BRAF(V600E) Mutation is a Strong Preoperative Indicator for Predicting Malignancy in Thyroid Nodule Patients with Atypia of Undetermined Significance Identified by Fine Needle Aspiration / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aimed to identify a reliable preoperative predictive factor for the development of thyroid cancer in patients with atypia of undetermined significance (AUS) identified by fine needle aspiration biopsy (FNAB). SUBJECTS AND METHOD: This was a retrospective cohort study. Two hundred and ninety-nine patients diagnosed with AUS by preoperative FNAB who underwent curative thyroid surgery at our institution between September 2005 and February 2014 were analyzed. Clinical, radiological and molecular features were investigated as preoperative predictors for postoperative permanent malignant pathology. RESULTS: The final pathologic results revealed 36 benign tumors including nodular hyperplasia, follicular adenoma, adenomatous goiter, nontoxic goiter, and lymphocytic thyroiditis, as well as 263 malignant tumors including 1 follicular carcinoma and 1 invasive follicular carcinoma; the rest were papillary thyroid carcinomas. The malignancy rate was 87.9%. The following were identified as risk factors for malignancy by univariate analysis: BRAFV600E gene mutation, specific ultrasonographic findings including smaller nodule size, low echogenicity of the nodule, and irregular or spiculated margin (p < 0.05). Multivariate analysis revealed that only BRAFV600E mutation was a statistically significant risk factor for malignancy (p < 0.05). When BRAFV600E mutation was positive, 98.5% of enrolled patients developed malignant tumors. In addition, the diagnostic rate of malignancy in these cases was approximately 16-fold higher than BRAF-negative cases. CONCLUSION: Patients with AUS thyroid nodules should undergo BRAFV600E gene mutation analysis to improve diagnostic accuracy and if the mutation is confirmed, surgery is recommended due to the high risk of malignancy.

Photodynamic Therapy for Recurrent Head and Neck Malignancy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: As a preliminary study, authors tried to verify clinical and side effects of Radachlorin in a photodynamic therapy for recurrent head and neck malignancy. Radachlorin shows an absorption peak at 662 nm, which indicates that it penetrates up to 10 mm. SUBJECTS AND METHOD: We treated 12 sites for 9 treatments in 6 recurrent head and neck malignacies, 4 cases of squamous cell cancers and each of adenoid cystic cancer, and undifferentiated nasopharyngeal cancer. A dose of 1 mg/kg or 2-5 mL of Radachlorin was i.v. injected into the mass according to the mass size. We used a diode laser, MILON-662 (Milon Laser Company, Russia) and Medlight cylindrical 10/20 radial diffuser and frontal diffuser as light delivery devices. About 3 hrs after intravenous injection, or 30 min after intralesional injection, a light dose of 200-300 J/cm2 or cm of laser was irradiated onto the tumor or intralesionally with the light dose of 200-300 J/cm2, or cm. RESULTS: There was partial tumor regression in three of the five primary tumors. In one case of metastatic node treated by intralesional injection and irradiation, tumor showed complete necrosis. But there was no effect in 2 cases of subcutaneous metastases. There were no side effects such as fever, chill and photosensitivity in any of the cases. CONCLUSION: The clinical effect of photodynamic therapy (PDT) using Radachlorin with 662 nm of laser light is not clear yet, but it seems to be a safe treatment for head and neck malignancy. We need to investigate the effect of this PDT system in untreated head and neck malignancies.

Larynx-Preserving Partial Pharyngectomy via Lateral Pharyngotomy for the Treatment of Small (T1~2) Hypopharyngeal Squamous Cell Carcinoma

OBJECTIVES: To evaluate the oncologic and functional results of larynx-preserving partial pharyngectomy (LPP) via lateral pharyngotomy approach as a primary treatment for small (T1 or T2) hypopharyngeal squamous cell carcinoma (HPSCC). METHODS: We performed a retrospective review of 23 patients who underwent LPP through lateral pharyngotomy approach for small HPSCC at the our department between January 1991 and June 2007. Fourteen (61%) patients had adjuvant postoperative radiotherapy. RESULTS: The 2-years and 5-years disease specific survival rate was 77% and 61%, respectively. Nine patients (39%) had tumor recurrence. The most common pattern of recurrence was isolated distant failure (n=4, 44%) followed by local (n=2, 22%) and loco-regional (n=3, 34%) recurrence. The ultimate cure rate of the primary tumor was 87% (20 of 23). Twenty-two of the 23 patients (95%) could be decannulated, tolerate an oral diet, and had acceptable postoperative phonatory function. CONCLUSION: LPP via lateral pharyngotomy approach appears to be a feasible procedure for selected small HPSCC patients in terms of both oncologic and functional outcomes.

