Morphologic Changes of the Inferior Turbinate after Total Laryngectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The cessation of airflow in nasal cavity after total laryngectomy could influence the function and morphology of the nasal mucosa. The effect on human nasal mucosa after total laryngectomy was investigated with endoscopic photographs and biopsies. SUBJECTS AND METHOD: Twenty-two laryngectomees were studied and compared with 15 normal controls. Inferior turbinate was checked with 0 degree endoscopic photographs, and the RGB (Red, Green, Blue) scale was analysed by a histogram of adobe photoshop 6.0. In thirteen patients, inferior turbinate mucosa was taken for microscopic examination. RESULTS: The difference of RGB scale between laryngectomees and normal control was statistically significant with the exception of the Red. Furthermore, the anterior part of the inferior turbinate was found to consist of ciliated columnar epitheliums which contained goblet cells. CONCLUSION: This study implicates that the stimulation of nasal airflow affects the function and morphology of the human nasal mucosa.

Augmentation Laryngotracheoplasty for Laryngotracheal Stenosis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laryngotracheal stenosis produces complications of respiratory and phonation difficulties and is one of the most troublesome diseases in the otolaryngological field. The purpose of this study is to determine the therapeutic effectiveness of augmentation laryngotracheoplasty for laryngotracheal stenosis as an operative management. MATERIALS AND METHOD: The authors retrospectively studied 16 cases of augmentation laryngotracheoplasty patients for the success rate, graft material, type of stent, number of surgery, and duration of treatment. RESULTS: The success rate was 68.7% (11 out of 16 cases). Three out of 5 cases which failed treatment were under 15 years of age. Decanulation was possible at 8.45 months (2-45 months) postoperatively on the average and the frequency of surgery was 4.36 times (2-13 times) on the average. There was no complication such as infection and necrosis. CONCLUSION: Our results show that augmentation laryngotracheoplasty is an acceptable option for the treatment of laryngotracheal stenosis, but needs multiple surgery and long time to be decannulated. The success rate of the augmentation laryngotracheoplasty in children is relatively low and a more aggressive approach could be selected. We conclude that augmentation laryngotracheoplasty in adult is a safe and effective procedure without major complications.

Immunohistochemical Study on bcl-2, c-myc, EGFR as Predictable Factor for Radiosensitivity in Early Glottic Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The radiotherapy or surgery is the main treatment modality for early glottic cancer. The advantage of radiotherapy is the preservation of good voice quality after treatment but the main problem is increased complications in the salvage surgery when local control fails. So, it is important to predict the success of radiotherapy. The purpose of this study is to find predictable factors of the radiosensitivity in the early glottic cancer. MATERIALS AND METHOD: Immunohistochemical staining was performed on the paraffin sections of the biopsy specimens of 57 patients with early glottic cancer who had undertaken radiotherapy treatments in Chonnam National University Hospital from January 1988 to October 1998. Primary antibodies were the anti-bcl-2 monoclonal antibody, the anti-c-myc monoclonal antibody, and the anti-EGFR monoclonal antibodies. The relation between the local control outcome after radiotherapy and the result of immunostaining was analyzed by the chi-square and the Fisher's exact test. RESULTS: Positive expression of bcl-2 was 21.1% in the local controlled group and 12.3% in the uncontrolled group. There was no statistical significance between two groups. The expression rate of c-myc was statistically higher in the controlled group (36.8%) than in the uncontrolled group (7.0%) (p=0.025). Expression of EGFR was 57.9% in the controlled group and 22.5% in the uncontolled group. However, there was no statistical significance between two groups. CONCLUSION: The relation between the positive c-myc expression and the radiosensitivity suggests that c-myc might be a predictable factor of the radiosensitivity in early glottic cancer.

