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1.
Article in English | WPRIM | ID: wpr-913917

ABSTRACT

Objectives@#. To compare the surgical outcomes of externally monitored and conventional buried flaps with the goal of determining the usefulness of external monitoring of buried flaps. @*Methods@#. In this case-control study with propensity score matching, 30 patients were evenly divided into externally monitored buried flap and conventional buried flap groups. The total operative time for free flap reconstruction, the flap survival rate, the length of hospital stay, the initial time of a reliable visual assessment, complications, the final diet achieved, and the duration until diet initiation were compared between the groups. @*Results@#. The mean operative time for reconstruction was 115 minutes (interquartile range, 85–150 minutes) and 142 minutes (interquartile range, 95–180 minutes) in the externally monitored and conventional groups, respectively (P= 0.245). The median length of hospital stay was 24 days (interquartile range, 18–30 days) and 27 days (interquartile range, 20–41 days) in the externally monitored and conventional groups, respectively (P=0.298). The median duration until diet initiation was 15 days (interquartile range, 15–21 days) and 18 days (interquartile range, 15–34 days) in the externally monitored and conventional groups, respectively (P=0.466). The final diet, initial time of a reliable visual assessment, and complications were comparable between the groups, but the external skin paddle provided an excellent visual assessment immediately postoperatively in all cases. @*Conclusion@#. The outcomes were comparable between the groups, indicating that externalization of the cutaneous component of a buried flap may be a straightforward and useful technique for monitoring a buried anterolateral thigh free flap in laryngopharyngeal reconstructions. The salvage and false-positive rates of compromised flaps should be compared in large subject groups in future studies to prove that the use of an external skin paddle improves flap monitoring.

2.
Article in English | WPRIM | ID: wpr-874421

ABSTRACT

Objectives@#. In subset of patients, acinic cell carcinoma (AcCC) exhibits aggressive features such as recurrence, distant metastasis, and mortality. This study aimed to investigate clinicopathologic factors influencing patients’ prognosis and to identify adverse features predictive of an unfavorable prognosis. @*Methods@#. Between January 2000 and December 2016, 59 patients with AcCC were enrolled in this study. @*Results@#. The patients’ 5-year overall survival rate was 93.3%, and their 5-year recurrence-free survival rate was 80.5%. During the study period, recurrence occurred in 10 patients. The mean time to recurrence after surgery was 26 months (range, 5–60 months). During the study period, three patients died from the disease. Univariate analysis showed that sex, surgical extent, extranodal extension, T classification, and TNM stage were significantly associated with disease recurrence. Multivariate analysis showed that, among the clinicopathologic factors included in the analysis, only TNM stage displayed a statistically significant correlation with disease recurrence. @*Conclusion@#. Surgical treatment alone yielded good results for AcCC, and additional treatment did not affect the recurrence-free survival rate or the overall survival rate, even when the resection margin was less than 1 mm. Other pathologic factors did not show prognostic significance for disease recurrence or death.

3.
Cancer Research and Treatment ; : 1214-1225, 2018.
Article in English | WPRIM | ID: wpr-717746

ABSTRACT

PURPOSE: The purpose of this study was to compare the clinical and functional outcomes in patients with primary base of tongue (BOT) cancer who received definitive radiotherapy (RT) or surgery followed by radiotherapy (SRT). MATERIALS AND METHODS: Between January 2002 and December 2016, 102 patients with stage I-IVB primary BOT cancer underwent either definitive RT (n=46) or SRT (n=56), and treatment outcomes were compared between two groups. The expression of p16 was also analyzed. RESULTS: The RT group had more patients with advanced T stage (T3-4) disease (58.7% vs. 35.7%, p=0.021) and who received chemotherapy (91.3% vs. 37.5%, p < 0.001) than the SRT group. At a median follow up of 36.9 months (range, 3.3 to 181.5 months), the 5-year overall survival (OS) and disease-free survival (DFS) were 75.5% and 68.7%, respectively. With respect to treatment group, the 5-year OS and DFS in the RT and SRT groups did not differ significantly (OS, 68.7% vs. 80.5%, p=0.601; DFS, 63.1% vs. 73.1%, p=0.653). In multivariate analysis, OS differed significantly according to p16 expression (p16-negative vs. p16-positive; hazard ratio [HR], 0.145; 95% confidence interval [CI], 0.025 to 0.853; p=0.033). Regarding DFS, p16 expression (p16-negative vs. p16-positive; HR, 0.164; 95% CI, 0.045 to 0.598; p=0.006) showed a significant effect in multivariate analysis. Functional defects (late grade ≥ 3 dysphagia or voice alteration) were more frequently reported in the SRT than in the RT group (16.1% vs. 2.2%, p=0.021). CONCLUSION: Despite advanced disease, patients in the RT group showed comparable survival outcomes and better functional preservation than those in the SRT group.


