Endoscopic Thyroidectomy via Axillary Approach / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A hypertrophic scar of the anterior neck is the leading complaint of patients who underwent conventional thyroid surgery. In order to minimize the postoperative scars, endoscopic thyroidectomy via axillary approach was tried. SUBJECTS AND METHOD: Thirty-nine cases (female 37, male two, average age 36.3 yrs) with either benign unilateral thyroid nodule or cyst underwent endoscopic thyroidectomy. Under general anesthesia, less than 7 cm of skin incision was made in the axilla of the same side and subcutaneous tunnel was made over the clavicle. Specially created retractor was placed within the tunnel between platysma and sternocleodomastoid muscle, and under rigid endoscope (4 mm, 5 mm ; 0degrees, 30degrees) thyroidectomy was performed. RESULTS: There were 35 cases of thyroid nodulectomy, one case of isthmusectomy, and three cases of subtotal lobectomy. Complete enucleations with the intact capsule were 13 cases, 24 cases with partial rupture of the capsule, and two cases with incomplete removal of the capsule. The mean operative time was 112.5 minutes. Postoperative complications included one case of postoperative bleeding, two cases of delayed wound healing, three cases of paresthesia of shoulder and arm, and five cases of hypertrophic scar of the axilla. For all cases, hospitalization period was two days. CONCLUSION: Endoscopic thyroidectomy via axillary approach has an excellent cosmetic advantage; however, the procedure requires longer operation time of about three times the conventional method. Operation time can be reduced with the development of more versatile surgical tools. However, limited thyroidectomy surgery can not be avoided.

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%.

Effect of Smoking to Warthin's Tumor of Parotid Gland / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Warthin's tumor is known to be the second most common benign tumor of the parotid gland. Recent reports describe epidemiological changes of Warthin's tumor in other nations, however its clinical manifestations are still the mainstay of domestic studies. The purpose of this study is to investigate the prevalence of this tumor from various standpoints and the correlation between smoking and the development of Warthin's tumor. MATERIALS AND METHOD: A retrospective review of medical records was carried out on 135 patients who underwent parotid surgery from January 1991 through December 2000 and were diagnosed pathologically as Warthin's tumor and pleomorphic adenoma. RESULTS: The overall incidences of Warthin's tumor and pleomorphic adenoma of parotid gland were 15% and 57% of all parotid tumors, respectively. The male to female ratio for Warthin's tumor was 3.8:1 and the median age at presentation was 57.4 years old. Smoking is significantly associated with the development of Warthin's tumor (p=0.0054). CONCLUSIONS: In this study, smoking seems to be a risk factor in the pathogenesis of Warthin's tumor.

The Usefulness of Cytokeratin Immunohistochemistry in Detection of Lymph Node Micrometastases in Neck Dissection Specimens / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cervical lymph node metastasis in head and neck cancer patients is one of the most important prognostic factors. The previous studies have shown that the detection of occult micrometastases using immunohistochemical method is superior compared to the routine hematoxylin-eosin stain. The aim of this study was to document the rate of missed occult micrometastases on routine hematoxylin-eosin stain. MATERIALS AND METHOD: Sixty-nine tumors from the patients with squamous cell carcinoma of the head and neck were included. Immunohisto-chemical staining was performed using Pancytokeratin AE1/AE3 antibody. The number of lymph nodes examined was 1710 (mean per patient:24.8;range:one to 66). RESULTS: Of 69 tumors studied, 14 lymph nodes had occult metastases detected by the immunohistochemical method. On review by pathologist, the lymph node metastases were confirmed in 4 of 14 lymph nodes, whereas even on hematoxylin-eosin stain. Hematoxylin-eosin stain was not sufficient to detect occult micrometastases in 10. CONCLUSION: Because immuno-histochemical method enhanced the detection rate of occult micrometastases in cervical lymph nodes of head and neck squamous cell carcinoma patients, it is recommended for routine diagnostic use in every patient, in whom the lymph nodes show negative for metastasis on routine hematoxylin-eosin stain.

