Morphologic Analysis of the Deviated Nasal Septum / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The nasal septum, centrally located in the nasal cavity, has dynamic relations with other craniofacial structures and is also influenced by them during development. Moreover, the mosaic structure of the septum is constituted through ossification. The purpose of this study was to evaluate the anatomical characteristics of the deviated nasal septum with preoperative computed tomography (CT) and calculations during surgery. SUBJECTS AND METHOD: We studied 62 patients with nasal septal deviation on one side, who underwent septoplasty between July 2008 and February 2009. The area of the septal cartilage, vomer, and perpendicular plate of the ethmoid bone was calculated with sagittal imaging using preoperative CT. The angle of deviation was also measured with coronal imaging. The length between the anterior nasal spine and sphenoidal sinus and that of the sphenoidal process was measured during surgery. RESULTS: The deviation angle increased significantly with the length of the sphenoidal process (p<0.01). The area of the septal cartilage decreased with age due to the progression of ossification. CONCLUSION: Nasal septal deviation without a history of trauma is influenced by the progression of nasal septal ossification.

Videofluoroscopic Evaluation of Swallowing in Patients with Amyotrophic Lateral Sclerosis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Dysphagia in patient with amyotrophic lateral sclerosis (ALS) is a critical symptom for prognosis. Proper evaluation and follow-up of their dysphagia is also important in management. Videofluoroscope is the gold standard method for evaluation of swallowing in ALS patients. The object of this study is to evaluate their dysphagia using videofluoroscope, on the basis of which we can plan the optimal rehabilitation method. SUBJECTS AND METHOD: The clinical records and videofluoroscopes of 7 ALS patients were reviewed. All patients were classified according to Hillel's ALS swallowing score. We analysed their videofluoroscopes and implied proper treatment strategies on the basis of those findings. RESULTS: All patients had dysfunction of tongue. In the early stage, dysphagia was solely attributable to oral phase dysfunction. In the advanced stage, pharyngeal phase was also affected. In some patients, cricopharyngeal dysphagia and aspiration were observed. After various form of treatment such as tongue exercise, position change, swallowing maneuver, tube feeding, and botulinum toxin injection to cricopharyngeal muscle, we could observe improvement in swallowing function. CONCLUSION: Videofluoroscope is a good method for evaluating patients with ALS. By applying tailored treatment strategies on the basis of videofluoroscopic finding, we can properly manage patients with ALS and eventually improve their quality of life.

Reconstruction of Mid-Facial Defect after Maxillectomy with Free Tissue Transfer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Postoperative defects of nasal cavity cancer are difficult to reconstruct because of its large and complicated defects. Large defects of the head and neck are challenging to reconstruct since there may be a 3-dimensional requirement of both volume and multiple surfaces of oral lining and external skin. SUBJECTS AND METHOD: We conducted a retrospective review of 14 patients who underwent reconstruction between 1999 and 2007. Outcome measures included free flap types, flap success and post-operative functional result. RESULTS: The anterolateral thigh flap method was used in 7 of the 14 patients (50%), the rectus abdominis free flap method in 4 patients (28%), the fibular osteocutanoeus free flap method in 2 patients (14%) and the radial forearm free flap method in 1 patient (7%). The free flap survival rate was 100 percent with partial flap necrosis in one patient. Return to regular diet was seen in 9 patients (64%), a soft diet in 3 (21%), and a liquid diet in one (7%). Speech was accessed as normal in 8 patients (57%), near normal in 5 (36%), intelligible in one patient (7%). CONCLUSION: Free tissue transfer provides the most effective and reliable form of immediate reconstruction for mid-facial defect after maxillectomy.

