Sialendoscopy as a Useful Diagnostic and Interventional Tool for the Various Salivary Gland Disease: Our Experiences / 대한이비인후과학회지

Background and Objectives@#Sialendoscopy is useful for the diagnosis and treatment of obstructive salivary gland diseases, but not yet universally employed because it requires dedicate, expensive, and fragile endoscopic equipment; moreover, the surgical technique is also delicate. Here, we describe our initial experience of sialendoscopy, as well as the learning curve, precautions, and drawbacks that beginners must overcome in employing sialendoscopy.Subjects and Method The medical records of 98 patients who underwent sialendoscopic procedures at Eunpyeong St. Mary’s Hospital from May 2019 to March 2022 were retrospectively reviewed. The type of procedure, success rate, operation time, and complications were analyzed. @*Results@#We have performed a total of 85 sialendoscopic procedures, including 79 to treat submandibular sialolithiasis, two to treat submandibular ductal stenosis, two to treat parotid sialolithiasis, and two to treat parotid ductal stenosis. Of the total of 81 patients with sialolithiasis, 82.4% were treated by sialendoscopy only, 15.3% by hybrid procedure, and 2.3% opted to preserve the salivary gland and convert to external submandibular gland excision. Four patients with ductal stenosis were treated via endoscopic bougination; stents were placed for 4 weeks without any restenosis. The operation time was significantly shorter for the second half than for the first half of the patients (58.6 min vs. 39.8 min). Longer operation time was associated with the parotid gland diseases, larger stones (>5 mm in diameter), more proximal stones (from the salivary gland), and multiple stones. We encountered no major surgical complications. @*Conclusion@#Sialendoscopy is useful and safe; even beginners can evaluate and manage obstructive salivary gland diseases.

Effect of Occupational Noise Exposure on the Prevalence of Benign Vocal Fold Lesions: A Nationwide Population-Based Study

Objectives@#. Voice abuse in noisy environments can result in voice disorders. However, insufficient studies have sought to differentiate vocal cord lesions through laryngoscopic examinations among workers in noisy environments. This study investigated the relationship between a history of noise exposure in the workplace and benign vocal fold lesions (BVFLs). @*Methods@#. We used Korea National Health and Nutrition Examination Survey data from 2010 to 2012. The chi-square test was used to compare characteristics between two groups according to the presence or absence of BVFLs. To investigate the association between BVFLs and noise exposure in the workplace, we calculated adjusted odds ratios and 95% confidence intervals (CIs) using multiple logistic regression analysis. @*Results@#. In total, 10,170 participants with available laryngoscopy results were enrolled. Smoking history, hypertension, diabetes, and exposure to noise for more than 3 months at the workplace were significantly more common in participants with BVFLs. After adjusting for age, sex, smoking, drinking, obesity, hypertension, diabetes, income, education, and occupation as confounders, we confirmed that BVFLs were 1.52 times more likely (95% CI, 1.157–1.990) to occur in individuals with occupational noise exposure. @*Conclusion@#. Working in a noisy environment could induce BVFLs in workers through voice abuse. Social recognition that a noisy environment is a risk factor for BVFLs needs to be improved, and preventive measures should be implemented.

Guideline for the Surgical Management of Locally Invasive Differentiated Thyroid Cancer From the Korean Society of Head and Neck Surgery

The aim of this study was to develop evidence-based recommendations for determining the surgical extent in patients with locally invasive differentiated thyroid cancer (DTC). Locally invasive DTC with gross extrathyroidal extension invading surrounding anatomical structures may lead to several functional deficits and poor oncological outcomes. At present, the optimal extent of surgery in locally invasive DTC remains a matter of debate, and there are no adequate guidelines. On October 8, 2021, four experts searched the PubMed, Embase, and Cochrane Library databases; the identified papers were reviewed by 39 experts in thyroid and head and neck surgery. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence, and to develop and report recommendations. The strength of a recommendation reflects the confidence of a guideline panel that the desirable effects of an intervention outweigh any undesirable effects, across all patients for whom the recommendation is applicable. After completing the draft guidelines, Delphi questionnaires were completed by members of the Korean Society of Head and Neck Surgery. Twenty-seven evidence-based recommendations were made for several factors, including the preoperative workup; surgical extent of thyroidectomy; surgery for cancer invading the strap muscles, recurrent laryngeal nerve, laryngeal framework, trachea, or esophagus; and surgery for patients with central and lateral cervical lymph node involvement. Evidence-based guidelines were devised to help clinicians make safer and more efficient clinical decisions for the optimal surgical treatment of patients with locally invasive DTC.

