Langerhans Cell Histiocytosis of the Tongue: A Clinical Case Report and Review of the Literature / 대한이비인후과학회지

Langerhans cell histiocytosis (LCH) is commonly characterized by abnormal function and differentiation or proliferation of monocytes. In LCH, granulomatous lesions, including langerine- positive histocytes and inflammatory infiltrates, can occur at all tissues, particularly the bones, skin, lungs, and pituitary gland. Thirty nine-year-old male patient visited outpatient clinic with a mass on his tongue that had been presented one month prior. The initial size was 2×1.5 cm, but it gradually grew larger. The authors performed an incisional biopsy under local anesthesia, and the pathological diagnosis confirmed that LCH of the tongue. Several studies including bone marrow biopsy were performed to assess involvement of other organs. These tests show that only the tongue was involved in this case. The patient underwent further treatment with low-dose radiotherapy. We present this case of tongue LCH with a review of the literature.

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.

Revised Electroencephalography Terminology and Clinical Consideration

Electroencephalography (EEG) has been used for decades to evaluate and assess brain function. It is a useful method to diagnose brain disorders. However, confirmed interpretation of EEG is quite challenging because there is no standardized method for EEG reading and this may lead to interrater variability even among expert electroencephalographers. In this background, uniformly accepted nomenclature for EEG pattern were required to improve interrater agreement and to support communication for EEG research. American Clinical Neurophysiology Society (ACNS) established the standardized critical care EEG terminology since 2012 and has recently published the revised 2021 version of EEG terminology. This review covers new concepts of 2021 ACNS EEG terminology and clinical considerations of various EEG patterns.

Retrieval of Metallic Foreign Bodies from the Upper Airway Using Intraoperative C-Arm Fluoroscopy: Case Report and Literature Review / 대한이비인후과학회지

Foreign body ingestion is commonly encountered by otolaryngologists. Most foreign bodies in the upper airway can be easily removed via direct endoscopy; however, if they penetrate the soft tissue deeply, both localization and retrieval may be challenging. Here, we report on the successful removal of multiple sewing needles from the throat using intraoperative, real-time C-arm fluoroscopy to guide endoscopic extraction. The use of intraoperative, real time C-arm fluoroscopy to guide endoscopic extraction allowed quick, safe treatment and avoided any development of complications in our patient.

Comparison of Surgical Outcomes for Treatment of Maxillary Sinus Inverted Papilloma: Endoscopic Prelacrimal Recess Approach versus Caldwell-Luc Approach / 대한이비인후과학회지

Background and Objectives@#Endoscopic prelacrimal recess approach (PLRA) was introduced to treat maxillary sinus inverted papilloma (IP) without sacrificing the inferior turbinate and nasolacrimal duct. This study aimed to compare surgical outcomes of prelacrimal recess approach with the conventional Caldwell-Luc approach (CLA) to remove IP of maxillary sinus and to evaluate the usefulness of the PLRA.Subjects and Method We retrospectively reviewed medical records of 51 patients who were treated in our institution for IP of nasal cavity and sinuses between March 2010 and June 2019. Twenty patients had maxillary sinus IP. Sixteen patients underwent endoscopic sinus surgery combined with either CLA (n=8) or PLRA (n=8). Demographic data, surgical technique, site of IP origin, intra- and postoperative complications, duration of follow-up, recurrence rate and pathologic diagnosis were reviewed. @*Results@#IP was the pathologic diagnosis for all 16 cases. Gross total removal was achieved in all cases. The mean follow-up period was 20.1 months in CLA group and 12.5 months in PLRA group. There was one case of massive bleeding during operation requiring transfusion and postoperative ICU care in CLA group. On postoperative follow-up, two patients from the CLA group had recurrence during the follow-up period. One patient had numbness around the gingival area, another patient had transient wound dehiscence, and another had persistent oro-antral fistula. In PLRA group, one patient had periorbital swelling after blowing nose; otherwise, no other patient from the PLRA group developed subjective complaints after surgery. @*Conclusion@#Endoscopic prelacrimal recess approach showed lower complication rates and recurrence rates compared to CLA. PLRA is a safe and effective method for the excision of primary maxillary sinus IP.