Soft Palate Reconstruction in Oral Cavity and Oropharyngeal Cancers / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various kinds of flaps are used for reconstruction of defected soft palate, and with these, physiologic functions can be preserved. We report the clinical results of our 44 consecutive soft palate reconstructions in oral and oropharyngeal cancers. SUBJECTS AND METHOD: We reviewed the medical records of patients who were offered soft palate reconstruction with various kinds of flaps after ablative surgery of oral and oropharyngeal cancer from July 1997 to July 2004 and analyzed primary site, resection area of soft palate, reconstruction methods and postoperative functions using Modified barium swallow (MBS), articulation and resonance test. RESULTS: Various kinds of flaps were used according to the resected area of soft palate. In cases of resection area less than 1/3 (63.6%), the reconstruction methods were local flap (7.1%), rectus abdominis myocutaneous flap (3.6%), lateral thigh free flap (LTFF)(3.6%), and radial forearm free flap (RFFF)(85.7%). In cases of resection area that is more than 1/3 of the total resection, all cases were reconstructed with RFFF, combining more complex techniques such as double folding, palmaris longus tendon, and superiorly-based pharyngeal flap. Velopharyngeal insufficiency (VPI) was examined in only 2 (11.8%) patients, and in residue after swallowing was examined in 10 (41.2%) patients. Postoperative pronunciation was 'good' in 15 (68.2%) patients. CONCLUSION: In oral and oropharyngeal cancer, reconstruction of resected soft palate using various kinds of flaps is very useful and effective in postoperative physiologic functions such as in swallowing and pronunciation.

The Role of Conservation Laryngeal Surgery in Locally Advanced Laryngeal Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Supracricoid partial laryngectomy (SCPL) and supraglottic partial laryngectomy (SPL) are considered as a good surgical procedure for satisfactory results on oncological and functional aspects in locally advanced laryngeal cancer. The purpose of this study is to research oncological and functional results to know the efficacy and safety of SCPL and SPL in locally advanced laryngeal cancer. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of 76 patients with locally advanced squamous cell carcinoma of larynx from March 1993 to May 2006, who underwent SCPL (N=64), SPL (N=8), extened supraglottic laryngectomy (ESPL)(N=4). We investigated retrospectively recurrence and survival rate to evaluate oncological safety and decannulation, oral feeding, voice analysis to evaluate preservation of laryngeal function. RESULTS: Seventy three patients had over 12 months follow up. In the oncologic aspect, the overall recurrence rate was 23.2% (17/73), but for the surgery only group, it was 18% (7/38). In the advanced T stage, the recurrence rate was increased without significant difference; more regional recurrence was observed in the N positive group without significant difference. Decannulation was achieved at the mean postoperative period of 23.0 days and oral diet was achieved for all patients starting at mean postoperative period 28.3 days. In the voice analysis, SCPL showed somewhat unsatisfactory results compared with SPL, but it allowed social interaction by maintaining fundamental frequency. CONCLUSION: The oncologic aspect of both SCPL and SPL showed that they are effective methods in treating locally advanced laryngeal cancer.

The Results of Treatment in Clinical N0 Oral Tongue Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The status of cervical lymph node and its treatment has a great influence on the prognosis of the patient with tongue cancer. We were to analyze the outcomes of treatment in patients with N0 tongue cancer, and the incidence and pattern of neck metastasis. SUBJECTS AND METHOD: The medical records of 50 patients with N0 tongue cancer who had surgical treatment performed at the department of Otolaryngology-HNS, College of Medicine, the Catholic University of Korea, between 1994 and 2006 were reviewed. All patients were treated surgically: 45 patients went through had neck dissection and 5 patients went through sentinel node biopsy. RESULTS: The overall rate of occult neck metastasis was 17.8% (8 of 45). The pathologic T stage with occult neck metastasis were 3 cases in T1, 4 cases in T2, and 1 case in T3. The local recurrence rate was 12%. The overall regional recurrence rate was 8%. The regional recurrence rate of neck dissection group and sentinel LN biopsy group were 6.7% (3 of 45) and 20.0% (1 of 5), respectively. The depth of invasion in T2 cases of the regional recurring group was deeper than in T2 cases of the non-regional recurring group. CONCLUSION: In clinical N0 tongue cancer, due to the relatively high overall occult metastasis rate and low recurrence rate at the neck node after the neck dissection, the elective neck dissection should be considered especially in deep tumor invasion cases.