Multi-Institute, Single Group, Prospective Observational Study to Evaluate the Efficacy of Mucomyst® in Relieving Symptoms of Globus Pharyngeus Refractory to Proton Pump Inhibitor

Background and Objectives@#Globus pharyngeus is one of the most common symptoms of patients visiting otorhinolaryngology out-patient clinic, and usually long-lasting, difficult to treat, and frequently recurrent. Mucomyst®, N-acetyl cysteine is an inhalation agent mainly used for mucolysis and reducing inflammation in airway via antioxidative effect. The purpose of this study was to evaluate the efficacy of inhaled Mucomyst® treatment in patients with globus pharyngeus refractory to proton pump inhibitor (PPI).Materials and Method We prospectively evaluated the efficacy of Mucomyst® in relieving symptoms of globus pharyngeus refractory to PPI in nine medical centers. Three hundred and three patients enrolled and finally 229 patients finished the inhaled Mucomyst® therapy for 8 weeks. We analyzed the change of Reflux Symptom Index (RSI), Reflux Finding Score (RFS), Visual Analogue Scale (VAS) for globus, and Globus Pharyngeus Symptom Scale (GPS) after use of Mucomyst® for 4 and 8 weeks. @*Results@#The GPS, RSI, RFS, and VAS score significantly decreased serially in patients who finished 8 week-inhalation treatment. The GPS improvement gap was significantly correlated with initial GPS (p<0.001) in multiple regression analysis. @*Conclusion@#Inhaled Mucomyst® therapy was effective for the reduction of both subjective and objective findings in refractory globus patients. This study might suggest new treatment option for patients with globus. However, further thorough studies would be needed to assess the real effect of inhaled Mucomyst® treatment as a standard treatment for globus.

Survival Benefits From Surgery for Stage IVa Head and Neck Squamous Cell Carcinoma: A Multi-Institutional Analysis of 1,033 Cases

Objectives@#. Head and neck squamous cell carcinomas (HNSCs) are frequently diagnosed at the locoregional advanced stage (stage IVa), but controversy remains regarding whether stage IVa HSNCs should be treated with upfront surgery or definitive chemoradiation therapy (CRT). The purpose of this study was to compare overall survival (OS) and disease-free survival (DFS) in patients with stage IVa HNSC treated primarily by surgery with curative intent with/without (neo)adjuvant treatment (surgery group) versus those treated primarily with CRT (CRT group). @*Methods@#. We reviewed data of 1,033 patients with stage IVa HNSC treated with curative intent at 17 cancer centers between 2010 and 2016. @*Results@#. Among 1,033 patients, 765 (74.1%) received upfront surgery and 268 (25.9%) received CRT. The 5-year OS and DFS rates were 64.4% and 62.0% in the surgery group and 49.5% and 45.4% in the CRT group, respectively. In multivariate analyses, OS and DFS were better in the surgery group than in the CRT group (odds ratio [OR] for death, 0.762; 95% confidence interval [CI], 0.592–0.981; OR for recurrence, 0.628; 95% CI, 0.492–0.802). In subgroup analyses, the OS and DFS of patients with oropharyngeal cancer were better in the surgery group (OR for death, 0.548; 95% CI, 0.341–0.879; OR for recurrence, 0.598; 95% CI, 0.377–0.948). In the surgery group, patients with laryngeal cancer showed better OS (OR for death, 0.432; 95% CI, 0.211–0.882), while those with hypopharyngeal cancer DFS was improved (OR for recurrence, 0.506; 95% CI, 0.328–0.780). @*Conclusion@#. A survival benefit from surgery may be achieved even in patients with stage IVa HNSC, particularly those with oropharyngeal and laryngeal cancer. Surgery led to a reduction in the recurrence rate in patients with hypopharyngeal cancer.

