The Effect of Total Thyroidectomy on the Speech Production

OBJECTIVES: Voice and speech alternations that can occur after total thyroidectomy are usually due to recurrent or superior laryngeal nerve injury. These alterations may also be associated with other extralaryngeal factors, such as neck muscle dysfunction and scar contracture of the neck. We performed a prospective acoustic analysis on speech changes after surgery, in the absence of laryngeal nerve injury. METHODS: Patients aged 19 to 58 years undergoing total thyroidectomy, in the absence of laryngeal/pulmonary disease, previous neck surgery, or other malignant diseases, were recruited prospectively. For the running speech analysis, the speaking fundamental frequencies (SFo), range of SFo and speaking intensity were evaluated before surgery, 7 days, and 1 and 3 months after surgery. For consonant analysis, the acoustic distinctions of stop consonant, the voice onset time (VOT), vowel duration and closure duration were evaluated at the same periods. RESULTS: SFo and range of SFo were specifically diminished after surgery, while speaking intensities were not changed significantly after surgery. The thyroidectomized speakers displayed systematically varied VOT for the consonant production, which was phonetically representative. However, VOT after surgery could be longer in the strong aspirated and glottalized stops, but not in the lax stop than before surgery. The vowel and closure durations were not affected before and after surgery. CONCLUSION: Patients with thyroidectomy have some difficulty of pitch control and consonant articulation during speaking. VOT is also one of the meaningful acoustic parameters and provide a reference for comparing acoustic measures before and after thyroidectomy.

Inhibition of L-type calcium currents by magnesium sulfate on the rat basilar artery smooth muscle cells

Objective: Vasospasm remains the leading cause of cerebral damage after aneurysmal subarachnoid hemorrhage. Although magnesium regulates the calcium influx in vascular smooth muscle and endothelial cells, it has not been reported whether L-type calcium channels are involved in magnesiuminduced vascular relaxation in rat basilar artery. So, the effect of magnesium sulfate on L-type calcium currents in freshly isolated smooth muscle cells from rat basilar artery was investigated. Methods: The smooth muscle cells were isolated from rabbit basilar artery by enzyme treatment. L-type Ca2+ currents were identified using cesium chloride, a potassium channel blocker and Bay K8644, an activator of L-type Ca2+ channel. Currents were recorded under step pulse whole cell patch clamp technique. Results: In the presence of cesium chloride (in pipette solution), inward currents were observed by depolarizing step pulses. The inward currents were significantly reduced by nimodipine (n=4, p<0.05), an L-type Ca2+ channel blocker and increased by Bay K8644 (n=5, p<0.05), an L-type Ca2+ channel activator. The L-type calcium currents (156±17.0 pA, n=12) were significantly reduced by the application of 5 mM magnesium sulfate (53.8±7.0 pA, n=12, p<0.01). Conclusion: These results suggest that magnesium may relax cerebral vessel of rat basilar artery through decreasing intracellular Ca2+ ion by inhibition of L-type Ca2+ channels.

A Case of Ectopic Lingual Thyroid with Situs Inversus Totalis / 대한갑상선학회지

Situs inversus totalis (SIT) is a rare congenital condition in which the viscera are transposed as a mirror of normal physiologic arrangement. We describe a rare case of lingual thyroid associated with SIT. A 64-year-old female who was diagnosed with SIT, visited our clinic due to pharyngeal foreign body sensation. Physical examination revealed a 2.5x2.5x2.0 cm sized, pinkish, round mass in the base of the tongue. Computed tomography suggested the diagnosis of lingual thyroid. She has been on regular follow up with levothyroxine therapy. To our best knowledge, this is the first case of lingual thyroid (LT) associated with SIT. The literature is reviewed and clinical features about LT and SIT are presented.