Methylation and Chromosomal Losses in Squamous Cell Carcinoma of the Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Methylation of CpG islands is associated with delayed replication, condensed chromatin and inhibition of transcription initiation in many human cancers. Another concern with regards to CpG methlation is unilateral chromosomal losses in head and neck cancer. In this study, we investigated the extent of chromosomal losses and the status of CpG methylation in head and neck cancer in relation with clinicopathologic factors. SUBJECTS AND METHOD: Both normal mucosa and tumor tissue samples were secured from 17 cases to a total of 34 samples to be examined with a methylation- specific PCR on 15 cancer-linked genes. A total of 29 cases were analyzed for PCR-based loss of heterozygosity (LOH) using a panel of 41 microsatellite markers on 8 chromosomes. RESULTS: The pattern of methylation changes between the paired normal mucosa and tumor site was variable. Of the total of 206 cases examined for the methylation status of non-CpG island, 34 cases showed hypomethylation changes, 26 cases hypermethylation changes, and 31 cases no methylation changes. Regions containting CpG islands had 8 cases showing hypomethylation changes, 17 cases hypermethylation changes, and 31 cases of no methylation changes. The relationship between methylation and lymph node invasion revealed that, in the event of lymph node invasion, p16 downstream 0.7 kbp, p16 upstream 1.0 kbp, and hMLH1 upstream 1.0 kbp showed hypomethylation, whereas BGLAP upstream 4.5 kbp, Runx3 upstream 1.7 kbp, KIAA downstream 0.4 kbp showed hypermethylation. However, the rest of the genes were not changed. In 29 tumor foci, a LOH was found most frequently on the chromosomes 3p, 8p, 9p, and 13q. Interestingly, although other previous reports have not reported the detection of 8p chromosomal loss in head and neck cancer, this study frequently detected 8p chromosomal loss. Chromosomal loss yielded an overall mean value of 4.79+/-2.2 per tumor focus. A special relationship could not be drawn based on the relationship between the methylation and LOH. But in several genes such as p16 and hMLH1, there were differences between the hypomethylation. Genetic instability was raised when hypomethylation increased. CONCLUSION: This study showed that the head and neck cancer and its progression generally need the proper level of chromosomal losses to accomplish cancer progression or development. Methylation pattern and LOH might be important rules and target event in head and neck cancer. In the future, experiments to find the point of genetic modification will help the way to prevent the cancer.

Bilateral Second Branchial Cleft Fistulas: A Case Report / 대한이비인후과학회지

The branchiogenic anomalies are common congenital cervical anomalies. They usually arise from an incomplete obliteration of the branchial apparatus during fetal development. These anomalies may be confused with and mistaken for other potentially more serious lesions, such as cystic hygromas, teratomas, and lymphomas. The anomalies are typically discovered in the pediatric and adolescent population and develop unilaterally. Bilateral manifestations are very rare and have a familial tendency. In addition, anomalies such as intrauterine and postnasal growth retardation, premature aging and unusual faces may be related with bilateral occurrence. This is the first report in the Korean language literature of bilateral branchial fistulas.

