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.

Clinical Analysis of Leukoplakia in the Larynx: Long-Term Follow-Up / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Leukoplakia is a clinical term solely designating a white patch or a plaque of the mucosa without considering its histological feature. Leukoplakia ranges microscopically from a hyperplasia to an invasive squamous cell carcinoma. This study attempted to find out the clinical progress and characteristics of leukoplakia in the larynx. SUBJECTS AND METHOD: Included in the study were 154 patients clinically diagnosed as leukoplakia from 1997 to 2010. We reviewed their medical records retrospectively for age, sex, smoking and drinking history, medical record, histopathologic finding, treatment method, and the follow-up records. RESULTS: Histopathologic findings of leukoplakia in the larynx showed hyperkeratosis (101 patients), invasive carcinoma (19 patients), dysplasia (14 patients), nodule (9 patients), papillomatosis (4 patients), chronic inflammation (4 patients) and tuberculosis (3 patients). Of the 128 patients, 39 patients who were diagnosed as hyperkeratosis, dysplasia, nodule or chronic inflammation in the larynx had recurrence and received re-biopsy over 2 times. Eight patients of these 39 who had recurrence had progression to invasive carcinoma. The mean interval between diagnosis of leukoplakia and invasive carcinoma was 53 months (ranged 7-114 month). Heavy smoking (more than 20 pack year) and drinking were significantly associated with recurrence or progression to invasive carcinoma. Age, gastroesophageal reflux disease and treatment method were not associated with recurrence. CONCLUSION: Leukoplakia in the larynx led to various histopathologic diagnoses, high recurrence rate, and progressed to invasive carcinoma even after 5 years. Smoking and drinking should be managed and longterm follow-up is needed.

Construction of a DNA Chip for Screening of Genetic Hearing Loss

OBJECTIVES: Hearing loss is the most common sensory disorder in humans and genetic causes are estimated to cause more than 50% of all incidents of congenital hearing loss. To develop an efficient method for a genetic diagnosis of hearing loss, we have developed and validated a genetic hearing loss DNA chip that allows the simultaneous analysis of 7 different mutations in the GJB2, SLC26A4, and the mtDNA 12S rRNA genes in Koreans. METHODS: A genotyping microarray, based on the allele-specific primer extension (ASPE) method, was used and preliminary validation was examined from the five patients and five controls that were already known their genotypes by DNA sequencing analysis. RESULTS: The cutoff Genotyping index (GI) of genotyping for each mutation was set up and validated to discriminate among the genotypes. The result of the DNA chip assay was identical to those of previous results. CONCLUSION: We successfully designed the genetic hearing loss DNA chip for the first time in Korea and it would be useful for a clinical genetic diagnosis of hearing loss. Further consideration will be needed in order to examine the accuracy of this DNA chip with much larger patient sample numbers.

Glomus Tumor of the Nasal Septum : A Case Report

Glomus tumor is a benign tumor, which is believed to represent hyperplasia or harmatomatous development of the glomus body. It is relatively rare in the head and neck region, especially in the nasal cavity. Up to now, only about twenty cases of glomus tumor in the nasal cavity have been reported. We report a case of glomus tumor originating from the anterior portion of nasal septum, which was treated by local excision.

Endoscopic Repairment of Septal Perforation with Using a Unilateral Nasal Mucosal Flap

OBJECTIVES: Nasal septal perforation is an anatomic defect of the cartilaginous and bone tissues of the nasal septum. Many approaches and techniques to repair nasal septal perforations have been reported on. The purpose of this paper is to report on our surgical technique and the results of the treatment for nasal septal perforations. METHODS: From May 2001 to March 2008, 14 patients (12 males and 2 females; mean age: 41.3 yr) were enrolled. The mean perforation size was 15 mm, and all the perforations were located at the cartilaginous portion. Our surgical technique is based on an endoscope-assisted endonasal approach, with dissection of unilateral advanced mucosal flaps with using a temporalis fascia graft. The follow-up periods ranged from 3 to 23 months (mean follow-up period: 8 months). RESULTS: Using our surgical technique on 14 patients, 12 cases (85.7%) of septal perforation were closed without complication. The remaining two patients (14.3%) had incomplete closures (about 2-3 mm) without any significant symptoms related to the remaining perforation. CONCLUSION: Our technique is a viable procedure with a high success rate for achieving closure of nasal septal perforations. It has the advantages of shortening the operative time, no external incision and avoiding any other perforation during the operation. Therefore, we consider it to be a good alternative for repairing nasal septal perforations.