The Effect of Allopurinol Mucosal Painting in a Hamster of Oral Mucositis Induced by 5-Fluorouracil / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: 5-Fluorouracil (5-FU) is a commonly used drug in carcinomas of the head and neck. Mucositis and bone marrow toxicity are the two major side effects. Some initial studies showed that the local use of allopurinol as a mouthwash may reduce the oral mucositis caused by the administration of 5-FU. The purposes of this study were to establish the stomatotoxicity of the chemotherapeutic agent in an animal model and to evaluate the effect of allopurinol mouthwashes in treating mucositis objectively. MATERIALS AND METHOD: Young male Golden Syrian hamsters were used. The combination of three intraperitoneal injection of 5-FU at five-day intervals and superficial mechanical mucosal irritation were applied and examined with a gross, light microscope, and a scanning electron microscope. The allopurinol oral mucosal paintings were applied three times everyday, starting with the treatment of 5-FU, only at the right buccal mucosa for one minute. RESULTS: Light microscopic changes were characterized by ulcer and inflammatory cells infiltration. The scanning electron microscopic examination showed irregular microridges and pits. Gross and histopathologic alterations were reliably reduced in the allopurinol mucosal painting group. CONCLUSION: This study suggests an effective animal model for stomatotoxicity of chemotherapeutic agents, and that allopurinol mouthwashes can be effective in treating or protecting the 5-FU induced stomatitis.

Treatment Results of Laser Cordectomy and Radiation Therapy for Early Glottic Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Early glottic cancer can be effectively treated with conservation laryngeal surgery, radiation therapy, and endoscopic laser surgery. The aim of this study was to compare the clinical results between laser cordectomy and radiation therapy for early glottic cancer and to evaluate the role of laser cordectomy. MATERIALS AND METHOD: From 1988 to 1998, 89 patients with T1-T2/N0 glottic cancer were treated initially with radiation therapy or laser cordectomy. There were 67 T1 and 22 T2 tumors. Fifty-two patients were treated by radiation therapy (RT), and thirty-seven patients were treated by endoscopic laser cordectomy. The method of primary treatment, local control rate, survival rate and larynx preservation were retrospectively evaluated. RESULTS: With the median follow-up period of 48.2 months, the local control rates in laser cordectomy and radiation therapy were 88.9%, 89.7% for T1, and 90.0% and 61.5% for T2 tumors, respectively. The 3-year survival rate was 88.9% and 87.2% for T1 and 80.0% and 61.5% for T2. Larynx preservation rate was 83.4% in T1 and 70.0% in T2 patients. These results of laser cordectomy were superior to those treated by radiation therapy. CONCLUSION: In T1b glottic cancer, radiation therapy gave better results than laser cordectomy, whereas for T2 glottic cancer, laser cordectomy was superior to radiation therapy in initial control of tumor. Compared with radiation therapy, laser cordectomy afforded a greater likelihood of larynx preservation and more options for further treatment in case of failure. We conclude that the laser cordectomy is a good surgical alternative for properly selected early glottic cancer.

Distribution of Beta-Catenin Expression in Adenoid Cystic Carcinoma of the Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: beta-catenin has functions in cell-cell adhesion with a complex of proteins that link cadherin to the cortical actin cytoskeleton and signal transduction through wnt developmental pathway. In this study, we investigated the distribution of beta-catenin in adenoid cystic carcinoma according to the histologic subtypes, perineural invasion, T classification, nodal status and stage. MATERIALS AND METHODS: Each formalin-fixed paraffin-embedded surgical specimens were obtained from seventeen patients with adenoid cystic carcinoma. We performed immunohistochemical staining with beta-catenin monoclonal antibodies and compared its staining patterns with patients' clinical characteristics. RESULTS: In tubular subtype, there were intense membranous staining pattern than other subtypes (p0.05). CONCLUSIONS: It is suggest that there are mixed functional roles of beta-catenin in adenoid cystic carcinoma in tumor aggressiveness.