A "Boxer Glove" Contoured Laryngeal Amyloidosis

Laryngeal amyloidosis is uncommon and poorly understood, with limited long-term studies. Although primary localized laryngeal amyloidosis is extremely rare, it frequently involves the ventricles and the false and true vocal cords. We present a 58-year-old woman with localized laryngeal amyloidosis who presented no symptoms. On indirect laryngoscopic examination, the mass involved both arytenoids only, and had a likeness to a "boxer glove." She was treated surgically by microlaryngoscopy under general anesthesia and the mass was excised using a carbon dioxide laser. We present this case and a review of literature.

A Clinical Analysis on Schwannoma in Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Neurogenic tumors in the head and neck are relatively rare and constitute around 0.5% of all head and neck tumors. Schwannoma, among neurogenic tumors, is a benign tumor originating from the spinal nerve root, peripheral nerve and all kinds of cranial nerves except the optic nerve and olfactory nerve. By presenting a series of head and neck schwannomas treated during a fifteen-year period, we aimed to analyze the clinical features, diagnosis, treatment and prognosis of schwannomas retrospectively. SUBJECTS AND METHOD: We retrospectively reviewed and analyzed clinical records of 34 patients with head and neck schwannomas who were treated surgically at the University Hospital from January, 1995 to January, 2010. RESULTS: We found 34 cases of schwannoma in the head and neck. Among the patients, 14 were males and 20 were females. The most common age group was the 60's while the most common site was the parapharyngeal space. The most common presenting symptom was palpable neck mass and the mean duration of symptoms was 41.6 months. The most common nerve of origin was the cervical plexus (29.4%). Preoperative diagnostic tools were FNA, CT and MRI. All cases were treated surgically and the most common postoperative complication was both transient and permanent voice changes. The mean follow-up period was 18.3 months and recurrence was not found during this period. CONCLUSION: Thirty-four cases of schwannoma in the head and neck were presented with respect to their clinical features.

Surgical Results of the Intraoral Removal for Plunging Ranula / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although sclerotherapy has been recently applied for plunging ranula, surgical approaches such as marsupialization have been the primary mode of treatment. Marsupialization may be done through simple excision via transcervical approach or via combined approach, intraorally and trabscervically. This study examined the effectiveness of intraoral excision for the treatment of plunging ranula. SUBJECTS AND METHOD: This prospective clinical study was comprised of 15 patients who were treated for plunging ranula through intraoral excision of the raluna and sublingual gland. RESULTS: All of the 15 patients showed a complete removal of sublingual gland. The cystic wall of ranula could be dissected for only three patients (20%) and for twelve patients (80%), it could not be dissected intraorally. Rupture of ranula developed in all patients (100%) during intraoral dissection. Recurrence did not occurr at all during a median follow-up period of 14 months (range, 7-35 month) after the intraoral excision. There were no side effects and external scarring. CONCLUSION: The intraoral approach for removal of the plunging ranula is highly effective as a primary treatment modality of plunging ranula.

Non-Recurrent Inferior Laryngeal Nerve in Thyroid Surgery: The Usefulness of Preoperative Neck CT and Clinical Review / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We investigated the expression of glucose uptake transporter-1 (GLUT-1) and epidermal growth factor receptor (EGFR) in the head and neck squamous cell cancer (HNSCC) and their influence on survival rate. We also aimed to demonstrate the relationships between the expressions of GLUT-1 and EGFR and the maximal standardized uptake values (mSUV) of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET). SUBJECTS AND METHOD: Surgical specimens from 50 patients with HNSCC, who had undergone surgical intervention, were first processed for tissue array and then for immunochemistry for GLUT-1 and EGFR. Expressions of GLUT-1 and EGFR were analyzed according to the differentiation of tumor, T & N stage and invasiveness of the tumor etc. The relationship between PET-mSUV and the expressions of EGFR and GLUT-1 was evaluated as well as its possibility as a prognostic factor of SUV. RESULTS: The expression of EGFR was significantly high in the lymph node of the positive group. Associated with the expression of GLUT-1, a tendency of increased index score (IS) values in the advanced T stages was observed but it was not statistically significant. The mSUV in FDG-PET showed statistically significant association with the maximal tumor size (pearson correlation 0.569, p=0.023); however, no association with GLUT-1 and EGFR was observed. A universal strong expression of GLUT-1 could have made it difficult to figure out statistically significant correlations. Disease free survival was to be influenced by T stage, moderate and poor differentiation and GLUT-1 expression. Only the T stages had independent significance in the multivariate analysis using the Cox regression model. CONCLUSION: We found that the expression of GLUT-1 could not show statistically significant correlation with PET-mSUV. Since the expression of EGFR has significant correlation with lymph node metastasis, EGFR may have the possibility of being a target for anticancer molecular therapy.