Subject(s)
Chemoradiotherapy , Deglutition Disorders , Disease-Free Survival , Drug Therapy , Follow-Up Studies , Humans , Multivariate Analysis , Organ Preservation , Radiotherapy , Radiotherapy, Adjuvant , Tongue Neoplasms , Tongue , Treatment Outcome , Voice
4.
Radiation Oncology Journal ; : 304-316, 2018.
Article in English | WPRIM | ID: wpr-741960

ABSTRACT

PURPOSE: The indication of elective neck treatment (ENT) for clinically N0 (cN0) paranasal sinus (PNS) carcinoma remains unclear. We aimed to investigate different treatment outcomes regarding ENT and propose optimal recommendations for ENT. MATERIALS AND METHODS: We identified patients with cN0 PNS carcinoma who underwent curative-intent treatment between 1992 and 2015. Survival outcomes and pattern of failure were compared between patients who received ENT and those who did not. We sought to identify significant patient or pathologic factors regarding treatment outcomes. RESULTS: Among 124 patients meeting the inclusion criteria, 40 (32%) received ENT (‘ENT (+) group’) and 84 (68%) did not (‘ENT (−) group’). With a median follow-up of 54 months, the 5-year overall survival (OS) was 67%, and the 5-year progression-free survival (PFS) was 45%. There was no significant difference between the ENT (+) and ENT (−) groups regarding OS (p = 0.67) and PFS (p = 0.50). Neither group showed a significantly different pattern of failure, including regional failure (p = 0.91). There was no specific benefit, even in the subgroups analysis by tumor site, histologic type, and T stage. Nevertheless, patients who ever had regional and/or distant failure showed significantly worse prognosis. CONCLUSION: ENT did not significantly affect the survival outcome or pattern of failure in patients with cN0 PNS carcinomas, showing that ENT should not be generalized in this group. However, further discussion on the optimal strategy for ENT should continue because of the non-negligible regional failure rates and significantly worse prognosis after regional failure events.


Subject(s)
Disease-Free Survival , Follow-Up Studies , Humans , Neck , Prognosis , Treatment Outcome
5.
Article in English | WPRIM | ID: wpr-6983

ABSTRACT

PURPOSE: The purpose of this study was to evaluate the clinical outcomes of patients treated with radiotherapy (RT) for a carcinoma of the external auditory canal (EAC) and middle ear. MATERIALS AND METHODS: The records of 32 patients who received RT from 1990 to 2013 were reviewed retrospectively. The Pittsburgh classification was used to stage all the cancers (early stage, T1/T2 [n=12]; advanced stage, T3/T4 or N positive [n=20]). Twenty-one patients (65.6%) were treated with postoperative RT and 11 patients (34.4%) were treated with definitive RT. The median radiation doses for postoperative and definitive RT were 60 Gy and 64.8 Gy, respectively. Chemotherapy was administered to seven patients (21.9%). RESULTS: The 5-year overall survival and disease-free survival rates for all patients were 57% and 52%, respectively. The disease control rates for the patients with early stage versus advanced stage carcinomawere 55.6% (5/9) and 50% (6/12) in the postoperative RT group and 66.7% (2/3) and 37.5% (3/8) in the definitive RT group, respectively. Overall, 15 cases (14 patients, 46.7%) experienced treatment failure; these failures were classified as local in four cases, regional in one case, and distant in 10 cases. The median follow-up period after RT was 51 months (range, 7 to 286 months). CONCLUSION: Patients with early stage carcinoma achieved better outcomes when definitive RT was used. Advanced stage carcinoma patients experienced better outcomes with postoperative RT. The high rate of distant failure after RT, with or without surgery, reflected the lack of a consensus regarding the best therapeutic approach for treating carcinoma of the EAC and middle ear.


