Characteristics of Glottic Closure Reflex in a Canine Model

PURPOSE: The most important function of the larynx is airway protection which is provided through a polysynaptic reflex closure triggered by the receptors in the glottic and supraglottic mucosa, evoking the reflex contraction of the laryngeal muscles especially by strong adduction of vocal cords. Based on the hypotheses that central facilitation is essential for this bilateral adductor reflex and that its disturbance can result in weakened laryngeal closure, we designed this study to elucidate the effect of central facilitation on this protective reflex. MATERIALS AND METHODS: Seven adult, 20 kg mongrel dogs underwent evoked response laryngeal electromyography under 0.5 to 1.0 MAC (minimum alveolar concentration) isoflurane anesthesia. The internal branch of the superior laryngeal nerve was stimulated through bipolar platinum-iridium electrodes, and recording electrodes were positioned in the ipsilateral and contralateral thyroarytenoid muscles. RESULTS: Ipsilateral reflex closure was consistantly recorded regardless of anesthetic levels. However, contralateral reflex responses disappeared as anesthetic levels were deepened. Additionally, late responses (R2) were detected in one animal at lower level of anesthesia. CONCLUSIONS: Deepened level of anesthesia affects central facilitation and results in the loss of the crossed adductor reflex, predisposing to a weakened glottic closure response. Precise understanding of this effect may possibly provide a way to prevent aspiration in unconscious patients.

Electroglottographic Measurement with Vocal and Videostroboscopic Analysis for T1 Glottic Cancer Patients after Curative Radiotherapy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was carried out to analyze voice changes after curative radiotherapy in T1 glottic cancer and the clinical efficacy of electroglottography (EGG) as a new treatment method for voice analysis. MATERIALS AND METHOD: From February 2002 to December 2004, 10 patients with T1 glottic squamous cell carcinoma who underwent a curative radiotherapy were studied prospectively. They received voice quality measurement (Perceptual evaluation, Acoustic analysis) and vocal function test (Aerodynamic study, Videostroboscopy, EGG) one year before and after radiotherapy. RESULTS: Perceptual test showed voice quality improvement after radiotherapy, but 3 cases had still abnormal voices. Acoustic analysis showed that although fundamental frequency, jitter and shimmer changed significantly after radiotherapy, HNR did not change and aerodynamic study had no changes after radiotherapy.On the other hand, in the videostroboscopy, glottic closure, wave and non-vibrating portion had significant changes after radiotherapy. In EGG, %Fx and Qx also showed significant changes whereas %Ax had no changes. CONCLUSION: This study suggests that the voice improves significantly after radiotherapy and multi-dimensional analysis with diverse method is required in voice analysis. In addition, EGG may be used as a reliable method in vocal function test.

The Current Clinical Propensity of Laryngeal Tuberculosis: Review of 60 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although laryngeal tuberculosis is not common, it still occurs with an increasing incidence of pulmonary tuberculosis. The clinical pattern and spread mechanism of this disease have also changed as well. This study was performed to examine the current propensity seen in laryngeal tuberculosis and the clinical characteristics of this disease in patients showing atypical clinical pattern. SUBJECTS AND METHOD: We retrospectively analyzed 60 cases of laryngeal tuberculosis diagnosed from 1994 to 2004 in the department of otorhinolaryngology at Severance Hospital by evaluating clinical and videostroboscopic records. RESULTS: The age of the patients ranged from 25 to 78 years, with their average age being 49.7 years. The ratio between men and women was 1.9 : 1. The major symptom encountered was hoarseness (96.6%). Clinically, granulomatous (n=22) and ulcerative types (n=11) of laryngeal tuberculosis were still prevalent, however, the incidence of atypical types such as polypoid (n=16) and nonspecific (n=11) were on the rise. Among 27 cases that showed polypoid or nonspecific types, unilateral lesion was seen in 20 cases (74%). The most frequently affected area by this disease was true vocal cord, followed by false vocal cord, epiglottis, arytenoids and posterior commissure. Active pulmonary tuberculosis was present in 28 (46.7%), inactive pulmonary tuberculosis in 20 (33.3%), normal lung status in 12 cases (20%). Primary laryngeal tuberculosis was present in 9 cases (15%). Single lesion, polypoid and nonspecific type were the prevalent characteristics found in patients with inactive tuberculosis or normal lung status. CONCLUSION: Physicians should be aware of changes in the clinical pattern of laryngeal tuberculosis, which pose serious complications and risk of spreading.