Benefits of Palliative Office-Based Hyaluronic Acid Injection Laryngoplasty in Cancer-Related Unilateral Vocal Cord Paralysis Patients

BACKGROUND AND OBJECTIVES: The effect of palliative injection laryngoplasty in cancer-related unilateral vocal cord paralysis patients on voice and swallowing function is uncertain and there are few previous studies of its suitability, benefits as a palliative treatment option. The purpose of this study is to confirm the objective results of voice and swallowing function after palliative office-based hyaluronic acid injection laryngoplasty in cancer-related unilateral vocal cord paralysis patients. MATERIALS AND METHOD: 36 patients who had unilateral vocal cord paralysis from non-thyroidal, extralaryngeal neoplasms were included in this study. To evaluate the clinical outcome, we analyzed perceptual GRBAS grading, acoustic analysis, aerodynamic study, Electroglottography (EGG), Voice Handicap Index (VHI-30) about voice function and disability rating scale (DRS), gastric tube dependency, aspiration pneumonia about swallowing function and 36-Item Short Form Survey version 2 (SF-36v2) about quality of life. RESULTS: In GRBAS scale, G (p < 0.001), R (p=0.004), B (p=0.001), A (p=0.011), and S (p=0.007) showed significant improvement. Jitter, shimmer, speaking fundamental frequency, maximal phonation time, VHI-30, DRS score, gastric tube dependency, aspiration pneumonia, and SF-36v2 were significantly improved after injection (p=0.016, p=0.011, p=0.045, p=0.005, p < 0.001, p < 0.001 p=0.003, p < 0.001, and p < 0.001 respectively). CONCLUSION: From this study we concluded office-based hyaluronic acid injection can be used as a useful palliative treatment option in cancer-related ill patients with unilateral vocal cord paralysis. Palliative hyaluronic acid injection laryngoplasty avoids the need for tube feeding, thus reducing the risk of aspiration pneumonia. These outcomes are accompanied by significant improvement in voice quality.

Comparison of Vocal Cord Motion and Voice Characteristics of Applied Music Singing Students before and after Singing Voice Therapy

BACKGROUND AND OBJECTIVES: Many students major in applied music singing have various difficulties in phonation when they sing or perform. But the studies about this cause are lack. The purpose of this study is whether singing voice therapy based on vocal music is effective or not to applied music singing students that have difficulties in phonation. MATERIALS AND METHODS: Singing voice therapy program had been done to 8 students major in applied music singing during 7 weeks. We did laryngeal stroboscope, perceptual, acoustic and aerodynamic examination before and after singing voice therapy to this students. And we studied post examination results have differences or improvements compared to pre examination results. RESULTS: Four male students don't have effective improvement after singing voice therapy but they shows slight improvement in aerodynamic examination values compared to pre examination values. Four female students shows improvement in aerodynamic examination values and pitch range increasing. Above all, one student's vocal nodules disappeared after singing voice therapy. CONCLUSIONS: Singing voice therapy based on music singing is very effective to the students major in applied music singing. Above all, their curriculum in applied music singing should include phonation training based on music singing before training perform and technic practices.

Visceral Fat as a Useful Parameter in the Differential Diagnosis of Crohn's Disease and Intestinal Tuberculosis

BACKGROUND/AIMS: Because of the similarities in the clinical presentations of Crohn's disease (CD) and intestinal tuberculosis (ITB), differential diagnosis is critical. Mesenteric adipose tissue hypertrophy and creeping fat are characteristic features of CD. The purpose of this study was to assess the usefulness of visceral fat for the differential diagnosis of CD and ITB. METHODS: We conducted a retrospective review of 50 patients with findings of CD or ITB between January 2005 and July 2008. Abdominal computed tomography (CT) was performed on all subjects during their first evaluation. The abdominal fat area was assessed using quantitative abdominal CT. RESULTS: The ratio of visceral fat to total fat (VF/TF) was significantly higher in male CD patients than in male ITB patients. The ratio of visceral fat to subcutaneous fat (VF/SF) was also higher in CD patients than in patients with ITB. For a VF/TF cut-off value of 0.46, the sensitivity and specificity for the diagnosis of CD were 42.1% and 93.3% respectively, with positive and negative predictive values of 88.9% and 56.0%, respectively. CONCLUSION: Measurement of the abdominal fat area using CT can be clinically useful for the differential diagnosis of CD and ITB.

A Case of Hyponatremia with Generalized Convulsion Following Sinus Surgery / 대한이비인후과학회지

Post-operative hyponatremia is associated with fluid overload and inappropriate secretion of antidiuretic hormone (ADH), which is related to stress, pain and others. Hyponatremia is a frequently encountered condition in clinical practice but severe post-operative hyponatremia has rarely been reported. Hyponatremia is curable; but severe hyponatremia is a fatal and emergency. Therefore, we should be aware of this phenomenon, diagnosis and management. We experienced one case of severe hyponatremia with generalized convulsion and neurologic symptoms in post-operative period.

