Lingual Metastasis to the Tip of the Tongue as the First Sign of Metastatic Spread in Lung Cancer: A Case Report and Review of the Literature / 대한이비인후과학회지

Lingual metastasis is defined as the metastasis of malignant tumors to the tongue from another primary organ cancer. Primary lung cancer which had metastasized to the tongue was reported in 0.2–1.6% of these cases. The base of the tongue is the most frequent site of lingual metastasis due to its rich vascular supply and relative lack of mobility compared with other areas of the tongue. The aim of this article is to report a benign appearing lingual metastasis to the tip of the tongue as the first sign of metastasis from squamous cell carcinoma of the lung. Clinical presentation of lingual metastasis resembled a hyperplastic or reactive lesion, such as a pyogenic granuloma or submucosal mass. In cases where there was a single metastatic focus, a surgical excision was recommended as a palliative measure for pain control, the prevention of infection or bleeding, and the maintenance of an acceptable oral function.

Treatment of Adeno-Squamous Cell Carcinoma at the Posterior Tongue via Median Glossotomy Approach / 대한이비인후과학회지

We report a rare case of adeno-squamous cell carcinoma (ASC) that was successfully treated via a median glossotomy approach at the center of the posterior tongue. The AJCC stages were IVa (T1, N2c, M0). The patient underwent bilateral modified radical neck dissection and mass excision via median glossotomy approach while tracheotomized. The patient has been followed with no evidence of recurrence for 5 years. Tongue mobility was slightly decreased because of the contracture. However, articulation was acceptable. The decreased mobility of the tongue required a slightly longer oral preparatory phase of swallowing. Although median glossotomy is acceptable only in limitted cases, it allows an excellent exposure and a safe margin to approach and excise the tumor for cases like the posterior tongue in ASC, which usually has locally aggressive invasion and poor prognosis.

Analysis of Dysphagia Patterns Using a Modified Barium Swallowing Test Following Treatment of Head and Neck Cancer

PURPOSE: The purposes of this study were to evaluate specific dysphagia patterns and to identify the factors affecting dysphagia, especially aspiration, following treatment of head and neck cancer. MATERIALS AND METHODS: A retrospective analysis of 57 patients was performed. Dysphagia was evaluated using a modified barium swallow (MBS) test. The MBS results were rated on the 8-point penetration-aspiration scale (PAS) and swallowing performance status (SPS) score. RESULTS: Reduced base of the tongue (BOT) retraction (64.9%), reduced laryngeal elevation (57.9%), and cricopharyngeus (CP) dysfunction (47.4%) were found. Reduced BOT retraction was correlated with clinical stage (p=0.011) and treatment modality (p=0.001). Aspiration in 42.1% and penetration in 33.3% of patients were observed. Twenty-four patients had PAS values over 6, implying aspiration. Forty-one patients had a SPS score of more than 3, 25 patients had a score greater than 5, and 13 patients had a SPS score of more than 7. Aspiration was found more often in patients with penetration (p=0.002) and in older patients (p=0.026). In older patients, abnormal swallowing caused aspiration even in those with a SPS score of more than 3, irrespective of stage or treatment, contrary to younger patients. Tube feeders (n=20) exhibited older age (65.0%), dysphagia/aspiration related structures (DARS) primaries (75.0%), higher stage disease (66.7%), and a history of radiotherapy (68.8%). CONCLUSION: Reduced BOT retraction was the most common dysphagia pattern and was correlated with clinical stage and treatment regimens including radiotherapy. Aspiration was more frequent in patients who had penetration and in older patients. In contrast to younger patients, older patients showed greater risk of aspiration even with a single abnormal swallowing irrespective of stage or treatment.