Clinical Characteristics and Voice Analysis of Mutational Dysphonia: Diplophonia and Clinical Use of Electroglottographic Measures / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mutational dysphonia, also referred to as mutational falsetto, is defined as the dysphonia that continuously have high pitch after adolescence. The aims of this study were to investigate the acoustic and electroglottographic characteristics of mutational dysphonia before and after voice therapy and to identify the factors that may be of help in its treatment. SUBJECTS AND METHOD: The clinical records of 15 patients with mutational dysphonia were reviewed, and analyses of their voice records were carried out with the help of Lx Speech Studio studio (Laryngograph Ltd, London, UK) program. RESULTS: After voice therapy was combined with manual compression method, the voices of the subjects were lowered in pitch and also improved in voice quality. Furthermore, we were able to classify the mutational dysphonia into 4 categories according to diplophonia and closed quotients. The most common type among the categories was bimodal distribution of fundamental frequency, or so-called diplophonic, accompanied with low closed quotient-falsetto voice-at high frequency area. However, the results also showed that all cases of mutational dysphonia can not be generalized simply as falsetto voice. The effect of the therapy for each type was different, and we could assume that in the cases with diplophonia accompanied with non-trained falsetto voice, it is expected that it can be treated readily. CONCLUSION: The diplophonia and closed quotient, which were easily analyzed by using Lx Speech Studio program, are important factors which help to classify the mutational dysphonia, choose the treatment options, monitor the efficacy of therapy, and estimate the prognosis of diseases.

The Clinical Characteristics and Voice Analysis of Reinke's Edema / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Reinke's edema is characterized by the swelling of the vocal folds, which is bilateral, and is found superficial to the vocal ligament, Reinke's space. However, the etiology of Reinke's edema is not well understood, and voice characteristics are still controvertial. The aim of this study was to evaluate the clinical characteristics of Reinke's edema, and to assess the voice qualities in patients with Reinke's edema before and after a laryngomicrosurgery. Furthermore, this study also determined which parameters were most associated with the improvement of postoperative voice quality in Reinke's edema. SUBJECTS AND METHOD: The clinical records from 61 patients with Reinke's edema were reviewed and telephone questionnaires were carried out about smoking, laryngopharyngeal reflux, voice abuse, and allergy. All the patients were classified according to the stroboscopic findings (Yonekawa's classification). The voice analysis of 61 patients with Reinke's edema were performed and compared with 30 normal controls. Also, the voice analysis of 23 patients, who underwent laryngomicrosurgery, was carried out 2 months after surgery. RESULTS: Smoking, voice abuse and laryngopharyngeal reflux may play important roles in developing Reinke's edema. There were 26, 22, and 13 patients identified as Yonekawa types I, II, and III, respectively. The preoperative voice analysis of 61 patients showed decreased FxM (mean fundamental frequency), and increased subglottic pressure. Furthermore, FxSD (fundamental frequency standard deviation), QxM (mean closed quotient), and QxSD (closed quotient standard deviation) were all higher for the patients than the normal group. The postoperative results showed an increase in the FxM and an improvement in the MFR (mean flow rate), Psub (subglottic pressure), shimmer, and HNR (harmonics to noise ratio). The correlation analysis showed that jitter, HNR, QxM, and CFx (% irregularity of frequency) were the parameters, showing the best correlation with improvement in the postoperative voice quality. CONCLUSION: The fundamental frequency was approximated to normal ranges, and stabilizing of vocal fold vibration, and the improvement of vocal efficiency was also found 2 months after layngomicrosurgery. The parameters which represented voice quality by correlation analysis after surgery were jitter, HNR, QxM, and CFx.