Survival Benefits From Surgery for Stage IVa Head and Neck Squamous Cell Carcinoma: A Multi-Institutional Analysis of 1,033 Cases

Objectives@#. Head and neck squamous cell carcinomas (HNSCs) are frequently diagnosed at the locoregional advanced stage (stage IVa), but controversy remains regarding whether stage IVa HSNCs should be treated with upfront surgery or definitive chemoradiation therapy (CRT). The purpose of this study was to compare overall survival (OS) and disease-free survival (DFS) in patients with stage IVa HNSC treated primarily by surgery with curative intent with/without (neo)adjuvant treatment (surgery group) versus those treated primarily with CRT (CRT group). @*Methods@#. We reviewed data of 1,033 patients with stage IVa HNSC treated with curative intent at 17 cancer centers between 2010 and 2016. @*Results@#. Among 1,033 patients, 765 (74.1%) received upfront surgery and 268 (25.9%) received CRT. The 5-year OS and DFS rates were 64.4% and 62.0% in the surgery group and 49.5% and 45.4% in the CRT group, respectively. In multivariate analyses, OS and DFS were better in the surgery group than in the CRT group (odds ratio [OR] for death, 0.762; 95% confidence interval [CI], 0.592–0.981; OR for recurrence, 0.628; 95% CI, 0.492–0.802). In subgroup analyses, the OS and DFS of patients with oropharyngeal cancer were better in the surgery group (OR for death, 0.548; 95% CI, 0.341–0.879; OR for recurrence, 0.598; 95% CI, 0.377–0.948). In the surgery group, patients with laryngeal cancer showed better OS (OR for death, 0.432; 95% CI, 0.211–0.882), while those with hypopharyngeal cancer DFS was improved (OR for recurrence, 0.506; 95% CI, 0.328–0.780). @*Conclusion@#. A survival benefit from surgery may be achieved even in patients with stage IVa HNSC, particularly those with oropharyngeal and laryngeal cancer. Surgery led to a reduction in the recurrence rate in patients with hypopharyngeal cancer.

Current concepts in thyroid gland surgery: transoral endoscopic and robotic surgical procedures

The increased incidence of thyroid cancer in young females may raise concerns about visible hypertrophic scarring on the center of the neck after thyroid gland surgery. Therefore, endoscopic surgical procedures have attracted significant interest from patients with thyroid cancer, leading to the development of various endoscopic and robotic approaches. Although the cosmetic outcomes of current endoscopic and robotic thyroid surgeries have been excellent, all the procedures still require a large incision and extensive flap elevation. Transoral endoscopic thyroid surgery is a newly developed surgical method performed by inserting an endoscope through a mucosal opening created in the mouth, obviating the need for a skin incision. Additionally, the dissection area is relatively small and no dressings are required. Showering or shaving may resume the day after surgery and the port created within the oral mucous membrane generally heals within one week. Importantly, this approach is markedly less invasive than other endoscopic approaches. Although transoral endoscopic thyroid surgery has not yet been universally accepted, it may emerge as the preferred method for thyroid surgery in the near future.

A Case of Transoral Endoscopic Thyroidectomy Combined with Facelift Modified Radical Neck Dissection / 대한이비인후과학회지

We recently experienced a case of transoral endoscopic thyroidectomy combined with a modified radical neck dissection (MRND) using a facelift approach in a patient with keloid-prone skin. A 35-year-old female was diagnosed with a papillary thyroid carcinoma, which was 1.2 cm in diameter and showed level II-III lateral cervical metastases. The patient required total thyroidectomy and MRND; however, she was concerned about the neck incision because she had keloid-prone skin. We first performed a transoral, endoscopic total thyroidectomy combined with bilateral central node dissection via a tri-vestibular approach, and then followed it by MRND (II-V) using a facelift approach with the Da Vinci robotic system. We noted no significant complications, such as vocal cord palsy, hypoparathyroidism, or permanent loss of the lower lip or auricle. This new method of combining transoral and facelift approaches will be useful for patients with small thyroid cancers and lateral neck metastases.

A Case of Transoral Endoscopic Thyroidectomy Combined with Facelift Modified Radical Neck Dissection / 대한이비인후과학회지

We recently experienced a case of transoral endoscopic thyroidectomy combined with a modified radical neck dissection (MRND) using a facelift approach in a patient with keloid-prone skin. A 35-year-old female was diagnosed with a papillary thyroid carcinoma, which was 1.2 cm in diameter and showed level II-III lateral cervical metastases. The patient required total thyroidectomy and MRND; however, she was concerned about the neck incision because she had keloid-prone skin. We first performed a transoral, endoscopic total thyroidectomy combined with bilateral central node dissection via a tri-vestibular approach, and then followed it by MRND (II-V) using a facelift approach with the Da Vinci robotic system. We noted no significant complications, such as vocal cord palsy, hypoparathyroidism, or permanent loss of the lower lip or auricle. This new method of combining transoral and facelift approaches will be useful for patients with small thyroid cancers and lateral neck metastases.

