Recurrence Patterns of the Maxillary Sinus Cancer after Total Maxillectomy

BACKGROUND AND OBJECTIVES: Maxillary sinus is anatomically located adjacent to the orbit and the skull base, so, in cases of advanced maxillary sinus cancer, it is difficult to completely remove the tumor with sufficient resection margins. Local recurrence is by far the most common cause of treatment failure and the long-term survival rates is low. The purpose of this study is to analyze the treatment outcomes and recurrence patterns of the advanced squamous cell carcinoma of the maxillary sinus after total or radical maxillectomy. SUBJECTS AND METHODS: A group of twenty patients who underwent total or radical maxillectomy for advanced squamous cell carcinoma of the maxillary sinus between 1995 and 2004 were examined. The medical records and radiologic findings of the same 20 patients were retrospectively reviewed. RESULTS: Eleven patients suffered from recurrence during the follow-up period. Isolated local recurrence was most common, and all local recurrences developed within 2 years after the treatment. The most common site of recurrence was the cheek. However, there was no significant difference in the recurrence rate in relation to the degree of tumor differentiation, concurrent inverted papilloma, existence of orbital involvement, the type of maxillectomy, and combined treatment. CONCLUSION: Despite the combined use of surgery and radiotherapy, prognosis of squamous cell carcinoma of the maxillary sinus is very poor as the recurrence rate is 55% within the post-treatment 2 years. Failure at the primary site is the main problem. Chemotherapy was ineffective for the recurred cases, so rescue surgery should be considered for the recurred cases, if resectable

Is Routine Central Neck Dissection Necessary for the Treatment of Papillary Thyroid Microcarcinoma?

OBJECTIVES: It remains unclear as to whether routine central neck dissection (CND) is necessary when performing surgery to treat patients with papillary thyroid microcarcinoma (PTMC). To determine the necessity for routine CND in PTMC patients, we reviewed the clinicopathologic and laboratory data of the patients of PTMC. METHODS: Between September 2001 and July 2005, 101 patients with PTMC and clinical N0 disease were retrospectively reviewed. The study cohort was devided into groups: the total thyroidectomy plus CND group (the CND group, N=48) and the total thyroidectomy without CND group (the no CND group, N=53). The serum stimulated thyroglobulin (Tg) levels were measured after surgery and prior to radioactive iodine ablation therapy (RAI) and at 6-12 months after RAI. Pathology, the Tg levels and recurrence data were compared between the 2 groups. RESULTS: Central nodal metastases were found in 18 of the 48 CND patients (37.5%). The incidence of Tg levels >5 ng/mL at RAI was higher in the no CND patients and in the 18 node-positive CND patients compared with the 30 node-negative CND patients (22-24% vs. 3%, respectively, P=0.020-0.058). The difference when performing a similar comparison using a >2 ng/mL Tg threshold level showed no significance (10-11% vs. 4%, respectively, P>0.1). Two of the no CND patients and one node-positive CND patient had recurrences in the thyroid bed or lateral neck during a mean follow-up of 24 months. CONCLUSION: The data showed that occult metastasis to the central neck is common in PTMC patients. A CND provides pathologic information about the nodal metastases, and it potentially provides guidance for planning the postoperative RAI. However, the long-term benefit of CND on recurrence and survival remains somewhat questionable.