A Clinical Review on 197 Cases of Phonosurgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The objectives were to analyze the results of the laryngeal framework surgery (LFS) in one institute during 12 years. We reviewed the present position of LFS in the phonosurgery field and discussed the prospects for this type of surgery in the future. SUBJECTS AND METHOD: One hundred seventy nine charts of patients who underwent LFS in Yongdong Severance hospital from 1992 to 2003 were reviewed. Types of procedures were made according to the classification/ nomenclature of European Laryngological Society. RESULTS: One hundred ninty seven operations had been performed during 12 years in 179 patients. Type I thyroplasty was the most common procedure (28.9%). Type I thyroplasty+Arytenoid adduction (26.4%), Type III thyroplasty (16.8%), Arytenoid adduction (15.2%), Injection medialization (11.2%), Type IV thryroplasty (1.5%) followed in the order of most commonly operated choices. Of 197 cases, 18 cases were revision. There was only one major complication (dyspnea). A variety of dysphonias, which include vocal fold paralysis (71.5%), various pitch problems (mutational dysphonia (14%), androphonia (1.1%)), glottal insufficiency (12.8%), and some cases of spasmodic dysphonia (0.6%), had been treated with LFS. CONCLUSION: Laryngeal framework surgery is a new type of surgery that aims to improve the voice by restructuring the laryngeal framework. This type of surgery has become increasingly popular, because it has been found to be safe and effective.

Voice Analysis after the Vertical Partial Laryngectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is generally believed that reconstruction of the glottic region after vertical partial laryngectomy (VPL) can improve glottic and supraglottic function. But reports on secondary healing without glottic reconstruction after VPL are lacking. This study attempts to obtain an objective phonatory data after VPL without glottic reconstruction. MATERIALS AND METHODS: From 1993 to 2001, 13 patients, who had been treated with VPL without glottic reconstruction, and 44 patients who underwent VPL were included in this study. Patients who had been followed up postoperatively less than 12 months were excluded from this study. Seven lesions were classified as T1 glottic cancer and six as T2 glottic cancer ; classic VPL (11 cases) and frontolateral VPL (2 cases). For the evaluation of voice, acoustic (fundamental frequency (Fo), jitter, shimmer, noise to harmonic ratio (NHR)), aerodynamic (maximal phonation time (MPT), mean flow rate (MFR)) analysis and videostroboscopy were done. RESULTS: There were significant differences in Fo, jitter, shimmer, NHR, MPT and MFR between VPL group and the normal control group. In videostroboscopy, the following tendencies were observed in many cases: incopmplete glottic closure, decreased and irregular mucosal wave and amplitude, supraglottic voicing, abnormal arytenoid movement and anterior commissure blunting. CONCLUSION: We had objective phonatory data after VPL without glottic reconstruction, which showed that voice quality after VPL without glottic reconstruction were somewhat unsatisfactory. Further studies on other surgical techniques of VPL would help to elucidate better ways of improving voice quality in these patients.