Current Trend of Early Glottic and Tongue Cancer Management in Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The management of early glottic, tongue and tongue base cancer remains controversial and the trends in the treatment rationale can be influenced by the clinician and/or the patient factors. This study assesses the current treatment trend in the management of glottic, tongue and tongue base cancer among the Korean Society of Head and Neck Surgeons membership. We want this data to give more information in regards to better selection of treatment against specific individual factors. MATERIALS AND METHODS: A survey instrument in the form of a questionnaire was designed by authors. The questionnaire was distributed to 91 members with 46 responses. After the data from these surveys were computerized, the analysis was performed using SAS software. RESULTS: The two most frequently used treatment regimens of T2N0 glottic cancers were conservation laryngeal surgery (45.7%) and radiation therapy alone (19.6%). T2N0 tongue cancer was usually treated with surgery (56.5%) and surgery with radiation therapy (26.1%). The treatment patterns for tongue base cancer were varied as follows: surgery, 23.9%; radiation therapy only, 21.7%; combined therapy, 30.4%; and patient choice, 23.9%. In situations where an unclear resection margin is found, participants usually underwent adjuvant postoperative radiotherapy. A trend toward lower application rates was noted from positive margin (82.6%) to close margin (67.4%) and the difference was statistically significant (p<0.020). Important factors to determine which patient should be entered into a combined therapy program after neck dissection were the N-staging system and the histological extracapsular spread of lymph node metastases. Examination of treatment rationale demonstrated that the most preferred form of treatment was based on the perception of superior oncologic outcomes (87.0%). Treatment recommendations were usually decided by the operator (52.3%) and the tumor board (25.0%). CONCLUSIONS: Treatment modalities were not significantly influenced by varied individual factors of participants. But a standard therapy has never been well defined. These varied factors in the management of early glottic, tongue and tongue base cancer and treatment rationale reflect that there are multiple influencing factors.

p27(Kip1) and Ki-67 Expression in Mucoepidermoid Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: p27(Kip1), novel cyclin-dependent kinase inhibitor plays an important role in the inhibition of cell cycle progression by binding to the cyclin E/cyclin-dependent kinase (CDK) 2 complex. And a nuclear antigen Ki-67, expressed in all phases of cell cycle except G0, is a reliable cellular proliferative index. The present study investigated p27(Kip1) and Ki-67 expressions in mucoepidermoid carcinoma for their usefulness of indicator in tumor progression, aggressiveness and prognosis. MATERIALS AND METHODS: Formalin-fixed paraffin-embedded surgical specimens were obtained from patients with mucoepidermoid carcinoma. We performed immunohistochemical staining with p27(Kip1) and Ki-67 monoclonal antibodies and compared its labeling index with patients' clinicopathologic characteristics and survival rates. RESULTS: There was significant correlation between low p27(Kip1), high Ki-67 expression and high grade, large tumor size, positive nodal status and high stages. Also, Ki-67 expression showed significant inverse correlation with p27(Kip1) expression and there were high survival rates in high p27(Kip1) and low Ki-67 patients. CONCLUSIONS: Therefore, p27(Kip1) and Ki-67 are good and reliable predictive markers of tumor progression, aggressiveness and prognosis in mucoepidermoid carcinomas.

Microscopic Adenoidectomy Using the Electric Adenotome / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The conventional adenoidectomy is performed via the transoral approach and can be accomplished with adenoid curette, adenotome, and adenoid punch. This method has been associated with many complications. We performed an adenoidectomy using an electric adenotome under the operating microscope. The aim of this study was to compare the electric adenotome adenoidectomy with the conventional adenoidectomy and to evaluate the effectiveness and outcome of the electric adenotome surgery. MATERIALS AND METHODS: One hundred cases of microscopic adenoidectomy using the electric adenotome and one hundred cases of conventional methods using curette or punch forceps were examined. RESULTS: There was less incidence of intraoperative and postoperative bleeding in the electric adenotome adenoidectomy group. There were no differences regarding the postoperative outcome and recurrence rate between the electric adenotome method group and the conventional method group. CONCLUSION: Compared to the conventional method, the electric adenotome method has similar postoperativc result but has a lower incidence of intraoperative and postoperative bleeding. We suggest that adenoidectomy using an electric adenotome is an attractive surgical method in children with symptomatic adenoid vegetation,

Clinical Study of the Hemangioma of the Head and Neck in Adult / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hemangiomas are the most common benign tumors in children, but are sometimes reported in adults. There are many reports about hemangioma in children, but rare in adults. We intended to identify the clinical manifestations of hemangiomas and their treatment modalities. MATERIALS AND METHOD: We reviewed medical records of 25 patients over 20 years old, who underwent operation and were diagnosed with hemangioma from 1985 to 1999. RESULTS: There were 12 males and 13 females with their age ranging from 20 to 65 years, and a peak incidence was observed in the third decade (44%). The diagnoses were classified depending on histopathologic findings, and they were cavernous hemangioma in 19 cases (76%), capillary hemangioma in 3 cases (12%) and mixed hemangioma (12%). The most prevalent site was tongue (36%), followed by nasal cavity (16%), parotid (12%) and buccal area (8%). All patients underwent surgical excision and radiation therapy was added in 2 cases. Postoperative recurrences were observed in 3 cases (14%). CONCLUSION: Unlike hemangiomas in children, hemangiomas in adults are less likely to undergo spontaneous involution and they rarely resolve. Therefore, the research recommends that more active interventions like excision should be considered rather than observation for adult hemangiomas.