Prognostic Significance and Treatment Outcomes of Combination of Radiotherapy and Chemotherapy in Nasopharyngeal Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: T he diagnosis of a nasopharyngeal carcinoma is frequently made at an advanced stage. The anatomic complexicity of the nasopharynx makes a surgical approach difficult, so the radiation therapy is traditionally used as a primary option. Because of the high incidence of a locoregional failure following the radiotherapy and the distant metastasis, the combined treatment modality with the chemotherapy has been applied. The author attempted to investigate the clinical characteristics and the treatment outcomes of nasopharyngeal cancer patients treated with the combination of the radiotherapy and the chemotherapy. SUBJECTS AND METHOD: We retrospectively analyzed 82 patients who were diagnosed with the nasopharyngeal carcinoma in Chonnam National University Hospital. RESULTS: The cumulative survival rates for a 5-year period were 42%. The pathologic type, the clinical stage, the cranial nerve invasion, and the response to the radiotherapy were related to the survival rate of the Kaplan-Meier test (p<0.05). In the Cox proportional hazard model, only the response to radiotherapy was related to the survival rate (p=0.05), as the clinical stage wasn't (p=.06). In the multivariate analysis between the responses to radiation and the clinical factor, the histological type (p=0.018) and the response to the chemotherapy (p=0.021) was statistically significant. CONCLUSION: The response to radiation is the most important in the patient's survival. The clinical stage is a probable prognostic factor. Factors affecting the response to radiation are the histological type and the response to chemotherapy.

Prognostic Significance of Expression of Glutathione S-Transferase-pi and Multidrug Resistance-Associated Protein in Nasopharyngeal Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: For the treatment of nasopharyngeal carcinoma (NPC), radiation therapy is a primary option. Because of distant metastasis and the high incidence of a locoregional failure following radiotherapy, the combined treatment modality with chemotherapy is applied, although resistance to chemotherapy makes chemotherapy less effective. The Cisplatin-based chemotherapy has been widely used in the field of nasopharyngeal cancer. The Cisplatin resistance is known to be caused by the multidrug resistance-associated protein (MRP), which is one of the drug-export pumps and the glutathione S-transferase (GST)-pi which catalyzes the conjugation of the GSH (glutathione) and the cisplatin. The aim of this study is to determine the predictive value of GST-pi and MRP upon the response to cisplatin in nasopharyngeal carcinoma. SUBJECTS AND METHOD: We analyzed tumor tissues from 49 cases of paraffin block specimens which were diagnosed with NPC and treated at Chonnam National University Hospital. The immunohistochemical study for the GST-pi and the MRP was performed with paraffin block specimens of nasopharyngeal cancers. RESULTS: In the GST-pi, the relationship between the early stage (64.3%) and the advanced stage (91.4%) was statistically significant (p=0.020). The expression of the GST-pi and the MRP had no relationship with the clinical factor, the response to chemotherpy and the survival rate. CONCLUSION: Because the expression of the GST-pi and the MRP in the nasopharyngeal carcinoma could not predict the response to chemotherapy. So the efforts to find the predictive value of the chemotherapy are needed.

Mutation of p53 Gene and Infection of Human Papillomavirus in Oral and Oropharyngeal Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Oral and oropharyngeal squamous cell carcinomas (SCC) are diseases that are largely attributed to environmental exposure. Tobacco use and alcohol consumption are well-established risk factors. However, small proportions of oral and oropharyngeal SCCs occur also in nonsmokers and nondrinkers, suggesting the presence of other risk factors. We investigated etiologic role of Human papillomavirus (HPV) in patients with oral and oropharyngeal SCCs and the association between infection with HPV and p53 alteration in oral and oropharyngeal SCCs. MATERIALS AND METHOD: Tumor tissues from 46 patients with oral and oropharyngeal SCCs were examined for the presence of HPV type 16 and 18 genome by polymerase chain reaction (PCR), and the p53 status of each tumor was analysed by sequencing and immunohistochemistry. RESULTS: Thirty-six (78.3%) of 46 cases revealed overexpression of p53 protein and 14 (30.4%) had p53 mutation. The rate of p53 overexpression was much higher in smokers than in nonsmokers (p=0.003). HPV was detected in 8 (17.4%) of 46 cases and all were HPV type 16. As compared with HPV-negative carcinomas, HPV-positive cancers were less likely to occur among smokers (p=0.001) and to have p53 mutation and p53 overexpression (p=0.007), and had a moderately and poorly differentiated cancer characteristic. CONCLUSION: The alteration of p53 is related to smoking which is counteractive to the presence of HPV infection, which can be considered as an independent etiologic factor in oral and oropharyngeal SCCs.