Preliminary Results of Mitomycin-C Application in the Treatment of Laryngeal Stenosis and Granuloma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mitomycin-C is an antibiotic, antineoplastic agent that inhibits DNA and protein synthesis, and fibroblast proliferation. It has been successfully used in adjunction to glaucoma surgery, dacryocystorhinostomy, pterygium surgery, and middle meatal antrostomy. The purpose of this study is to evaluate the efficacy and safety of intraoperative Mitomycin-C application as an adjunct therapy in the endoscopic treatment of laryngeal stenosis and granulation. MATERIALS AND METHOD: A total 13 subjects, of whom 2 had anterior glottic web, 4 posterior laryngeal stenosis, and 7 laryngeal granuloma were included. All underwent stroboscopy and were treated with endoscopic laryngomicrosurgery with CO2 laser. Then, 1 cc of 0.4 mg/mL Mitomycin-C was directly applied for 4 minutes on the surgical site. The patients' symptoms were assessed, and the size of the airway was graded on a scale of I (< or =50%) to IV (total occlusion) after a mean follow-up period of 5 months. The recurrence of the laryngeal granuloma was checked. RESULTS: There was a significant improvement in postoperative symptoms in the group of posterior laryngeal stenosis. Two with tracheotomy underwent decannulation. The postoperative size of airway was markedly increased and restenosis was not noted. There was only one case of recurrence in the granuloma group. CONCLUSION: According to these preliminary results, it is suggested that application of Mitomycin-C can be used as a beneficial adjunct therapy in the endoscopic COc laser excision for laryngeal stenosis and granuloma.

Vocal Analysis after Vertical Partial Laryngectomy

It is generally believed that a reconstruction of the glottic region after a vertical partial laryngectomy (VPL) can improve the glottic and supraglottic function. However, there is a paucity of reports on secondary healing without a glottic reconstruction after a VPL. The aim of this study was to obtain objective phonatory data after a VPL without a glottic reconstruction. From 1993 to 2001, 13 patients, who had been treated with VPL without a glottic reconstruction, were enrolled in this study. Patients with a postoperative follow up of less than 12 months were excluded. Seven lesions were classified as T1 glottic cancer and six as T2 glottic cancer- standard VPL (11 cases) and frontolateral VPL (2 cases). Acoustic ( (fundamental frequency, Fo), jitter, shimmer, the noise to harmonic ratio (NHR) ), aerodynamic (maximal phonation time (MPT), mean flow rate (MFR) ) analysis and videostroboscopy were performed to evaluate the voice. There were significant differences in the Fo, jitter, shimmer, NHR, MPT and MFR between the VPL group and normal control group. In videostroboscopy, the following tendencies were observed in many cases: incomplete glottic closure, a decreased and irregular mucosal wave and amplitude, supraglottic voicing, abnormal arytenoid movement and anterior commissure blunting. Objective phonatory data after VPL without a glottic reconstruction was obtained. The voice quality after a VPL without a glottic reconstruction was somewhat unsatisfactory. A further comparison with other different surgical techniques of a VPL would help determine a better way of improving the voice quality in these patients.

A Clinical Review on 173 Cases of Unilateral Vocal Cord Paralysis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Unilateral vocal cord paralysis is a common finding in the practice of otolaryngology. Having an idiopathic cause, requiring surgeries on neck and chest, presenting tumors, trauma and neurological diseases are considered to be its major etiology. We reviewed and compared both domestic and international papers and analyzed the trend of clinical characteristics and causes of unilateral vocal cord palsy in Korean patients. MATERIALS AND METHOD: We reviewed 173 patients who visited the Severance Hospital and the Yong dong Severance Hospital from April, 1995 to December, 2001. They were diagnosed with unilateral vocal cord palsy by reviewing systems, physical examination, radiographic studies, and endoscopy. They were analyzed according to sex, age, cause of vocal cord palsy, condition of the paralyzed vocal cord and treatment methods by a preestablished protocol. RESULTS: The male to female ratio was 1.6: 1. Patients in their fifties consisted of 24.3% of the total number of cases, and patients over 60 formed 30.6%, showing that the frequency of unilateral vocal cord palsy increased with age. The paralyzed vocal cord was fixed at paramedian position in 79.8% of the cases. The left vocal cord was paralyzed about twice as much as the right vocal cord. Among the causes of vocal cord palsy, 32.4% of the cases were due to postoperative paralysis, and most of those were developed after thyroid surgery. About 67% of the cases were not related to surgery, of which the causes were most commonly idiopathic, with tumor being the next frequent. In 38.4% of the patients, atrophy of the membranous portion of the paralyzed vocal cord was noted. Rotation of the arytenoid cartilage was seen in 25.3%. CONCLUSION: Vocal cord paralysis is not only a disease entity in itself, but can be seen as a sign of an underlying disease. Thus, determining the cause of vocal cord paralysis is extremely important. Although the number of cases of vocal cord paralysis due to surgery is now decreasing, those due to trauma or idiopathic causes are rising and paralysis due to tumor is increasing. Consequently, it is necessary to perform a complete and thorough search for the underlying cause of vocal cord paralysis.

