A case report of a carotid space abscess due to extraluminal migration of a fishbone into the deep cervical space / 고신대학교의과대학학술지

Laryngopharyngeal foreign bodies are among the cases most frequently encountered by otolaryngologists. Most foreign bodies can be easily removed without any complications. However, surgical removal is required in some cases. Therefore, a delayed diagnosis or misdiagnosis could cause fatal complications for patients who need a surgical approach. We report a rare case of extraluminal migration of a foreign body to the deep cervical space. The foreign body (a fishbone) was removed by a surgical approach. With a literature review, we also propose an algorithm for the management of suspicious foreign bodies in the neck.

Evaluation of Ultrasonography and CT for Imaging of Head and Neck Pilomatricoma in Children and Adolescents / 대한이비인후과학회지

Background and Objectives@#Pilomatricoma is a frequently diagnosed skin lesion of the head and neck that may often be misdiagnosed as other skin lesions. This study evaluated whether ultrasonography (USG) or computed tomography (CT) is the most helpful imaging modality for the accurate preoperative diagnosis of pilomatricoma in head and neck regions of children and adolescents.Subjects and Method A retrospective review was conducted for 59 patients with pilomatricoma under the age of 19 years. All cases were pathologically confirmed with pilomatricoma in the head or neck. @*Results@#Preoperative imaging examinations were performed with USG in six cases and with CT in nine cases. The accuracy of preoperative diagnosis was compared between three groups: 1) with clinical findings only, 2) with USG, and 3) with CT. The correct preoperative diagnosis was made in 18 (30.5%) of the total of 59 cases. Using only clinical findings, 10 (22.7%) out of 44 patients were diagnosed as pilomatricoma. With the addition of USG, pilomatricoma was diagnosed in 1 (16.7%) out of six cases, whereas with the addition of CT, 7 (77.8%) out of 9 cases (77.8%) were diagnosed correctly. Preoperative diagnosis of pilomatricoma with CT imaging was more accurate than clinical findings only (vs. CT; odds ratio [OR]=11.900, 95% confidence interval [CI] 2.126-66.615; p=0.001) or USG (vs. CT; OR=17.500, 95% CI 1.223-250.357; p=0.020). @*Conclusion@#In the preoperative diagnosis of pilomatricoma, imaging modalities such as CT and USG are helpful, with CT offering higher diagnostic accuracy and USG procedural benefits in younger children.

Endoscopic Trans-Turbinal Medial Maxillectomy: A Modified Endoscopic Medial Maxillectomy Technique to Preserve the Inferior Turbinate / 대한이비인후과학회지

Endoscopic medial maxillectomy (EMM) and its modifications are surgical techniques are used to treat recalcitrant maxillary sinusitis as well as maxillary sinus tumors. In this report, we propose a simple and efficient modification of EMM, called endoscopic trans-turbinal medial maxillectomy (ETTMM), by which the inferior turbinate (IT), nasolacrimal duct, and anatomical integrity of the nasal valve area are preserved. A total of 10 patients (five tumorous and five nontumorous maxillary diseases) underwent ETTMM. Briefly, a turbinate mucosal flap on the superior aspect of the IT was elevated after middle meatal antrostomy. Then a trans-turbinal window was developed to expose the inferior meatus, after which an extended maxillary antrostomy was generated. Finally, the turbinate mucosal flap was repositioned after complete removal of the antral lesions. All lesions were successfully treated using ETTMM. Our modification was easy to perform, and we achieved good endoscopic visualization and accessibility throughout the whole antrum by creating a trans-turbinal window and extended maxillary antrostomy. We could perform postoperative surveillance easily through the wide antrostomy using rigid endoscopes of various angles. ETTMM is a simple and useful modification of EMM that provides clear visualization and great accessibility to most aspects of the maxillary antrum while preserving the nasal functional units, including the IT and nasal valve area.