Expression of Matrix Metalloproteinase-2,-9 and Extracapsular Spread of Cervical Node Metastasis in the Head and Neck Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cervical lymph node metastasis is the most important prognostic factor in head and neck squamous cell carcinoma (HNSCC). Further, it is important to predict extracapsular spread (ECS) before treatment, because ECS makes prognosis worse. It has been well established that matrix metalloproteinases (MMPs) expression correlates with cervical lymph node metastasis, but studies on its involvement in extracapsular spread are not enough. The aim of this study was to investigate the correlationship between extracapsular spread of cervical lymph node metastasis and expression of matrix metalloproteinases in the primary sites of head and neck cancer and metastatic cervical lymph nodes. SUBJECTS AND METHOD: An immunohistochemical study was carried out using monoclonal antibodies to MMP-2, MMP-9 on tissue obtained from 46 patients with head and neck cancer who underwent a surgery of primary tumor removal and neck dissection. We evaluated correlations between the expressions of MMP-2, MMP-9 in the primary tumor and ECS of metastatic lymph nodes, and that between expressions of MMP-2, MMP-9 in the metastatic lymph nodes and ECS. RESULTS: The result showed that while there is no significant correlation between expressions of MMP-2, MMP-9 in primary tumor and ECS of cervical lymph nodes, expressions of the MMPs in the positive lymph nodes and ECS of the lymph nodes have significant relationships. CONCLUSION: Expression of MMP-2,-9 may play a pivotal role in extracapsular spread beyond lymphatic metastasis and in the progression of HNSCC.

A Case of Thornwaldt's Cyst Removed with Nasal Endoscopy / 대한이비인후과학회지

Thornwaldt's cyst is a rare benign developmental lesion induced by persistent notocord remnants within the midline nasopharynx. Although most patients with the cyst are symptom-free, inflammation or an abscess can develop. Treatment involves excision or wide marsupialization of the cyst. In previous reports, the cysts have been removed transorally by adenoid currette, scissors, and so on. But recently by introduction of nasal endoscopy and its extended application, transnasal approach using nasal endoscopy becomes useful surgical approach to nasopharynx. We report a case of Thornwaldt's cyst which was successfully removed with nasal endoscopy in a 30-year-old man.

Prognostic Significance of the Microvessel Density in Nasopharyngeal Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The nasopharyngeal cancer (NPC) of nasopharyngeal neoplasms is a rare disease with a relatively poor prognosis, because they tend to be diagnosed in the far advanced stage. Therefore, radiotherapy had been the treatment of choice. Angiogenesis is a crucial step in the tumor growth and progression. The authors attempted to investigate the prognostic value of the microvessel density in NPC. SUBJECTS AND METHOD: We analyzed tumor tissues from 57 cases of paraffin block specimens which had been diagnosed with NPC and treated at Chonnam National University Hospital. The anti-human von Willebrand factor antibody was used to determine the microvessel density (MVD). RESULTS: The MVD was 48.5 in the early stage (stage I and II) and 51.2 in the advanced stage (stage III and IV), which were not statistically significant (p=0.057). The MVD was 55.3 in type I, 54.4 in type II, and 41.8 in type III, and there were no statistical significance between these values (p=0.36). The MVD was not statistically significant between T and N stages (p=0.26, 0.42). There was no significance between the MVD and the survival rates (p>0.05). CONCLUSION: The results suggest that the MVD was not a prognostic significance in NPC.

Radiotherapy in Supraglottic Carcinoma: With Respect to Locoregional Control and Survival / 대한방사선종양학회지