Treatment of Cricopharyngeal Dysphagia with Shaker's Head Lift Exercise / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cricopharyngeal dysphagia refers to the dysfunction of the upper esophageal sphincter complex, which is composed of the cricopharyngeus, inferior pharyngeal constrictor and the upper segment of the cervical esophagus. Adequate relaxation of the cricopharyngeal muscle in conjunction with anterosuperior excursion of the larynx by suprahyoid muscles and propulsion of food bolus are prerequisite for normal swallow, mechanisms of which, if altered, may result in cricopharyngeal dysfunction. Head lift exercise, first described by Shaker, can be utilized in patients with cricopharyngeal dysphagia by strengthening the suprahyoid musculature and reducing the intrabolus pressure. The objective of this study was to introduce Shaker's head lift exercise in the treatment of cricopharyngeal dysphagia patients. SUBJECTS AND METHOD: Two patients suffering from cricopharyneal dysphagia after receiving skull base surgery were managed with Shaker's head lift exercise and the swallowing function was evaluated with videofluoroscopy. RESULTS: Both patients who had been taught how to perform head lift exercise showed improvement in swallowing function as observed with videofluoroscopy. Aspiration disappeared and both patients were able to take oral diet without the aid of gastrostomy tubes. CONCLUSION: Shaker's head lift exercise enabled oral feeding without aspiration in two patients. This demonstrates that Shaker's head lift exercise can be a promising noninvasive treatment modality in the treatment of cricopharyngeal dysphagia.

Pathogenetic Hypothesis of Benign Laryangeal Disease from Histopathologic Change in the Basement Membrane Zone and the Superficial Layer of Lamina Propria / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The epithelium, basement membrane zone (BMZ) and superficial layer of lamina propria (SLLP) in the vocal fold possess similar mechanical properties and behave as one single tissue, which is commonly referred to as the "cover". The purpose of this study is to elucidate the ultra structural and histopathological changes and differences in the cover of benign laryngeal lesions, and also to investigate the pathogenetic response. MATERIALS AND METHOD: The cover of the vocal fold in vocal nodule, polyp and Reinke's edema was investigated on 87 patients. Immunohistochemical analysis was performed with monoclonal antibodies directed against collagen type III and VII for identification of SLLP and anchoring fiber. Control specimens were obtained from 10 uninvolved side vocal fold in the laryngeal specimen after total laryngectomy. RESULTS: One type of injury in the cover was due to a little or no change of SLLP, which was seen more often in vocal nodules. The second type of pathologic finding shows disorganized anchoring fiber and extensive interstitial injury, which was seen more often in vocal polyp. The third type shows injury in the anchoring fiber and sparse distribution of collagen type III in SLLP, which was the main finding in Reinka's edema. These findings lead us to understand the pathogenesis of the disease that developed as different entities. CONCLUSION: We conclude that collagens in BMZ and SLLP are the structures that seem to provide the pathogenetic portion of benign laryngeal diseases which develop from the same phonotrauma into clinically different disease entities.

The Extent of Chromosomal Losses and the Status of CpG Methylation in Squamous Cell Carcinoma of the Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Carcinogenesis is known to arise as a result of the accumulation of genetic alterations including unilateral chromosomal losses and epigenetic modification. In this study, we investigated the extent of chromosomal losses and the status of CpG methylation in squamous cell carcinoma of the head and neck in relation to the clinicopathologic factors. SUBJECTS AND METHOD: A total of 20 tumor foci from 12 cases were examined wtih PCR-based loss of heterozygosity (LOH) analysis using a panel of 41 microsatellite markers on 8 chromosomes and a total of 10 tumor foci from 5 cases were examined with methylation-specific PCR on 2 extragenic regions of the 3 cancer-linked genes. RESULTS: In 20 tumor foci, LOH was found most frequently on the chromosome 8p. Multiple tumor foci of a given case had the same or a similar extent of chromosomal losses and yielded an overall mean value of 5.5 per tumor focus. Even though the tumor foci showed histological homogeneity, they revealed genetical heterogeneity. The relation between methylation changes between the paired normal mucosa and tumor site was variable and 10 tumor sites examined for the methylation status of 6 extragenic regions showed 21 (35%) hypomethylation changes, 6 (10%) hypermethylation changes, and 33 (55%) no methylation changes. The degree of methylation changes indicated the tendency to cluster in the range of U1 and M1 low-grade changes. With respect to relationship between bet methylation changes and clinicopathologic factors, hypomethylation changes were dominant in those cases with increased depth of invasion. CONCLUSION: These results showed that multiple intratumoral foci of the head and neck cancer patients were generally under the influence of a similar level of chromosomal losses and hypomethylation changes.