Comparison of cone beam CT and conventional CT in absorbed and effective dose / 대한구강악안면방사선학회지

PURPOSE: This study provides comparative measurements of absorbed and effective doses for newly developed cone beam computed tomography (CT) in comparison with these doses for conventional CT. MATERIALS AND METHODS: Thermoluminescent dosimeter rods (TLD rod: GR-200, Thermo Fisher Scientific Inc., Waltham, MA, USA) were placed at 25 sites throughout the layers of Male ART Head and Neck Phantom (Radiology Support Devices Inc., Long Beach, USA) for dosimetry. Implagraphy, DCT Pro (Vatech Co., Hwasung, Korea) units, SCT-6800TXL (Shimadzu Corp., Kyoto, Japan), and Cranex 3+ (Soredex Orion Corp., Helsinki, Finland) were used for radiation exposures. Absorption doses were measured with Harshaw 3500TLD reader (Thermo Fisher Scientific Inc., Waltham, MA, USA). Radiation weighted doses and effective doses were measured and calculated by 2005 ICRP tissue weighting factors. RESULTS: Absorbed doses in Rt. submandibular gland were 110.57 mGy for SCT 6800TXL (Implant), 24.56 mGy for SCT 6800TXL (3D), 22.39 mGy for Implagraphy3, 7.19 mGy for DCT Pro, 5.96 mGy for Implagraphy1, 0.70 mGy for Cranex 3+. Effective doses (E2005draft) were 2.551 mSv for SCT 6800TXL (Implant), 1.272 mSv for SCT 6800TXL (3D), 0.598 mSv for Implagraphy3, 0.428 mSv for DCT Pro and 0.146 mSv for Implagraphy1. These are 108.6, 54.1, 25.5, 18.2 and 6.2 times greater than panoramic examination (Cranex 3+) doses (0.023 mSv). CONCLUSION: Cone beam CT machines recently developed in Korea, showed lower effective doses than conventional CT. Cone beam CT provides a lower dose and cost alternative to conventional CT, promising to revolutionize the practice of oral and maxillofacial radiology.

A study of panoramic focal trough for the six-year-old child / 대한구강악안면방사선학회지

PURPOSE: To make a focal trough (image layer) for an average maxillary dental arch of 6-year-old korean in panoramic radiography. MATERIALS AND METHODS: Phantom for the maxillary dental arch was designed using intercanine width, intermolar width, tooth size, and interdental spacing to record the data of 6-year-old child. The characteristics of pre-corrected panoramic machine (for adult) was evaluated using the phantom, resolution test pattern for margin of the image layer, and metal ball for the center of the image layer. Panoramic image layer of the child was developed by means of decreasing the speed of film-cassette and positioning the phantom backwards, and then the characteristics of post-corrected panoramic machine (for child) were reevaluated. RESULTS: At post-corrected panoramic image layer, beam projection angles at all interdental areas increased for about 2.6-3.8 degrees, the position of the image layer was shifted toward the rotation center for about 2.5 mm at the deciduous central incisior area. The width of image layer decreased at all areas. CONCLUSION: Increased beam projection angle will reduce the disadvantage of tooth overlap, and the same form between the center of the image layer and dental arch will improve image resolution.

A Study on Dietary Patterns and Nutrient Intake in Women with Hypercholesterolemia / 대한지역사회영양학회지

The purpose of this study was to investigate the difference of general characteristics, menopause status, dietary patterns and nutrient intakes between women aged from 30 to 65 years old with a hypercholesterolemia group and normocholesterolemia group. The subjects were classified as belonging to the hypercholesterolemia group or normocholesterolemia group barred on The Guidelines for Korean Hyperlipidemia. Dietary intakes of fatty acids were measured by means of a 24-hr recall method with food models and measuring tools. We analyzed both data sets together using analysis of variance chi-square test and student's t-test(SPSS for WINDOWS, version 7.5). Significance was defied as a p value< 0.05. The results obtained are summarized as follows. Mean age and BMI of the hypercholesteroemia group were significantly higher than those of the normocholesterolemia group. Intakes of cereal, vegetables, mushrooms and sea food in the normocholesterolemia group were significantly higher than those in the hypercholesterolemia group. Most of the nutrient intakes were not significantly different between the normocholesterolemia group and the hypercholesterolemia group. However, vitamin E intake of the normocholesterolemia group was significantly higher than that of the hypercholesterolemia group. There was a significant negative correlation between vitamin E intake and serum TC(r = -.363, p<0.001) and LDL-C(r = -.359, p<0.001). In addition, Serum TG had significantly correlation with carbohydrate(r = 0.137, p<0.001) and vitamin E intake(r = -0.134, p<0.001). Therefore, women who suffered from hypercholesterolemia were recommended to control body weight, and to consume foods containing high vitamin E and foods containing high dietary fiber such as vegetables, mushrooms, and sea food.