Characteristics of Adduct Spasmodic Dysphonia and Muscle Tension Dysphonia Using Spectrogram / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Adduct spasmodic dysphonia (ADSD) is a neurogenic and focal laryngeal dystonia resulting in a strained voice quality with spastic voice breaks. While muscle tension dysphonia (MTD) is caused by functional voice disorders, its symptoms are similar to those of ADSD. Because the approaches of treatment for ADSD and MTD are radically different, accurate evaluations are necessary for precise diagnosis. A spectrogram analysis for differentiating ADSD from MTD provides differentiations on four spectral findings (abrupt voice breaks, irregular wide-spaced vertical striations, well-defined formants and high-frequency spectral noise). The aim of this study was to evaluate if the spectrogram could provide detailed information on the visual characteristics that distinguish ADSD and MTD. SUBJECTS AND METHOD: 11 female patients of ADSD and 13 female patients of MTD who were diagnosed by laryngoscope and stroboscope from 2009 through 2012 were selected for this study. The speech samples of subjects were obtained using Computerized Speech Lab. The two speech therapists evaluated a wide-band (300 Hz) spectrogram by blind test using 4 scales (0-3 point) for four spectral findings. RESULTS: Abrupt voice breaks and irregular wide-spaced vertical striations of ADSD were significantly higher than those of MTD. Well-defined formants and high-frequency spectral noise were not found significantly different between two groups. CONCLUSION: The spectrograms provided visual perceptual information needed to differentiate ADSD from MTD. Voice therapy to reduce hypertension could be considered for patients of ADSD with excessive formants and noise. If spectrogram analysis were used along with other assessments, it would be more useful in distinguishing ADSD from MTD.

Metachronous Adenoid Cystic Carcinoma in the Peripheral Lung and at Base of the Tongue

Primary lung adenoid cystic carcinoma (ACC) is extremely rare and accounts for approximately 0.1%-0.2% of all lung cancers. ACC of the head and neck has generally been regarded as a slow-growing, low-grade malignancy which has a tendency for local recurrence and frequent distant metastasis. When ACC of the lung is identified, physicians must determine whether it represents distant metastasis or a primary lung cancer. Thyroid transcription factor-1 staining is one of the most useful methods to differentiate primary from metastatic lesions in lung cancer. Herein we report a case of metachronous, not synchronous, ACC at the peripheral lung followed by ACC presentation at the base of the tongue, and review of relevant literatures.

Comparison of Voice Outcomes in Early Glottic Cancer Patients after Laser Surgery or Radiotherapy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Radiotherapy and laser surgery are the main treatment modalities for early glottic cancer. However, which treatment has better voice outcome is unclear. Few studies have considered the effect of radiation dose on voice outcomes after radiotherapy. The purpose of this study was to compare voice outcomes in early glottic cancer patients between two treatment modalities and to identify whether radiation dose affects voice outcomes. SUBJECTS AND METHOD: From January 1995 to December 2010, 66 patients with the early glottic cancer who underwent laser surgery (n=27) or radiotherapy (n=39) were retrospectively investigated. Voice quality was assessed using Computerized Speech Lab and F0, Jitter, Shimmer and noise to harmonic ratio were evaluated. For aerodynamic test, maximum phonation time was also evaluated. RESULTS: F0 differed statistically between the laser surgery group and radiotherapy group. In laser surgery group, F0 was elevated after surgery. On the other hand, F0 decreased statistically after radiotherapy. In the radiotherapy group, the dose was statistically different between the lower and higher dose groups. In T2 stage disease, which received a higher radiation dose, voice outcomes were poorer than in T1a or T1b stage diseases. CONCLUSION: In early glottic cancer, F0 differed statistically between the laser surgery group and the radiotherapy group: F0 decreased statistically after radiotherapy. In the radiotherapy group, voice quality was affected by radiation dose as the higher dose resulted in poorer voice outcomes.

Office-Based Laryngoesophageal Procedure / 대한이비인후과학회지

Office-based procedures of laryngoesophageal region have become significantly more common in recent years. The term "office-based" refers to an awake patient in an upright position, typically with no sedation and receiving local topical anesthesia alone. The goal of this article is to introduce various recent office-based laryngological procedures, including diagnosis and treatment and to review of literatures along with our experiences. The authors hope that this document will encourage otolaryngologists to expand the role of office-based diagnosis and treatment in laryngology for the best treatment of their patients' care.