Larynx-Preserving Partial Pharyngectomy via Lateral Pharyngotomy for the Treatment of Small (T1~2) Hypopharyngeal Squamous Cell Carcinoma

OBJECTIVES: To evaluate the oncologic and functional results of larynx-preserving partial pharyngectomy (LPP) via lateral pharyngotomy approach as a primary treatment for small (T1 or T2) hypopharyngeal squamous cell carcinoma (HPSCC). METHODS: We performed a retrospective review of 23 patients who underwent LPP through lateral pharyngotomy approach for small HPSCC at the our department between January 1991 and June 2007. Fourteen (61%) patients had adjuvant postoperative radiotherapy. RESULTS: The 2-years and 5-years disease specific survival rate was 77% and 61%, respectively. Nine patients (39%) had tumor recurrence. The most common pattern of recurrence was isolated distant failure (n=4, 44%) followed by local (n=2, 22%) and loco-regional (n=3, 34%) recurrence. The ultimate cure rate of the primary tumor was 87% (20 of 23). Twenty-two of the 23 patients (95%) could be decannulated, tolerate an oral diet, and had acceptable postoperative phonatory function. CONCLUSION: LPP via lateral pharyngotomy approach appears to be a feasible procedure for selected small HPSCC patients in terms of both oncologic and functional outcomes.

Surgical Treatment of Carotid Body Paragangliomas: Outcomes and Complications According to the Shamblin Classification

OBJECTIVES: The objective of this study was to review our experience in the surgical management of carotid body paragangliomas and evaluate the outcomes and complications according to the Shamblin classification. METHODS: Thirteen patients who had been diagnosed and surgically treated for carotid body tumors (CBTs) were enrolled in this study. We reviewed patient demographics, radiographic findings, and surgical outcomes collected from medical records. RESULTS: Fifteen CBTs were found in 13 patients and 13 tumors were resected. Selective preoperative tumor embolization was performed on six patients. The median blood loss, operation time, and hospital stay for these patients were not significantly reduced compared to those without embolization. The median tumor size was 2.3 cm in Shamblin I and II and 4 cm in Shamblin III. The median intraoperative blood loss was 280 mL and 700 mL, respectively (P<0.05). Internal carotid artery ligation with reconstruction was accomplished on three patients (23%), and they all belonged to Shamblin III (38%). One Shamblin III patient (8%) developed transient cerebral ischemia, and postoperative stroke with death occurred in another Shamblin III patient. Postoperative permanent cranial nerve deficit occurred in three patients (23%) who were all in Shamblin III (P=0.03). There were no recurrences or delayed complications at the median follow up of 29 months. CONCLUSION: Shamblin III had a high risk of postoperative neurovascular complications. Therefore, early detection and prompt surgical resection of CBTs will decrease surgical morbidity.

Growth Inhibition and Apoptosis with H31 Metabolites from Marine Bacillus SW31 in Head and Neck Cancer Cells

OBJECTIVES: To determine whether a novel marine micro-organism with anticancer properties, H31, the metabolic product of Bacillus SW31, has anti-tumor effects on head and neck cancer, and potential for apoptotic-enhancing anti-cancer treatment of affected patients. METHODS: The cell viability and apoptosis assays were performed. Changes in the signal pathway related to apoptosis were investigated. Then, the therapeutic effects of H31 were explored in mouse xenograft model and drug toxicity of H31 was examined in zebrafish model. RESULTS: We identified the anticancer activity of H31, a novel metabolic product of Bacillus SW31. Bacillus SW31, a new marine micro-organism, has 70% homology with Bacillus firmus and contains potent cytotoxic bioactivity in head and neck cancer cells using MTT assay. Combined with c-JUN, p53, cytochrome C, and caspase-3, H31 induced apoptosis of KB cells, a head and neck cancer cell line. In a separate in vivo model, tumor growth in C3H/HeJ syngeneic mice was suppressed by H31. In addition, in a zebrafish model used for toxicity testing, a considerable dose of H31 did not result in embryo or neurotoxicity. CONCLUSION: Growth inhibition and apoptosis were achieved both in vitro and in vivo in head and neck cancer cells after exposure to H31, a metabolite from the marine Bacillus species, without any significant toxicity effects even at considerable H31 dose concentrations.