Microscopic Partial Tonsillectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Conventional tonsillectomy with the naked eye has posed problems in obtaining a good surgical field and in minimizing damage to the adjacent tissue. Tonsillectomy using an operating microscope offers outstanding illumination and visualization of the surgical field, thereby reducing the incidence of complications associated with tonsillectomy. The objective of this study was to compare the surgical methods of the conventional and the microscopic tonsillectomies, and to evaluate the usefulness and effectiveness of the microscopic tonsillectomy. MATERIALS AND METHODS: Two hundred children between the ages of five and ten who received tonsillectomy between June 1995 and August 1998 at Korea University Hospital were divided into two groups,' one group underwent tonsillectomy using an operating microscope (Group 1, n=100) and the other group underwent tonsillectomy using the conventional dissection and snare technique (Group 2, n = 100). Duration of surgery, post-operative healing period, amount of intra and post-operative hemorrhage, post- operative pain score, and the incidence of post-operative cicatrical pharyngeal stenosis were compared between the two groups. RESULTS: There was no statistically significant diference in operating time and post-operative healing period between the two groups, but cicatrical pharyngeal stenosis due to post-operative scarring was more common in the group that underwent conventional tonsillectomy. The amount of hemorrhage both intra and post-operatively, and post-operative pain was significantly decreased in the microscopic tonsillectomy group. CONCLUSION: The widespread use of operating microscope in otolaryngological surgeries allows this technique to be applied to tonsillectomy with few problems. This technique affords decreased intra-operative bleeding, less post-operative complications, and decreased post-operative pain compared with conventional techniques. We believe that microscopic tonsillectomy is a safe, elegant and effective procedure that represents a new concept in tonsil surgery.

Clinical Experience of Chronic Recurrent Parotitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic recurrent parotitis has been considered as an ascending infection from the oral cavity, but its causes remain unknown. Although conservative mechanical and medical measures are usually effective in controlling the acute exacerbations of this disease, surgical treatment may become necessary when the infection become too frequent or severe for episodic treatment. This study was designed to evaluate the etiology and pathology, and to analyse the outcome of surgery. MATERIALS AND METHODS: A retrospective study was conducted on nine patients who were managed by surgery(seven patients: superficial parotidectomy, two patients: total parotidectomy) after failure with all conservative measures. The age distribution was from 25 to 72 years, with the mean of 44 years. RESULTS: Of nine patients, the numbers of recurrence were 1-5 times (with the average of three times). Duration of illness ranged from one to 42 years, with a mean of 12 years. Conservative treatments preceding surgery included parotid gland massage, sialogogues, repeated use of antibiotics, and Stensens duct probing in all patients. The disease persisted in all the patients despite these measures, but following parotidectomy (superficial: 7 patients, total: 2 patients), all had complete resolution of the disease. Two patients developed transient facial weakness (House-Brackmann grade II) postoperatively without permanent sequelae. Other complications included seroma in two patients, facial deformity in two patients, Freys' syndrome in one patient, and salivary fistula in one patient. CONCLUSION: Chronic recurrent parotitis, when deeply severe, causes significant. When all the conservative medical management fail, parotidectomy can be offered as the last resolution.

Malignant Ve rsus Benign Lesions in the Head and Neck: The Usefulness of Magnetization Transfer Imaging