Subject(s)
Classification , Consensus , Disease-Free Survival , Drug Therapy , Ear Canal , Ear, Middle , Follow-Up Studies , Humans , Radiotherapy , Retrospective Studies , Treatment Failure
6.
Article in English | WPRIM | ID: wpr-647420

ABSTRACT

We report a rare case of adeno-squamous cell carcinoma (ASC) that was successfully treated via a median glossotomy approach at the center of the posterior tongue. The AJCC stages were IVa (T1, N2c, M0). The patient underwent bilateral modified radical neck dissection and mass excision via median glossotomy approach while tracheotomized. The patient has been followed with no evidence of recurrence for 5 years. Tongue mobility was slightly decreased because of the contracture. However, articulation was acceptable. The decreased mobility of the tongue required a slightly longer oral preparatory phase of swallowing. Although median glossotomy is acceptable only in limitted cases, it allows an excellent exposure and a safe margin to approach and excise the tumor for cases like the posterior tongue in ASC, which usually has locally aggressive invasion and poor prognosis.


Subject(s)
Contracture , Deglutition , Humans , Neck Dissection , Prognosis , Recurrence , Tongue
7.
Article in English | WPRIM | ID: wpr-653246

ABSTRACT

BACKGROUND AND OBJECTIVES: Anterolateral thigh (ALT) flaps are commonly used for head and neck surgery reconstruction. However, a thick ALT often leads to long operation times. Therefore, ALT thickness on a preoperative non contrast image of positron emission tomography-computed tomography (PET-CT) scan was measured to predict surgical outcome. SUBJECTS AND METHOD: The correlation between ALT thickness and total reconstruction time was analyzed in 106 patients. The differences in ALT thickness between the successful and compromised-flap groups were analyzed retrospectively. RESULTS: Median ALT thickness was 4.49 mm, and total reconstruction time was 190 min. Total reconstruction time was significantly correlated with ALT thickness (p=0.019). ALT thickness, body mass index (BMI), total reconstruction time and ischemia time were significantly greater in the compromised-flap group than in the successful group. In the multivariate analysis, only BMI and ischemia time were predictors for the compromised flap. CONCLUSION: ALT thickness measured on a non-contrast image of PET-CT scan is useful as a surgical outcome predictor with respect to total reconstruction time. A further study may suggest the risk of a thick ALT in a compromised flap in head and neck reconstruction using an ALT free flap.


Subject(s)
Body Mass Index , Electrons , Free Tissue Flaps , Head and Neck Neoplasms , Head , Humans , Ischemia , Methods , Multivariate Analysis , Neck , Positron-Emission Tomography , Retrospective Studies , Thigh
8.
Article in English | WPRIM | ID: wpr-654688

ABSTRACT

Full skin auto-grafts are required for reconstruction of skin burns and trauma scars. However, currently available clinical approaches such as sheet skin graft, mesh skin grafts, artificial skin graft, and in vivo skin expansion have limitations due to their potential danger for secondary damage and scar formation at the donor site, and discomfort during skin expansion. We developed an advanced bioreactor system and evaluated its function in skin expansion using porcine full skin. The reactor was designed as a pneumatic cylinder type, was programmed to adjust the pressure and the operating time. The system was composed of culture chamber unit, environmental control unit, and monitoring unit. Skins were expanded at 200 kPa pneumatic force and the expanded skins were analyzed by immunohistochemistry and histology. Furthermore we carried out auto-grafting experiment of the expanded skins in vivo using Yucatan pigs and skins were harvested and histologically analyzed after 8 weeks. The results showed that the bioreactor expanded skins to 160% in 4 hours. Histological analysis of the expanded skins revealed that epidermal cells and dermal fibroblasts were viable and remained integrity. The results of auto-grafting experiment indicated that fibrosis and scars were not detected in the grafted skins. This study demonstrates that the newly developed skin bioreactor enabled to obtain large sized full skin rapidly and successful grating.


