Treatment Outcome of Olfactory Neuroblastoma: Analysis of 11 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Olfactory neuroblastoma is a rare tumor arising from the olfactory neuroepithelium, for which surgery is the mainstay of treatment; but there are no generally accepted treatment approaches, according to tumor stage. In this study, we present our experiences with this tumor and the results of treatment to consider the clinical analysis and treatment modality. SUBJECTS AND METHOD: All of the patients, who had been treated for olfactory neuroblastoma at Severance hospital during the past ten years, were analyzed retrospectively and each of their diagnosis of olfactory neuroblastoma was histologically confirmed. RESULTS: Eleven patients aged 8 to 70 years were assessed, and 5 year disease-free survival rate were 60%. Sixty-four percent of those patients had received surgical treatment. Craniofacial resection was used mainly as an initial surgical treatment and followed by postoperative radiotherapy in 57% of the patients. If only cervical lymph node metastasis had developed at the initial diagnosis, elective neck treatment including bilateral neck dissection was performed. Chemotherapy was used either as postoperative adjuvant therapy, initial therapy with radiotherapy or salvage therapy, but not as an initial single treatment modality. Forty-five percent of the patients had recurrence and metastasis developed after the initial treatment. In the patients with cervical lymph node metastasis (n=1) and nodal recurrence (n=2), neck dissection was effective in nodal control. CONCLUSION: Complete surgical resection and postoperative radiotherapy were the main treatment modalities of olfactory neuroblastoma. Especially, postoperative radiotherapy is an essential treatment to both early- and advanced-stage olfactory neuroblastoma. Craniofacial resection is a main surgical modality, but in early stage, limited external intervention including endoscopic mass excision can be considered. If the patient has cervical lymph node metastasis or nodal recurrence, radical neck dissection should be performed. Chemotherapy seems to be considered as an adjuvant therapy, not single treatment modality.

Change of the Tinnitus after Neurotological Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tinnitus is a common and often very disturbing symptom. Current tinnitus treatment strategies emphasize multimodality therapy, including masking, pharmacological, and psychological treatment. In this study, we aimed to evaluate the change in the tinnitus symptoms following a neurotological surgery. SUBJECTS AND METHOD: A total of one hundred thirty one patients who visited the tinnitus clinic of Severance Hospital complaining of severe tinnitus between 1988 and 2002 were included in this study. They were all performed surgical procedures: there were 80 cases of chemical labyrinthectomy, 38 cases of cochlear implant, 11 cases of vestibular neurectomy, and 2 cases of cochlear neurectomy. RESULTS: Statistical analysis revealed a significant reduction in the tinnitus intensity: in cochlear implant, 82% were improved; in chemical labyrinthectomy, 44% were improved; in vestibular neurectomy, 91% were improved, and all cases of cochlear neurectomy were improved. CONCLUSION: Surgical procedures such as cochlear implant, chemical labyrinthectomy, vestibular neurectomy are effective modalities in the management of severe tinnitus within limited situation.

Supraglottic Partial Laryngectomy: Oncologic and Functional Results / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Supraglottic partial laryngectomy allows the removal of selected supraglottic tumors, preserving a functioning larynx and avoiding a permanent tracheotomy. The purpose of this study was to evaluate our experience with supraglottic partial laryngectomy and to review the functional and oncologic results of the operation. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of 40 patients with squamous cell carcinoma of the supraglottis and 1 patient with sarcomatoid cancer ; they were either treated with supraglottic laryngectomy (n=31) or extended supraglottic laryngectomy (n= 10) from May 1991 and December 2001. Fifteen patients had tumors in T1, 25 patients in T2, and 1 patient in T3. The primary lesion of the tumors were as follows: suprahyoid epiglottis (n=12), infrahyoid epiglottis (n=13), aryepiglottic fold (n=10), false vocal cord (n=4), and pyriform sinus (n=2). A Kaplan-Meier, Willcoxon and Fisher's exact test was performed to obtain the survival rate and the prognostic factors. The evaluations of postoperative function were performed with regard to decannulation, oral diet, and average time taken to decannulate and to initiate oral intake. RESULTS: The disease-specific 3-year survival rate was 87%. Pathologic lymph node metastasis and the invasion of tumor to the preepiglottic space were significant clinical prognostic factors affecting survival. Local recurrence was developed in only one case (2.6%). Decanulation was possible in 93% of our patients. Ninety-five percent of our patients could ultimately take oral diet. The average decannulation time was postoperative 28.3 days and the average time taken to begin oral feeding time was 23.2days. CONCLUSION: This study suggests that supraglottic partial laryngectomy may be used with acceptable oncologic and functional results for supraglottic cancers.

Effect of Cervical Lymph Node Metastasis on Prognosis and it's Risk Factors in Parotid Carcinomas / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Management of the clinically negative neck remains a controvertial issue in patients with carcinoma of the parotid gland. In order to assist in selecting appropriate patients of elective neck dissection, we sought to determine how regional nodal metastasis affects survival in patients with parotid carcinomas and to identify clinical predictors for nodal disease. MATERIALS AND METHOD: We retrospectively evaluated 124 patients with parotid carcinoma who received their definitive treatment at the Severance hospital between 1988 and 2003. A total of 84 neck dissections (ND) were performed. 24 of 84 patients who underwent neck dissection had pN(+)-staged stage. Seventy patients had an elective ND (subdigastric ND in 50 and supraomohyoid ND in 20), usually because of ominous histology or high T stage. Kaplan-Meier survival analysis was conducted to compare patients with and without histopathologic evidence of nodal disease. Univariate and multivariate analyses were carried out using logistic regression evaluating the significance of demographic, clinical, and pathological data. RESULTS: Patients with no evidence of nodal disease had significantly improved survival over patients with pathologically positive nodes (p<0.00001). The following variables were significantly associated to the risk of lymph node metastasis by univariate analysis: sex (p=0.0093), facial palsy (p=0.0001), T stage (p=0.0003), tumor location (p=0.01) and histologic type (p=0.0009). By multivariate analysis, only facial palsy had the highest correlation with lymph node metastasis. CONCLUSION: Nodal disease significantly decrease survival in patients with parotid carcinoma. Tumor histopathologic type and facial nerve involvement are the most important predictors of nodal disease. Therefore, even in cN0, we should consider elective neck dissection in parotid carcinomas in case of high-grade malignancy and/or facial nerve paralysis.