Transoral Endoscopic Thyroid Surgery: Indication, Preparation and Surgical Technique / 대한이비인후과학회지

Natural orifice transluminal endoscopic surgery (NOTES) is the latest surgical technique for inserting an endoscope through the mouth, anus, vagina etc., and for performing surgery with mucosal incision only, i.e., without skin incision. Recently, a number of researchers have applied NOTES to thyroid surgery in several trials, with the aim of removing the thyroid gland through oral cavity. The transoral endoscopic thyroid surgery became widely known after Anuwong et al. reported successful results for their first 60 patients and it has become increasingly recognized as a feasible novel surgical procedure. The purpose of this article is to review and summarize the existing literature, and describe in detail the preoperative considerations, rationale for patient selection, surgical method and postoperative management for transoral thyroid surgery.

A Case of Hepatocellular Carcinoma Metastasis to the Dorsal Tongue / 대한이비인후과학회지

Hepatocellular carcinoma (HCC) is a common neoplasm, and its metastasis to the head and neck area is rare. We herein describe a unique case of HCC metastasis to the dorsal tongue. A 54-year-old male who was already diagnosed with HCC visited our hospital complaining of dysphagia and a progressively enlarging dorsal tongue mass. We operated to excise on the mass using CO₂ laser including mucosal margin and deep margin. The diagnosis of HCC metastasis was confirmed immunohistochemically. After 2 weeks of follow-up, the patient did not exhibit any evidence of complication and could eat orally without any problem. Further treatment to the other metastatic lesion was rejected, and the patient was followed up for more than six months. We introduce this first case of metastatic HCC in the dorsal tongue. With the extended life expectancy of HCC patients, the incidence of rare metastasis is expected to increase.

A Case of Pneumorrhachis Associated with Spontaneous Pneumomediastinum and Subcutaneous Emphysema / 대한이비인후과학회지

Pneumorrhachis or epidural emphysema is an uncommon finding observed in the spinal epidural space. Pneumorrhachis could be occasionally associated with pneumomediastinum or pneumothorax or subcutaneous emphysema. Probably this results from air that leaks from the mediastinum, which traverses through the fascial planes and intervertebral neural foramina. In particular, without any causes, these conditions rarely appear simultaneously with trauma, surgery, malignancy, anesthesiological interventions, or Valsalva maneuvers. We report a case of pneumorrhachis accompanied by spontaneous pneumomediastinum and subcutaneous emphysema that was resolved after conservative treatment.

Transoral endoscopic thyroidectomy via the trivestibular route

We recently experienced a case of transoral endoscopic thyroidectomy via the trivestibular approach. We identified and preserved all neighboring critical structures during surgery. The patient was discharged on postoperative day 3. There were no complications in thyroid function, vocal cord function, or lower lip sense. Transoral endoscopic thyroidectomy via a trivestibular approach provides a short and direct route to the thyroid and an adequate workspace without a skin incision. Therefore, it is worthwhile to develop and refine the surgical techniques of this promising new surgical approach.

Relationship Between Preepiglottic Space Invasion and Lymphatic Metastasis in Supracricoid Partial Laryngectomy With Cricohyoidopexy

OBJECTIVES: The aim of this study was to determine the role of preepiglottic space (PES) invasion in lymph node metastasis and prognosis in patients undergoing supracricoid partial laryngectomy (SCPL) with cricohyoidopexy (CHP). METHODS: A retrospective review of 42 previously untreated patients with squamous cell carcinoma of the larynx that underwent surgery was performed. The mean age of the subjects was 61.3 years, and the male-to-female ratio was 38:4. Regarding their pathological stages, there were 3, 8, 22, and 9 cases of stage T1 to T4, respectively. Concerning the disease stage of the cervical lymph nodes, there were 30, 5, 6, and 1 cases with N0 to N3, respectively. RESULTS: The PES invasion rate was 23.8% (10/42). Significant correlations were found between PES invasion and cervical lymph node metastasis (P=0.002). Seven of the 10 patients (70.0%) with PES invasion had cervical lymph node metastasis, whereas only 5 of the 32 patients (15.6%) without any evidence of PES invasion had lymph node metastasis. There was also a significant correlation of PES invasion with age (P=0.002) and T stage (P=0.030). However, there was no significant relationship between gender, primary tumor site, anterior commissure invasion, subglottic extension, paraglottic space invasion and PES invasion. There was a 5-year disease-specific survival of 70%. PES invasion served as a statistically significant prognostic factor for disease-specific survival (P=0.004). Cervical nodal metastasis (P=0.003) and subglottic extension (P=0.01) were also statistically significant prognostic factors associated with disease-specific survival. CONCLUSION: The PES invasion was significantly related to the cervical lymph node metastasis and prognosis in patients undergoing SCPL with CHP.

