A Case of Unilateral Conductive Hearing Loss Treated with Stapedial Tenotomy / 대한이비인후과학회지

The ossification of stapedial tendon is a rare disorder of middle ear that results in conductive hearing loss. It might be easily misdiagnosed as otosclerosis, and only exploratory tympanotomy can indicate cases where the mobility of stapes is not fixed or has increased. Cutting of the tendon results in nearly normal ossicular mobility and hearing improvement. A 41-year-old patient visited our clinic with slowly progressive hearing loss. Hearing evaluation revealed that he had a conductive hearing loss with intact tympanic membrane. The mobility of stapes was enhanced by cutting of the tendon through exploratory tympanotomy ; hearing was improved thereafter.

Endoscopic Hemithyroidectomy via a Unilateral Axillo-Breast Approach without Gas Insufflation in Unilateral Benign Thyroid Lesions: Preliminary Results of a Novel Approach / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although the usefulness of various endoscopic thyroid surgery techniques has been reviewed, little specific information is available regarding ENT surgeons who maybe unfamiliar with laparoscopic surgery and must performing endoscopic thyroidectomy. We examined the feasibility and safety of endoscopic thyroid surgery via a novel approach without gas insufflation. SUBJECTS AND METHOD: Forty-one patients undergoing endoscopic hemithyroidectomy via a unilateral axillo-breast approach without gas insufflation were enrolled in this study. Our indications for endoscopic thyroid surgery were as follows: 1) benign nodules less than 6 cm in diameter, 2) follicular neoplasm less than 6 cm in diameter, and 3) only unilateral thyroid lesions. The following variables were examined: perioperative complications, operation time, diameter of resected thyroid nodule, permanent pathology, time of hospital discharge after operation, duration of drain placement, and total amount of drainage. RESULTS: Postoperative pathology revealed 8 follicular adenomas, 31 nodular hyperplasias, and 2 lymphocytic thyroiditis. The operating time in the first 10 hemithyroidectomies was 154.0+/-64.88 min, which was 38.07 min longer than in the last 31 hemithyroidectomies (115.93+/-32.64 min; p=0.1426). The amount and duration of postoperative drainage were 249.34+/-118.47 mL in 4.01+/-1.31 days, respectively. The postoperative hospital stay was 6.12+/-1.99 days. Overall, perioperative complications occurred in seven patients (7/41, 17.1%), including one transient recurrent laryngeal nerve palsies (2.4%), five seromas (12.2%), and one hematoma (2.4%), which arose from a subplatysmal skin flap. CONCLUSION: These results suggest that endoscopic hemithyroidectomy via a unilateral axillo-breast approach without gas insufflation is safe and effective in selective unilateral benign thyroid lesions and appears to provide better cosmetic results and a shorter operation time than other endoscopic thyroidectomy methods. However, more invasiveness due to significant dissection aimed at obtaining an adequate working space and longer operation time needed than with either traditional open surgery or the minimally invasive video assisted technique should be overcome through accumulation of experience.

Endoscopic Removal of Parathyroid Tumors via an Unilateral Axillo-Breast Approach / 대한이비인후과학회지

Since Gagner introduced the first endoscopic parathyroidectomy in 1996, various approaches for endoscopic thyroidectomy & parathyroidectomy have been proposed. We have recently developed an unilateral axillo-breast approach for endoscopic thyroid surgery without gas insufflation. Through our experiences of more than 100 cases of endoscopic thyroidectomy, we have recently performed the endoscopic removal of parathyroid tumors. Case 1 was diagnosed as parathyroid adenoma, and we could not exclude the possibility of a thymic cyst, bronchogenic cyst, or brachial cleft cyst before the operation in Case 2. The final pathologic diagnosis of case 2 was a parathyroid cyst. To our knowledge, this is the first report of endoscopic removal of parathyroid tumor by an ENT surgeon in this country. This report suggests that endoscopic removal of parathyroid tumor or paratracheal mass via unilateral axillo-breast approach without gas insufflation could be a valid option for selective patients with major concern of cosmesis.

A Case of Dermoid Cyst of the Nasal Septum / 대한이비인후과학회지

Nasal dermoid cysts are rare neoplasms, which are diagnosed frequently in childhood. These lesions are derived from both ectoderm and mesoderm, and have keratinizing epithelium with skin appendages. A fistula, pit, or mass is the common clinical presentation. The diagnosis is primarily based on the medical history, physical examination, clinical symptoms, and radiologic findings. Complete surgical excision is the treatment of choice. A 15-year-old boy presented with a fistula on the nasal vestibule, which existed from birth. Fistulography revealed a contrast-filling fistulous tract and cyst in the caudal portion of the nasal septum. The lesion was removed surgically and pathology confirmed the diagnosis of dermoid cyst. We report, with a review of the literature, a rare case of dermoid cyst that occurred from the nasal septum.

Alveolar Soft Part Sarcoma of the Lung: A Report of Six Cases and Clinicopathological Analysis

BACKGROUND: Alveolar soft part sarcoma (ASPS) accounts for 0.5-1% of soft tissue sarcomas, and often metastasizes to the lung. Cases of pulmonary ASPS of unknown primary site have rarely been reported in literature. METHODS: Here, we report three cases of metastatic pulmonary ASPS and three cases of presumably primary ASPS using immunohistochemistry and clinicoradiologic findings. RESULTS: All of the cases occurred in young females. Two of the cases had metastasized from soft tissue ASPS of the lower extremities, and one case had metastasized from one of the patient? femur bones. Immunohistochemical stains were applied to four cases that had available paraffin blocks. The tumor cells of all cases on which immunohistochemical stains were done were positive for vimentin (4/4, 100%). None of the tumors were positive for myoglobin, desmin, smooth muscle actin, progesterone receptor, estrogen receptor, thyroid transcription factor-1, S-100 protein, pancytokeratin, and HMB-45 antibodies. CONCLUSION: The present study revealed that the rare pulmonary ASPS has nonspecific clinicoradiologic findings. In the immunohistochemical results, no differences existed between the presumably primary ASPS and the metastatic ASPS except for a higher Ki-67 labeling index in the latter (less than 0.1% vs. 30%). The higher index was not dissimilar to those of the extrapulmonary ASPS which showed a tumor with a low proliferation index, signifying a better prognosis and have a low potential to metastasize.