 patients suffering vertigo associated with migraine and their responses to antimigrainous medications. Neurotologic tests such as oculomotor tests, calorictest, and audiometry were performed between attacks. RESULTS: A marked female predominance was found. The duration of rotational (77%) and/or to-and-fro vertigo (23%) lasted from a few seconds to several hours or, less frequently, even days. We found that patients showed vestibular abnormalities in central and peripheral types. In the symptom-free interval, 31% of the patients showed central oculomotor signs such as delayed saccadic latency and horizontal saccadic pursuit. On the other hand, 15% showed unilateral weakness in the caloric test and 15% showed positive results in the head thrust tests. Overall, 85% of patients experienced resolution or significant reduction of their attacks of vertigo with medication. CONCLUSION: Most patients with migraine-associated vertigo showed normal results on the vestibular tests and responded well to preventive medication. Migraine-associated vertigo caused various clinical manifestations and there should be relevant differential diagnosis for epiodic vertigo.

Hereditary Angioneurotic Edema of the Larynx: A Case Report and Literature Review / 대한이비인후과학회지

Hereditary angioneurotic edema (HAE) is an autosomal dominant disease that results from the deficiency of C1 esterase inhibitor (C1-INH) function. Urgent proper intervention of the upper airway is warranted to save the life of patients with the disease, which often causes acute airway obstruction. We present, with a review of literature, a case of 37-year old woman with HAE of larynx.

Interutricular and Intermastoid Distance Measured in the Koreans Using MRI / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The distance between the utricles is important in vestibular tests like the unilateral centrifugation test for examining the utricular function. In this test, the axis of rotation crosses precisely through one utricle, thus only the opposite utricle is stimulated. The interutricular distance needs to be known in order to stimulate one utricle maximally for this test, and it would be better if the distance could be estimated from surface landmarks like intermastoid distance. SUBJECTS AND METHOD: We investigated the correlation between the interutricular distance (IUD) and the intermastoid distance (IMD), measured on magnetic resonance images. Data were collected from 177 subjects (72 men and 105 women), who suffered from dizziness, sensorineural hearing loss and facial nerve disorders. RESULTS: We found that IUDs were 7.33+/-0.42 cm (6.03-8.75 cm) and the maximum difference of IUDs between the subjects was 2.73 cm. There was a significant correlation between IUD and IMD. The IUDs of men (7.57+/-0.38 cm) and women (7.17+/-0.38 cm) showed the similar correlation with those of IMD. The correlation was not different from that published for Caucasian subjects. CONCLUSION: These findings show that there is a significant correlation between IUD and IMD. IMD can be useful for estimating IUD, which enables exact stimulation to be given to the unilateral utricle in the unilateral centrifugation test. Moreover, individual assessment of IUD gives more precise stimulation than using a fixed IUD in the unilateral centrifugation test.

Otolith Function Tests in Patient with Vestibular Neuritis

BACKGROUND AND OBJECTIVES: Vestibular evoked myogenic potentials (VEMP) test provides a useful method for assessment of saccule function and the functional integrity of the inferior vestibular nerve, and subjective visual vertical (SVV) abnormalities are presumably related to a lesion of the utricle. The aim(s) of this study were to measure otolith function using SVV and VEMP tests, and to define the influence of the otolithic organs in patients suffering from vestibular neuritis. MATERIALS AND METHOD: From September 2005 to January 2006, twelve patients who received treatment in hospital and also had been tested for caloric test, subjective visual vertical (SVV) and vestibular evoked myogenic potential (VEMP) tests with unilateral vestibular neuritis were enrolled. All the tests were done within 8 days after the onset of their symptoms, simultaneously. The SVV was measured in 34 normal subjects as well as in patients. RESULTS: Eight of 12 patients showed abnormal tilt to the lesion side in SVV test, and five of 8 patients showed no VEMP on the affected side. There was no correlation between SVV tilts and unilateral weakness (UW) in caloric tests. Two patients with abnormal UW (54, 82%) showed normal finding in SVV & VEMP tests. One patient with abnormal UW (83%) and SVV tilts (18.04Degree) to the lesion side was normal in VEMP test. Two patients with abnormal UW (28, 37%) and no response in VEMP test were normal in SVV test. CONCLUSION: Our results demonstrate that the incidence of abnormal results were 62.5, 66.7% in VEMP and SVV tests in acute stage of vestibular neuritis, respectively. There was no correlation between the abnormal results of the tests and these findings suggest that impairment of the otolithic function is depending on the extent and/or the localization of vestibular neuritis.

Otolith Function Tests in Patient with Vestibular Neuritis

BACKGROUND AND OBJECTIVES: Vestibular evoked myogenic potentials (VEMP) test provides a useful method for assessment of saccule function and the functional integrity of the inferior vestibular nerve, and subjective visual vertical (SVV) abnormalities are presumably related to a lesion of the utricle. The aim(s) of this study were to measure otolith function using SVV and VEMP tests, and to define the influence of the otolithic organs in patients suffering from vestibular neuritis. MATERIALS AND METHOD: From September 2005 to January 2006, twelve patients who received treatment in hospital and also had been tested for caloric test, subjective visual vertical (SVV) and vestibular evoked myogenic potential (VEMP) tests with unilateral vestibular neuritis were enrolled. All the tests were done within 8 days after the onset of their symptoms, simultaneously. The SVV was measured in 34 normal subjects as well as in patients. RESULTS: Eight of 12 patients showed abnormal tilt to the lesion side in SVV test, and five of 8 patients showed no VEMP on the affected side. There was no correlation between SVV tilts and unilateral weakness (UW) in caloric tests. Two patients with abnormal UW (54, 82%) showed normal finding in SVV & VEMP tests. One patient with abnormal UW (83%) and SVV tilts (18.04Degree) to the lesion side was normal in VEMP test. Two patients with abnormal UW (28, 37%) and no response in VEMP test were normal in SVV test. CONCLUSION: Our results demonstrate that the incidence of abnormal results were 62.5, 66.7% in VEMP and SVV tests in acute stage of vestibular neuritis, respectively. There was no correlation between the abnormal results of the tests and these findings suggest that impairment of the otolithic function is depending on the extent and/or the localization of vestibular neuritis.