PURPOSE: To determine whether magnetization transfer ratio(MTR) helps differentiate malignant from benignlesions of the head and neck. MATERIALS AND METHODS: In 36 patients with pathologically proven head and necklesions (malignant tumor, n=22; benign tumor and inflammation, n=14), we prospectively obtained axial SE T1, TSET2, and pre-and post-MT images(2D FLASH; TR/TE/=500/12, flip angle=20 degree) using a 1.5T superconducting unit. TheMT pulse used for MT images was 7 msec gaussian, with 2 kHz off-resonance. The signal intensities of ROI oflesions, muscle, fat, and CSF were measured during pre- and post-MT imaging. MTRs and corrected MTRs(cMTRs) werecalculated and compared between benign and malignant lesions. Statistical differences were evaluated by Wilcoxonrank sum and student t test. RESULTS: Statistically significant differences were found between MTRs and cMTRs ofmalignant and benign lesions(p<0.01) and muscle (p<0.01). The differences in MTRs and cMTRs of benign andfat(p<0.01) or CSF(p<0.01) were also statistically significant. In the case of malignant tumors, mean MTR and cMTRwere greater than those of benign lesions(0.343 +/-0.024 and 0.328 +/-0.026, vs 0.228 +/-0.049 and 0.193 +/-0.047,p<0.01). Using a criterion of 0.3 for malignancy, the diagnostic sensitivity, specificity, and accuracy of MTR formalignancy are 91, 93, and 92%, respectively. Using a criterion of 0.28, the corresponding figures for cMTR 95,93, and 94%, respectively. CONCLUSION: MTR analysis of MT imaging could help to differentiate malignant andbenign lesions of the head and neck.

A Double Immunohistochemical Study on the Expression of Matrix Metalloproteinase-2 and Type IV Collagen in Squamous Cell Carcinoma of the Oral Cavity and Oropharynx / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Matrix metalloproteinase-2 (MMP-2) is produced by tumor cells that specifically cleaves type IV collagen, one of the major constituents of basement membrane. The MMP-2 and type IV collagen have been postulated to have an important role in the invasion and spread of malignant tumors. However, little has been reported about expression of MMP-2 and type IV collagen in primary tumors and metastatic lymph nodes of oral cavity and oropharynx simultaneously. So we investigated that MMP-2 and type IV collagen can be used as the prognostic indicators of metastasis in squamous cell carcinoma of oral cavity and oropharynx. MATERIALS AND METHODS: Double immunohistochemistry was used to detect MMP-2 and type IV collagen in 32 primary tumors (14 cases had metastatic nodes and 18 cases had no metastatic node) of surgically treated squamous cell carcinoma of the oral cavity and oropharynx. The findings were compared to clinical findings of each cases. RESULTS: The immunoreactivity of MMP-2 increased significantly as more destructive patterns of basement membrane components in primary tumor (p=0.019) than metastatic lymph nodes. The cases with cervical metastasis showed more destructive patterns than cases with absence of cervical metastasis in primary tumor (p=0.003), but expression of MMP-2 had no correlation with presence or absence of cervical metastasis. The cases with diffuse invasion showed more destructive pattern than cases with any other patterns in primary tumor. However, expression of MMP-2 had no correlation with invasion mode of primary tumor. In metastatic lymph node, neither of them had no correlation with invasion mode. No statistical correlations in expression of MMP-2 and type IV collagen were detected between primary tumor and metastatic lymph nodes. CONCLUSION: The expression patterns of MMP-2 and type IV collagen in oral cavity and oropharyngeal squamous cell carcinoma can be useful in predicting cervical metastasis.

Thyrotracheal Anastomosis for Combined Laryngotracheal Stenosis: Experience in 11 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The combined Laryngotracheal stenosis produces cripling complications of respiratory and phonation difficulty. The area between cricoid cartilage and first tracheal ring is the most common site of stenosis and is the most difficult area to manage, therefore, appropriate selection of surgical method is the important factor determining the success of treatment. The authors treated laryngotracheal stenosis with thyrotracheal anastomosis and here we report the results and problems of thyrotracheal anastomosis to provide aid in the management of laryngotracheal stenosis. MATERIALS AND METHODS: Authors retrospectively studied 11 cases of laryngotracheal resection with thyrotracheal anastomosis patients for clinical characteristics, site and degree of stenosis, operation technique such as granulation tissue removal under bronchoscopy, CO2 laser excision, insertion of T-tube, insertion of laryngeal stent, and its results. RESULTS: 1) Decannulation was possible in seven cases (63.6%). 2) The success rates of patients under the ages of 20years was 80%, patients with normal vocal cord movement was 85.7%. 3) The patients with residual neurologic symptom, or with decreased coughing reflex failed in decannulation. CONCLUSION: Treatment of combined laryngotracheal stenosis is very difficult and our study showed a success rate of 63.6%. Laryngotracheal resection and end to end thyrotracheal anastomosis showed to be the most effective treatment method and in general the patients under the ages of 20 years, or with normal vocal cord movement showed better prognosis. Therefore, a radical treatment planning with efforts to reduce complication at this group may produce satisfactory results in the management of laryngotracheal stenosis.