Evolution of Neck Dissection: Radical to Superselective / 대한이비인후과학회지

No abstract available.

Occult Lymph Node Metastasis in Early Oral Tongue Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The most significant prognosticator of survival for patients with squamous cell carcinoma of the oral tongue has been the association of neck nodal metastasis. However, no consensus exists as to whether an elective neck dissection should be performed in patients with early oral tongue squmous cell carcinoma with a clinically negative neck. SUBJECTS AND METHOD: A retrospective analysis was performed on 54 early oral tongue squamous cell carcinoma patients (T1=26 and T2=28) with clinically negative necks who were treated between 1992 to 2003. All patients had an ipsilateral neck dissection and 29 patients had a contralateral neck dissection. Surgical treatment was followed by postoperative radiotherapy in 20 patients. The follow-up period ranged from 3 to 110 months (mean, 56 months). Data were analyzed using the Kaplan-Meier method, log-rank test, and the chi-square test. RESULTS: Clinically occult, but pathologically positive ipsilateral lymph nodes were found in 26% (14/54) and contralateral lymph nodes in 3% (1/29). Based on the clinical staging of the tumor, 19% (5 of 26) of the cases showed lymph node metastases in T1 tumors, and 36% (10 of 28) in T2. All regional recurrences developed in the ipsilateral necks, there was no cases of contralateral neck recurrence. Patients with no evidence of occult nodal cancer have significantly improved disease-specific free survival rates over patients with any pathologically positive nodes (5 year disease specific survival rate, 90% vs 38%, p< or = 0.05). CONCLUSION: This study showed that ipsilateral elective neck dissection should be performed for early oral tongue cancers. On the other hand, our series suggests that it may not be harmful to observe the contralateral N0 neck in the treatment of early oral tongue cancer.

Hereditary Angioneurotic Edema of the Larynx: A Case Report and Literature Review / 대한이비인후과학회지

Hereditary angioneurotic edema (HAE) is an autosomal dominant disease that results from the deficiency of C1 esterase inhibitor (C1-INH) function. Urgent proper intervention of the upper airway is warranted to save the life of patients with the disease, which often causes acute airway obstruction. We present, with a review of literature, a case of 37-year old woman with HAE of larynx.

Is the Dissection of the Level IV Lymph Node Pads Necessary in the Elective Lateral Neck Dissection of N0 Supraglottic Squamous Cell Carcinoma? / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To determine whether level IV lymph nodes can be saved in the elective lateral neck dissection (LND) as a treatment for patients with squamous cell carcinoma of the supraglottic larynx. SUBJECTS AND METHODS: From January 1997 to May 2002, 42 patients with supraglottic squamous cell carcinoma and a clinically N0 neck who underwent an elective LND were studied prospectively. The incidence of pathological metastasis to the level IV lymph nodes and a regional recurrence after an elective LND were evaluated. RESULTS: Of the 42 patients, 10 (24%) had lymph nodes positive for microscopic metastatic squamous cell carcinoma. Two (5%) of the 42 patients had involvement of the level IV lymph nodes, whose clinical T-stages were above cT3. None of the clinical T1 or T2 tumors showed level IV nodal metastasis. There were two cases (5%) of the ipsilateral neck recurrence: these patients developed recurrence in the level II and stomal area, respectively. CONCLUSION: The level IV lymph node metastasis was rare in this study, and nodal recurrence after LND in squamous cell carcinoma of the supraglottic larynx was infrequent. Therefore, this region may be preserved in elective LND for patients with early squamous cell carcinoma of the supraglottic larynx.

