Distribution of Elastic and Collagen Fiber in Uvular Tissue of Patients with Obstructive Sleep Apnea and Snorers / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sleep related obstructive breathing disorders are frequently observed in adults. Despite extensive work of recent years, the essential pathophysiologic mechanism that mediates this process is still unclear. This study was conducted to determine whether distribution of connective tissue in the uvula is different among apneics, snorers and normal controls. MATERIALS & METHODS: Uvula was obtained by uvulopalatopharyngoplasty in 8 apneics, 6 snorers (mean apnea index: 17.1, 2.43 respectively) and by autopsy in 5 individuals not known to have snoring. The surgical specimen of uvula was fixed in 10% formalin and subsequently embedded in paraffin. Each specimen was cut into 5 micrometer-thick section and stained with hematoxylin-eosin for general appearance, Masson-Trichrome stain for collagen fiber, and Verhoeff stain for elastic fiber. Microscopic examination was performed by two pathologists who were blinded to the polysomnographic data. RESULTS: Infiltration of inflammatory cells and edema were significantly increased in the snorer and apneic groups compared with the control group (p<0.0001, p<0.05 respectively). Compared with the normal group, the density of elastic fibers and collagen fibers were significantly decreased in snorers and apneics (elastic fiber: p<0.0005, collagen fiber: <0.01). The distribution of elastic and collagen fiber showed significantly heterogeneous patterns in the snorer and apneic group compared to the control group (elastic fiber: p<0.001, collagen fiber: p<0.0005). CONCLUSION: Since connective tissue fibers have the supportive function in the body, this condition may result in increased collapsibility of upper airway and contributes to the development of obstructive sleep apnea.

Expression of E-Cadherin and beta-Catenin in Human Squamous Cell Carcinoma of the Tongue / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It has been suggested that inactivation of the cadherin-mediated cell to cell adhesion system plays a role in the initial steps of cancer invasion and metastasis. We investigated the relationship between the expressions of E-cadherin and beta-catenin to the clinicopathologic findings in squamous cell carcinoma of the tongue. MATERIALS AND METHOD: The expression of the E-cadherin and beta-catenin was examined immunohistochemically in 39 squamous cell carcinomas of the tongue and 5 cases of normal tissue. RESULTS: The expression of the E-cadherin and beta-catenin was reduced or absent in 15/39 (39%), 20/39 (51%) cases of the tumors examined, respectively. The reduced expression of the E-cadherin was associated with decreased histologic differentiation (p=0.001) and lymph node metastasis (p=0.006) and the reduced expression of the beta-catenin with decreased histologic differentiation (p=0.001). There were significant correlation between E-cadherin and beta-catenin expression (p=0.001). CONCLUSION: The present study demonstrates a significant down-regulation of E-cadherin, and that the beta-catenin expression in squamous cell carcinoma of the tongue is specifically associated with decreased histologic differentiation and lymph node metastasis. These results suggest that E-cadherin and beta-catenin may be useful markers of lymph node metastatic potential and valuable prognostic markers in the early stage of the disease.

Functional Results of Tongue Reconstruction Using Free Flaps after Total Glossectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Total glossectomy and postoperative radiotherapy is the treatment of choice for advanced carcinoma of the floor of mouth and tongue. But, it has the potential for causing severe speech impairment and disrupting the deglutition and may cause life-threatening aspiration. Proper reconstruction is essential for the postoperative functional rehabilitation. The aim of the present study is to evaluate the oncologic results and the results of speech and swallowing function tests in patients who were reconstructed using surgical flaps after total glossectomy. MATERIALS AND METHODS: We reviewed the medical records of 7 patients who underwent total glossectomy (Jul. 1995 to Feb. 2000). Modified barium swallow (MRS) according to Longmann's method was done in 5 patients and speech function tests which comprised of Kim's method, Bzoch's method and Allison's method were done in 4 patients. RESULTS: Six patients were found to be stage T4 primary tumors and one was stage a T3 primary tumor. The lateral thigh free flap was most commonly was used in five cases. In two cases, either a rectus abdominis free flap or a radial forearm free flap was used. Six patients received postoperative radiotherapy. Currently, four patients are completely cured but three developed recurrence, of whom two have expired and one is living. Six patients regained swallowing and independent oral alimentation. MBS showed poor intraoral transport but, good propulsive pharyngeal emptying. Also, they regained intelligible speech. Speech intelligibility was grade 4 in all patients. CONCLUSION: The reconstruction with the free flap after total glossectomy provides considerably satisfactory functional results in swallowing and speech as well as providing better oncologic results in advanced tongue cancers.

A Case of Congenital Absence of the Epiglottis in an Adult / 대한이비인후과학회지

Congenital absence of the epiglottis is a rare anomaly of the larynx. We present a case in a young female adult who was identified incidentally as the first case of congenital absence of the epiglottiscase found in an adult. In her history, she had suffered from frequent upper respiratory infections and muffled voice. She had a herniated lumbar nucleus pulposus, and was scheduled to undergo a laminectomy. While inducing general anesthesia on the patient, the anesthesiologists had a great deal of difficulty in intubation of the endotracheal tube by routine procedure and consulted the department of ENT. The absence of the epiglottis was observed as a result of ENT consultation when examining the patient through a fiberoptic endoscope. fiberoptic laryngoscope and neck lateral plain X-ray. Using a fiberoptic laryngoscope and a neck lateral plain X-ray, v,e confirmed a congenital absence of the epiglottis, hypertrophy of aryepiglottic fold and arytenoid region, elongated larynx, a large false vocal cord.