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The Korean Society of Laryngology, Phoniatrics and Logopedics created a task force to establish clinical practice guidelines for the use of botulinum toxin (BT) in otolaryngology. We selected 10 disease categories: spasmodic dysphonia, essential vocal tremor, vocal fold granuloma, bilateral vocal fold paralysis, Frey’s syndrome, sialocele, sialorrhea, cricopharyngeal dysfunction, chronic sialadenitis, and first bite syndrome. To retrieve all relevant papers, we searched the CORE databases with predefined search strategies, including Medline (PubMed), Embase, the Cochrane Library, and KoreaMed. The committee reported 13 final recommendations with detailed evidence profiles. The guidelines are primarily aimed at all clinicians applying BT to the head and neck area. In addition, the guidelines aim to promote an improved understanding of the safe and effective use of BT by policymakers and counselors, as well as in patients scheduled to receive BT injections.
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Background and Objectives@#There have not been any studies that compared retroauricular hairline (RAH) and V-shaped incisions for parotidectomy. In this regard, we aimed to evaluate the results of RAH and V-shaped incisions.Subjects and Method Between 2016 and 2019, 81 patients who underwent parotidectomy using RAH (n=46) and V-shaped (n=35) incisions were included in this study. Patient characteristics, tumor profiles, surgical parameters, postoperative complications, and cosmetic results were assessed. Mann-Whitney U test and the chi-squared test were used to inspect differences in continuous and categorical variables between the groups, respectively. @*Results@#In the RAH and V-shaped groups, the patient age was 52.7 and 42.1 years, respectively (p=0.002), and the tumour size was 2.7 and 1.8 cm, respectively (p<0.001). All parotidectomies were successfully completed with no incision extension or major complications. There were no significant differences in surgical parameters and postoperative complications between the two groups. The subjective scar satisfaction scores assessed at 3 months postoperatively were 9.0 and 9.3 in the RAH and V-shaped groups, respectively (p=0.191). The scores of male patients were 8.9 and 9.5 in the RAH and V-shaped groups, respectively, (p=0.026), while those of the female patients were 9.2 and 9.2, respectively (p=0.906). @*Conclusion@#The RAH and V-shaped incisions yields comparable surgical and cosmetic outcomes, with high patient satisfaction. For male patients, the use of V-shaped incision, if indicated, would provide higher scar satisfaction than the use of RAH incision.
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Purpose@#We aimed to evaluate the true prevalence and characteristics of vagus nerve (VN) variations using the carotid artery (CA) and the internal jugular vein (C-I axis). @*Methods@#We examined patients who underwent neck ultrasonography (US) conducted by a single operator. A VN variation was defined as a VN located anterior or medial to the C-I axis. The subtypes of VN variation were classified as anterolateral, anteromiddle, anteromedial, and medial based on the relative location of the VN to the CA. The primary outcome parameters were the prevalence of VN variations and differences according to side, age, and sex. @*Results@#Out of 536 patients, right and left VN variations were identified in 20 (3.7%) and 186 (34.7%), respectively (P<0.001). The anteromiddle type was the commonest type observed on both sides. Eight right (1.5%) and 50 left VNs (9.3%) were located <2 mm from the lateral border of the ipsilateral thyroid gland (P<0.001). The prevalence of VN variations in male and female patients was 42.1% and 32.7%, respectively (P=0.029), and that in patients aged <20, 20-39, 40-59, and ≥60 years was 23.8%, 22.5%, 34.4%, and 47.4%, respectively (P<0.001). @*Conclusion@#Variations in the VN position were relatively common on US. The variations primarily involved the left VN in the lower cervical region, and an increasing prevalence with age was observed.
