Pharyngeal Closure Reinforced With Sternohyoid and Omohyoid Muscle After Total Laryngectomy / 대한이비인후과학회지

Pharyngocutaneous fistula occurring after total laryngectomy is a bothersome complication as it can even cause a massive bleeding due to carotid artery rupture. Preoperative radiation, extensive diseases which need flap reconstruction, low albumin or hemoglobin level, history of smoking, or underlying diseases have been domestically reported to have a relationship with the condition. To reduce this complication, simultaneous coverage for the pharyngeal closure has been developed using flaps, such as the pectoralis major muscle, the radial forearm or the anterolateral thigh, which are distant from the radiation field. However, these methods need additional surgical techniques and times. Another method advocated is pharyngeal reinforcement using flaps that can be easily obtained from the same surgical field, such as the sternocleidomastoid or the infrahyoid muscle or the acellular dermal graft with relative significances. Here we suggest reinforcement of pharyngeal closure after total laryngectomy using the sternohyoid and omohyoid muscle flaps.

Dysphagia Caused by Giant Granuloma Arising from the Oropharyngeal Posterior Wall

Granuloma is an uncommon benign disease that develops in the process of wound healing. Pharyngeal or laryngeal granuloma can be associated with gastric reflux, mechanical injury or trauma including intubation, voice abuse, or foreign body. 50-year-old female was transferred to our institute with a huge mass occupying the upper aerodigestive tract causing dysphagia. The patient has been suffering from a brain hemorrhage for several months and was kept in bed due to the quadriplegia with stuporous mental status, and was tracheotomized. On examination, the whole oropharynx and hypopharynx was covered by a smooth-surfaced soft big diffuse granular mass, which extended down to the upper trachea through the larynx. The huge granuloma was successfully removed with surgery and was found to have a pedunculating stalk on the oropharyngeal posterior wall with a small mucosal defect, suggestive of the origin of the mass. The defect was closed primarily after the cauterization. The patient is now followed up regularly without any recurrence of the disease.

Dysphagia Caused by Giant Granuloma Arising from the Oropharyngeal Posterior Wall

Granuloma is an uncommon benign disease that develops in the process of wound healing. Pharyngeal or laryngeal granuloma can be associated with gastric reflux, mechanical injury or trauma including intubation, voice abuse, or foreign body. 50-year-old female was transferred to our institute with a huge mass occupying the upper aerodigestive tract causing dysphagia. The patient has been suffering from a brain hemorrhage for several months and was kept in bed due to the quadriplegia with stuporous mental status, and was tracheotomized. On examination, the whole oropharynx and hypopharynx was covered by a smooth-surfaced soft big diffuse granular mass, which extended down to the upper trachea through the larynx. The huge granuloma was successfully removed with surgery and was found to have a pedunculating stalk on the oropharyngeal posterior wall with a small mucosal defect, suggestive of the origin of the mass. The defect was closed primarily after the cauterization. The patient is now followed up regularly without any recurrence of the disease.

Evaluation of Prognostic Factors for the Parotid Cancer Treated With Surgery and Postoperative Radiotherapy

Objectives@#. To investigate the prognostic factors and treatment outcomes of primary parotid carcinoma treated with surgery and postoperative radiotherapy (PORT). @*Methods@#. We reviewed retrospectively 57 patients with primary parotid carcinoma who were treated with surgery and PORT between 2005 and 2014. Superficial parotidectomy was performed in 19 patients, total parotidectomy in 10 patients, and total parotidectomy with lymph node dissection in 28 patients PORT on the tumor bed was performed in 41 patients, while PORT on tumor bed and ipsilateral cervical lymph nodes was performed in 16 patients. @*Results@#. With a median follow-up of 66 months, the 5-year overall survival, disease-free survival, locoregional control, and distant control rates were 77.0%, 60.2%, 77.6%, and 72.8%, respectively. The 5-year overall survival by stage was 100%, 100%, 80.0%, and 46.4% in stage I, II, III, and IV, respectively. Recurrences at primary lesions were found in seven patients, while at cervical nodes in six patients. Distant recurrences were developed in 12 patients. No patient with the low and intermediate histologic grade developed distant failure. As prognostic factors, the histologic grade for overall survival (P=0.005), pathological T-stage (P=0.009) and differentiation grade (P=0.009) for disease-free survival, pathological T-stage for locoregional control (P=0.007), and lympho-vascular invasion (P=0.023) for distant recurrence were significant on multivariate analysis. @*Conclusion@#. This study revealed that differentiation grade, histologic grade, pathological T-stage, and lympho-vascular invasion were significant independent prognostic factors on clinical outcomes.

