A Case of Laryngeal Amyloidosis: Role of US and US-CNB for Preoperative Diagnosis / 대한이비인후과학회지

Amyloidosis is a rare benign disease characterized by the extracellular deposition of nonsoluble fibrillar proteins (amyloids) within organs. Laryngeal amyloidosis (LA) accounts for only 9%-15% of all cases of amyloidosis. Since clinical manifestations and laryngoscopic findings often overlap with those of laryngeal cancer, it is challenging to differentiate LA from laryngeal cancer prior to surgical biopsy. We report a case of LA mimicking laryngeal cancer, in which the diagnosis was facilitated by preoperative ultrasonography (US) and US-guided core-needle biopsy (US-CNB) prior to surgical biopsy. The US findings of this case were distinguishable from those of laryngeal cancer, which enabled us to consider a diagnosis other than laryngeal cancer. Amyloidosis was diagnosed preoperatively using office-based percutaneous US-CNB, avoiding general anesthesia needed for suspension laryngoscopic examination. This case suggests that US and US-CNB could be used as supplementary diagnostic modalities to evaluate suspicious laryngeal masses mimicking laryngeal cancer.

Role and Recent Trend of Intraoperative Parathyroid Hormone Monitoring During Parathyroidectomy in Patients With Primary Hyperparathyroidism / 대한이비인후과학회지

In the last few decades, the standard surgical treatment for primary hyperparathyroidism (PHPT) has shifted from bilateral neck exploration to focused/minimally invasive parathyroidectomy (FMIP). This shift was accelerated by the introduction of intraoperative parathyroid hormone (IOPTH) monitoring, which can provide intraoperative information regarding the localization and complete excision of the pathological parathyroid gland during FMIP. Since the first clinical application of the IOPTH assay in 1991, IOPTH monitoring has substantially improved to date to increase its performance and availability. In addition, the clinical applications of IOPTH changed with the needs of actual clinical practice, although the fundamental concept and technique remained unchanged. In this review, we discuss the role of IOPTH monitoring in the surgical management of PHPT based on the results of contemporary studies and summarized the major issues regarding IOPTH.

Comparison of the Facelift Incision versus V-Shaped Incision for Parotidectomy / 대한이비인후과학회지

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.

Bozola Flap for Oral Cavity Reconstruction in Patients with Tongue Cancer / 대한이비인후과학회지

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.

Severe Upper Gastrointestinal Bleeding in Patients on Antithrombotic Therapy

BACKGROUND/AIMS: As the elderly population taking antithrombotic therapy (ATT) increases, gastrointestinal (GI) bleeding risk during ATT may likely increase. This study was conducted to evaluate the clinical characteristics of severe upper GI bleeding (UGIB) during ATT. MATERIALS AND METHODS: Among patients on ATT at Gyeongsang National University Hospital between March 2005 and February 2010, those with severe UGIB requiring endoscopic hemostasis were selected for the study. Their medical records were retrospectively reviewed for clinical variables. RESULTS: Among 59,773 patients taking ATT, 125 (0.21%) developed severe UGIB and comprised 12.8% of the overall endoscopic hemostasis cases (125/978) during the same period. The patients with severe UGIB on ATT were older than the ones not on ATT (68.3 vs. 59.9 years, P<0.001). The common indications for ATT were cardiovascular (60.8%, 76/125) and cerebrovascular diseases (25.6%, 32/125). Fifty-nine patients (47.2%) were taking two or more agents, 36 (28.8%) were on aspirin monotherapy, while 22 (17.6%) were taking warfarin alone. Aspirin was involved in 68.8% (86/125) of severe UGIB. According to ATT type, the incidence of severe UGIB was 0.48% with warfarin, 0.38% with aspirin, and 0.33% with clopidogrel. The main causes of severe UGIB were gastric (78, 62.4%) and duodenal ulcers (15, 12.0%). UGIB recurred in 11 cases (8.8%), but all were successfully controlled with repeated hemostasis and there was no mortality. CONCLUSIONS: The frequency of severe UGIB during ATT was 0.21%. Aspirin was the most common agent leading to severe UGIB, but its incidence was highest with warfarin. Gastric ulcer was the most common focus. Endoscopic hemostasis was effective and safe for UGIB during ATT.

Pneumoretroperitoneum, Pneumomediastinum, Subcutaneous Emphysema After a Rectal Endoscopic Mucosal Resection

An endoscopic mucosal resection (EMR) is an effective and safe therapeutic technique for treating a patient with a laterally-spreading tumor (LST). Colonoscopic-procedure-related complications are noted to be about 2.8% worldwide, and a perforation is the most common. Most colon perforations cause pneumoperitoneum. However, a perforation within the retroperitoneal portion of the colon (rectum and some of sigmoid colon) may cause an extraperitoneal perforation, and the leaking free air may induce pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema, depending on the amount of discharged air. Herein, we present the case of a patient with an extraperitoneal colon microperforation which manifested as pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema after an EMR for a sigmoid LST, which was successfully treated with medical treatment and endoscopic clipping.