A Case of Multiple Hypoglossal Neurilemmomas in the Submandibular Space / 대한이비인후과학회지

Neurilemmoma is a benign tumor which is known to originate from the myelin-producing Schwann cells of the spinal nerve root, peripheral nerve and all kinds of cranial nerves except the optic nerve and olfactory nerve. Approximately, 25% to 40% of all neurilemmomas are found in the neural structures of the head and neck. Neurilemmoma of the 12th cranial nerve is rare ; multiple neurilemmoma is even more rare. Recently, the authors experienced a case of multiple (x3) hypoglossal neurilemmoma in the submandibular space. The tumor was removed completely and verified histopathologically as neurilemmoma.

A Case of Warthin's Tumor Associated with Primary Tuberculosis of the Parotid Gland / 대한이비인후과학회지

Warthin's tumor is a common neoplasm of the major salivary glands. Tuberculosis of the parotid gland is rare. It may result from the involvement of intraparotid lymph nodes or the infection of parenchyma, either primary or secondary to nodal disease. Clinically, tuberculosis of the parotid may not be distinguishable from a neoplasm. This report presents a patient with a parotid mass that was thought to be a malignancy but, after surgery, was diagnosed to be Warthin's tumor associated with tuberculosis.

A Clinical Study of the Cervical Necrotizing Fasciitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To clarify the presenting signs and symptoms, clinical course, pathologic organisms, and management of cervical necrotizing fasciitis. SUBJECTS AND METHOD: We retrospectively reviewed the inpatient charts treated at our ENT department for cervical necrotizing fasciitis. Seven such patients were identified as having been treated from January 2002 to December 2004. RESULTS: During the 36-months period, 7 adults consisting of 5 males and 2 females with cervical necrotizing fasciitis were diagnosed and treated. The mean age was 45 years ranging from 25 to 59 years. All patients had infections in more than five fascial spaces. The most commonly involved sites of infection were the superficial neck space (100%), followed by submandibular (85.7%), and parapharyngeal and submental space (57.1%). The most commonly known associated preceding illness were tonsillitis and dental abscess (28.5%). Painful neck swelling and difficulty in moving the neck were the most frequent symptoms and signs. The most common pathogen was Streptococcus species (4/7), followed by Staphylococcus epidermidis and Klebsiella pneumoniae (1/6). The mean duration of hospitalization was 17.2 days (range, 8-24). Leukocytosis (WBC>10000/mm3) was found in all patients. All patients received parenteral antibiotics and surgical drainage after admission. Six patients recovered and one patient died after surgical drainage. Tacheotomy was performed on five patients. CONCLUSION: Cervical necrotizing facilitis is an uncommon but often fatal bacterial infection of the skin, subcutaneous fat, superficial fascia, and deep fascia. It is characterized by marked tissue edema, rapid spread of inflammation, and signs of systemic toxicity. High index of suspicion, prompt aggressive surgery, appropriate antibiotics, and supportive care are the mainstays of management.

A Case of Lingual Thyroid with Unilateral Thyroid Agenesis and Contralateral Goiter / 대한이비인후과학회지

Ectopic thyroid is an uncommon embryological aberration characterized by the presence of thyroid tissue in sites other than in its usual pretracheal region. Lingual thyroid, although it is the most common manifestation of benign ectopic thyroid tissue, is still a rare clinical entity. Thyroid hemiagenesis is also a very rare abnormality, in which one thyroid lobe fails to develop. We report a case of left thyroid hemiagenesis and goiter in the right lobe of a 26-year-old female patient with ectopic lingual thyroid.

Traumatic Pseudoaneurysm of the Superficial Temporal Artery / 대한이비인후과학회지

Pseudoaneurysm of the superficial temporal artery is very rare and can potentially be a critical cause of facial masses. Most pseudoaneurysms form as a result of blunt trauma and present as painless, pulsatile tumors that may be associated with neuropathic findings and enlarged size. They can be accurately diagnosed through physical examination alone. The treatment of choice is surgical ligation and resection. We present a case of traumatic pseudoaneurysm of the superficial temporal artery caused by blunt injury and discuss pertinent diagnosis and treatment option.

A Case of Melanotic Neuroectodermal Tumor of Infancy / 대한이비인후과학회지

The melanotic neuroectodermal tumor of infancy (MNTI) is a rare osteolytic pigmented neoplasm that most frequently arises from the anterior maxillary alveolar ridge. It presents in the first few months of life, and usually follows a benign course. We present a 5-month-old girl with a melanotic neuroectodermal tumor of infancy of maxilla.

A Cases of Primary Branchial Cleft Cyst Carcinoma / 대한이비인후과학회지

The hypothesis that primary branchiogenic carcinoma originates from a branchial cleft cyst is controversial since the entity was first described in 1882. In 1950, stringent criteria were established for the diagnosis of primary branchiogenic carcinoma, the most important criterion being histologic proof of carcinoma arising from a normal cyst epithelium. Only a limited number of cases have successfully fulfilled these criteria. In this article, we describe a case of squamous cell carcinoma arising in the second branchial cleft cyst and also discuss the diagnosis, histopathologic features, and therapeutic options.