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Objective@#To evaluate the feasibility and diagnostic performance of ultrasound (US)-guided fine-needle aspiration cytology and core-needle biopsy (US-FNAC/CNB) for the diagnosis of laryngo-hypopharyngeal masses. @*Materials and Methods@#This was a single-center prospective case series. From January 2018 to June 2019, we initially enrolled 40 patients with highly suspicious laryngo-hypopharyngeal masses on laryngoscopic examinations. Of these, 28 patients with the mass involving or abutting the pre-epiglottic, paraglottic, pyriform sinus, and/or subglottic regions were finally included. These patients underwent US examinations with/without subsequent US-FNAC/CNB under local anesthesia for evaluation of the laryngo-hypopharyngeal mass. @*Results@#Of the 28 patients who underwent US examinations, a laryngo-hypopharyngeal mass was identified in 26 patients (92.9%). US-FNAC/CNB was performed successfully in 25 of these patients (96.2%), while the procedure failed to target the mass in 1 patient (3.8%). The performance of US caused minor subclinical hematoma in 2 patients (7.7%), but no major complications occurred. US-FNAC/CNB yielded conclusive results in 24 (96.0%) out of the 25 patients with a successful procedure, including 23 patients with squamous cell carcinoma (SCC) and 1 patient with a benign mass. In one patient with atypical cells in US-FNAC, additional direct laryngoscopic biopsy (DLB) was required to confirm SCC. Among the 26 patients who received US-FNAC/CNB, the time from first visit to pathological diagnosis was 7.8 days. For 24 patients finally diagnosed with SCC, the time from first visit to the initiation of treatment was 25.2 days. The mean costs associated with US-FNAC/CNB was $272 under the Korean National Health Insurance Service System. @*Conclusion@#US-FNAC/CNB for a laryngo-hypopharyngeal mass is technically feasible in selected patients, providing good diagnostic performance. This technique could be used as a first-line diagnostic modality by adopting appropriate indications to avoid general anesthesia and DLB-related complications.
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Objective@#To evaluate the feasibility and diagnostic performance of ultrasound (US)-guided fine-needle aspiration cytology and core-needle biopsy (US-FNAC/CNB) for the diagnosis of laryngo-hypopharyngeal masses. @*Materials and Methods@#This was a single-center prospective case series. From January 2018 to June 2019, we initially enrolled 40 patients with highly suspicious laryngo-hypopharyngeal masses on laryngoscopic examinations. Of these, 28 patients with the mass involving or abutting the pre-epiglottic, paraglottic, pyriform sinus, and/or subglottic regions were finally included. These patients underwent US examinations with/without subsequent US-FNAC/CNB under local anesthesia for evaluation of the laryngo-hypopharyngeal mass. @*Results@#Of the 28 patients who underwent US examinations, a laryngo-hypopharyngeal mass was identified in 26 patients (92.9%). US-FNAC/CNB was performed successfully in 25 of these patients (96.2%), while the procedure failed to target the mass in 1 patient (3.8%). The performance of US caused minor subclinical hematoma in 2 patients (7.7%), but no major complications occurred. US-FNAC/CNB yielded conclusive results in 24 (96.0%) out of the 25 patients with a successful procedure, including 23 patients with squamous cell carcinoma (SCC) and 1 patient with a benign mass. In one patient with atypical cells in US-FNAC, additional direct laryngoscopic biopsy (DLB) was required to confirm SCC. Among the 26 patients who received US-FNAC/CNB, the time from first visit to pathological diagnosis was 7.8 days. For 24 patients finally diagnosed with SCC, the time from first visit to the initiation of treatment was 25.2 days. The mean costs associated with US-FNAC/CNB was $272 under the Korean National Health Insurance Service System. @*Conclusion@#US-FNAC/CNB for a laryngo-hypopharyngeal mass is technically feasible in selected patients, providing good diagnostic performance. This technique could be used as a first-line diagnostic modality by adopting appropriate indications to avoid general anesthesia and DLB-related complications.