Guidelines for the Surgical Management of Oral Cancer: Korean Society of Thyroid-Head and Neck Surgery

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient's treatment goals.

Comparison of Skin Graft for the Defect of the Radial Forearm Free Flap / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study compared two types of skin graft reconstruction for the defect of the radial forearm free flap. SUBJECTS AND METHOD: Ten cases of split-thickness skin graft (STSG) harvested from the thigh were analyzed. Also, ten cases of full-thickness skin graft (FTSG) harvest from the inguinal area applied with vacuum-assisted closure (VAC) system were analyzed. RESULTS: The defect size of the radial forearm was increased more in the STSG group than in the FTSG group (p<0.05). Skin grafts were recovered completely sooner in the FTSG group than in the STSG group although it was not statistically significant (p=0.082). Five complications (pruritus, hypertrophic scar) were found in the donor site in the STSG group (p<0.05). FTSG gave better scores according to the Vancouver Scar Scale in terms of pigmentation, pliability, and height (p<0.05). CONCLUSION: FTSG harvested from the inguinal area with the application of VAC system has many advantages for the defect of the radial forearm free flap although it is usually used for smaller size defects than for STSGs.

Intensity-modulated radiotherapy for stage I glottic cancer: a short-term outcomes compared with three-dimensional conformal radiotherapy

PURPOSE: To investigate the differences in treatment outcomes between two radiation techniques, intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT).MATERIALS AND METHODS: We retrospectively analyzed 160 (IMRT = 23, 3DCRT = 137) patients with stage I glottic cancer treated from January 2005 through December 2016. The IMRT was performed with TomoTherapy (16 patients), volumetric-modulated arc therapy (6 patients), and step-and-shoot technique (1 patient), respectively. The 3DCRT was performed with bilateral parallel opposing fields. The median follow-up duration was 30 months (range, 31 to 42 months) in the IMRT group and 65 months (range, 20 to 143 months) in the 3DCRT group.RESULTS: The 5-year overall survival and 3-year local control rates of the 160 patients were 95.7% and 91.4%, respectively. There was no significant difference in 3-year local control rates between the IMRT and 3DCRT groups (94.4% vs. 91.0%; p = 0.587). Thirteen of 137 patients in the 3DCRT group had recurrences. In the IMRT group, one patient had a recurrence at the true vocal cord. Patients treated with IMRT had less grade 2 skin reaction than the 3DCRT group, but this had no statistical significance (4.3% vs. 21.2%; p = 0.080).CONCLUSION: IMRT had comparable outcomes with 3DCRT, and a trend of less acute skin reaction in stage I glottic cancer patients

Comparison of Skin Graft for the Defect of the Radial Forearm Free Flap / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#This study compared two types of skin graft reconstruction for the defect of the radial forearm free flap. SUBJECTS AND METHOD: Ten cases of split-thickness skin graft (STSG) harvested from the thigh were analyzed. Also, ten cases of full-thickness skin graft (FTSG) harvest from the inguinal area applied with vacuum-assisted closure (VAC) system were analyzed. @*RESULTS@#The defect size of the radial forearm was increased more in the STSG group than in the FTSG group (p<0.05). Skin grafts were recovered completely sooner in the FTSG group than in the STSG group although it was not statistically significant (p=0.082). Five complications (pruritus, hypertrophic scar) were found in the donor site in the STSG group (p<0.05). FTSG gave better scores according to the Vancouver Scar Scale in terms of pigmentation, pliability, and height (p<0.05). @*CONCLUSION@#FTSG harvested from the inguinal area with the application of VAC system has many advantages for the defect of the radial forearm free flap although it is usually used for smaller size defects than for STSGs.