PURPOSE: A retrospective study was undertaken to determine the role of conventional radiotherapy with or without surgery for treating a supraglottic carcinoma in terms of the local control and survival. MATERIALS AND METHODS: From Jan. 1986 to Oct. 1996, a total of 134 patients were treated for a supraglottic carcinoma by radiotherapy with or without surgery. Of them, 117 patients who had completed the radiotherapy formed the base of this study. The patients were redistributed according to the revised AJCC staging system (1997). The number of patients of stage I, II, III, IVA, IVB were 6 (5%), 16 (14%), 53 (45 %), 32 (27%), 10 (9%), respectively. Eighty patients were treated by radical radiotherapy in the range of 61.2~79.2 Gy (mean : 69.2 Gy) to the primary tumor and 45.0~93.6 Gy (mean : 54.0 Gy) to regional lymphatics. All patients with stage I and IVB were treated by radiotherapy alone. Thirty-seven patients underwent surgery plus postoperative radiotherapy in the range of 45.0~68.4 Gy (mean : 56.1 Gy) to the primary tumor bed and 45.0~59.4 Gy (mean : 47.2 Gy) to the regional lymphatics. Of them, 33 patients received a total laryngectomy (+-lymph node dissection), three had a supraglottic horizontal laryngectomy (+-lymph node dissection), and one had a primary excision alone. RESULTS: The 5-year survival rate (5YSR) of all patients was 43%. The 5YSRs of the patients with stage I+I, III+V were 49.9%, 41.2%, respectively (p=0.27). However, the disease-specific survival rate of the patients with stage I (n=6) was 100%. The 5YSRs of patients who underwent surgery plus radiotherapy (S+T) vs radiotherapy alone (RT) in stage II, III, IVA were 100% vs 43% (p=0.17), 62% vs 52% (p=0.32), 58% vs 6% (P<0.001), respectively. The 5-year actuarial locoregional control rate (5YLCR) of all the patients was 57%. The 5YLCR of the patients with stage I, II, III, IVA, IVB was 100%, 74%, 60%, 44%, 30%, respectively (p=0.008). The 5YLCR of the patients with S+T vs RT in stage II, III, IVA was 100% vs 68% (p=0.29), 67% vs 55% (p=0.23), 81% vs 20% (P<0.001), respectively. In the radiotherapy alone group, the 5YLCR of the patients with a complete, partial, and minimal response were 76%, 20%, 0%, respectively (P<0.001). In all patients, multivariate analysis showed that the N-stage, surgery or not, and age were significant factors affecting the survival rate and that the N-stage, surgery or not, and the ECOG performance index were significant factors affecting the locoregional control. In the radiotherapy alone group, multivariate analysis showed that the radiation response and N-stage were significant factors affecting the overall survival rate as well as locoregional control. CONCLUSION: In early stage supraglottic carcinoma, conventional radiotherapy alone is an equally effective modality compared to surgery plus radiotherapy and could preserve the laryngeal function. However, in the advanced stages, radiotherapy combined with concurrent chemotherapy for laryngeal preservation or surgery should be considered. In bulky neck disease, all the possible planned neck dissections after induction chemotherapy or before radiotherapy should be attempted.

The Detection of Human Papillomavirus and Epstein-Barr Virus DNA in Maxillary Sinus Carcinoma by Polymerase Chain Reaction / 대한이비인후과학회지

OBJECTIVES: Maxillary sinus carcinoma is rare when compared with cancers of other sites, and its etiology remains unknown. Recent reports demonstrate the possible etiologic role of human papillomavirus (HPV) and Epstein-Barr virus (EBV) in maxillary sinus carcinoma. The aim of this study is to detect HPV and EBV in the maxillary sinus carcinoma and examine the relationship between HPV, EBV and maxillary sinus carcinoma. We also compared the clinical features of patients with HPV-positive and HPV-negative to determine the clinical significance of HPV. MATERIALS AND METHOD: The authors retrospectively searched for HPV and EBV in 40 cases of maxillary sinus carcinoma by using the polymerase chain reaction (PCR) on DNA extracted from formalin-fixed, paraffin-embedded tissues. RESULTS: HPV was detected in 5 of the 40 cases (12.5%) of maxillary sinus carcinoma, whose histological type was all squamous cell carcinoma. EBV was not detected. Among the five HPV-positives, three were HPV subtype 16 and two were not determined. CONCLUSION: HPV may play a role in the pathogenesis of maxillary sinus carninoma, but EBV needs further study. However, the presence of HPV is not related to T-category, cervical metastases, or local recurrence.