The Clinical Feasibility of Functional 3-Dimensional Laryngeal CT as a New Technique: Preliminary Study in Unilateral Vocal Fold Paralysis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are many clinical procedures that are related to the evaluation of kinematic events concerning vocal fold vibration. However, many of these procedures are hardly applicable for precise analyses of physiological and morphological changes in vocal folds with respect to the pitch control, and vocal fold volume changes from the phonatory aspect of larynx. The purpose of this study was to examine the clinical feasibility of a new 3 dimensional image method, the functional laryngeal CT, which can provide a clear sagittal image of the vocal fold in each of the anteroposterior directions during phonation and resting state. SUBJECTS AND METHOD: Functional laryngeal CT was performed in 4 normal control and 2 cases of unilateral vocal fold paralysis. The subjects were instructed at resting position to produce sustained vowel phonation of three different kinds of pitch. Three-dimensional endoscopic images were reconstructed through segmentation and surface-rendering algorithm on personal computer, using the DICOM (Digital Image and Communication in Medicine) file of axial images. RESULTS: The dynamic vocal fold 3D image that was reconstructed by serial section image during phonation showed that the vocal fold became thin and volume was decreased in relation to the increase in pitch. Typical subglottic shoulder formation and ventricular widening was noted in the high pitched tone. CONCLUSION: Functional 3D laryngeal CT (F3DLxCT) is an informative tool for visualizing the active changes in length, tension and mass of the vocal folds for pitch control. Furthermore, the volume defect and the level difference in the paralysed vocal fold are easily detectable with this new techinque.

Hypermethylation of TIG1 in Head and Neck Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Decreased expression and growth suppression of Tazarotene-Induced Gene 1 (TIG1) were reported in prostate cancer. In this study, we examined the possibility of TIG1 transcriptional silencing by hypermethylation in head and neck cancer. SUBJECTS AND METHOD: We extracted DNA and total RNA from five head and neck cell lines (O11, O12, O19, O22 and O28), and three prostate cell lines (PC3, LNCap and DU145). We checked the methylation status of TIG1 by methylation-specific PCR (MSP) and RT-PCR. We also examined primary cancer tissues of 32 head and neck cancer, 31 prostate cancer and 10 normal samples. RESULTS: We found that all of five head and neck (100%) cell lines and two of three prostate (66.7%) cell lines were methylated. RT-PCR analysis confirmed the absence of TIG1 expression in six cell lines with methylation. We checked primary cancer by MSP and found TIG1 methylation in 16 of 32 (50%) head and neck cancers, and 17 of 31 (54.8%) prostate cancers. Normal head and neck and prostate tissues were free of methylation. CONCLUSION: Our results support the notion that methylation might be an important mechanism of TIG1 inactivation and a target event in head and neck cancer.

Functional Results of Voice and Swallowing in Patients Treated with Surgery or Radiation Therapy for Early Glottic Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laryngeal neoplasms such as early glottic cancer can be effectively treated with several methods, namely laser surgery, conservation laryngeal surgery and radiotherapy. Therefore, the preservation of the ability to speak and swallow normally is another important consideration in the selection of therapy for early glottic cancer. The purpose of this study is to compare the functional results of voice and deglutition for early glottic cancer patients treated with surgery or radiation. SUBJECTS AND METHOD: Between January 2002 and September 2004, 17 patients with the early glottic cancer who had undergone radiotherapy (n=6) or surgery (n=11) were retrospectively investigated. All the patients were phonetically analysed using CSL and Fo, Jitter, Shimmer and NHR were evaluated. For aerodynamic test, maximum phonation time (MPT) and mean air flow rate (MFR) were also evaluated. Modified barium swallow (MBS) was performed to evaluate swallowing function. RESULTS: There were no significant difference in all the vocal parameters between radiotherapy group and surgery group. But Shimmer differed significantly between radiotherapy group and laser cordectomy group. In aerodynamic study, MPT was significantly longer in the radiotherapy group than in the surgery group, but no significant difference was observed between the radiotherapy group and laser cordectomy group. MBS showed better results in the surgery group than in the radiotherapy group. CONCLUSION: Therapeutic modality for patients with early glottic cancer should be chosen in consideration of voice quality and swallowing, and according to multiple parameters of the patients' conditions.