Imaging Findings of Venous Malformation in Neck / 전남의대학술지

No abstract available.

Supraclavicular Lymph Node Excision Biopsy in Patients with Suspected Supraclavicular Lymph Node Metastasis of Lung Cancer: Experience in a Tertiary Hospital / 전남의대학술지

The aim of this study was to evaluate the usefulness and accuracy of supraclavicular lymph node excision biopsy in the diagnosis of suspected supraclavicular lymph node metastasis of lung cancer. A retrospective review was performed to evaluate patients with suspected supraclavicular lymph node metastasis of lung cancer who underwent supraclavicular lymph node excision biopsy from January 2011 to July 2014. Forty-six patients with suspected supraclavicular lymph node metastasis of lung cancer underwent supraclavicular lymph node excision biopsy, which diagnosed benign diseases in 6 patients and malignant diseases in 40 patients. Supraclavicular lymph node excision biopsy was usually performed on patients during their first clinical visit under local anesthesia. For diagnosing suspected lung cancer, supraclavicular lymph node excision biopsy had a diagnostic sensitivity of 100%, specificity of 97.6%, positive-predictive value of 83.3%, negative-predictive value of 100%, and accuracy of 97.8%. No major complication resulted from surgical intervention. Supraclavicular lymph node excision biopsy is a useful and accurate adjunct for the evaluation of suspected supraclavicular lymph node metastasis of lung cancer in a tertiary hospital.

Supraclavicular Lymph Node Excision Biopsy in Patients with Suspected Supraclavicular Lymph Node Metastasis of Lung Cancer: Experience in a Tertiary Hospital / 전남의대학술지

The aim of this study was to evaluate the usefulness and accuracy of supraclavicular lymph node excision biopsy in the diagnosis of suspected supraclavicular lymph node metastasis of lung cancer. A retrospective review was performed to evaluate patients with suspected supraclavicular lymph node metastasis of lung cancer who underwent supraclavicular lymph node excision biopsy from January 2011 to July 2014. Forty-six patients with suspected supraclavicular lymph node metastasis of lung cancer underwent supraclavicular lymph node excision biopsy, which diagnosed benign diseases in 6 patients and malignant diseases in 40 patients. Supraclavicular lymph node excision biopsy was usually performed on patients during their first clinical visit under local anesthesia. For diagnosing suspected lung cancer, supraclavicular lymph node excision biopsy had a diagnostic sensitivity of 100%, specificity of 97.6%, positive-predictive value of 83.3%, negative-predictive value of 100%, and accuracy of 97.8%. No major complication resulted from surgical intervention. Supraclavicular lymph node excision biopsy is a useful and accurate adjunct for the evaluation of suspected supraclavicular lymph node metastasis of lung cancer in a tertiary hospital.

Isolated Parotid Gland Sarcoidosis Mimicking Parotid Tumor

No abstract available.