Subject(s)
Bioreactors , Burns , Cicatrix , Fibroblasts , Fibrosis , Humans , Immunohistochemistry , Skin , Skin, Artificial , Swine , Tissue Donors , Transplants
9.
Yonsei Medical Journal ; : 265-268, 2016.
Article in English | WPRIM | ID: wpr-220772

ABSTRACT

Among various surgical methods introduced to optimize esthetic results, robotic surgery has gradually expanded in scope. As incision, approach, and operation view in robotic surgery differ from existing surgical methods, we should consider reconstruction from a different perspective. We recently experienced two mandibular reconstruction cases after tumor ablative surgery with robotic neck dissection using the conventional reconstruction method and virtual surgical planning (VSP), respectively. We found that the conventional reconstruction method is inappropriate in modified facelift incision in robotic neck dissection because it provides limited surgical scope, restricts access to the defect area, and therefore, consumes considerable time before anastomosis. For these reasons, the authors consider VSP far more viable in the era of robotic surgery.


Subject(s)
Adult , Carcinoma, Squamous Cell/diagnostic imaging , Chondrosarcoma/diagnostic imaging , Female , Humans , Imaging, Three-Dimensional , Mandibular Osteotomy/methods , Mandibular Reconstruction/methods , Neck Dissection/methods , Rhytidoplasty , Robotic Surgical Procedures/methods , Robotics/methods , Treatment Outcome
10.
Article in English | WPRIM | ID: wpr-26787

ABSTRACT

PURPOSE: The purpose of this study is to determine whether luminacin, a marine microbial extract from the Streptomyces species, has anti-tumor effects on head and neck squamous cell carcinoma (HNSCC) cell lines via autophagic cell death. MATERIALS AND METHODS: Inhibition of cell survival and increased cell death was measured using cell viability, colony forming, and apoptosis assays. Migration and invasion abilities of head and cancer cells were evaluated using wound healing, scattering, and invasion assays. Changes in the signal pathway related to autophagic cell death were investigated. Drug toxicity of luminacin was examined in in vitro HaCaT cells and an in vivo zebrafish model. RESULTS: Luminacin showed potent cytotoxicity in HNSCC cells in cell viability, colony forming, and fluorescence-activated cell sorting analysis. In vitro migration and invasion of HNSCC cells were attenuated by luminacin treatment. Combined with Beclin-1 and LC3B, Luminacin induced autophagic cell death in head and neck cancer cells. In addition, in a zebrafish model and human keratinocyte cell line used for toxicity testing, luminacin treatment with a cytotoxic concentration to HNSCC cells did not cause toxicity. CONCLUSION: Taken together, these results demonstrate that luminacin induces the inhibition of growth and cancer progression via autophagic cell death in HNSCC cell lines, indicating a possible alternative chemotherapeutic approach for treatment of HNSCC.


Subject(s)
Apoptosis , Autophagy , Carcinoma, Squamous Cell , Cell Death , Cell Line , Cell Survival , Drug-Related Side Effects and Adverse Reactions , Flow Cytometry , Head and Neck Neoplasms , Head , Humans , Keratinocytes , Neck , Signal Transduction , Streptomyces , Toxicity Tests , Wound Healing , Zebrafish
11.
Yonsei Medical Journal ; : 812-818, 2015.
Article in English | WPRIM | ID: wpr-77281