Clinical Experiences of Rhinoplasty with Patients' Assessment of the Results / 대한이비인후과학회지

BACKGROUND AND OBJECTIVE: The aim of this study is to investigate patients' satisfaction following rhinoplasty through analyzing questionnaires. MATERIALS AND METHODS: Study materials were 69 patients who underwent rhinoplasty at the Department of Otorhinolaryngology, Asan Medical Center, between 1989 and 1996. Causes of nasal deformities, applied surgical procedures, and postoperative complications were retrospectively investigated by reviewing medical records, and patients' satisfaction was investigated through analyzing questionnaires about cosmetic and functional outcomes. RESULTS: Silastic implants were used to augment the flat nose in 35 patients, and were extruded in four patients (11%). Thirty-six (52%) of 69 patients replied to the questionnaires. The results of patients' self-assessment were satisfactory (15 patients: 41.5%), fair (6 patients: 17%), and unsatisfactory (15 patients: 41.5%). There was no significant difference in the satisfaction rate between patients undergoing augmentation rhinoplasty and those undergoing corrective rhinoplasty. Young male patients (10-29 years in age) were much more unsatisfactory with surgical results than the rest of the male patients (67% vs. 11%) Twenty-six patients of 36 responders to the questionnaires underwent concomitant septoplasty and 22 (85%) of them answered that their breathing function was improved postoperatively. CONCLUSION: These results indicate that we failed to meet the patients' expectation for cosmetic improvement. Hence, improving surgical skills of the surgeons and explaining the patients preoperatively about limitations and possible unsatisfactory outcomes are needed.

8 Cases of Nasopharyngeal Angiofibromas / 대한이비인후과학회지

INTRODUCTION: Nasopharyngeal angiofibroma is a rare histologically benign tumor which occurs almost exclusively in adolescent boys. The morbidity and mortality associated with this tumor are related to its prominent vascularity and its propensity for aggresive local growth. MATERIALS AND METHOD: From November 1990 through February 1996, 8 patients with a diagnosis of nasopharyngeal angiofibroma were managed at Asan Medical Center. For the devasculation of the tumor before the surgery, preoperative arterial embolization was performed on 6 patients. RESULTS: The main tumor supplying vessel was ipsilateral internal maxillary artery in all cases. According to Chandler classfication(Table 1), stage II was 4 cases and stage III was 4 cases. Operative procedures were midfacial degloving approach(4 cases), transpalatal approach(1 case), transantral approach(1 case), combined approach(1 case: Caldwell-Luc op & endoscopic op), medial maxillectomy(1 case). There were no treatment-related deaths and no major surgical complications.

A Study of the Dietary Intake Status and One Portion Size of Commonly Consumed Food and Dishes in Korean Elderly Women / 대한지역사회영양학회지

The use of semiquantitative food frequency to estimate dietary intake has become widespread in nutritional epidemiologic studies. It had been suggested that knowledge about a person's usual portion size of each meal in addition to consumption frequency will improve the accuracy of this method. This study was performed to investigate the dietary intake status(nutrient, food, and dish intake) and one portion size of commonly consumed food and dishes to develop a semiquantitative food frequency questionnaire that will be used to expore the relationship between the incidence of cardiovascular disease and diet in Korean women after menopause. Intake of food or dish in 123 elderly women were measured by 3-day food records in March to May, 1996. The results obtained in this study were summarized as follow : 1) Calcium, vitamin A, and vitamin E intakes were less adequate than Recommended dietary allowances(RDA). 2) The subjects who consumed more than 20% of the energy from fat were 35% and the subjects consumed dietary cholesterol more than 300mg were 18%. 3) The most frequently consumed foods or dishes by the subjects were Korean cabbage kimchi