Relationships between Tumor Volume and Lymphatic Metastasis and Prognosis in Early Oral Tongue Cancer

OBJECTIVES: Although T stage is an important prognostic tool for oral tongue cancer, it fails to define the depth of invasion and true three-dimensional volume of primary tumors. The purpose of this paper is to determine the relations between tumor volume and lymph node metastasis and survival in early oral tongue cancer. METHODS: Forty-seven patients with T1-2 tongue cancer were included. Tumor volumes were measured by the computerized segmentation of T2-weighted magnetic resonance imaging. RESULTS: The overall average tumor volume was 27.7 cm3 (range, 1.4 to 60.1 cm3). A significant positive correlation was found between tumor volume and pathological T stage, depth of invasion, and cervical lymph node metastasis (P or =20 cm3) and the 5-year disease-specific survival (P=0.046). CONCLUSION: Tumor volume larger than 20 cm3 was associated with greater risk cervical lymph node metastasis and poor 5-year disease-specific survival rate in early oral tongue cancer patients.

Analysis of Recipient Vessel for Microvascular Reconstruction of the Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the relationship between the free flap compromise and the choice of recipient vessels, the method of venous anastomosis, the use of an interposition vein graft, and the number of venous anastomosis for microvascular anastomosis. SUBJECTS AND METHOD: A retrospective review was carried out for 237 patients who underwent 247 microvascular free flap reconstructions after head and neck ablative surgery from October 1993 to July 2009. Flap donor sites included the radial forearm (n=187), anterolateral thigh (n=34), rectus abdominis (n=11), fibula (n=8), and lateral thigh (n=7). RESULTS: The frequently used recipient artery included facial (66.4%), superior thyroid (17.8%), lingual (8.1%), transverse cervical (6.9%), and external carotid (0.8%). The recipient vein included facial (43.7%), external jugular (39.3%), superior thyroid (5.8%), anterior jugular (1.7%), and transverse cervical (0.7%). End-to-end venous anastomoses were completed in 230 flaps and end-to-side anastomoses in 14 flaps. Three patients had one end-to-end and one endto- side anastomoses. The interposition vein grafts were used in 3 cases. Dual venous anastomoses were performed in 48 cases and single anastomosis in 199 cases. Twenty-one (8.5%) cases of free flap compromise due to vascular obstruction were identified and 11 flaps were lost (4.5%) with an overall success rate of 95.5%. There was no relationship between free flap compromise and the choice of recipient artery (p=0.360) or vein (p=0.125), the method of venous anastomosis (p=0.683), the use of an interposition vein graft (p=0.595), and the number of venous anastomosis (p=0.076). CONCLUSION: All vessels in the head and neck are potentially suitable for microvascular anastomoses. Flap compromise was not related to the method of venous anastomosis, the interposition vein graft or the number of venous anastomosis.

Rehabilitation Protocol for Postoperative Dysphagia in Head and Neck Cancer Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Treatment of head and neck cancer patients with surgical removal may result in some degree of dysphagia. Swallowing disorders depend on the site, the extent of surgical resection, and the nature of the surgical reconstruction. As a result, rehabilitation needs to be managed by head and neck surgeons with specific anatomical knowledge. However, in Korea, only occupational therapists can get approval for dysphagia rehabilitation from the national health insurance cooperation. Therefore, we designed a Advanced Rehabilitation Protocol (ARP) rehabilitation and carried out a comparative study against the current rehabilitation protocol. SUBJECTS AND METHOD: Data were collected by reviewing medical records of 40 patients who received operation on oral cavity, larynx and hypopharynx from November 2007 to January 2009. Of these, 20 patients were treated with ARP under the management of head and neck surgeons but the other 20 patients were not. RESULTS: Although the results had no statistical significance, the study showed that ARP had the effect of shortening the rehabilitation and enabled them to start adjuvant therapies early. CONCLUSION: Rehabilitation needs to be managed cooperatively by a multidisciplinary team that includes an otolaryngologist who has specific anatomical knowledge of the concerned area and reconstruction according to specific swallowing problems.