The Relative Risk of Cancer in Sonographically Detected Thyroid Nodules with Calcifications / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this retrospective study was to evaluate the significance of sonographically detected thyroid calcifications in the diagnosis of thyroid cancer. SUBJECTS AND METHOD: Two hundred ninety-one patients with thyroid disease, including 75 with thyroid cancer and 54 with calcified thyroid nodule, were reviewed during the period of January 2001 to May 2003. Each patient underwent preoperative high resolution sonography to evaluate the thyroid gland for the presence of calcifications. RESULTS: The highest incidence of calcification was found in thyroid cancer (36%), followed by multinodular goiter (20%), follicular adenoma (13%), and single nodular goiter (3%). The incidence of cancer was significantly higher in calcified nodules (50%) than in noncalcified nodules in the entire group (20%) (p<0.001), with a relative risk of 3.9. In the group of solitary thyroid nodules, the incidence of cancer in the calcified nodules (56%) was higher than that in the nodules without calcification (21%) (p=0.002). In the group of multiple thyroid nodules, the incidence of cancer in the calcified nodules (47%) was higher than that in the nodules without calcification (19%) (p=0.001). The relative risk in presence of calcification was 4.6 in the solitary nodules and 3.7 in the multiple nodules. Compared with multiple noncalcified thyroid nodules, the solitary calcified nodules demonstrated a relative risk of 5.2. In patients younger and older than 40 years, the relative risk in the presence of calcification was about the same, around 4. CONCLUSION: The detection of thyroid calcifications by sonography is diagnostically valuable. The presence of calcifications should raise the suspicion of malignancy.

A Clinical Study of the Deep Neck Infections in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The objective of this study was to clarify the presenting signs and symptoms, clinical course, pathologic organisms, and management of deep neck infections in children. SUBJECTS AND METHOD: We retrospectively reviewed the in-patient charts of children treated at our ENT department for deep neck infections. Thirty-six such patients were identified as having been treated from January 2000 to December 2003. RESULTS: During the 4-year period, 36 children with deep neck space infection were diagnosed and treated, including 20 (56%) boys and 16 (44%) girls. The ages ranged from 11 months to 15 years, with the mean of 6.9+/-4.5 years. The most common site of infection was the peritonsillar space (41.7%), followed by the parapharyngeal (27.8%) and submandibular (16.6%) space. Six (16.6%) children had infections in more than one fascial space. The most commonly known associated preceding illness was viral upper respiratory infection (53%). Neck swelling, fever, and dysphagia were the most frequent symptoms. The most common pathogens were Streptococcus pyogens (3/10) and Staphylococcus aureus (2/10). The mean duration of hospitalization was 7.7 days (range, 2-15). Leukocytosis (WBC>15000/mm3) was found in 13 (36%) patients. All patients received parenteral antibiotics after admission. Thirteen (36%) children recovered from the infection with conservative treatment and twenty-three (64%) children received surgical drainage. No complication and tracheotomy occurred. CONCLUSION: Deep neck space infections in children are rapidly progressive and usually present with neck swelling and fever. Peritonsillar space and Streptococcus pyogens infections were most common anatomic sites and pathogen in deep neck infection of children, respectively.

Primary Hodgkin's Lymphoma of the Parotid Gland / 대한이비인후과학회지

Hodgkin's lymphoma with its primary manifestation in the parotid gland is an exceedingly rare entity and seldom described in the literature. The vast majority of lymphoma occurs within lymph nodes. Lymphoma of parotid glands are typically a manifestation of systemic disease processes. This case report describes a parotid gland mass as a first symptom of Hodgkin's lymphoma. The patient underwent surgical excision and chemotherapy. The final diagnosis was established after an excisional biopsy and immunohistochemical staining.

Surgical Treatment of Parathyroid Adenoma 4 Cases / 대한이비인후과학회지

Parathyroid adenoma is an uncommon disease in Korea. However, the frequency of this disease has slowly increased with routine measurement of serum calcium and increasing awareness by the public of hyperparathyroidism in recent years. We have experienced 4 cases of parathyroid adenoma during recent months and analyzed the cases to evaluate clinical characteristics and outcome of surgical treatment retrospectively. Four cases were diagnosed by persistent elevation of serum calcium and parathyroid hormone. They presented asymptomic clinical symptoms, osteoporosis/ osteodeficiency, or renal stone, gastrointestinal disturbance or neck mass. Parathyroid lesions were detected preoperatively by ultrasonography, thyroid scanning or neck computerized tomographic imaging in three of them. The tumor locations were left lower in two cases and right lower in two cases. All patients received proper surgical management and their histopathologic findings disclosed adenoma in all cases. These results would be a useful guideline for better diagnostic strategies, proper surgical management and follow-up study for recurrence in the primary hyperparathyroidism.

The Characteristics of Musical Formant and Vocal Fold Vibration in the Classical and Western-Style Singers / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Professional singers have a particular "ringing" sound quality during singing, so called singer's formant. Two types of professional singers in Korea that sound very different are classical (pansori) and western style performers. The purpose of this research was to systematically analyze and compare the acoustic sound structure of both the speaking and singing voices of Korean classical singers (pansori). We also investigated the morphologic and vibratory characteristics of vocal folds using videostroboscopy. MATERIALS AND METHODS: 24 classical singers and 29 western style singers were subjects. The formant frequencies, intensities and singing power ratio was evaluated for clarifying the existence of singing formant. Using laryngeal stroboscopy, the vibratory characteristics were evaluated. RESULTS: The all formant intensities were incraesed in the classical singers, but typical increase of third and fourth formant in the western style singers. The singing power ratio was smaller in the western style singers. Most of classical singers showed abnormal vibratory patterns. CONCLUSION: The western style singers have typical singing formant during singing, but not in the classical singers. Most of classical singers showed abnormal vibratory patterns of vocal folds during phonation, but usually normal vibration in the western style singers.