Combination of Mutated Herpes Simplex Virus (G207) with Radiation for the Treatment of Squamous Cell Carcinoma of the Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: G207 virus is an ideal candidate of oncolytic viral therapy. It is a multi-gene mutant of HSV-1 with a deletion at the gamma34.5 loci and a LacZ gene insertion in the ICP6 gene, encoding the HSV ribonucleotide reductase. Ionizing radiation induces the growth arrest-inducible gene, Gadd34, a protein that correlates with apoptosis following radiation and has homology with the G207 gamma34.5 gene. It is hypothesized that the combination of radiotherapy with G207 virus may have a synergic effect on viral replication and efficacy. The purpose of this study is to evaluate the combination of the cytotoxic G207 virus with radiation therapy to treat head and neck tumors. MATERIALS AND METHOD: Five human SCCHN cell lines and one murine SCC cell line were utilized in this study. There were two groups of cells: control cells received no irradiation while the second group was irradiated with 400 cGy. Cells were infected with G207 vectors at a multiplicity of infection (MOI) of 0.1. Cytotoxicity assay was performed for 5 days. Cells and culture medium supernatant were collected and viral titers determined by plaque forming units on Vero cells. To evaluate infection efficiency, X-gal staining was performed at 24hr post infection. RESULTS: All head and neck squamous cancer cell lines tested demonstrated an increased susceptibility to the combination of G207 virus with radiation therapy when compared with each single modality (more than additive effect, p<0.05). Even though cell lines such as SCC25, MSKQLL2, or SCCVII were radioresistant, the combination of G207 with radiation therapy showed significantly increased cytotoxic effect. X-gal staining and viral growth curve studies demonstrated that G207 replications in radiated cell lines were not decreased as compared with non-radiated ones. CONCLUSION: The results provide preliminary support for the use of G207 oncolytic virus as a radiation adjuvant in treatment of head and neck cancer. The combination of radiation and oncolytic viral gene therapy may eventually be useful in treating patients with radio-resistant, non-resectable disease, and patients with a high probability of contracting postoperative microscopic residual diseases.

Epidemiologic Survey of Head and Neck Cancers in Korea

Head and neck cancers have never been systematically studied for clinical purposes yet in Korea. This epidemiological survey on head and neck cancer patients was undertaken from January to December 2001 in 79 otorhinolaryngology resident-training hospitals nationwide. The number of head and neck cancer patients was 1,063 cases in the year. The largest proportion of cases arose in the larynx, as many as 488 cases, which accounted for 45.9%. It was followed by, in order of frequency, oral cavity (16.5%), oropharynx (10.0%), and hypopharynx (9.5%). The male:female ratio was 5:1, and the mean age was 60.3 yr. Surgery was the predominant treatment modality in head and neck cancers: 204 (21.5%) cases were treated with only surgery, 198 (20.8%) cases were treated with surgery and radiotherapy, 207 cases (21.8%) were treated with combined therapy of surgery, radiotherapy, and chemotherapy. Larynx and hypopharynx cancers had a stronger relationship with smoking and alcohol drinking than other primary site cancers. Of them, 21 cases were found to be metastasized at the time of diagnosis into the lung, gastrointestinal tract, bone, or brain. Coexisting second primary malignancies were found in 23 cases. At the time of diagnosis, a total of 354 cases had cervical lymph node metastasis accounting for 42.0%.