Cerebello-Pontine Angle Lipoma: Case Report and Review of the Literature

Intracranial lipomas located in the cerebellopontine angle are extremely rare. These tumors are maldevelopmental lesions which can cause slowly progessive neurological symptoms. The clinical management of these tumours differs significantly from other lesions in this region. A 45 year old man presented with a 3-month history of vertigo and tinnitus in the left ear. In T1-weighted magnetic resonance imaging, the lesion was hyperintense and did not enhance after application of gadolinium. The patient was treated with medical therapy with good response. We present a review of the literature, with particular regard to management. Conservative treatment is recommended and limited surgery is usually indicated if the patients suffer from disabling neurological symptoms and signs e.g., vertigo, nausea, trigeminal neuralgia, facial weakness or facial spasm.

Results of Vestibular Function Tests in Patients with Cerebello-Pontine Aangle Tumors

BACKGROUND AND OBJECTIVES: Acoustic neuroma (AN) is commonly encountered in the cerebello-pontine angle (CPA) and AN arises principally from the vestibular division of the nerve, which can show not only hearing disturbance but also various vestibular symptoms and laboratory findings by affecting central and peripheral vestibular system. Vestibular testing is reported not to be a useful screening test for AN, but can be helpful in defining whether the tumor arises from the superior or inferior division and identifying the cause of dizziness or vertigo. MATERIALS AND METHOD: We are presenting four patients with CPA tumors accompanied by various abnormal findings of vestibular function tests including head-shaking nystagmus, vibration-induced nystagmus, hyperventilation- induced nystagmus and vestibular evoked myogenic potential and subjective visual vertical, which can enable us to understand the pathomechanism of the abnormal results. RESULTS: All patients presented hearing loss and mild dizziness. Caloric test, head thrust test and vibration-induced nystagmus was helpful in localizing the disease, but head-shaking nystagmus and hyperventilation-induced nystagmus was less helpful. Otolith tests did not always show abnormal results. CONCLUSION: We should consider abnormal results of the vestibular function tests in a whole to estimate the status of vestibular compensation in patients with CPA tumors.

Is the Dissection of the Level IV Lymph Node Pads Necessary in the Elective Lateral Neck Dissection of N0 Supraglottic Squamous Cell Carcinoma? / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To determine whether level IV lymph nodes can be saved in the elective lateral neck dissection (LND) as a treatment for patients with squamous cell carcinoma of the supraglottic larynx. SUBJECTS AND METHODS: From January 1997 to May 2002, 42 patients with supraglottic squamous cell carcinoma and a clinically N0 neck who underwent an elective LND were studied prospectively. The incidence of pathological metastasis to the level IV lymph nodes and a regional recurrence after an elective LND were evaluated. RESULTS: Of the 42 patients, 10 (24%) had lymph nodes positive for microscopic metastatic squamous cell carcinoma. Two (5%) of the 42 patients had involvement of the level IV lymph nodes, whose clinical T-stages were above cT3. None of the clinical T1 or T2 tumors showed level IV nodal metastasis. There were two cases (5%) of the ipsilateral neck recurrence: these patients developed recurrence in the level II and stomal area, respectively. CONCLUSION: The level IV lymph node metastasis was rare in this study, and nodal recurrence after LND in squamous cell carcinoma of the supraglottic larynx was infrequent. Therefore, this region may be preserved in elective LND for patients with early squamous cell carcinoma of the supraglottic larynx.

The Effect of Somatosensory Input on Subjective Visual Vertical in Normal Subjects

BACKGROUND AND OBJECTIVES: Aims of the study were to determine if the somatosensory input influences on vertical perception by comparing the results with the head or body tilted (15Degree to the right and to the left, and to examine the influence of tactile sensation in the perception of verticality in head lateral positions. MATERIALS AND METHOD: We tested 34 normal subjects in their ability to set a straight line to the perceived gravitational vertical. Measurements were taken in static conditions, sitting upright, head tilted (15Degree, body tilted (15Degree, and head lateral positions (90Degree on the right/left sides with or without physical support under the head. RESULTS: The normal range of the subjective visual vertical (SVV) was 0.65Degree/-.23Degreein upright position. The normal ranges of SVV in head-tilts 15Degreeto the left/right sides were -0.47Degree/-.76Degreeand 1.88Degree/-.94Degree which were significantly different from those in upright position (E-effect). But the normal ranges of SVV in body-tilts 15Degreeto the left/right were not different from those in upright position. And the normal ranges of SVV in head lateral positions maintained actively and passively were not different each other, but significantly larger than that in upright position (A-effect). CONCLUSION: Our results support that neck somatosensory input plays a part in the perception of verticality. In contrast, tactile sensation of the head had no effect on the settings of a visual line to visual vertical in head lateral positions.