Invasive Fungal Sinusitis of the Sphenoid Sinus

OBJECTIVE: This study was conducted to present the clinical outcome of invasive fungal sinusitis of the sphenoid sinus and to analyze clinical factors influencing patient survival. METHODS: A retrospective review of 12 cases of invasive fungal sphenoiditis was conducted. RESULTS: Cases were divided into acute fulminant invasive fungal spheonoidits (n=4) and chronic invasive fungal sphenoiditis (n=8). The most common underlying disease was diabetes mellitus (n=9). The most common presenting symptoms and signs included visual disturbance (100%). Intracranial extension was observed in 8 patients. Endoscopic debridement and intravenous antifungals were given to all patients. Fatal aneurysmal rupture of the internal carotid artery occurred suddenly in two patients. The mortality rate was 100% for patients with acute fulminant invasive fungal sphenoiditis and 25% for patients with chronic invasive fungal sphenoiditis. In survival analysis, intracranial extension was evaluated as a statistically significant factor (P=0.027). CONCLUSION: The survival rate of chronic invasive fungal sphenoiditis was 75%. However, the prognosis of acute fulminant invasive fungal sphenoiditis was extremely poor despite the application of aggressive treatment, thus, a high index of suspicion should be required and new diagnostic markers need to be developed for early diagnosis of invasive fungal sinusitis of the sphenoid sinus.

A Case of Macroglossia due to Amyloidosis Associated with Multiple Myeloma / 대한이비인후과학회지

Amyloidosis is a condition of abnormal deposition of extracellular insoluble fibrillar proteins, termed amyloid, in tissue and organs throughout the body. Systemic amyloidosis, consisting of light amyloid protein (AL protein), the spectrum of multiple myeloma and plasmacytoma, is categorized as a primary amyloidosis; secondary amyloidosis consists of an acute phase reactant serum amyloid A protein (AA protein), which is associated with neoplasm. Amyloid involvement of the tongue is almost always secondary to systemic AL amyloidosis. Macroglossia due to amyloid depositions can lead to serious airway obstruction. We report a case of a 68-year-old woman suffering from dyspnea due to macroglossia. She was diagnosed with amyloidosis associated with multiple myeloma.

Guillain-Barre Syndrome Presenting as Bilateral Vocal Cord Paralysis / 대한이비인후과학회지

Guillain-Barre syndrome (GBS) presenting as bilateral vocal cord paralysis is extremely rare. We report an unusual case of GBS in which the patient manifested hoarseness resulting from bilateral vocal cord paralysis. In conclusion, GBS needs to be considered as possible causes of new onset bilateral vocal cord paralysis. We emphasize that early recognition of atypical presentations of GBS warrants further evaluation and appropriate management.

Vascular Leiomyoma in the Head and Neck Region: 11 Years Experience in One Institution

OBJECTIVES: Vascular leiomyoma is an uncommon benign tumor of smooth muscle origin that arises from the muscularis layer of blood vessel walls. We report our experiences with the clinical manifestations, pathologic characteristics, and management of vascular leiomyoma in the head and neck. METHODS: The clinical records of 12 patients with vascular leiomyoma of the head and neck in the 11-year period were reviewed retrospectively. RESULTS: The 12 patients included nine men and three women. The locations of the tumors were variable, including nasal cavity, auricle, hard palate, upper lip, upper eyelid, and supraclavicular space. All but three patients reported an asymptomatic spherical mass; the other three patients complained of intermittent epistaxis or unilateral nasal obstruction resulting from the tumor originating in the nasal cavity. All tumors were painless. Computed tomography consistently revealed a well-defined, intensely enhanced small mass on the mucosa. No case was dignosed corretly as vascular leiomyoma before surgical excision. All patients underwent localized surgical excision of the tumor without recurrence. Five of 12 tumors (42%) were of solid type, four (33%) were of venous type, and three (25%) were of cavernous in histological classification. The histologic type was not related to gender, site of occurrence, and presence of pain. CONCLUSION: Vascular leiomyoma presents as a small, painless mass in various locations of the head and neck region. Localized surgical excision is the only way to make the diagnosis and yields excellent results.