Usefulness of Flexible Bronchoscopy in the Diagnosis of Tracheobronchial Foreign Bodies in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Diagnosis of foreign body aspiration in children has not been satisfactory, although many methods have included history, physical examination, radiographic findings, computed tomography, magnetic resonance imaging, and lung scan. Therefore, a simple and definitive method is needed and we have studied the usefulness of flexible bronchoscopy in the diagnosis of tracheobronchial foreign bodies in children. MATERIALS AND METHOD: A retrospective review was undertaken of 67 cases referred with suspicion of foreign body aspiration. The age of patients ranged from 3 months to 192 months, with a mean age of 33.5 months. Flexible bronchoscopy was performed in 37 cases with topical-local anesthesia, because the evidence of tracheobronchial foreign body aspiration was not conclusive. RESULTS: We detected foreign bodies in 72.9% (27) and secretion suggesting foreign bodies in 18.9% (7). All of 34 children who were suspicious of having foreign bodies underwent rigid bronchoscopy and 32 had foreign bodies. Three children who had normal flexible bronchoscopic examination were discharged after improvement by medical treatment. There were no complications except transient cyanosis. CONCLUSION: We suggest that the diagnostic use of the pediatric flexible bronchoscope is safe, definitive, and cost-effective method for the identification of patients with tracheobronchial foreign bodies.

Prognostic Factors for Local Control in Early Glottic Cancer Treated with Radiation Therapy / 대한방사선종양학회지

PURPOSE: This study was performed to find out the prognostic factors affecting local control in early glottic cancer treated with radiation therapy alone. MATERIALS AND METHODS: We analysed 37 patients of histologically confirmed early glottic cancer treated at Chonnam National University Hospital between July 1986 and December 1995, retrospectively. Age of patients ranged from 30 to 73 years (median; 59 years). Thirty-five (95%) patients were male. Histological type was all squamous cell carcinoma. According to the staging system of 1997 American Joint Committee on Cancer, 37 patients were restaged as follows: T1a; 27 (73%), T1b; 3 (8%), T2; 7 (19%). Radiation therapy was done using 6 MV X-ray of linear accelerator. The range of total radiation dose delivered to the glottic lesion was between 5,040 cGy and 7,020 cGy (median; 6,600 cGy). Median follow-up period was 80 months. Local control rates were calculated by Kaplan-Meier method. Generalized Wilcoxon test was used to evaluate the difference of control rates between comparable groups. Multivariate analysis using Cox proportional hazard model was done to find out prognostic factors affecting local control. RESULTS: 5 year survival rate of 37 patients was 89%. Local control rate of 37 patients was 74% in 5 years. We included age, T-stage, anterior commissure involvement, fraction size, total radiation dose, treatment time of radiotherapy as potential prognostic factors in univariate and multivariate analysis. As a result, treatment time had statistical significance in local control rate in both univariate ( p=0.026) and multivariate ( p=0.017) analysis. Complication was not recorded except one patient with hypothyroidism. CONCLUSION: This study revealed that overall treatment time of radiation was a significant factor affecting local control rate.

The Effect of Air in a Sauna on Nasal Mucociliary Function / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There has been many attempts to find out the changes in the nasal mucociliary transport function under various conditions. In this study, we intended to determine if air in a sauna exerts any beneficial effect on the nasal mucociliary function using the saccharin method, which is regarded as the proper screening test for nasal mucociliary function. MATERIALS AND METHODS: Normal healthy adults (16 men, 15 women) aged from 18 to 22 volunteered for this study. We measured each saccharin transit time (STT) twice, inside a room (25degreesC, 85%), a dry sauna (70degreesC, 85%), and a wet sauna (70degreesC, 100%), respectively. RESULTS: The average STT was 7.98+/-2.95 minutes at the room, 8.47+/-1.71 at the dry sauna, and 7.59+/-2.95 at the wet sauna. There was no meaningful relationships of STT among each condition (p=0.157). CONCLUSION: Air in a sauna has neither any beneficial effect on the nasal mucociliary function nor any harmful effect on it.

