A Case of Dysplastic Nevus of the External Auditory Canal Presenting with Conductive Hearing Loss

A nevus which is a benign melanocytic neoplasm rarely occurs within the external auditory canal (EAC). A dysplastic nevus presents atypical features both clinically and histologically, and is important as a potential precursor for melanoma. We present a case of a 33-year-old female patient with a dysplastic nevus in her EAC. Physical examination revealed a protruding mass arising from the posterior wall of the left cartilaginous EAC. The mass showed clinically characteristic findings of a melanocytic nevus. The patient underwent excisional biopsy via a transcanal approach under local anesthesia. Histopathological examination revealed an intradermal nevus with atypical melanocytes without pleomorphism. There was no evidence of recurrence two years after surgical excision.

Functional Benefit after Modification of Radial Forearm Free Flap for Soft Palate Reconstruction

OBJECTIVES: To compare the velopharyngeal function, swallowing and speech of the conventional and modified radial forearm free flap (RFFF) for soft palate reconstruction. METHODS: Retrospective clinical study. Twenty-eight patients who underwent oropharyngeal reconstruction with RFFF were divided into two groups: 10 patients had conventional folded RFFF and 18 patients underwent modified method. RESULTS: The average speech intelligibility score in modified RFFF group was 8.0+/-2.4, and 6.2+/-2.2 in conventional RFFF group (P<0.05). The nasalance was 27.4+/-7.8% in modified group and 38.6+/-2.7% in conventional group during no nasal passage reading and 43.6+/-7.3% in modified group, 55.2+/-7.6% in conventional group during high nasal passage reading (P<0.05). The subjective swallowing functional score was 2.8 in modified group and 2.1 in conventional group. CONCLUSION: The speech assessment and nasalance demonstrate a more favorable outcome in modified group than conventional group.

Role of Hepatocyte Growth Factor and c-met Gene Expression in Oral Cavity and Oropharyngeal Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The hepatocyte growth factor (HGF)/c-Met signal pathway may play various roles in carcinogenesis of several organs. However, studies about this pathway in head and neck cancers, especially oral cavity and oropharyngeal squamous cell carcinoma (SCC), are very rare. Our objectives are to evaluate the relationship between the mRNA and protein expression of HGF and c-met genes in oral cavity and oropharyngeal carcinomas. SUBJECTS AND METHOD: In this study, we examined the mRNA expression of HGF and c-Met by means of the immunohistochemistry (IHC) method and reverse transcription polymerase chain reaction (RT-PCR) in 40 cases of surgically resected oral cavity and oropharyngeal SCC and 10 cases of low grade dysplasia. RESULTS: Using RT-PCR, HGF mRNA amplification was detected in 67.5% and 10% of carcinoma and dysplasia. c-Met mRNA over-expression was detected in 57.5% and 20% of carcinoma and dysplasia. Using IHC, HGF and c-Met protein over-expression was detected in 55% and 62.5% in carcinoma, but not detected in dysplasia. CONCLUSION: These results suggest that HGF/c-Met signal pathway may be associated with the development of oral cavity and oropharyngeal SCC.

Two Cases of Adenoid Cystic Carcinoma of the Trachea: Laryngotracheal Reconstruction with Sternocleidomastoid Myoperiosteal Flap / 대한이비인후과학회지

Adenoid cystic carcinoma of the trachea, although rare, is the second most common primary tumor of the trachea. It has a local infiltration and potential for regional and distant metastasis. Complete resection is the management of choice. But complete resection must be followed by proper reconstruction of laryngotrachea. The sternocleidomastoid myoperiosteal flap is an excellent technique for subglottic or tracheal reconstruction in selected cases of primary trachea tumor. The advantages of the sternocleidomastoid myoperiosteal flap lie in its single-stage reconstruction, the ease of the procedure, the relatively low complication rate, stabilization of the airway with good phonation, and long-term success. We report 2 cases of laryngotracheal reconstruction with sternocleidomastoid myoperiosteal flap. Both patients had acceptable airway patency and good phonation.

The Utility of Paramedian Mandibulotomy for Resection of Oral Cavity and Oropharynx Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mandibulotomy approach is the most popular method for resection of oral cavity and oropharyngeal cancers because of wide surgical exposure with minimal morbidities. The purposes of this study are to evaluate the utility and morbidity of the mandibulotomy approach. SUBJECTS AND METHOD: A total of 191 patients who had cancer in the oral and oropharynx were surgically treated between 1995 and 2005. Among them, 51 patients underwent mandibulotomy. The types of the mandibular osteotomy were consisted of the paramedian osteotomy in 44 patients. RESULTS: First, only 10% (11 of 110) of the oral cavity cancer patients were required to use the mandibulotomy approach for primary resection. In the oropharynx cancer, the mandibulotomy rates was 49% (40 of 81). The rates of the mandibulotomy according to T stages were as follows: T1, 0% (0 of 27), T2; % (17/92), T3; 50% (24/48), and T4, 42% (10 of 24). Second, an average mean time to start oral diet after the mandibulotomy was 14th day and average mean duration of the tracheostomy until decannulation in the cannula was 19th days. Third, the complication rate related with the paramedian mandibulotomy related was 23% and the most of the complications could be managed with conservative treatment. CONCLUSION: The paramedian mandibulotomy with the stair-step osteotomy and miniplate fixation is an excellent surgical approach for posterior lesion of oral cavity cancer and oropharyngeal advanced tumors.