Supraglottic Partial Laryngectomy is Contraindicated in Patients Elder than 70 Years Old? / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Some use age 70 as a cut-off point for supraglottic laryngectomy because of postoperative aspiration and deglutition complications. But the relationship between age and postoperative aspiration and deglutition complications has not been adequately reported. Therefore, we reviewed postoperative aspiration and deglutition complications of supraglottic laryngectomy in patients older than 70 years old and investigated whether age was one of the factors influencing functional outcome in supraglottic laryngectomy. Patients and Method: From 1994 to 2001, the decannulation day and the postoperative day when oral feeding was started were retrospectively investigated on seven patients who underwent supraglottic partial laryngectomies among early (T1, T2) supraglottic squamous cell carcinoma patients elder than 70 years old. RESULTS: There were no cases requiring either a persistent tube feeding and a gastrostomy. Decannulation could be performed in all cases. The average decannulation day was postoperative 20.6 days and the average oral feeding day was 16.3 days. There were no postoperative complications such as aspiration, fistula and dysphagia. There were no differences according to age. CONCLUSION: No differences were found regarding age in the functional outcomes of supraglottic laryngectomy. So, one's chronological age does not necessarily reflect his or her physiological age and therefore cannot be a contraindication of supraglottic laryngectomy.

Combined Chemotherapy and Radiotherapy versus Radiotherapy alone in the Management of Localized Angiocentric Lymphoma of the Head and Neck / 대한방사선종양학회지

PURPOSE: To clarify the clinical benefit derived from the combined modality therapy (CMT) consisting of chemotherapy (CT) and involved field radiotherapy (RT) for stage I and II angiocentric lymphomas of the head and neck. MATERIALS AND METHODS: Of 143 patients with angiocentric lymphoma of the head and neck treated at our hospital between 1976 and 1995, 104 patients (RT group) received involved field RT alone with a median dose of 50.4 Gy (range : 20-70 Gy), while 39 patients (CMT group) received a median 3 cycles (range : 1-6 cycles) of CT before involved field RT. The response rate, patterns of failure, complications, and survival data of the RT group were compared with those of the CMT group. RESULTS: Despite a higher response rate, local failure was the most common pattern of failure in patients of both groups. The patterns of failure, including the systemic relapse rate were not influenced by the addition of combination CT. Although both modalities were well tolerated by the majority of patients, aberrant immunologic disorders or medical illnesses, such as a hemophagocytic syndrome, sepsis, intractable hemorrhage, or the evolution of second primary malignancies were more frequently observed in patients of the CMT group. The prognosis of patients in the RT group was relatively poor, with a 5-year overall actuarial survival rate of 38% and disease-free survival rate of 32%, respectively. However, their clinical outcome was not altered by the addition of systemic CT. Achieving complete remission was the most important prognostic factor by univariate and multivariate analyses, but treatment modality was not found to be a prognostic variable influencing survival. Conclusions : Involved field RT alone for angiocentric lymphoma of the head and neck was insufficient to achieve an improved survival rate, but the addition of CT to involved field RT failed to demonstrate any therapeutic advantage over involved field RT alone.

Choice of Surgical Approaches and Method of Reconstruction for Base of Tongue Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are various surgical approaches for resection of base of tongue cancer, but reports on indications of each approach are lacking. PATIENTS AND METHODS: From 1993 to 1999, surgically treated patients with base of tongue cancer were reviewed retrospectively. Fourteen patients were included in this study. All but one were previously untreated. Approaches used to remove the tongue base lesions were as follows: lateral pharyngotomy, transhyoid pharyngotomy, mandibular swing approach with or without supraglottic partial laryngectomy (SPL), extended supraglottic partial laryngectomy (ESPL), lingual release or lingual-mandibular release technique, and pull through approach. Free flap or myocutaneous flap were used for the reconstruction of surgical defect in five patients. RESULTS: Surgical resection margin was positive in five patients. In these, the lateral wall of oropharynx was the most frequent site of positive margin. All patients, except one total laryngectomee, could do well without tracheostoma and oral feeding was possible in all cases. CONCLUSIONS: In small lateral tumor, transpharyngeal resection was a good alternative for vigorous transmandibular resection. In case of tumor with vallecular or supraglottic involvement, supraglottic partial laryngectomy with or without mandibular swing was needed. For total glossectomy, lip and mandible could be spared with pull through or lingual release approach. Even though we could choose any surgical approach with very wide surgical field, we needed more generous safety margin for this notorious tongue base cancer.