Endoscopic Thyroidectomy via an Axillo-Breast Approach without Gas Insufflation for Benign Thyroid Nodules and Micropapillary Carcinomas: Preliminary Results

PURPOSE: To examine the feasibility of endoscopic thyroidectomy (ET) via an axillo-breast approach without gas insufflation for large thyroid tumors and micropapillary carcinomas. MATERIALS AND METHODS: The patients in the benign group were separated into groups 1 (n=95, or =4 cm in tumor diameter). Also, 57 patients in the micropapillary carcinoma group underwent an endoscopic hemithyroidectomy (HT) (group 3) and were compared with 60 patients who received conventional open HT (group 4). Postoperative functional outcome, local complications, surgical outcomes, and pathological outcomes were compared between the groups. RESULTS: In the benign group, there was no significant difference in mean operating time, hospital stay, or overall perioperative complications between the two groups. In the micropapillary carcinoma group, mean operating time and hospital stay in group 3 were significantly longer than in group 4 (p=0.015 and p or =4 cm and micropapillary carcinomas. Although it has the advantage of better cosmetic results over open thyroidectomy, there is room for improvement in terms of lessening its invasiveness and shortening the operative time.

Retrosigmoid Approach in the Removal of Vestibular Schwannoma

BACKGROUND AND OBJECTIVES: The use of several approaches, involving different cerebellopontine angles, has enabled vestibular schwannoma removal to be tailored to each patient's pathology and physiological status. The retrosigmoid approach provides simple and direct access to cerebello-pontine angle lesions. SUBJECTS AND METHODS: We retrospectively assessed outcomes in 35 consecutive patients who underwent vestibular schwannoma removal via the retrosigmoid approach. RESULTS: Of the 35 patients, 12 were men and 23 women; their age was 52.5+/-10.4 years (range, 35-75 years). One tumor was small (3 cm). Symptoms included hearing disturbance (31 patients, 89%), tinnitus (14 patients, 40%), headache (12 patients, 34%), vertigo (11 patients, 31%), and facial palsy (9 patients, 25%). Postoperative complications included facial palsy, intracranial hemorrhage, dysphagia, and disseminated intravascular coagulopathy, with facial palsy remaining permanently. Four patients (11.4%) had tumor regrowth, at a mean of 36.3 months after primary surgery. The mean diameter of regrowing tumors was 20.5+/-4.4 mm (range 14.5-25.0 mm). CONCLUSIONS: The retrosigmoid approach for vestibular schwannoma removal was associated with higher rates of facial palsy and hearing loss. This approach, however, can minimize injury to the lower cranial nerve.

Retrosigmoid Approach in the Removal of Vestibular Schwannoma

BACKGROUND AND OBJECTIVES: The use of several approaches, involving different cerebellopontine angles, has enabled vestibular schwannoma removal to be tailored to each patient's pathology and physiological status. The retrosigmoid approach provides simple and direct access to cerebello-pontine angle lesions. SUBJECTS AND METHODS: We retrospectively assessed outcomes in 35 consecutive patients who underwent vestibular schwannoma removal via the retrosigmoid approach. RESULTS: Of the 35 patients, 12 were men and 23 women; their age was 52.5+/-10.4 years (range, 35-75 years). One tumor was small (3 cm). Symptoms included hearing disturbance (31 patients, 89%), tinnitus (14 patients, 40%), headache (12 patients, 34%), vertigo (11 patients, 31%), and facial palsy (9 patients, 25%). Postoperative complications included facial palsy, intracranial hemorrhage, dysphagia, and disseminated intravascular coagulopathy, with facial palsy remaining permanently. Four patients (11.4%) had tumor regrowth, at a mean of 36.3 months after primary surgery. The mean diameter of regrowing tumors was 20.5+/-4.4 mm (range 14.5-25.0 mm). CONCLUSIONS: The retrosigmoid approach for vestibular schwannoma removal was associated with higher rates of facial palsy and hearing loss. This approach, however, can minimize injury to the lower cranial nerve.