Hearing Results after Stapedotomy in Stapes Fixation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Many studies have demonstrated that stapedotomy is a successful means of improving hearing for stapes fixation. The aim of this study was to analyze the pre and post-operative hearing improvements and causes of unsuccessful cases after stapedotomy. SUBJECTS AND METHOD: We reviewed the medical records and video recordings of 38 patients(39 ears) retrospectively who underwent stapedotomy between January 1994 and March 2006. Beside stapes fixation, patients, having other ossicular anomaly, stapes fixation in chronic middle ear disease and past history of ear surgery, were excluded. Patient ages ranged from 6 to 60 years, with the patients consisting of 15 males, 16 ears and 23 females, 23 ears. Observation ranged from 8 to 50 months and the mean observation time was 15.4+/-11.6 months. Hearing improvements at the final examination were designated as successful when air-bone gap was reduced to 20 dB or less. RESULTS: Pre-operative mean bone and air conduction thresholds were 21.6+/-10.8 (mean+/-SD) dBHL, 53.4+/-12.1 dBHL respectively and mean air-bone gap were 31.8+/-8.8 dB. After stapedotomy, mean bone and air conduction thresholds were 17.6+/-9.0 dBHL, 29.6+/-11.9 dBHL respectively and mean air-bone gap were 11.5+/-7.1dB at the last audiologic follow-up. Successful hearing improvements were achieved in 36 ears (92.3%). Three patients underwent revision surgery. CONCLUSION: This study suggests that stapes surgery is successful for hearing improvement for stapes fixation with unknown etiology.

Second Primary Malignancies in Patients with Head and Neck Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A clinical study of second primary malignancies in patients with cancer of the head and neck was performed. SUBJECTS AND METHOD: Among 1741 patients with head and neck cancer, 91patients were diagnosed as second primary malignancies. We retrospectively reviewed the medical records about site, chronology, and survival. RESULTS: There was association between the sites of index and second primary malignancy. This was explained by the concept of field cancerization. Three year-survival rate was 28.6%, and second primary malignancies in the advanced stages had poor survival. However, the chronological variable was not significant. CONCLUSION: The prevalence of second primary malignancies in patients with head and neck cancer was of 5.2%. Most of them were located in the upper aerodigestive tract. Frequent and regular follow-up is important for early detection of second primary malignancies.

Comparison of Clinical Characteristics of B Cell Lymphoma and NK/T cell Lymphoma of the Nose and Paranasal Sinuses

BACKGROUND AND OBJECTIVES: There are various subtypes in lymphoma of the nasal cavity and paranasal sinuses. This study aimed to compare the clinical differences between NK/T cell lymphoma and B cell lymphoma in the nose and paranasal sinuses. MATERIALS AND METHODS: From 1991 through 2003, 18 patients were diagnosed with lymphoma by histopathologic biopsy (NK/T cell 13 : B cell 5). We reviewed the medical records retrospectively regarding subjective symptoms, physical findings, and PNS CT findings. RESULTS: The most common symptom of NK/T cell lymphoma was nasal obstruction (8/13), and the main endoscopic finding was ulcerative small lesion. The PNS CT finding of NK/T cell lymphoma was homogenous, poorly enhanced, small mass. In contrast, the most common symptom of B cell lymphoma was periorbital swelling (2/5), and the main endoscopic finding was fungating mass. The PNS CT finding of B cell lymphoma was heterogenous, well-enhanced, large mass with bone destruction. The location of NK/T cell lymphoma was the inferior or middle turbinate in the nasal cavity, whereas the location of B cell lymphoma was the ethmoid or maxillary sinus. CONCLUSION: It is suggested that there may be significant clinical differences between NK/T cell lymphoma and B cell lymphoma in the sinonasal cavity.

Gender Differences of Polysomnographic Findings in Snoring Patients

Snoring was considered as a problem limited to male. This study was performed to evaluate the possible differences between female and male patients who have snoring problems. A polysomnography was performed at the Asan Medical Center from Jan.1989 to May.2003 on 145 female and 1065male patients who had complained of snoring at the Asan Medical Center. Multivariate model techniques were used. For female patients, RDI was correlated with BMI (correlation coefficient [r]= 0.342, p<0.001). In male patients, RDI was correlated with BMI (r=0.332, p<0.001) as well. In female patients, there was a significant correlation between age and RDI (r=0.355, p<0.001) In male patients, the correlation was not significant between age and RDI (r=-0.010, p=0.745). In conclusion, both male and female snoring patients have more severe apnea with obesity. In female patients, apnea is more severe with aging but in male patients, there was no correlation between apnea and age.