Computed Tomographic Evaluation of Thyroglossal Duct Cysts in Children Under 11 Years of Age / 전남의대학술지

The purpose of this study was to review the computed tomography (CT) features of thyroglossal duct cysts (TDCs) in children less than 11 years of age. A retrospective chart review was performed at Chonnam National University Hospital for the period of March 2005 to June 2011. CT scans of 16 patients having TDCs were evaluated for the following features: site of the mass, relationship to the midline, walls, margins, internal septa, rim enhancement, internal density, and the presence or absence of the thyroid gland. Of the 16 lesions, 8 (50%) were located in the midline and 12 (75%) were infrahyoid in location. Twelve (75%) of the 16 patients had well-circumscribed walls and peripheral rim enhancement. Internal septa were seen in four of the cysts, and all but one of the cysts demonstrated homogeneous or low-density attenuation. The most common CT findings of TDCs in children less than 11 years of age were a homogeneous or low-density lesion. TDCs in children under the age of 11 years were mostly located in the infrahyoid neck.

Computed Tomographic Evaluation of Thyroglossal Duct Cysts in Children Under 11 Years of Age / 전남의대학술지

The purpose of this study was to review the computed tomography (CT) features of thyroglossal duct cysts (TDCs) in children less than 11 years of age. A retrospective chart review was performed at Chonnam National University Hospital for the period of March 2005 to June 2011. CT scans of 16 patients having TDCs were evaluated for the following features: site of the mass, relationship to the midline, walls, margins, internal septa, rim enhancement, internal density, and the presence or absence of the thyroid gland. Of the 16 lesions, 8 (50%) were located in the midline and 12 (75%) were infrahyoid in location. Twelve (75%) of the 16 patients had well-circumscribed walls and peripheral rim enhancement. Internal septa were seen in four of the cysts, and all but one of the cysts demonstrated homogeneous or low-density attenuation. The most common CT findings of TDCs in children less than 11 years of age were a homogeneous or low-density lesion. TDCs in children under the age of 11 years were mostly located in the infrahyoid neck.

A Case of Tracheobronchopathia Osteochondroplastica / 대한이비인후과학회지

Tracheobronchopathia Osteochondroplastica (TO) is a rare disease of the trachea characterized by the development of submucosal cartilaginous and bony nodules. The nodules are usually located at the anterior and lateral walls and sometims on the posterior membranous wall. Clinically, the manifestations of TO vary from the incidentally detected asymptomatic to life threatening diseases with airway obstruction. Bronchoscopy is a useful diagnostic tool and radiographic studies also play an important role in the diagnosis of TO. The treatment of TO is reserved for the symptomatic lesion with severe airway narrowing and the prevention of recurrent respiratory infections.

Comparative Study of Sensation with or without Preservation of Great Auricular Nerve during Parotidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Whether to sacrifice the posterior branch of great auricular nerve (GAN) during parotidectomy is disputatious. This study was to provide a guideline for decision-making. SUBJECTS AND METHOD: Thirty-two patients who underwent parotidectomy due to parotid mass were randomized into two groups. Three patients who underwent further treatment were excluded. Fourteen patients underwent classic parotidectomy by sacrificing GAN whereas 15 patients underwent surgery that preserved the nerve. A two-point discrimination test, sensation of light touch, sharp instrument, blunt instrument and temperature were evaluated preoperatively, and at 7 days, 1, 3, 6, 12 months and 45 months, postoperatively. Patients' preference for the operation time to preserve the nerve was also evaluated. RESULTS: The mean preservation time was 156 seconds. There was no difference in touch sensation, preoperatively, between the two groups. The two-point discrimination test of the infra-auricular area showed significant differences at 1 week postoperatively (p<0.05). The two-point discrimination test of lobule showed significant differences at 1 month (p<0.05), but these differences disappeared at 1 and 3 months. All measured data had no statistically significant differences at 3 and 6 months. At one year, light touch sensation of lobule and temperature sensation of infra-auricular area showed significant differences (p<0.05). Differences in temperature were found at 45 months of follow-up. Of the patients, 95% wanted to preserve the nerve. CONCLUSION: The authors suggest that the posterior branch of GAN was preserved according to patients' preference for the sensation of temperature in the infra-auricular area.