ABSTRACT

PURPOSE: Decision to perform concurrent ipsilateral thyroidectomy on patients with hypopharyngeal cancer is important, and unnecessary thyroidectomy should be avoided if oncologically feasible. We hypothesized that concurrent ipsilateral thyroidectomy is not routinely required to prevent occult metastasis. This study aimed to determine the prevalence of histological thyroid invasion in patients with hypopharyngeal cancer, and to refine the indications for prophylactic ipsilateral thyroidectomy in patients with hypopharyngeal cancer. MATERIALS AND METHODS: A retrospective review of the medical records from the Department of Otolaryngology at Yonsei University College of Medicine was conducted from January 1994 to December 2009. A total of 49 patients underwent laryngopharyngectomy with thyroidectomy as a primary treatment of hypopharyngeal cancer. RESULTS: The incidence of thyroid gland involvement was 10.2%. The most common route of invasion was direct extension through the thyroid cartilage. Thyroid cartilage invasion (p=0.034) was the most significant factor associated with thyroid invasion. Disease-specific survival at 5 years was lower in patients with than without thyroid gland invasion (26.7% vs. 55.2%, respectively; p=0.032). Disease-free survival at 5 years was also lower in patients with than without thyroid gland invasion (20.0% vs. 52.1%, respectively; p=0.024). CONCLUSION: Ipsilateral thyroidectomy in combination with total laryngopharyngectomy is indicated when invasion of the thyroid cartilage is suspected in patients with hypopharyngeal cancer.


Subject(s)
Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/epidemiology , Disease-Free Survival , Female , Humans , Hypopharyngeal Neoplasms/epidemiology , Incidence , Laryngectomy , Male , Middle Aged , Neoplasm Invasiveness , Neoplasms, Second Primary/epidemiology , Pharyngectomy , Predictive Value of Tests , Prevalence , Republic of Korea/epidemiology , Retrospective Studies , Thyroid Gland/pathology , Thyroid Neoplasms/epidemiology , Thyroidectomy/methods
12.
Article in English | WPRIM | ID: wpr-21492

ABSTRACT

BACKGROUND: Functional restoration of the facial expression is necessary after facial nerve resection to treat head and neck tumors. This study was conducted to evaluate the functional outcomes of patients who underwent facial nerve cable grafting immediately after tumor resection. METHODS: Patients who underwent cable grafting from April 2007 to August 2011 were reviewed, in which a harvested branch of the sural nerve was grafted onto each facial nerve division. Twelve patients underwent facial nerve cable grafting after radical parotidectomy, total parotidectomy, or schwannoma resection, and the functional facial expression of each patient was evaluated using the Facial Nerve Grading Scale 2.0. The results were analyzed according to patient age, follow-up duration, and the use of postoperative radiation therapy. RESULTS: Among the 12 patients who were evaluated, the mean follow-up duration was 21.8 months, the mean age at the time of surgery was 42.8 years, and the mean facial expression score was 14.6 points, indicating moderate dysfunction. Facial expression scores were not influenced by age at the time of surgery, follow-up duration, or the use of postoperative radiation therapy. CONCLUSIONS: The results of this study indicate that facial nerve cable grafting using the sural nerve can restore facial expression. Although patients were provided with appropriate treatment, the survival rate for salivary gland cancer was poor. We conclude that immediate facial nerve reconstruction is a worthwhile procedure that improves quality of life by allowing the recovery of facial expression, even in patients who are older or may require radiation therapy.


Subject(s)
Facial Expression , Facial Nerve , Follow-Up Studies , Head , Humans , Neck , Neurilemmoma , Quality of Life , Radiotherapy , Salivary Gland Neoplasms , Sural Nerve , Survival Rate , Transplants
13.
Yonsei Medical Journal ; : 1503-1514, 2015.
Article in English | WPRIM | ID: wpr-177076

ABSTRACT

PURPOSE: Although follicular thyroid cancer (FTC) has a relatively fair prognosis, distant metastasis sometimes results in poor prognosis and survival. There is little understanding of the mechanisms contributing to the aggressiveness potential of thyroid cancer. We showed that hypoxia inducible factor-1alpha (HIF-1alpha) induced aggressiveness in FTC cells and identified the underlying mechanism of the HIF-1alpha-induced invasive characteristics. MATERIALS AND METHODS: Cells were cultured under controlled hypoxic environments (1% O2) or normoxic conditions. The effect of hypoxia on HIF-1alpha, and epithelial-to-mesenchymal transition (EMT) related markers were evaluated by quantitative real-time PCR, Western blot analysis and immunocytochemistry. Invasion and wound healing assay were conducted to identify functional character of EMT. The involvement of HIF-1alpha and Twist in EMT were studied using gene overexpression or silencing. After orthotopic nude mouse model was established using the cells transfected with lentiviral shHIF-1alpha, tissue analysis was done. RESULTS: Hypoxia induces HIF-1alpha expression and EMT, including typical morphologic changes, cadherin shift, and increased vimentin expression. We showed that overexpression of HIF-1alpha via transfection resulted in the aforementioned changes without hypoxia, and repression of HIF-1alpha with RNA interference suppressed hypoxia-induced HIF-1alpha and EMT. Furthermore, we also observed that Twist expression was regulated by HIF-1alpha. These were confirmed in the orthotopic FTC model. CONCLUSION: Hypoxia induced HIF-1alpha, which in turn induced EMT, resulting in the increased capacity for invasion and migration of cells via regulation of the Twist signal pathway in FTC cells. These findings provide insight into a possible therapeutic strategy to prevent invasive and metastatic FTC.