Secondary Tongue Cancer in Patients with Chronic Graft-Versus-Host Disease(GVHD) after Bone Marrow Transplantation: Report of Two Cases / 대한이비인후과학회지

We report two patients with chronic graft-versus-host disease (GVHD) after bone marrow transplantation (BMT) who developed cancers in the mobile tongue. The first patient, a 15-year old female who had undergone bone marrow transplantation for Fanconi's anemia five years ago, developed chronic GVHD on the oral cavity 1.5 years after the transplantation and have suffered from it ever since. Recently, she developed squamous cell carcinoma in the tongue. The second patient, a 50-year old male who had received the bone marrow transplantation due to severe aplastic anemia, developed chronic GVHD on the oral cavity 5 months later and have suffered from it thereafter. He developed squamous cell carcinoma of the tongue 15 years later after BMT. These cases imply that cancers including tongue neoplasms may develop in patients with GVHD after bone marrow transplantation. A thorough examination of head & neck and close follow-up are recommended to patients treated with bone marrow transplantation, particularly to those with GVHD.

Temporal Analysis of Oropharyngeal Swallow in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Studies of normal oropharyngeal swallow in children are essential for the analysis of pediatric dysphagia. The purpose of this study is to define the temporal characteristics of the oropharyngeal swallow in children and to compare these data with young adults. SUBJECTS AND METHOD: This investigation evaluated oropharyngeal swallow physiology during swallows of pudding in 16 children (age 3-13) who had no swallowing complaints including velopharyngeal deficits after surgical treatment of cleft palate and submucous cleft, and 16 normal young adults with no swallowing complaints. temporal analysis of swallow in the children was compared with that of similar temporal measures in the 16 young adults (age 21-29). RESULTS: Temporal measures of pharyngeal swallow events in the children revealed significantly shorter pharyngeal response time, shorter duration of tongue base contact to the posterior pharyngeal wall and longer duration of tongue base posterior movement toward the pharyngeal wall as compared with the normal young adult subjects. CONCLUSION: These differences in the temporal measures of the pharyngeal swallow between children and adults could be the results of differences in the pharyngeal anatomy and the pharyngeal contraction pattern between children and adults. further study of a larger population of normal children is needed.

A Case of Nasopharyngeal Glioma Causing Respiratory Distress in Neonate / 대한이비인후과학회지

Nasal gliomas are rare benign congenital midline tumors composed of heterotopic neuroglial tissue with the potential for intracranial extension. They are commomly seen in newborns and children but rarely in adults. Preoperative diagnostic imaging is essential to delineate the exact site and extension of tumor and to plan the appropriate surgical approach. Endoscopic surgery is considered appropriate for the removal of intranasal glioma without intracranial extension. We experienced a case of nasophryngeal glioma in a newborn who had been presented with respiratory distress. The tumor was successfully removed by endoscopic surgery. So we report this rare case with the review of literatures.