Clinical Approaches for Understanding the Expression Levels of Pattern Recognition Receptors in Otitis Media with Effusion

OBJECTIVES: Bacterial infections in the normally sterile environment of the middle ear cavity usually trigger host immune response, whereby the innate immune system plays a dominant role as the host's first line of defense. We evaluated the expression levels of Toll-like receptors (TLRs) -2, -4, -5, -9, and nucleotide-binding oligomerization domain-containing proteins (NODs) -1 and -2, all of which are related to bacterial infection in pediatric patients with otitis media with effusion (OME). METHODS: The study sample consisted of 46 pediatric patients with OME, all of whom had ventilation tubes inserted. The expression levels of TLR-2, -4, -5, -9, NOD-1 and -2 mRNA in middle ear effusion were assessed by polymerase chain reaction (PCR). Difference of pattern recognition receptors (PRRs) expression level by presence of bacteria, ventilation tube insertion rate, and effusion fluid character was assessed. RESULTS: All effusion fluid samples collected from patients with OME showed expression of TLR-2, -4, -5, -9, NOD-1, and -2 mRNA by PCR. However, we found no differences among expression levels of PRRs in relation to characteristics of exudates, presence of bacteria, or frequencies of ventilation tube insertion (P>0.05). CONCLUSION: Our findings suggest that exudates of OME patients show PRR expressions that are related to the innate immune response regardless of the characteristics of effusion fluid, presence of bacteria in exudates, or frequency of ventilation tube insertion.

Successful Treatment of Tracheal Stenosis with Slide Tracheoplasty after the Failure of Resection with End-to-End Anastomosis

The combined effects of inhaled irritant gases and heat in burn patients can result in the development of laryngotracheal strictures. Several factors could adversely affect the development of tracheal stenosis and cause the growth of granulation tissue. Yet the current treatment options for this condition are limited because of the paucity of case reports. We report here on a case of a patient who experienced recurrent upper tracheal stenosis after an inhalation injury. She displayed repetitive symptoms of stenosis even after several laryngomicrosurgeries and resection with end-to-end anastomosis. Finally, 5 yr after the burn injury, slide tracheoplasty was successfully performed and the postoperative check-up findings and the increased airway volume seen on imaging were all satisfactory.

Lipid Peroxide Levels and Total Peroxyl Radical-Trapping Ability in the Placenta of Women with Normal Pregnancy and Preeclampsia / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to investigate lipid peroxide levels, total peroxyl radical-trapping antioxidative parameter (TRAP) values, and antioxidant vitamin levels in placental tissues of women with preeclampsia and to evaluate their roles in the pathophysiology of preeclampsia. STUDY DESIGN: Samples of placental tissue homogenates were obtained from 23 normal and 18 preeclamptic women between 33 and 40 weeks gestation. TNF-alpha was assayed by an enzyme-linked immunoassay. Lipid peroxide levels measured by thiobarbituric acid reaction. The TRAP values were measured by modified Wayners method. Ascorbic acid, uric acid, retinol, alpha-tocopherol, and gamma-tocopherol were measured by high performance liquid chromatography (HPLC) CoulArray detector. RESULTS: TNF-alpha levels in placental tissue homogenates of women with preeclampsia were significantly higher than that of women with preeclampsia (21.4+/-3.39 vs. 10.3+/-1.06 pg/ml, p<0.05). Lipid peroxide levels in placental tissue homogenates of women with preeclampsia were significantly higher than that of women with preeclampsia (6.65+/-0.57 vs. 4.98+/-0.37 nmol/mg protein, p<0.05). TRAP values in placental tissue homogenates of women with preeclampsia were significantly lower than that of women with normal pregnancy (0.24+/-0.02 vs. 0.31+/-0.03 mM, p<0.05). Ascorbic acid levels in placental tissue homogenates of women with preeclampsia were significantly lower than that of women with normal pregnancy (217.0+/-21.0 vs. 333.3+/-32.8 nmol/ml, p<0.05). CONCLUSION: The above results suggest that increased oxidative stress in placenta is involved in the pathophysiology of preeclampsia and ascorbic acid may act as an important preventive factor in the development of preeclampsia.