Subject(s)
Adenocarcinoma, Follicular/genetics , Animals , Hypoxia/genetics , Cadherins/genetics , Epithelial-Mesenchymal Transition/genetics , Gene Expression Regulation, Neoplastic , Hypoxia-Inducible Factor 1, alpha Subunit/genetics , Lymphokines , Mice , Neoplasm Invasiveness , Phenotype , Real-Time Polymerase Chain Reaction , Signal Transduction/drug effects , Thyroid Neoplasms/genetics , Transcriptional Activation , Twist-Related Protein 1/genetics , Vimentin/metabolism
14.
Article in English | WPRIM | ID: wpr-8121

ABSTRACT

Thyroglossal duct carcinoma is uncommon, occurring in approximately 1% of all thyroglossal duct remnants. This rare neoplasm is characterized by relatively nonaggressive behavior with infrequent lymph nodal spread. Another rare neoplasm of the head and neck region is a carotid body tumor. A 78-year-old woman with a 3-year history of midline and bilateral neck masses was referred to us. Fine needle aspiration biopsies and a computed tomography scan suggested the diagnosis of thyroglossal duct carcinoma with cervical lymph node metastasis. Interestingly, the left-side neck mass was found to be splaying the carotid bifurcation, on computed tomography imaging. Carotid arteriography demonstrated a highly vascular mass in the bifurcation of the carotid artery that was compressing the internal and external carotid arteries. To our knowledge, this is the first reported instance of a thyroglossal duct carcinoma with neck metastasis accompanied by a carotid body tumor. In addition, the carotid body tumor in this case mimicked neck metastasis from the thyroglossal duct carcinoma.


Subject(s)
Aged , Angiography , Biopsy , Biopsy, Fine-Needle , Carotid Arteries , Carotid Artery, External , Carotid Body Tumor , Carotid Body , Diagnosis , Female , Head , Humans , Lymph Nodes , Lymphatic Metastasis , Neck , Neoplasm Metastasis , Thyroglossal Cyst
15.
Radiation Oncology Journal ; : 125-131, 2014.
Article in English | WPRIM | ID: wpr-209407

ABSTRACT

PURPOSE: We reviewed treatment outcomes and prognostic factors for patients with salivary ductal carcinoma (SDC) treated with surgery and postoperative radiotherapy from 2005 to 2012. MATERIALS AND METHODS: A total of 16 patients were identified and 15 eligible patients were included in analysis. Median age was 61 years (range, 40 to 71 years) and 12 patients (80%) were men. Twelve patients (80%) had a tumor in the parotid gland, 9 (60%) had T3 or T4 disease, and 9 (60%) had positive nodal disease. All patients underwent surgery and postoperative radiotherapy. Postoperative radiotherapy was delivered using 3-dimensional conformal radiotherapy or intensity-modulated radiotherapy. Locoregional failure-free survival (LRFFS), distant failure-free survival (DFFS), progression-free survival (PFS), and overall survival (OS) were calculated using the Kaplan-Meier method. Differences in survival based on risk factors were tested using a log-rank test. RESULTS: Median total radiotherapy dose was 60 Gy (range, 52.5 to 63.6 Gy). Four patients received concurrent weekly chemotherapy with cisplatin. Among 10 patients who underwent surgery with neck dissection, 7 received modified radical neck dissection. With a median follow-up time of 38 months (range, 24 to 105 months), 4-year rates were 86% for LRFFS, 51% for DFFS, 46% for PFS, and 93% for OS. Local failure was observed in 2 patients (13%), and distant failure was observed in 7 (47%). The lung was the most common involved site of distant metastasis. CONCLUSION: Surgery and postoperative radiotherapy in SDC patients resulted in good local control, but high distant metastasis remained a major challenge.