Management of Contralateral N0 Neck in Tonsillar Squamous Cell Carcinomas / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is well established that tonsillar squamous cell carcinoma has high probability to be disseminated to the neck. An ipsilateral neck treatment is mandatory during initial treatment stages of II-IV tonsillar carcinomas. However, no consensus exists as to whether an elective contralateral neck management should be performed. SUBJECTS AND METHOD: A retrospective analysis was performed on 43 N1-3 tonsillar cancer patients with contralateral negative necks who were treated between 1992 to 2002. All patients had a contralateral elective neck dissection. Surgical treatment was followed by postoperative radiotherapy in 33 patients. The follow-up period ranged from 2 to 120 months (mean, 38 months). The Kaplan-Meier method and log-rank test were used to calculate the disease-specific survival rates and prognostic significance of contralateral occult lymph node metastasis. RESULTS: Clinically occult, but pathologically positive contralateral lymph nodes were found in 16% (7 of 43). In cases of ipsilateral N (+) neck, contralateral occult lymph node metastases developed in 21% (7 of 33) and there was no incidence of that in the cases of ipsilateral N0 necks. Based on the clinical stages of the tumor, 5% (1 of 22) of the cases metastatically involved ymph nodes in the T2 tumors, 36% (5 of 14) in the T3, and 25% (1 of 4) in the T4. T1 tumors (3 cases) had no pathologically positive lymph nodes (T1+T2 vs T3+T4, p<.05). Patients with no evidence of contralateral nodal cancer had significantly improved disease-specific free survival rates over patients with any pathologically positive nodes (5 year disease specific survival rate, 92% vs 28%, p=<.05). CONCLUSION: The risk of contralateral occult neck involvement in above T3 staged tonsillar squamous cell carcinomas with unilateral metastases was high and patients who presented with contralateral metastatic neck have worse prognosis than those who are staged as N0. Therefore, we advocate a routine bilateral neck dissection in tonsillar squamous cell carcinoma patients with unilateral node metastases.

Treatment Outcome, Prognostic Factors and Patterns of Failure of Nasopharyngeal Carcinoma / 대한이비인후과학회지

PURPOSE: The first treatment of choice for nasopharyngeal carcinoma (NPC) is radiotherapy as NPC is more responsive to radiotherapy than any other head and neck cancer. We analyzed the clinical characteristics and prognostic factors of NPC patients treated at the Severance Hospital. SUBJECTS AND METHOD: Charts of 123 patients diagnosed with NPC at the Severance Hospital from 1995 to 2002 were reviewed and retrospectively analyzed. They were staged according to the 1997 AJCC criteria. According to the WHO classification, the type I included 14 cases, type II 44 cases, and type III 65 cases. Sixty-five cases were treated with radiotherapy only and 58 cases were treated with a combined modality of chemotherapy and radiotherapy. RESULTS: The factors for a poor prognosis were age over 47 years' old, histologic findings of WHO type I and advanced T, N stage. The overall 5 year survival rate was 66.22%. According to treatment modality, only the radiotherapy group was 68.6%, while the chemoradiotherapy group was 63.6%. There was no difference in survival (p>0.05). In chemoradiotherapy group, the survival of induction chemoradiotherapy group was 82.1% and the concurrent chemoradiotherapy group was 36.8%. There was significant difference in survival. CONCLUSIONS: There was no significant difference in the 5 year survival rate between the patients who were treated with radiotherapy only and those who were treated with both radiotherapy and chemotherapy.

Chondrosarcoma of the Head and Neck

Chondrosarcoma of the head and neck region is a rare disease, representing approximately 0.1% of all head and neck neoplasms. The 5-year survival rate of chondrosarcoma is 70- 80%, showing relatively good prognosis; however, it is known to progress slowly and eventually cause multiple metastases. In this study, we reviewed chondrosarcoma cases experienced at Yonsei University Medical College during the last 15 years to investigate its clinical characteristics and treatment outcome. The medical records of 8 patients who were diagnosed with chondrosarcoma of the head and neck region and underwent surgical treatment between December 1990 and December 2002 were retrospectively reviewed. The primary sites were sinus, mastoid, jugular foramen and thyroid cartilage. In all patients, the initial treatment modality was surgery, and postoperative radiation therapy was performed in 4 cases. The pathological findings showed chondrosarcoma in 7 cases and mesenchymal chondrosarcoma in 1 case. The treatment outcome resulted in 3 cases of recurrence, of which 2 cases were treated successfully and the other case expired of disease, indicating a survival rate of 87.5%. In the case that resulted in death, complete excision could not be achieved. Therefore, we concluded that wide excision is a beneficial initial treatment of this rare disease.