Clinical Evaluation and Proper Antibiotics Therapy in Office Base for the Patients Who were Infected with MRSA after ESS / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Methicillin resistant staphylococcus aureus (MRSA) prevalence has increased over the world during past several decades and now it has become a world wide problem. It is especially more serious in domestic situations but unfortunately, until this time, there is no report about MRSA infection treatment after endoscopic sinus surgery (ESS). The objective of our study is to evaluate clinical feature of MRSA infection and to find out what kinds of treatment is the best way to control of the MRSA infection after ESS. SUBJECTS AND METHOD: The medical records of 58 patients who had the evidence that they were infected with MRSA after ESS were retrospectively reviewed. Samples were obtained by sinus endoscopy in the office base. RESULTS: Those of MRSA infected only cases were 26 cases. Co-infected cases with another microorganism were 32 cases. Forty-three cases were treated with oral rifampin alone and 11 cases were treated by a combination with oral quinolone or trimethoprim-sulfimethoxazole. Four cases failed to be treated with oral antibiotic therapy. CONCLUSION: Rifampin is the useful medication for the treatment of MRSA infected patients who had underwent ESS. Also, Rifampin is a cost effective medication compared with the glycopeptide antibiotics especially if it is used in the office base.

Clinical Significance of the Expression of Galectin-3 in Thyroid Tumor / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Galectin-3 is a beta-galactoside binding protein, of which the major function is not fully elucidated in malignant tumor. However, galectin-3 is expressed in epithelial cells and contributes to the progression of cancer. Although galectin-3 is expressed in a variety of tissues and plays important roles in malignant transformation or tumor progression, the study on its expression related to clinicopathological parameters in thyroid tumor is rare. So, the present study aims to find out the clinical significance of galectin-3 in thyroid tumor. SUBJECTS AND METHOD: We assessed mRNA and protein expressions of the galectin-3 gene by means of the RT-PCR method and immunohistochemical staining in 100 cases of thyroid tumors (50 papillary carcinomas, 10 follicular carcinomas, 20 follicular adenomas, 20 nodular hyperplasia). The expression of galectin-3 is compared with the clinical prognostic factors of thyroid papillary cancer. RESULTS: Using RT-PCR, galectin-3 mRNA was detected in 41 (82%) in papillary carcinoma, 6 (60%) in follicular carcinoma, 8 (40%) in follicular adenoma and 9 (45%) in nodular hyperplasia cases. Using immunohistochemical staining, galectin-3 protein expressions were detected in 46 (92%), 7 (70%), 3 (15%) and 1 (5%). The expressions of the galectin-3 mRNA and protein were significantly recognized in thyroid papillary carcinoma. However, the galectin-3 mRNA and protein over-expression is not significantly correlated with the clinical prognostic factors of thyroid papillary carcinoma. CONCLUSION: These results suggest that galectin-3 expression may be associated with thyroid papillary carcinoma development.

Clinical Efficacy of Intranasal Azelastine Hydrohloride Spray in Korean Vasomotor Rhinitis Patients

Background & Objectives: Vasomotor rhinitis (VMR) is a chronic non-allergic rhinitis without the increased Ig E level and eosinophilia. Azelastine hydrochloride is a second generation anti-histamine medication with anti-inflammatory properties that inhibits the synthesis of inflammatory materials. There are reports that azelastine hydrochloride can be effective in the treatment of VMR. Therefore, this study examined the clinical efficacy of intranasal azelastine hydrochloride spray in comparison with placebo for the treatment of VMR. MATERIALS AND METHOD: This study was a prospective double blind randomized test. The subjects consisted of 84 VMR patients. Among them, 54 patients were treated with intranasal azelastine hydrochloride for 4 weeks and 30 patients with intranasal normal saline. Following the treatment, an analysis of the symptom score was performed in order to compare the treatment effects between the study group and the control group. RESULTS: In the study group, the symptom score was significantly improved in the areas of sneezing (1.38 to 0.72), rhinorrhea (1.57 to 0.76), nasal obstruction (1.76 to 1.01) and postnasal drip (1.43 to 0.65). In the control group, however, the symptom score was significantly improved in a single area of rhinorrhea (1.73 to 0.65). Patients in the study group, thus, displayed greater improvements in the areas of sneezing, rhinorrhea, nasal obasturction and postnasal drip comparative to the control group. Consequently, the study group patients were more satisfied with their quality of life than those of the control group. CONCLUSION: Azelastine chloride is a useful medicine for the treatment of VMR, especially in controlling sneezing, rhinorrhea, nasal obstruction and postnasal drip.