Clinical Analysis of Voice Change as a Parameter of the Premenstrual Syndrome / 대한이비인후과학회지

OBJECTIVES: We have attempted to evaluate the relationship between voice change and the premenstrual syndrome (PMS) by observing changes of the acoustic parameter between the proliferative stage and the premenstrual period. MATERIALS AND METHODS: Twenty-eight women were studied for 2 months for this research. Each person was asked to produce an /a/ sound for 5 seconds at the proliferative phase of the menstrual cycle and then 1-2 days before menstruation. The sound of the voice in each case was recorded and analyzed by the Doctors speech science program. Subjects were divided into PMS positive and negative groups according to the Dignostic and Statistical Manual of mental disorder (DSM-IV). RESULTS: Compared with the acoustic parameters between two period, there was not a significant difference in all subjects. In the PMS positive group (N=16), jitter was significantly increased during the premenstrual period compared with proliferative stage (p=0.048). There was no correlation between the patients PMS score and the severity of voice change. CONCLUSION: The change of voice parameter was objectively identified in PMS positive group, so more careful voice habituation was required during the prementrual period.

Selection of Surgical Treatment for Warthin's Tumors of Parotid: Experience in 20 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Warthin's tumor is characterized by its frequent occurrence in the parotid tail and multifocal presentation. Superficial or total parotidectomy was advocated by many surgeons due to its multifocal nature. Recently, with the advancement of various radiologic diagnostic methods, more conservative surgical management with low morbidities can be considered since an accurate pattern and site of the tumor can be determined. MATERIALS AND METHODS: Authors retrospectively studied 20 cases of pathologically diagnosed Warthin's tumor for clinical pattern, tumor site in parotid gland, recurrence and complication rate according to different surgical methods. Patients were divided into two groups: Group II received enucleation and Group II received either superficial parotidectomy or total parotidectomy. RESULTS: Post operative complication rate was low in enucleation group, compared with parotidectomy. There was no difference in the recurrence between the two groups. CONCLUSION: Enucleation is an effective method in treatment of solitary or multifocal Warthin's tumors.

Magnetization Transfer Ratio in Head and Neck Lymphadenopathy

PUYPOSE: The purpose of this study was to determine whether the magnetization transfer ratio(MTR) differs between malignant and benign cervical lymphadenopathy. MATERIALS AND METHODS: Magnetization transfer ratios were obtained from 104 lymph nodes of 43 patients. Fifty-five nodes were malignant and 49 were benign. Biopsy or cervical lymph node dissection was performed in 83 nodes, while the remaining 21 were diagnosed clinically or by follow-up imaging studies. Among the 55 malignant nodes, squamous cell carcinomas accounted for 29 cases, lymphomas for 15, undifferentiated carcinomas for four, acute myelogenous leukemia for four, and melanomas for three. The 49 benign nodes comprised 21 cases of reactive hyperplasia, 12 of Kikuchi's disease, nine of acute lymphadenitis, and seven of tuberculous lymphadenitis. All scans were performed using a 1.5T Magnetom Vision(Siemens, Erlangen, Germany) with phased-array or Helmholtz-type neck coil. Scanning was performed with and without magnetization transfer pulse(MT pulse : 11.2 T, 250 Hz band-width, off-set 2.0 KHz) using FLASH 2D sequencing. The region of interest(ROI) for signal intensity(SI) measurements was sampled at the same nodes by keeping the position, shape and size of the ROI constant for the scans before and after the MT pulse was applied. SI measurements were repeated more than three times in each node and the mean value was used to calculate MTR. In this study, however, corrected MTRs(CoMTRs) were used for correction of the effect of background noise produced by magnetic field inhomogeneity. RESULTS: Mean CoMTRs of malignant and benign nodes were 0.33(SD: +/- 0.04) and 0.28(SD: +/- 0.05), respectively. This difference was statistically significant. At CoMTR 0.31, the sensitivity and specificity of malignant nodes were 83% and 75%, respectively. CONCLUSION: A CoMTR of above 0.31 suggests malignant lymphadenopathy. CoMTR is one of the MR criteria which can serve to differentiate between malignant and benign lymphadenopathy.

Partial Adenotonsillectomy

No abstract available.