The Clinical Feasibility of Functional 3-Dimensional Laryngeal CT as a New Technique: Preliminary Study in Unilateral Vocal Fold Paralysis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are many clinical procedures that are related to the evaluation of kinematic events concerning vocal fold vibration. However, many of these procedures are hardly applicable for precise analyses of physiological and morphological changes in vocal folds with respect to the pitch control, and vocal fold volume changes from the phonatory aspect of larynx. The purpose of this study was to examine the clinical feasibility of a new 3 dimensional image method, the functional laryngeal CT, which can provide a clear sagittal image of the vocal fold in each of the anteroposterior directions during phonation and resting state. SUBJECTS AND METHOD: Functional laryngeal CT was performed in 4 normal control and 2 cases of unilateral vocal fold paralysis. The subjects were instructed at resting position to produce sustained vowel phonation of three different kinds of pitch. Three-dimensional endoscopic images were reconstructed through segmentation and surface-rendering algorithm on personal computer, using the DICOM (Digital Image and Communication in Medicine) file of axial images. RESULTS: The dynamic vocal fold 3D image that was reconstructed by serial section image during phonation showed that the vocal fold became thin and volume was decreased in relation to the increase in pitch. Typical subglottic shoulder formation and ventricular widening was noted in the high pitched tone. CONCLUSION: Functional 3D laryngeal CT (F3DLxCT) is an informative tool for visualizing the active changes in length, tension and mass of the vocal folds for pitch control. Furthermore, the volume defect and the level difference in the paralysed vocal fold are easily detectable with this new techinque.

Surgical Management of Tonsil Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Surgery and postoperative radiation therapy have been the main stream management of tonsil cancer. There is a variety of surgical approach methods are used for the resection of tonsil cancer, however, there have only been a few reports of the results of surgical treatment of tonsil cancer. So, on the basis of our experience, we report the results of our surgical treatments of tonsil cancer. SUBJECT AND METHOD: 32 medical records, from 1994 April to 2003 June, of patients surgically treated for tonsil cancer were reviewed. Evaluated were disease status, surgical approach methods, types of the neck dissection, surgical margin, reconstruction methods, postoperative complications, time of oral diet and decannulation, recurrence, and survival rate. RESULTS: Mean follow up periods were 2.3 years. There was 1 patient in Stage I, 5 in Stage II, 2 in Stage III, and 24 in Stage IV. For Tumor excision, 5 patients underwent intraoral approach, 10 mandibulotomy approach, and 17 lateral pharyngotomy approach. Surgical defects were primary closed in 5 patients and reconstructed with pectoralis major myocutaneous flap in 7 patients and radial forearm fasciocutaneous free flap in 20 patients. There were 2 local recurrences, 5 regional recurrences, and one distant metastasis. The mean time of the beginning of oral diet/decannulation after operation were 19.8/11.3 days in lateral pharyngotomy and 25.3/12.9 days in mandibulotomy. The mean survival period was 41.4 months. CONCLUSION: Because most of tonsil cancers are advanced diseases, more precise tumor resection and meticulous neck management are needed. Lateral pharyngotomy approach had priority to other surgical approaches in selected cases except T4. It has advantages of full range of vision for resection, better functional status and less postoperative morbidity.

A Case of Invasive Tracheobronchial Aspergillosis Inducing a Respiratory Failure in Immunocompromised Patient / 대한이비인후과학회지

Aspergillus infection localized to the tracheobronchial tree is an unusual form of invasive aspergillosis in which patients are usually immunocompromised. The infected airway may produce mucosal exudates and become obstructed partially or completely with fungal plugs and pseudomembranes. Microscopically, the superficial portion of the airway wall is acutely inflammed and invaded by fungal hyphae. We recently experienced a case of invasive aspergillus tracheobronchitis that occurred in a 43 year-old woman with acute lymphoblastic leukemia, for which she had received a 2nd consolidation chemotherapy. We report this case with a review of literatures.