Supraglottic Partial Laryngectomy: Oncologic and Functional Results / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Supraglottic partial laryngectomy allows the removal of selected supraglottic tumors, preserving a functioning larynx and avoiding a permanent tracheotomy. The purpose of this study was to evaluate our experience with supraglottic partial laryngectomy and to review the functional and oncologic results of the operation. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of 40 patients with squamous cell carcinoma of the supraglottis and 1 patient with sarcomatoid cancer ; they were either treated with supraglottic laryngectomy (n=31) or extended supraglottic laryngectomy (n= 10) from May 1991 and December 2001. Fifteen patients had tumors in T1, 25 patients in T2, and 1 patient in T3. The primary lesion of the tumors were as follows: suprahyoid epiglottis (n=12), infrahyoid epiglottis (n=13), aryepiglottic fold (n=10), false vocal cord (n=4), and pyriform sinus (n=2). A Kaplan-Meier, Willcoxon and Fisher's exact test was performed to obtain the survival rate and the prognostic factors. The evaluations of postoperative function were performed with regard to decannulation, oral diet, and average time taken to decannulate and to initiate oral intake. RESULTS: The disease-specific 3-year survival rate was 87%. Pathologic lymph node metastasis and the invasion of tumor to the preepiglottic space were significant clinical prognostic factors affecting survival. Local recurrence was developed in only one case (2.6%). Decanulation was possible in 93% of our patients. Ninety-five percent of our patients could ultimately take oral diet. The average decannulation time was postoperative 28.3 days and the average time taken to begin oral feeding time was 23.2days. CONCLUSION: This study suggests that supraglottic partial laryngectomy may be used with acceptable oncologic and functional results for supraglottic cancers.

Surgical Laryngeal Preservation in Early-Staged Hypopharyngeal Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hypopharyngeal cancer is aggressive, grows rapidly and often tends to spread through the submucosa combined with multiple "skip lesions" or tumor satellites. Therefore, even in the early stages, most patients require wide resection, usually including total laryngectomy followed by radiotherapy. However, it is obvious that, with consideration of quality of life, the laryngeal function and cancer control are equally important. The purpose of this study is to evaluate the oncologic and functional results of laryngeal conservation surgery for early-staged hypopharyngeal cancer. SUBJECTS AND METHOD: Fourteen patients with T1 or T2 carcinoma of the various subsites of the hypopharynx, including the medial wall of pyriform sinus (four patients), lateral wall of pyriform sinus (four patients), and posterior pharyngeal wall (six patients), who were treated surgically between 1992 and 2000, were studied. All except one patient who had skin graft underwent surgical resection of the primary tumor with laryngeal preservation and immediate reconstruction with forearm free flap transfer or primary closure. Follow-up period was 6-54 months. RESULTS: One patient died in the immediate postoperative period due to myocardial infarction. However, other postoperative complications were minimal. There was no evidence of disease for at least 1 postoperative year in 7of 13 patients (53.8%) with hypopharyngeal cancer who have been performed the conservation surgery. All patients except one who died of myocardial infarction, were decannulated. All but 2 patients achieved oral intake without continuous aspiration. Of these 2 patients, one patient had severe dysphagia due to the bulkiness of the reconstructed flap and he was fed through a gastrostomy tube. The other patient died of myocardial infarction before the trial of oral diet. CONCLUSION: Our data suggest that if the precise evaluation of the extent of the tumor and a careful selection of the well adjustable patients are done preoperatively, the laryngeal conservation surgery in early hypopharyngeal cancer may be valuable in terms of oncologic and functional aspect.