The Effect of Induction Chemotherapy Using Docetaxel and Platinum in Treatment Methods of Nasopharyngeal Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to determine the efficacy of induction chemotherapy with docetaxel and platinum in patients with nasopharyngeal carcinoma. SUBJECTS AND METHOD: The medical records of 52 patients, who were diagnosed with NPC at our department from January 1995 to December 2005, were reviewed and retrospectively analyzed. Patients were divided into three groups according to treatment methods. Twenty-eight cases treated with induction chemotherapy consisted of docetaxel, platinum and RT, 17 cases treated with induction chemotherapy consisted of 5-FU, platinum and RT, and 7 cases were treated with RT only. A total of 114 chemotherapy cycles were administered to patients and most received 2 cycles. RESULTS: The T stage distribution at the time of diagnosis was 48%, 14%, 15%, and 23% for T1, T2, T3 and T4, respectively. According to the WHO classification, the type I included 11 cases, type II 2cases, and type III 39 cases. The overall 5-year survival rate was 60.6%. According to the treatment modality, only the RT group was 42.9%. In the chemoradiotherapy group, the 5-year survival rates of 5-FU and platinum combination group and docetaxel and platinum combination group were 47.1% and 78.8%, respectively. There was significant difference in survival (p=0.037). There was no difference in sex, age, and N stage with regards to the 5-year survival rate. CONCLUSION: Although no valid conclusions could be drawn because of the small number of patients examined in the present study, we found that induction chemotherapy consists of docetaxel and that platinum may improve the outcome of patients with NPC.

The Utility of Serum PTH Assessment 1 Hour after Total Thyroidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hypocalcemia is the most frequent complication following total thyroidectomy. This prospective study examines the predictive value of parathyroid hormone (PTH) levels measured 1 hour after surgery. MATERIALS AND METHOD: Twenty-four patients underwent total or near-total thyroidectomy for benign or malignant thyroid tumor in one year. Serum calcium and PTH levels were measured preoperatively and at 1 hour after surgery. RESULTS: All patients were classified into three groups according to hypocalcemic symptoms and postoperative serum calcium levels. A total of 6 (25%) patients were found with hypocalcemia, as demonstrated by clinical and laboratory findings. PTH levels at 1 hour were below normal level (100%) for 6 of the 6 symptomatic hypocalcemia patients, 5 (45%) of the 11 biochemical hypocalcemia patients, and in 1 (14%) of 7 normocalcemic patients (p=0.002). The sensitivity and specificity of postoperative 1 hour PTH assessment to predict symptomatic hypocalcemia were 100% and 66%. The positive and negative predictive rate of postoperative 1 hour PTH assessment to predict symptomatic hypocalcemia were 50% and 100%. CONCLUSION: Parathyroid gland insufficiency is the main determinant of transient hypocalcemia after bilateral thyroid surgery. Low PTH level at 1 hour after surgery is therefore a feasible predictor of postoperative symptomatic hypocalcemia and permanent hypoparathyroidism.