Preliminary Results of Vocal Fold Augmentation by Injection of Autologous Fascia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Vocal fold augmentation by injection under direct visual control is a quick, easy, and accurate operation. However, when autologous fat or bovine collagen is used, both showed considerable resorption over time and gave variable results. Autologous fascia is a newly introduced graft material and has a low metablolic requirements with also a relatively stable histological characteristics. The goal of this study was to confirm the autologous fascia as a new injection material of vocal fold augmentation and assess the impact of the fascia injection on voice acoustics. MATERIALS AND METHOD: Six subjects with vocal cord palalysis and three with sulcus vocalis were analyzed after injection. The temporalis muscle fascia and abdominal fat were harvested. The fascia was cut into small pieces and injected using the pressure syringe with a 18 G needle on the lateral aspect of the vocal fold under the direct visual control. The preoperative and postoperative parameters including jitter, shimmer, signal to noise ratio, and maximum phonation time were analyzed. RESULTS: There was significant improvement in all parameters measured in the group of vocal cord palsy. But there was no definite improvement in the sulcus vocalis group. There was only one laryngeal complication, the postoperative granuloma at leakage site of injection. CONCLUSION: According to these preliminary results, it is suggested that vocal fold augmentation by injection of autologous fascia can be a stable and effective surgical treatment for vocal cord palsy.

Frequency and Patterns of nodal metastasis in supraglottic squamous cell carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Supraglottic larynx is a well-known primary site of the head and neck cancer with frequent nodal metastasis, but pathologically confirmed data is lacking in our country. PATIENTS AND METHODS: Pathologic reports of supraglottic squamous cell carcinoma were reviewed using the records of 73 patients who underwent surgery as an initial treatment at Severance Hospital between April 1992 and December 1999. Fifty-three patients had simultaneous bilateral neck dissection, while 13 had unilateral neck dissection. The average number of nodes investigated was 46.5 +/- 14.0 for the comprehensive neck dissection specimen and 29.4 +/- 10.9 for he lateral neck dissection. RESULTS: Seventy-one percent of the patients had patholigically proven nodal metastasis at the time of diagnosis. Ninty-percent (47/52) of patients with pathologically proven metastasis had multiple lymph node metastasis. Nodal metastasis rate according to T stages was as follows ; T1 57.1% (4/7), T2 72.0% (18/25), T3 76.0% (19/25), T4 68.8% (11/16) respectively. Metastasis rate according to subsite was as follows ; 79.3% for epiglottis, 56.5% for false cord, 76.2% for aryepiglottic fold respectively. Ipsilateral and contralateral occult metastasis rate were 28.6% (8/28) and 14.3% (4/28), respectively. The percentage of contralateral occult metastasis for clinically ipsilateral node positive patient was 27.8% (10/36). 40.4% (19/47) of the patients with tumor which involved the midline had contralateral metastasis while 11.5% (3/26) for the patients with tumor were confined to one side. CONCLUSION: Patients with supraglottic squamous cell carcinoma need aggressive treatment of neck, because nodal metastasis is very frequent at the time of diagnosis. Elective treatment of contralateral neck may be needed for ipsilateral node positive patients. Patients who were clinically proven NO also need to take elective treatments at least for the ipsilateral side.