Clinical Outcome of Squamous Cell Carcinoma of the Tongue in Young Patients: A Stage-Matched Comparative Analysis

OBJECTIVES: The reported incidence of tongue cancer in young patients has recently increased. The aim of this study was to analyze the clinical characteristics of tongue cancer in a young group of patients, and to compare them with those of an older group of tongue cancer patients. METHODS: We retrospectively reviewed the records of 85 patients who were diagnosed with squamous cell carcinoma of the tongue. They were divided into two age groups: over 45 years of age and under 45 years. To compare the prognosis of similarly staged patients in the group, each age group was divided into the early (stage I, II) and advanced stage groups (stage III, IV), and then they were compared. The young group consisted of 23 patients and the older group had 62 patients. RESULTS: At the early stage, the clinical prognosis of the patients in both age groups was good, and no significant difference was observed. However, at the advanced stage, the overall and regional recurrence rates were significantly higher in the younger age group as compared to that in the old age group (P=0.007, P=0.001, respectively). The disease-specific survival rate of the patients in the young group was significantly lower than that in the old age group (P=0.025). CONCLUSION: Tongue cancer in young subjects has significantly different clinical outcomes according to the stage. The clinical outcome of the advanced-stage tongue cancer in young subjects was poorer than that in the older subjects. Regional recurrence seemed to be the main cause of the poor prognosis.

Patterns and Clinical Significance of Nodal Metastasis in Squamous Cell Carcinoma of Hypopharynx / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the incidence and prognostic significance of cervical lymph node metastasis in squamous cell carcinoma (SCC) of the hypopharynx. SUBJECTS AND METHOD: A retrospective review of the 64 patients who were previously untreated for SCC of the hypopharynx and underwent surgery was performed from October 1993 to June 2008. Fifty-six patients had simultaneous bilateral neck dissection, whereas eight had unilateral neck dissection. RESULTS: The median age was 61.0 years (range, 34-75 years) for the study group consisting of 62 males and two females. Evaluating according to the N stages, there were 15 (23.4%), 10 (15.6%), 37 (57.8%), and 2 (3.1%) cases with N0, N1, N2 and N3, respectively. Forty-nine patients (76.6%) had pathologically proven cervical metastasis. Contralateral occult lymph node metastasis occurred in 20.5%. Ipsilateral and contralateral occult metastasis rates for clinically node negative patients were 41.2% and 11.8%, respectively. The most frequent sites for positive neck nodes occuring at each level were as follows: II (48.5%), level III (40.6%), level IV (26.6%), paratracheal node (21.4%), level V (9.4%), levels I (7.8%), and retropharyngeal node (6.3%). The 5-year overall survival and disease-specific survival rates were 50% and 53%, respectively. Cervical nodal metastasis (p=0.044) was statistically significant prognostic factors for disease-specific survival. CONCLUSION: Metastasis to the cervical lymph node group is very frequent and has an impact on survival in patients with hypopharyngeal SCC. Therefore, we advocate bilateral neck dissection in patients with hypopharyngeal SCC with clinically positive metastasis. Ipsilateral elective neck dissection may be needed for clinically node negative patients.

Congenital Middle Ear Cholesteatoma in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Congenital middle ear cholesteatoma (CMEC) is a rare entity that may go undiagnosed for years. Aims of this study were to assess the characteristic features and recurrence of CMEC in pediatric patients of different stages and to determine the value of preoperative CT scan in CMEC. SUBJECTS AND METHOD: Thirty cases of CMEC under 15 years old that had been treated at the hospitals of the Catholic University from 1995 through 2005 were reviewed retrospectively. The age range was from 2 to 13 with the mean age of 6.2. The main outcome measures were CT findings, surgical findings, recurrence rate and hearing assessment. RESULTS: Preoperative CT scan accurately predicted the extent of the cholesteatoma seen during surgery in 25/30 (83.3%). The recurrence rate of CMEC was 6.7% (2/30) and all of recurrent cases were belonged to stage IV. In the recurrent cases, cholesteatomas were extended to sinus tympani and facial recess at revisional operation as well as at the initial operation. CONCLUSION: Preoperative CT scan is essential in defining the extent of existing pathology. The intra-operative CMEC extension and location influence the outcome of surgery. In the higher stages, careful eradication of disease, particularly in the region of sinus tympani and facial recess, are recommended.