Treatment Outcomes and Pattern of Failure in the Surgically Treated Squamous Cell Carcinoma of Floor of the Mouth / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Squamous cell carcinoma involving the floor of the mouth remains one of the most aggressive neoplasms of the head and neck. Its propensity to invade the mandible and to involve the lymphatic beds of both necks often makes local and regional control exceedingly difficult. This study reports the oncologic results of the surgically treated squamous cell carcinoma of the floor of mouth. SUBJECTS AND METHOD: From July 1992 to September 2001, 27 previously untreated floor of the mouth squamous cell carcinoma patients were treated with surgery with or without postoperative radiotherapy at Severance Hospital. Survival rates and factors affecting survival were studied using standard statistical analysis to determine statistical significance. RESULTS: The 2 year and 3 year disease-specific free survival rate in early staged carcinomas (stage I and II) were 85% and 77%, respectively, and in advanced staged carcinomas, 75% and 60%, respectively. Significantly decreased survival was seen in the patients with positive pathologic lymph nodes (p=0.001). However, there was no statistical significance for the effects of cT stage (p=0.56), performance of mandibular resection (p=0.755), mandibular invasion (p=0.688), and positive margins (p=0.98) on survival. Thirty-three percent of patients had recurrence. Recurrence was highest at the primary site, followed by the neck, and these were the most common sites of treatment failure. Two cases (67%) of nodal recurrence occurred in the anterior lymphatic chain (level VI). Distant metastasis was noted in 7.4% of the patients. CONCLUSION: Treatment with radical surgery of primary lesions and elective neck dissection including the anterior neck lymphatic chains may improve survival of patients with squamous cell carcinoma of the floor of mouth.

Superficial versus Total Parotidectomy in the Treatment of Parotid Carcinoma Confined to the Superficial Lobe of Parotid Gland / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although there is little consensus regarding the extent of surgical ablation needed to attain cure in parotid cancers, most surgeons has been used to perform total parotidectomy. However, the chance of development for postoperative facial palsy may be incresed in case of total parotidectomy. The aim of this study was to determine whether superficial parotidectomy (SP) yielded local control and resulted in overall survival rates that are comparable to those of total parotidectomy (TP). MATERIALS AND METHOD: The medical records of 82 patients who were treated at the Severance Hospital from 1991 to 2000 and diagnosed with the parotid cancers confined to the superficial lobe and had parotidectomy were reviewed. There were 42 males and 40 females, ranging in age from 8 to 84 years. There were 47 patients in group 1 (SP) and 35 in group 2 (TP). 52 patients underwent neck dissection simultaneously with primary lesion. Surgical treatment was followed by radiotherapy in 48 patients. The follow-up period ranged from 2 to 132 months with the mean of 37.7months. Data were analyzed using the Kaplan-Meier method and Log-Rank test and Fisher's exact test. RESULTS: The clinical prognostic factors of SP group and TP group were not significantly associated with the following variables: histologic grade, tumor size, surgical margin, facial nerve involvement and postoperative radiotherapy. The overall crude 2- and 5- survival rates for the SP group were 87% and 79%, respectively, and those for the TP group were 80.5% and 64.9% (p>0.05), respectively. Also, there was no statistically significant difference in the locoregional recurrence between the SP group and TP group (p>0.05). However, there was statistically significant difference in the presence of postoperative facial palsy between two groups (p<0.05). Therefore, in terms of oncologic integrity, superficial parotidectomy may be a safe procedure without potential morbidity, such as postoperative facial palsy in the treatment of parotid cancer confined to the superficial lobe.