A Case of Lobular Capillary Hemangioma at the False Vocal Cord With Intermittent Stridor

Lobular capillary hemangioma (LCH) is a type of benign vascular tumor. It arises from vascular endothelial cells and contains capillaries arranged in a lobular pattern. In the head and neck, the most common presenting location of LCH is the lips, and presentation in the larynx is very rare. LCH might not be distinct from granuloma in macroscopic views. We report a 71-year-old female with LCH of the larynx that was totally resected via laryngeal microsurgery with a CO2 laser and briefly review the literature.

A Case of Hyperparathyroidism Caused by Intrathyroidal Parathyroid Adenoma

Hyperparathyroidism is a common endocrine disorder, but intrathyroidal parathyroid adenoma is extremely rare. We report a on a case of hyperparathyroidism caused by intrathyroidal parathyroid adenoma. This case is important in that it affects an effective test for the diagnosis of intrathyroidal parathyroid adenoma, and shows the decision of the treatment process and the results.

A Case of Hyperparathyroidism Caused by Intrathyroidal Parathyroid Adenoma

Hyperparathyroidism is a common endocrine disorder, but intrathyroidal parathyroid adenoma is extremely rare. We report a on a case of hyperparathyroidism caused by intrathyroidal parathyroid adenoma. This case is important in that it affects an effective test for the diagnosis of intrathyroidal parathyroid adenoma, and shows the decision of the treatment process and the results.

Pathophysiology of Upper Airway Collapse / 대한이비인후과학회지

Previous pathophysiologic studies have revealed that the upper airway dimension reaches a minimal value at the end of expiration, and pharyngeal negative pressure is not an essential prerequisite for upper airway collapse. Furthermore, pharyngeal collapse occurs in spite of increased activity of upper airway dilator muscles in patients with obstructive sleep apnea (OSA) compared with normal subjects. Pharyngeal sensory threshold is elevated in patients with OSA, which contributes to inadequate activity of upper airway dilator muscles. Pharyngeal narrowing results in several types of airflow limitation, of whom the mechanisms are mainly explained using Starling resistor model and negative effort dependence. Several studies have been conducted over the past years to validate polysomnographic surrogate markers which indicate specific pathophysiologic phenotypes, and such attempts may be able to lead us to personalized treatment for OSA.

Prognostic Value of Combined Programmed Cell Death 1 Ligand and p16 Expression Predicting Responsiveness to Radiotherapy in Patients with Oropharyngeal Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#This study examined the expressions of p16 and the programmed cell death 1 ligand (PD-L1) in patients with oropharyngeal cancer (OPC) treated with radiotherapy (RT) to identify the correlation between p16 and PD-L1 expression, and to examine the prognostic significance of these markers for OPC patients receiving RT.SUBJECTS AND METHOD: Forty-eight OPC patients diagnosed and treated at a tertiary referral hospital were enrolled in this retrospective analysis. Patients were initially treated with RT or chemoradiotherapy (CRT) with curative intent and completed the planned schedule. Expression of p16 and PD-L1 by primary tumors was evaluated by immunohistochemistry, and results were interpreted separately and dichotomized according to outcome analyses.@*RESULTS@#Of the 48 patients, 25 (52.1%) expressed p16 and 15 (31.3%) expressed PD-L1. Expression of these markers showed a mutual positive correlation (p=0.046). Positive PD-L1 expression was associated with poor complete remission (CR) rates after RT (p=0.040). Positive p16 expression was associated with better recurrence-free survival (RFS) (p=0.004) but not overall survival (OS) (p=0.192). PD-L1 expression showed no independent association with survival (p>0.05); however, PD-L1 expression tended toward poorer RFS, even in p16-positive individuals.@*CONCLUSION@#There was a positive correlation between the expression of p16 and PD-L1 in OPCs. PD-L1 expression was associated with poorer CR rates after RT or CRT. PD-L1 alone did not show an association with RFS or OS, but when combined with p16, it tended toward poorer RFS, even in p16-positive cases.