Correlations among Tumor Microvessel Density, p53 Protein Expression, and Cervical Lymph Node Metastasis in Squamous Cell Carcinoma of the Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Angiogenesis is a crucial step in tumor growth and progression, and regulated by the net balance between positive and negative angiogenic factors. Recent studies suggested that angiogenesis is controlled by p53 regulation. immunohistochemical study was carried out using monoclonal antibodies against p53 protein and CD34. In this study, immunohistochemical study was carried out using monoclonal antibodies against p53 protein and CD34 in order to determine the relationship between p53 protein expression and angiogenesis in squamous cell carcinoma in the head and neck. MATERIALS AND METHODS: Tumor tissues from 35 cases of paraffin block specimens of head and neck cancers were used from the archives of Department of Pathology in Chonnam University hospital to study the relationship between p53 protein expression and angiogenesis. RESULTS: p53 protein expression was present in 20 (57.1%) of 35 cases and the median micro-vessel count (MVD) was 49.0 (9-126) in x200 microscopic field. MVD was 45.5 (20-126) in cases with p53 protein expression and 50.0 (9-108) in cases without p53 protein expression. There was no statistical significance between MVD and p53 protein expression. An inverse relationship was seen between MVD and primary tumor size. P53 protein expression was not associated with nodal metastasis and primary tumor size. CONCLUSION: There were no significant relations between MVD and p53 protein expression, nor among MVD, p53 and nodal metastasis in head and neck squamous cell carcinoma.

An Analysis on Factors Affecting Local Control and Survival in Nasopharyngeal Carcinoma / 대한방사선종양학회지

PURPOSE: This study was performed to find out the prognostic factors affecting local control, survival and disease free survival rate in nasopharyngeal carcinomas treated with chemotherapy and radiation therapy. MATERIALS AND METHODS: We analysed 47 patients of nasopharyngeal carcinomas, histologically confirmed and treated at Chonnam University Hospital between July 1986 and June 1996, retrospectively. Range of patients' age were from 16 to 80 years (median; 52 years). Thirty three (70%) patients was male. Histological types were composed of 3 (6%) keratinizing, 30 (64%) nonkeratinizing squamous cell carcinoma and 13 (28%) undifferentiated carcinoma. Histological type was not known in 1 patient (2%). We restaged according to the staging system of 1997 American Joint Committee on Cancer. Forty seven patients were recorded as follows: T1; 11 (23%), T2a; 6 (13%), T2b; 9 (19%), T3; 7 (15%), T4; 14 (30%), and N0; 7 (15%), N1; 14 (30%), N2; 21 (45%), N3; 5 (10%). Clinical staging was grouped as follows: Stage I; 2 (4%), IIA; 2 (4%), IIB; 10 (21%), III; 14 (30%), IVA; 14 (30%) and IVB; 5 (11%). Radiation therapy was done using 6 MV and 10 MV X- ray of linear accelerator. Electron beam was used for the lymph nodes of posterior neck after 4500 cGy. The range of total radiation dose delivered to the primary tumor was from 6120 to 7920 cGy (median; 7020 cGy). Neoadjuvant chemotherapy was performed with cisplatin+5-fluorouracil (25 patients) or cisplatin+pepleomycin (17 patients) with one to three cycles. Five patients did not received chemotherapy. Local control rate, survival and disease free survival rate were calculated by Kaplan-Meier method. Generalized Wilcoxon test was used to evaluate the difference of survival rates between groups. Multivariate analysis using Cox proportional hazard model was done for finding prognostic factors. RESULTS: Local control rate was 81% in 5 year. Five year survival rate was 60% (median survival; 106 months). We included age, sex, cranial nerve deficit, histologic type, stage group, chemotherapy, elapsed days between chemotherapy and radiotherapy, total radiation dose, period of radiotherapy as potential prognostic factors in multivariate analysis. As a result, cranial nerve deficit (P=0.004) had statistical significance in local control rate. Stage group and total radiation dose were significant prognostic factors in survival (P=0.006, P=0.012), and in disease free survival rates (P=0.003, P=0.008), respectively. Common complications were xerostomia, tooth and ear problems. Hypothyroidism was developed in 2 patients. CONCLUSION: In our study, cranial nerve deficit was a significant prognostic factor in local control rate, and stage group and total radiation dose were significant factors in both survival and disease free survival of nasopharyngeal carcinoma. We have concluded that chemotherapy and radiotherapy used in our patients were effective without any serious complication.