Effect of Cervical Lymph Node Metastasis on Prognosis and it's Risk Factors in Parotid Carcinomas / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Management of the clinically negative neck remains a controvertial issue in patients with carcinoma of the parotid gland. In order to assist in selecting appropriate patients of elective neck dissection, we sought to determine how regional nodal metastasis affects survival in patients with parotid carcinomas and to identify clinical predictors for nodal disease. MATERIALS AND METHOD: We retrospectively evaluated 124 patients with parotid carcinoma who received their definitive treatment at the Severance hospital between 1988 and 2003. A total of 84 neck dissections (ND) were performed. 24 of 84 patients who underwent neck dissection had pN(+)-staged stage. Seventy patients had an elective ND (subdigastric ND in 50 and supraomohyoid ND in 20), usually because of ominous histology or high T stage. Kaplan-Meier survival analysis was conducted to compare patients with and without histopathologic evidence of nodal disease. Univariate and multivariate analyses were carried out using logistic regression evaluating the significance of demographic, clinical, and pathological data. RESULTS: Patients with no evidence of nodal disease had significantly improved survival over patients with pathologically positive nodes (p<0.00001). The following variables were significantly associated to the risk of lymph node metastasis by univariate analysis: sex (p=0.0093), facial palsy (p=0.0001), T stage (p=0.0003), tumor location (p=0.01) and histologic type (p=0.0009). By multivariate analysis, only facial palsy had the highest correlation with lymph node metastasis. CONCLUSION: Nodal disease significantly decrease survival in patients with parotid carcinoma. Tumor histopathologic type and facial nerve involvement are the most important predictors of nodal disease. Therefore, even in cN0, we should consider elective neck dissection in parotid carcinomas in case of high-grade malignancy and/or facial nerve paralysis.

Vocal Analysis after Vertical Partial Laryngectomy

It is generally believed that a reconstruction of the glottic region after a vertical partial laryngectomy (VPL) can improve the glottic and supraglottic function. However, there is a paucity of reports on secondary healing without a glottic reconstruction after a VPL. The aim of this study was to obtain objective phonatory data after a VPL without a glottic reconstruction. From 1993 to 2001, 13 patients, who had been treated with VPL without a glottic reconstruction, were enrolled in this study. Patients with a postoperative follow up of less than 12 months were excluded. Seven lesions were classified as T1 glottic cancer and six as T2 glottic cancer- standard VPL (11 cases) and frontolateral VPL (2 cases). Acoustic ( (fundamental frequency, Fo), jitter, shimmer, the noise to harmonic ratio (NHR) ), aerodynamic (maximal phonation time (MPT), mean flow rate (MFR) ) analysis and videostroboscopy were performed to evaluate the voice. There were significant differences in the Fo, jitter, shimmer, NHR, MPT and MFR between the VPL group and normal control group. In videostroboscopy, the following tendencies were observed in many cases: incomplete glottic closure, a decreased and irregular mucosal wave and amplitude, supraglottic voicing, abnormal arytenoid movement and anterior commissure blunting. Objective phonatory data after VPL without a glottic reconstruction was obtained. The voice quality after a VPL without a glottic reconstruction was somewhat unsatisfactory. A further comparison with other different surgical techniques of a VPL would help determine a better way of improving the voice quality in these patients.

HMGI(Y) Protein Expression in Head and Neck Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Expression of HMGI(Y), a nucleoprotein that binds to A/T rich sequences in the minor groove of the DNA helix, is observed in neoplastically transformed cells but not in normal cells. We have analyzed HMGI(Y) expression in the head and neck squamous cell carcinoma and evaluated its clinicopathologic significance. MATERIALS AND METHODS: HMGI(Y) mRNA was measured by RT-PCR and immunohistochemical staining for HMGI(Y) was performed in the head and neck squamous cell carcinoma. RESULTS: Expression of HMGI(Y) by immunohistochemical staining was observed in 35 of 40 (87.5%) head and neck squamous cell carcinoma samples, whereas normal mucosa and/or the mucosa adjacent to the tumor tissue showed negative or weakly positive staining (p<0.05). Semiquantification of HMGI(Y) by RT-PCR were 2.98+/-2.24 in cancer and 0.47+/-0.25 in normal tissue (p<0.001). High expression of HMGI(Y) was observed in well differentiated group and recurrent cases compared to the less differentiated group and/or non-recurrent cases (p<0.05). But no significant correlation was observed between the levels of HMGI(Y) expression and other clinical factors such as stage, tumor size and cervical lymph node metastasis. CONCLUSION: We think that the HMGI(Y) gene plays some roles in carcinogenesis and cellular proliferation of the head and neck squamous cell carcinoma. HMGI(Y) gene can be used as a cancer marker, but the correlation between the gene expression and the prognosis of the cancer patient should be proved in the future studies.