Surgical Management of Tonsil Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Surgery and postoperative radiation therapy have been the main stream management of tonsil cancer. There is a variety of surgical approach methods are used for the resection of tonsil cancer, however, there have only been a few reports of the results of surgical treatment of tonsil cancer. So, on the basis of our experience, we report the results of our surgical treatments of tonsil cancer. SUBJECT AND METHOD: 32 medical records, from 1994 April to 2003 June, of patients surgically treated for tonsil cancer were reviewed. Evaluated were disease status, surgical approach methods, types of the neck dissection, surgical margin, reconstruction methods, postoperative complications, time of oral diet and decannulation, recurrence, and survival rate. RESULTS: Mean follow up periods were 2.3 years. There was 1 patient in Stage I, 5 in Stage II, 2 in Stage III, and 24 in Stage IV. For Tumor excision, 5 patients underwent intraoral approach, 10 mandibulotomy approach, and 17 lateral pharyngotomy approach. Surgical defects were primary closed in 5 patients and reconstructed with pectoralis major myocutaneous flap in 7 patients and radial forearm fasciocutaneous free flap in 20 patients. There were 2 local recurrences, 5 regional recurrences, and one distant metastasis. The mean time of the beginning of oral diet/decannulation after operation were 19.8/11.3 days in lateral pharyngotomy and 25.3/12.9 days in mandibulotomy. The mean survival period was 41.4 months. CONCLUSION: Because most of tonsil cancers are advanced diseases, more precise tumor resection and meticulous neck management are needed. Lateral pharyngotomy approach had priority to other surgical approaches in selected cases except T4. It has advantages of full range of vision for resection, better functional status and less postoperative morbidity.

The Determination of Thyroid Dimension by Routine Neck Computed Tomography and Its Relationship to Age, Sex, and Body Size in Korean Adults / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to establish a "normal" range of dimensions of the thyroid glands on routine neck computed tomography in the Korean population. Also, this study investigated the possible influence of some physical factors. MATERIALS AND METHOD: Neck computed tomography scans of 100 adults were reviewed retrospectively to measure the size of the thyroid gland and to evaluate its relationship to the trachea and cervical vertebra. The width, thickness, and length of each thyroid lobes, as well as the estimated volume of the thyroid gland were measured. The cross-sectional areas of the trachea and cervical vertebra were utilized as two parameters of standard in measuring the size of thyroid glands according to different body size. RESULTS: The mean widths were 15.7 mm (right) and 15.2 mm (left). The mean thicknesses were 20.9 mm (right) and 18.9 mm (left). The mean lengths were 61.8 mm (right) and 58.5 mm (left). The mean estimated volumes of each lobe were 8.8 cm3 (right) and 7.6 cm3 (left). The mean volume of total thyroid glands (including isthmus) was 17.5 cm3. There was no significant difference between the total study group and normal thyroid function group. The dimensions of right lobe was significantly larger that of the left. There was no significant difference between males and females. The results of the multiple regression analysis supported the likelihood that the influence of the body weight was most pronounced. CONCLUSION: Our study presents initial data for assessing the thyroid gland on neck computed tomography scans in Koreans, providing the limit values of normal thyroid glands.

Long-Term Outcome of the Voice Rehabilitation after Total Laryngectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The voice rehabilitation following total laryngectomy is very important for the quality of life of patients who are cured by cancer treatment. The purpose of this study is to investigate the success rate and complications of various procedures used in our clinics and to evaluate various factors that can affect the success rate of the voice rehabilitation. SUBJECTS AND METHOD: From March 1993 to November 2002, 77 medical charts of the patients who underwent total laryngectomy were reviewed retrospectively to determine the immediate and long-term success rates of voice rehabilitation. The statistic correlation between the variables (age, tumor stage, tumor site, radiotherapy) and the success rate was analysed. RESULTS: Good vocalization was achieved in 90.5% of patients after Provox insertion, 81% after Amatsu procedure, while esophageal voice was acquired by 11.1%. The long-term success rate in 39 patients was 75% in Provox group, 81.8% in Amatsu group and 30.5% in esophageal voice group. There were no statistically significant correlation between the variables and the success rate of vocie rehabilitation. CONCLUSION: The result of this study suggested that tracheoesophageal puncture with Provox prosthesis and Amatsu operation are very effective procedures for the long term voice rehabilitation following total laryngectomy.