Subject(s)
Cisplatin , Disease-Free Survival , Drug Therapy , Follow-Up Studies , Humans , Lung , Male , Neck Dissection , Neoplasm Metastasis , Parotid Gland , Radiotherapy , Radiotherapy, Conformal , Radiotherapy, Intensity-Modulated , Risk Factors , Salivary Ducts
16.
Yonsei Medical Journal ; : 1248-1252, 2013.
Article in English | WPRIM | ID: wpr-74276

ABSTRACT

PURPOSE: To review the 5-year outcomes of our modified mandibulotomy technique. Retrospective review of a tertiary level oral cancer center. MATERIALS AND METHODS: During a 5-year period, 30 patients who had a uniform surgical technique consisting of a lower lip-splitting, modified stair-step osteotomy with thin saw blade and osteotome after plate-precontouring and combination fixation with monocortical osteosynthesis (miniplate) and bicortical osteosynthesis (maxiplate and bicortical screws), with at least 14 months postoperative follow-up, were selected and reviewed retrospectively. RESULTS: There were 8 women and 22 men with an average age of 56.5 years. All the patients involved malignancies were squamous cell carcinoma. The main primary sites of the those who underwent a mandibulotomy were the tonsil, the base of tongue, the oral tongue, the retromolar pad area, and others. Others included buccal cheek, floor of mouth, and soft palate. 23 patients received postoperative radiation therapy, and among whom 8 patients also received chemotherapy. Total four (13%) mandibulotomy-related complications occurred, only two (6.7%) requiring additional operation under general anesthesia. CONCLUSION: Our modified mandibulotomy meets the criteria for an ideal mandibulotomy technique relatively well because it requires no intermaxillary fixation, can precise preserve the occlusion in a precise way, allows early function, requires no secondary procedures, and has few complications.


Subject(s)
Adult , Aged , Female , Humans , Male , Mandible/surgery , Mandibular Osteotomy/adverse effects , Middle Aged , Oropharyngeal Neoplasms/surgery , Postoperative Complications/prevention & control , Retrospective Studies
17.
Yonsei Medical Journal ; : 139-144, 2013.
Article in English | WPRIM | ID: wpr-66230

ABSTRACT

PURPOSE: The treatment of a clinically node-positive (cN+) neck is important in the management of oral cavity squamous cell carcinoma (OSCC). However, the extent of neck dissection (ND) remains controversial. The purpose of our study was to evaluate whether level IV or V can be excluded in therapeutic ND for cN+ OSCC patients. MATERIALS AND METHODS: We performed a retrospective chart review of 92 patients who underwent a comprehensive or selective ND as a therapeutic treatment of cN+ OSCC from January 1993 to February 2009. RESULTS: The incidence rate of metastasis to level IV or V was 22% (16 of 72) on the ipsilateral neck. Of 67 cases without clinically suspicious nodes at level IV or V, 11 cases (16%, 11 of 67) had pathologically proven lymphatic metastasis to level IV or V. Only a nodal staging above N2b was significantly relevant with the higher rate of level IV or V lymph node metastasis (p=0.025). In this series, selective ND, combined with proper adjuvant therapy, achieved regional control and survival rates comparable to comprehensive ND in patients under the N stage of cN2a OSCC. CONCLUSION: In conclusion, level IV and V patients can avoid recurrence under cN2a OSCC.