The Surgical Managements for the Stone in the Hilum of the Submandibular Gland / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Transcervical submandibular gland excision has been commonly used for the treatment of stone in the hilum and intraglandular of SMG because of surgical difficulty. This study introduces a surgical approach without unnecessary submandibular or cervical resection. SUBJECTS AND METHOD: 27 patients who had stones in the hilum and internal area of SMG were treated at our department during the past one year. RESULTS: All stones were removed through intraoral approach without transcervical submandibular gland excision for all patients. For 18 patients with poor surgical field, the sublingual gland was removed before the removal of stone. Although a long term follow-up observation was not carried out, SMG hypertrophy was alleviated as time went by. No recurrence had been found so far. Post-surgical complications such as paralysis of the lingual nerve and the hypoglossal nerve were not found. CONCLUSION: This surgical method is a possible choice for the treatment of stones in the hilum and internal area of submandibular gland.

Incidence of Malignancy within Cytologically Indeterminate Thyroid Nodules / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES : The optimal management of cytologically indeterminate thyroid nodules is controversial given the variable malignancy rates reported in this patient population. We examined the prevalence of malignancy within cytologically indeterminate atypical and follicular thyroid lesions in an attempt to predict malignancy based on cytologic features. Subjects and METHOD : Cytopathologic reports obtained after fine-needle aspiration biopsy (FNAB) examination of indeterminate follicular thyroid lesions were studied over a 2-year period. The prevalence of malignancy on final pathology was determined in 2 indeterminate cytopathologic categories. RESULTS : A total of 138 records were available (122 women, 16 men). The mean patient age was 45.5+/-13.5 years. All patients underwent surgery and had histopathologic diagnosis. The prevalence of malignancy in atypical and follicular thyroid lesions were 77.7% (42 of 54) and 17.8% (15 of 84), respectively. CONCLUSION : The high prevalence of malignancy within indeterminate atypical and follicular thyroid lesions may necessitate thyroidectomy for patients with indeterminate atypical and follicular lesions on the FNAB examination.

Giant Cell Tumor of the Temporal Bone / 대한이비인후과학회지

Giant cell tumor of bone is an uncommon, primary neoplasm that occurs chiefly in the ends of the long bones. Giant cell tumor is rarely encountered in the skull, where it preferentially involves the sphenoid, ethmoid, and temporal bones. Radiographically, there are no characteristic findings which can be regarded as typical of a giant cell tumor. Therefore, the diagnosis must be made by biopsy. This tumor is characterized by benign histologic features, but it can be locally aggressive and can even metastasize. Complete surgical excision is the treatment of choice for giant cell tumor. We have experienced a case of giant cell tumor of the temporal bone which was removed with infratemporal fossa approach type B. So, we report with review of literatures.

Surgical Treatment and Clinical Study of Postoperative Maxillary Cyst / 대한이비인후과학회지

BACKGROUND: Postoperative maxillary cyst(POMC) occurs as a delayed complication following Caldwell-Luc(C-L) operation. Revisional C-L operation has been preferred by most surgeons. Recently, marsupialization with intranasal endoscope has been increased in the management of POMC. OBJECTIVES: The aim of this sutdy was to evaluate the clinical characteristics of POMC and the relationship between location of the cyst on axial PNS CT and surgical approaches. MATERIALS AND METHODS: The 24 patients(26 sides) were reviewed from 1990 to 1996. According to the classification methods of Nakamura, sixteen cases were located in medial, two cases in posterolateral and eight cases in anterolateral of the maxilla. RESULTS: The 22 cases including medial(16 cases), posterolateral(2 cases) and Anterolateral(4 cases) types were treated with marsupialization via intranasal endoscopic approach, 4 of 8 cases which were located in anterolateral type were treated with Caldwell-Luc approach. There was no complication and showed improvement in all patients. CONCLUSION: We think that the classification methods of cyst was useful in deciding surgical approaches. The endoscopic intranasal marsupialization is an effective therapeutic method of POMC especially in medial and posterolateral types.