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Background and Objectives@#The incidence of papillary thyroid microcarcinoma (PTMC) continues to increase worldwide. However, there is a lack of a comprehensive understanding of recurrence after hemithyroidectomy in patients with PTMC. We aimed to evaluate the characteristics and risk factors of recurrence after hemithyroidectomy in patients with PTMC.Subjects and Method We included 527 patients with PTMC who underwent hemithyroidectomy between 2009 and 2017. @*Results@#At a mean follow-up of 76.4 months after hemithyroidectomy, recurrence occurred in 4.2% (22/527) of the patients. The times of recurrence were 60 months after initial surgery in 1 (4.5%), 6 (27.3%), 5 (22.7%), 4 (18.2%), 4 (18.2%), and 2 (9.1%) patient(s), respectively. The most common recurrence site was the contralateral remaining thyroid lobe. In univariate analyses, only multifocality was demonstrated to be associated with an increased risk of recurrence [hazard ratio (HR), 2.834; confidence interval (CI), 1.044-7.693; p=0.041). In multivariate analyses, multifocality (HR, 2.982; CI, 1.091-8.155; p=0.033) and central lymph node metastasis (HR, 9.649; CI, 1.238-75.217; p=0.030) were demonstrated to be associated with an increased risk of recurrence. @*Conclusion@#The follow-up after hemithyroidectomy for PTMC should focus on the postoperative 1–5-year period with meticulous inspection of the remaining thyroid lobe, particularly in patients with multifocality or central lymph node metastasis.
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BACKGROUND AND OBJECTIVES: The purpose of the present study was to compare the results of V-shaped and modified facelift incisions for parotidectomy. SUBJECTS AND METHOD: Ninety parotidectomy patients who underwent V-shaped and modified facelift incisions from 2014 to 2018 were enrolled in this study. Patient characteristics, tumor profiles, surgical outcomes, postoperative complications, and cosmetic results were assessed for the V-shaped (n=20) and modified facelift (n=70) incision groups. RESULTS: The tumor size was significantly larger in the modified facelift incision group than in the V-shaped incision group (2.6 cm vs. 1.9 cm, p < 0.001). There were no significant differences between the two groups regarding other baseline tumor characteristics, operating time, and postoperative complications. Although the results of Vancouver Scar Scale was similar in both groups, the V-shaped incision group showed higher subjective scar satisfaction scores than the modified facelift incision group (9.3 vs. 8.6, p=0.001). CONCLUSION: The results suggest that the V-shaped incision is feasible and can provide better subjective scar satisfaction in selected parotidectomy patients without increased complications.
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Humanos , Cicatriz , Métodos , Neoplasias de la Parótida , Complicaciones Posoperatorias , RitidoplastiaRESUMEN
BACKGROUND AND OBJECTIVES: The purpose of the present study was to evaluate the usefulness of a posterior-based buccinator myomucosal flap (the Bozola flap) for the reconstruction of oral cavity defects after tongue cancer resection. SUBJECTS AND METHOD: Fifteen patients who underwent from 2014 to 2016 reconstruction of the oral cavity with a Bozola flap after surgical management of tongue cancer were enrolled in the study. Patient characteristics, surgical outcomes, and complications associated with the Bozola flap were evaluated. RESULTS: The flap was successfully harvested and transferred in all patients. The mean flap harvesting time was 25.3 min. The donor site was closed primarily in 14 patients, and a buccal fat pad flap was used in one patient. Although partial necrosis of the flap occurred in two patients, no other major complications were noted. CONCLUSION: The results of this study demonstrate that the Bozola flap is a good option for reconstruction of moderate sized oral cavity defects in tongue cancer patients.
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Humanos , Tejido Adiposo , Métodos , Mucosa Bucal , Boca , Necrosis , Procedimientos de Cirugía Plástica , Donantes de Tejidos , Neoplasias de la Lengua , LenguaRESUMEN
BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the feasibility and safety of a retroauricular hairline incision in partial superficial parotidectomy. SUBJECTS AND METHOD: Twenty-three patients who underwent partial superficial parotidectomy via retroauricular hairline incision from 2014 to 2016 were enrolled in the study. Patient's characteristics, surgical outcomes and postoperative complications were assessed. Subjective cosmetic satisfaction was assessed using a visual analog scale 3 months after surgery. RESULTS: In all 23 cases, parotid tumors were removed successfully via retroauricular hairline incision alone without any exposure failure. The mean operating time and the amount of postoperative drainage was 117.6 min (range, 75–163 min) and 51.5 mL (range, 25–91), respectively. Major complications such as permanent facial nerve paralysis and hematoma were not reported. The mean visual analogue scale score for subjective satisfaction with the incision scar was 9.0 (range, 6–10). CONCLUSION: We conclude that partial superficial parotidectomy via retroauricular hairline incision for the treatment of benign parotid tumor is technically feasible and it provides excellent cosmetic outcomes without an increase in complications.