Experimental Study of Laryngeal Chemoreflex in Puppies / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mechanical or chemical stimulation of the supraglottic mucosa may result in either or both of two responses: the laryngeal adductor reflex response (LAR), which causes glottic closure, and the laryngeal chemoreflex (LCR), which results in centrally mediated apnea, hemodynamic instability and swallowing. Exaggeration of this normally protective reflexes is thought to be responsible for several disorders, including the sudden infant death syndrome (SIDS). MATERIALS AND METHODS: The supraglottic laryngeal mucosa which was topically stimulated by saline, distilled water, cow's milk and acid at pH 1.0 was introduced in 14 anesthetized puppies of three different age groups. In group I, four puppies were 2-weeks-of-age, and in group II and III, five puppies were 4 and 6-weeks-of-age, respectively. RESULT: 1) Strong acid (pH 1.0) induced the LCR response.20) After stimulating, respiration was depressed initially, followed by later hyperventilation. We found strong contraction or laryngospasm of thyroarytenoid (TA) muscle after a short period of latency. 3) Respiration was not, or minimally depressed in group I. Moderate depression or apnea was elicited in group II and III. 4) After stimulating, the heart rate was reduced, but it had no statistical meaning. 5) We found 3 types of TA muscle contraction pattern. Type I showed no laryngospasm, but large contraction wave was noted by EMG. Type II showed no laryngospasm, but strong contraction was noted initially and followed by some large waves by EMG. Type III showed laryngospasm that was visible to the naked eye and by EMG. 6) Peak to peak amplitude differences of TA muscle were significantly increased statistically in all age groups. CONCLUSION: We suggest that the LCR is an age-dependent response which is absent in very young puppies before 2 weeks and appears after that age. Thus, it has important implications that postnatal neural maturation may influence laryngeal reflex to some extent.

A Case of Infantile Fibromatosis of Neck / 대한이비인후과학회지

Infantile fibromatosis, which represents the childhood counterpart of musculoaponeurotic fibromatosis (abdominal or extraabdominal desmoid), usually arises as a solitary mass in skeletal muscle or in the adjacent fascia, aponeurosis, or periosteum. It chiefly affects children from birth to 8 years of age and is slightly more common in boys than in girls. Although infantile fibromatosis is a benign tumor, its nature is malignant for an aggressive clinical course with a tendency to recur in high percentage. Complete excision with an ample margin, the choice of treatment, is often extremely difficult and in some cases, may be impossible without disfigurement or dysfuction. In recurred cases, supplemental radiotherapy and chemotherapy can be tried. We present one case of infantile fibromatosis that has appeared at the right neck during first several months of life. The lesion was excised and diagnosis was confirmed by histologic examination. Some reviews with literature were supplemented.

Diagnostic Significance of the Endoscopy-guided Biopsy with Tonsillectomy in Suspected Occult Primary Tumor / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: An occult primary tumor is defined as histologic evidence of malignancy in the cervical lymph nodes with no apparent primary site of origin for the metastatic tumor. MATERIALS AND METHODS: Twenty-three patients who have failed to detect primary tumor on their initial physical examinations, endoscopy and other imaging studies, underwent endoscopy-guided biopsy under the general anesthesia. The histologic examination of frozen sections was done in the operation room. For those failing to give results by the histologic study, we performed the ipsilateral tonsillectomy biopsy. RESULTS: Nine primary lesions were identified: four cases of tonsillar fossa, one case each of nasopharynx, base of tongue, hypopharynx, supraglottis, and esophagus. In the three of the four tonsillar cancer cases, the primary foci were also identified by tonsillectomy biopsy. All the patients whose primary foci were tonsillar fossa showed metastasis of the jugulodigastric lymph node. CONCLUSION: Our results indicate that patients who are considered to have occult primary tumor should be evaluated by endoscopy-guided biopsy under the general anesthesia. Also, this study finds that if the histologic result of the frozen section were negative, ipsilateral tonsillectomy can be justified, especially for patients who show metastasis of jugulodigastric cervical lymph node.