Guidelines for the Surgical Management of Laryngeal Cancer: Korean Society of Thyroid-Head and Neck Surgery

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.

The Efficacy of Voice Screening Using the Thyroidectomy Related Voice Questionnaires / 대한이비인후과학회지

Most common cause of vocal dysfunction after thyroidectomy is nerve injury, but an understanding of the anatomy and surgical techniques associated with such voice problems reduces the risk of damage to these nerves. Despite these efforts, many patients still suffer from voice-related problems without obvious accidental nerve injury or vocal-cord palsy. The possible causes of vocal dysfunction without nerve injury are a strap muscle contraction due to surgery, impairment of laryngeal movement, laryngeal trauma after endotracheal intubation, modification of the vascular supply, and psychological problem. However, multiple means of assessing vocal function are time-consuming, require specific instruments and specialists, and increase costs. Thus, the authors developed the Perioperative Voice-Screening Protocol for Thyroid Surgery using the Thyroidectomy-Related Voice Questionnaire (TVQ). This questionnaire was developed at our institution and is a self-assessment tool that measures quality of voice. It consists of 20 questions; responses to each are scored from a minimum of 0 (no voice alterations or symptoms) to a maximum of 80 (highest voice impairment and multiple vocal symptoms). This questionnaire was developed based on the voice handicap index and it concern general voice complaints, representative symptoms related to LPR and vocal cord palsy, and swallowing-related symptoms associated with thyroidectomy. Based on the results of the study, we recommend that a preoperative voice work-up should be performed in patients with a high preoperative TVQ score (≥5). We also recommend that a postoperative voice work-up should be performed in patients with a high postoperative TVQ score (≥25).

Three-Dimensional Reconstruction Based on Images from Spiral High-Resolution Computed Tomography of Temporal Bone: Anatomy and Clinical Application / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The intricate anatomy of the temporal bone has always been difficult to visualize. In this regard, the advantages of computer-assisted reconstruction of temporal bone based on image data from computed tomography (CT) are widely recognized. The goal of this study was to investigate the usefulness of three-dimensional (3D) reconstruction of computed tomography in determining the anatomy and topographic relationship of various important structures. SUBJECTS AND METHOD: For 40 ears of 20 patients with various otological diseases, 3D reconstruction based on image data from spiral high-resolution CT was performed by segmentation, volume-rendering and surface-rendering algorithm on a personal computer. The scanning was carried out in axial plane with technical factors of 140 kV, 100 mAs, 1 mm thickness, and 1 second scanning time. A software (Vworks(TM) 4.0, CyberMed Inc, Korea) was used for image processing. RESULTS: We were able to demonstrate the 3D display of the middle and inner ear structures. The computer-assisted measurement of reconstructed structures demonstrated the anatomic details comprehensively, which improved the surgeon's understanding of their spatial relationship, and provided many details that could not be easily measured in vivo. CONCLUSION: The 3D reconstruction of temporal bone CT can be useful in demonstrating and thus understanding the anatomical structures of temporal bone. Also, its clinical applications are inestimable. But it is necessary to confirm the correlation between 3D reconstructed images and histologic sections through the validation study.

The Clinical Significance of Three-Dimensional Reconstruction of Paranasal Sinus Computed Tomography in Assessing the Aeration of Unilateral Maxillary Sinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purposes of this study were to evaluate the aeration of maxillary sinus, using 3-dimensional reconstruction of computed tomography (3DR-CT), to compare the estimated air volume of the normal maxillary sinus with that of the inflamed one, and to evaluate the relationship between the aeration of maxillary sinus and the degree of decreased area of natural ostium. SUBJECTS AND METHOD: In 10 patients having unilateral maxillary sinusitis refractory to proper medical therapy, 3-dimensional reconstruction images were obtained based on high-resolution CT by surface-rendering technique on a personal computer. A software (Vworks(TM) 4.0, CyberMed Inc, Korea) was used for 3-dimensional reconstruction. "Maxillary ostium on CT" was defined to measure the maxillary natural ostium on 3-dimensional reconstruction images. RESULTS: In unilateral maxillary sinusitis, an air volume of the affected sinus was 4.71+/-3.12 mL, and that of the contralateral normal one was 13.29+/-9.76 mL. The area of the affected "maxillary ostium on CT" was 11.10+/-14.40 mm2, and that of the contralateral normal sinus was 24.20+/-18.64 mm2. The air volume and area of "maxillary ostium on CT" of the affected maxillary sinus were reduced significantly, compared with those of the contralateral normal one (p<0.05). But, there was no significant correlation between the aeration of maxillary sinus and the degree of decreased area of "maxillary ostium on CT" (p=0.285). CONCLUSION: 3DR-CT is the new technique, which enables us to measure the volume of maxillary sinus as well as the area of maxillary ostium. Also, it is helpful in assessing the aeration of maxillary sinus.