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Humanos , Cicatriz , Drenaje , Nervio Facial , Hematoma , Métodos , Parálisis , Glándula Parótida , Complicaciones Posoperatorias , Escala Visual AnalógicaRESUMEN
BACKGROUND AND OBJECTIVES@#The purpose of this study was to evaluate the feasibility and safety of a retroauricular hairline incision in partial superficial parotidectomy.SUBJECTS AND METHOD: Twenty-three patients who underwent partial superficial parotidectomy via retroauricular hairline incision from 2014 to 2016 were enrolled in the study. Patient's characteristics, surgical outcomes and postoperative complications were assessed. Subjective cosmetic satisfaction was assessed using a visual analog scale 3 months after surgery.@*RESULTS@#In all 23 cases, parotid tumors were removed successfully via retroauricular hairline incision alone without any exposure failure. The mean operating time and the amount of postoperative drainage was 117.6 min (range, 75–163 min) and 51.5 mL (range, 25–91), respectively. Major complications such as permanent facial nerve paralysis and hematoma were not reported. The mean visual analogue scale score for subjective satisfaction with the incision scar was 9.0 (range, 6–10).@*CONCLUSION@#We conclude that partial superficial parotidectomy via retroauricular hairline incision for the treatment of benign parotid tumor is technically feasible and it provides excellent cosmetic outcomes without an increase in complications.
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BACKGROUND AND OBJECTIVES: Pectoralis major flap is the most versatile and reliable flap in the head and neck reconstruction. Owing to the recent development of microsurgical techniques, free flap reconstruction is gaining its popularity as a primary option for the reconstruction of head and neck defects. However, pectoralis major flap is a useful workhorse for the wide variety of situations including heavily irradiated neck, failure of prior reconstruction, and poor recipient vascular status. This study aimed to review our experience of pectoralis major flap surgery and to evaluate its clinical usefulness. SUBJECTS AND METHOD: We reviewed medical records of 113 patients (130 cases) who underwent pectoralis major flap surgery from 1995 to 2014. Indications and complications of pectoralis major flap surgery were evaluated. Association between complication rates and clinical factors were analyzed. RESULTS: Reconstruction of primary surgical defect was the most common indication (n=81/130, 62.3%). Complications developed in 17 cases (13.1%). Flap failure was observed in 2 cases (1.5%). The length of flap pedicle was closely related with complication rate (p=0.01). However, other factors including flap size, types of flap, radiation history did not influence complication rate. CONCLUSION: Pectoralis major flap is still a very useful option with a relatively low risk of complication for the head and neck reconstruction even in the era of frequent free flap surgery and heavy irradiation.
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Humanos , Colgajos Tisulares Libres , Cabeza , Registros Médicos , Cuello , Músculos Pectorales , Complicaciones Posoperatorias , Procedimientos de Cirugía Plástica , Colgajos QuirúrgicosRESUMEN
Synchronous or metachronous head and neck cancer is known to occur in up to 20% of patients, negatively affecting long-term prognosis. We experienced a case of metachronous head and neck cancers in a Human papillomavirus (HPV)-positive patient without a history of smoking, initially presenting with as a cancer of unknown primary (CUP), and then with a contralateral tonsil cancer with metastatic lymphadenopathy five years later. This report highlights the clinical usefulness of HPV typing to determine the optimal extent of surgery and the follow-up strategy in CUP.