Widespread Inverted Papilloma in the Frontal Sinus Treated by Unilateral Osteoplastic Flap Surgery without Obliteration / 대한이비인후과학회지

Inverted papilloma is a rare sinonasal tumor that mainly occurs in adults during the 5th decade. Three characteristics make this tumor very different from other sinonasal tumors: a relatively strong potential for local destruction, high rate of recurrence, and a risk of carcinomatous evolution. Etiology remains little understood, but an association with human papilloma virus has been reported in up to 40% of cases, raising the suspicions of implication in the pathogenesis of inverted papilloma. Treatment of choice is surgery, by endonasal endoscopic or external approach, depending on extension and tumoral characteristics. We experienced a case of 42-year-old male with inverted papilloma which originated from the ethmoid roof and spread into the frontal sinus. He was treated successfully by unilateral osteoplastic flap surgery without obliteration, and we report on the treatment of this case, along with a review of literature.

Malignant Solitary Fibrous Tumor of the Parotid Gland / 대한이비인후과학회지

Solitary Fibrous tumor is usually arising in the pleura of the thoracic cavity and it has been described in a variety of extrapleural sites including the abdominal cavity, soft tissue, upper respiratory tract and rarely in head and neck region. We experienced a rare case of solitary fibrous tumor in the parotid gland. A 49-year-old woman presented with a painless mass in the left parotid. The mass was well-demarcated and easily dissected, and it showed a patternless arrangement of potential malignant spindle cells in a fibrotic background and prominent vascular structures. In immunochemistry, the mass cells were positive for CD34, vimentin, and negative for actin, S-100 protein, and cytokeratins. Therefore, the parotid mass diagnosed as SFT. During the 24 months of follow-up, there was no recurrence of tumor growth.

A Case of Renal Metastasis from Follicular Thyroid Carcinoma Mimicking Renal Cell Carcinoma / 대한이비인후과학회지

Follicular thyroid carcinoma is the second most common form of thyroid cancer. It accounts for 10 percent of all thyroid cancer, and is found three times more frequently in men than in woman. It is well known that follicular thyroid carcinoma usually occurs in regions where it is hard for people to intake iodine. Most follicular thyroid carcinomas occur asymptomatically but occasionally reveal as masses in the thyroid nodules. The occurence of metastasis of follicular thyroid cancer in the lymph node is less than 10%, which is relatively low compared to that of papillary cancer. Follicular carcinomas are metastasized hematogenously and are common in the bone, liver, lung and brain. It is especially rare for metastatic follicular thyroid cancer to be diagnosed as renal tumor. We recently experienced and further investigated a case of follicular thyroid carcinoma that metastasised to the kidney in a 57-year-old woman, who had had abdominal distension. We report this case with a review of the reference.

A Case of Mucosa-Associated Lymphoid Tissue Lymphoma in Sublingual Glands without Autoimmune Disease / 대한이비인후과학회지

Mucosa-associated lymphoid tissue (MALT) lymphomas are low-grade extranodal B-cell lymphomas that may involve various sites in the head and neck including the thyroid, salivary, and lacrimal glands. In particular, primary salivary gland MALT lymphoma is rare, with sublingual gland tumors especially rarer and frequently malignant. In Korea, there has been no reported case of MALT lymphoma in sublingual glands. Here we report a case of a MALT lymphoma in the sublingual gland.

Extraskeletal Myxoid Chondrosarcoma of Larynx / 대한이비인후과학회지

Primary cartilaginous tumors of the laryngeal lesion are rare and it accounts for only 1% of laryngeal tumor pathology. They are most commonly located on the endolaryngeal surface of cricoid cartilage, and it is extremely rare to find them in vocal muscle lesion. In most cases, treatment of choice is based on surgical excision, and postoperative radiotherapy is typically recommended. We experienced a case of a 22-year-old young woman without underlying disease, presenting extraskeletal myxoid chondrosarcoma of vocal cord, especially in the vocal muscle. The patient underwent mass excision through suspension laryngoscope and radiation therapy.