Subject(s)
Adult , Aged , Carcinoma, Squamous Cell/mortality , Chemoradiotherapy , Disease-Free Survival , Female , Humans , Lymphatic Metastasis , Male , Middle Aged , Mouth Neoplasms/mortality , Neck/surgery , Neck Dissection , Neoplasm Metastasis , Radiotherapy, Adjuvant , Retrospective Studies , Treatment Outcome
18.
Article in Korean | WPRIM | ID: wpr-651091

ABSTRACT

BACKGROUND AND OBJECTIVES: Supraglottic partial laryngectomy (SPL), which provides the removal of selected tumors involving the upper structure of the glottis, shows equivalent oncologic outcome when compared to total laryngectomy with functional preservation. We report our 18-year experience of applying supraglottic partial laryngectomy in the Yonsei Head and Neck Cancer Clinic. SUBJECTS AND METHOD: We retrospectively reviewed the charts of 78 patients who underwent SPL. We divided the patients into two groups, the early and the recent, and performed Kaplan-Meier survival analysis and chi2-test on the groups. The post-operative functional outcome was assessed. RESULTS: The 3-year-disease-specific survival rate of the early and recent period was 87% and 84.6%, respectively. Decannulation and tolerability of an oral diet was possible in 93% and 95% of the earlier group, and 95% and 98% in the recent group, respectively. There was no statistically significant difference in survival rate, recurrence pattern, decannulation and tolerability of oral diet between the two groups. CONCLUSION: We achieved a satisfactory survival rate through SPL. In addition, almost all patients could be decannulated and eventually tolerated an oral diet. Our results confirm that SPL is an oncologically & functionally sound procedure for selected supraglottic tumors.


Subject(s)
Diet , Glottis , Head and Neck Neoplasms , Humans , Laryngeal Neoplasms , Laryngectomy , Recurrence , Retrospective Studies , Survival Rate
19.
Article in English | WPRIM | ID: wpr-17750

ABSTRACT

A 53-year-old woman presented with left mandibular area pain, trismus, and facial numbness that had persisted for 4 years. Physical examination revealed a 3x5 cm, hard, non-tender, and round mass on the left mandibular area. Computed tomography and magnetic resonance imaging revealed an expansile tumor involving the left mandibular ramus and temporomandibular joint area with bone destruction, extending to the base of middle cranial fossa and left zygomatic bone. The mass at the segment of left mandible and zygomatic bone, and base of middle cranial fossa was removed. Pathological examination of the mass revealed a giant cell tumor. The defect was reconstructed with iliac bone for the mandible and temporal bone and fascia for the cranial bone and dura. The case is described along with a review of the literature.


Subject(s)
Cranial Fossa, Middle , Fascia , Female , Giant Cell Tumors , Giant Cells , Humans , Hypesthesia , Magnetic Resonance Imaging , Mandible , Middle Aged , Physical Examination , Skull , Temporal Bone , Temporomandibular Joint , Trismus
20.
Yonsei Medical Journal ; : 193-197, 2012.
Article in English | WPRIM | ID: wpr-145832

ABSTRACT

PURPOSE: We hypothesized that comprehensive neck dissection could be achieved via a gasless transaxillary approach using a robotic system. We intended to evaluate the accessibility of level I, IIB and VA nodes with transaxillary robot-assisted neck dissection of four cadavers. MATERIALS AND METHODS: Transaxillary robotic neck dissection was performed in four cadavers through a 7-cm longitudinal incision at the anterior axilla and a 0.8-cm-sized incision in the chest wall. RESULTS: We successfully performed neck dissection from level II to V in all four cadavers. However, dissection of levels IIB and VA, which lie on the cephalic portion of the spinal accessory nerve, was difficult. Vital structures, including the internal jugular vein, carotid artery, vagus nerve, phrenic nerve, superior thyroid artery and hypoglossal nerve, were successfully identified and preserved. CONCLUSION: Our results demonstrate the feasibility of robot-assisted neck dissection using a transaxillary approach. We suggest that gasless, transaxillary robotic neck dissection is a promising technique for treating nodal metastasis in thyroid cancers or in selected squamous cell carcinomas of the head and neck. However, some modification of the approach might be needed when performing comprehensive neck dissections of all levels of the neck.


Subject(s)
Cadaver , Endoscopy/instrumentation , Feasibility Studies , Female , Head and Neck Neoplasms/surgery , Humans , Male , Neck/blood supply , Neck Dissection/instrumentation , Neoplasms, Squamous Cell/surgery , Robotics/methods , Thyroid Neoplasms/surgery
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