Epiphora after Medial Maxillectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Medial maxillectomy is commonly performed for benign and low-grade malignancies involving the lateral wall of the nose. The most frequent complications are cavity crusting, epicanthal scarring and epiphora. Silicone stent, tube fixation in lacrimal sac have been used for prophylaxis of epiphora. Authors studied for the incidence of epiphora and necessity for prophylatic procedure of epiphora in patients who underwent medial maxillectomy. MATERIALS AND METHOD: This study was performed on 26 patients treated with medial maxillectomy without additional procedure for management of epi-phora. The minimal duration of follow-up was 6 months. RESULTS: Twenty one patients were treated with medial maxillectomy only and five patients were treated with medial maxillectomy combined with irradiation. Incidence of epiphora was about 7% (2/26). All patients who complained of epiphora had inverted papilloma and underwent medial maxillectomy without irradiation. No patients treated with combination of medial maxillectomy and irradiation complained epiphora. CONCLUSION: It is not necessary to do routine prophylatic procedures for epiphora at the initial procedure.

A Case of Bilateral Mixed Type Laryngocele / 대한이비인후과학회지

A laryngocele is an uncommon, air-filled dilatation of the laryngeal saccule or appendix of the laryngeal ventricle with an unclear etiology. This abnormality is generally classified into internal, external, or mixed type depending on their relationship to the thyrohyoid membrane. Many laryngoceles are asymptomatic and are discovered incidentally when radiographs of the neck or endolaryngeal examinations are performed for unrelated symptoms. We have experienced a case of bilateral mixed type laryngocele.

Expression of Matrix Metalloproteinase-2 in the Cervical Lymph NodeMetastasis of the Head and Neck Squamous Cell Carcinoma-A Clinicopathologic Study- / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Death as a result of cancer is primarily due to regional and/or systemic metastasis. The first essential step of metastasis is active migration of cancer cells from their tissue organ. It is associated with the degradation of extracellular matrix macromolecule, including the basement membrane component of vessels and interstitial stroma. Matrix metalloproteinase-2, one of many matrix degrading enzymes, has been identified as a basement membrane-degrading enzyme and is thought to play an important role in the malignant behavior of cancer. But only a little is known about clinicopathologic features of head and neck squamous cell carcinoma in the relation to the production of MMP-2. This study was designed to investigate the relationship between MMP-2 expression in the cancer cell membrane and ervical lymph node metastasis in the head and neck squamous cell carcinoma using immunohistochemistry. MATERIALS AND METHODS: Tissues were obtained from 55 patients with head and neck cancer who underwent the surgery of primary tumor resection and radical neck dissection. And paraffin embedded 5nm thin sections were immunohistochemically stained for MMP-2. RESULTS: 1) Immunoreactivity for MMP-2 was detected primarily in the cancer cell nests, whereas it was either not observed or observed infrequently and only faintly in the normal epithelium. 2) Metastasis to a lymph node was more frequently observed with the MMP-2 production in the head and neck cancer than that with no expression of MMP-2 (p<0.01). 3)There was no significant correlation between the expression of MMP-2 and the patient's age, tumor size, primary tumor site, clinical tumor stage (TNM classification), and histologic grading. CONCLUSION: These results suggest that intensity of MMP-2 expression in the cancer nests may be a biochemical parameter to predict a metastatic potential, prognosis, and aggressiveness of the head and neck squamous cell carcinoma.

Augmentation Rhinoplasty Using Calvarial Bone Graft / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Multiple autogenous and alloplastic implants have been used in nasal reconstruction. Autogenous implants include auricular and septal cartilage as well as rib and iliac crest bone grafts. Alloplastic materials include acrylic, supramid mesh, Gortex, and silicone rubber. Autogenous grafts have been shown to provide excellent long-term reliable results in nasal reconstruction. our study was designed to demonstrate the usablility of calvarial bone as primary choice of graft material in nasal dorsum reconstruction. MATERIAL AND METHODS: Eleven patients with saddle nose underwent augmentation rhinoplasty using a calvarial bone graft from Jan. 1993 to Dec. 1996. We observed for any complications in the donor and/or recipient sites, stability of grafted bone, and final results including volume loss through medical records and photographs taken during follow-up periods. RESULTS: Hematoma in the scalp was the only complication. CSF leakage, or infection have been observed. Grafts were well fixed without screws or K wires. Displacement of grafted bone were not seen. External nasal contour was well achieved in all cases. CONCLUSION: In augmentation rhinoplasty, split calvarial bone is recommended as a good material.