Patterns of Regional Metastasis in Patients with Periorbital Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To identify patterns of regional metastasis according to primary tumor location in patients with malignant periorbital tumor. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of the patients diagnosed with periorbital malignant tumors between 1997 and 2008. We analyzed demographic data, pathologic diagnosis, primary tumor location, lymph node metastasis and recurrences. RESULTS: Ninety-five patients with periorbital cancer were reviewed. Amongst them, 16 patients (M : F=7 : 9, mean age: 57.0 years) had regional metastasis. The follow-up duration of 16 patients was 46.2 months on the average. Nine tumors were located in the medial half, two tumors in the lateral half and five tumors in both halves. The parotid gland was the most common regional metastatic site regardless of primary tumor location, and whether or not medially located. CONCLUSION: The parotid gland lymph node group is crucial for medially located periorbital tumor as well as for laterally located one. Once a malignant periorbital tumor is diagnosed, the whole cervical and parotid lymph nodes should be evaluated carefully.

Schwannoma Mimicking Laryngocele

A schwannoma of the larynx is a rare benign tumor that usually presents as a submucosal mass in the pyriform sinus and the aryepiglottic space, and this type of schwannoma constitutes a diagnostic and therapeutic challenge for otolaryngologists. We present here two cases of supraglottic schwannomas that were misdiagnosed as laryngoceles. Both were excised through a lateral thyrotomy approach without a tracheostomy, and the laryngeal function was successfully maintained. We discuss the clinical and imaging findings and the management of this rare neoplasm with focusing on the differential diagnosis of laryngeal schwannoma and laryngocele. We also review the relevant medical literature.

Role of Temporary Injection Laryngoplasty in Acute Unilateral Vocal Fold Paralysis with Aspiration / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We evaluated the role of temporary injection laryngoplasty in patients with unilateral vocal fold paralysis (UVFP) after cardiothoracic surgeries. SUBJECTS AND METHOD: Taking the introduction of injection laryngoplasty as a milestone, we divided patients into those who underwent cardiothoracic surgery with UVFP during the years 2001-2004, before the introduction of injection laryngoplasty as pre-injection group (n=83) and those who underwent after the introduction during the years 2000-2007 as post-injection group (n=103). Of the post injection group, patients who received injection laryngoplasty postoperatively before being discharged were defined as injection group (n=37). Patients were also divided into non-esophageal surgery group and esophageal surgery group. Clinical outcomes including the length of hospital stay and oral feeding initiation time were compared between the pre-injection group and the injection group within the same operation group. The degrees of aspiration were classified into 4 grades. RESULTS: In the non-esophageal surgery group, the injection group with aspiration grade III had shorter hospital stay and oral feeding initiation time after extubation compared to the pre-injection group with grade III aspiration (p=0.042). However, in the esophageal surgery group, there was no statistical difference between the pre-injection and injection groups. CONCLUSION: Temporary injection laryngoplasty can reduce the hospital stay and enhance oral feeding initiation in patients with aspiration due to UVFP after non-esophageal cardiothoracic surgeries.

Gastric Choristoma of the Oropharynx

Heterotopic gastric mucosa tissue is also called gastric choristoma, and this type of lesion can be found anywhere in the alimentary tract. However, gastric choristoma in the pharynx is very rare; only 10 cases of pharyngeal gastric choristoma have been reported in the English medical literature. A 32-yr-old woman was referred to our institution for the evaluation of a large mass that originated from the posterior wall of the oropharynx. The mass did not cause any symptoms except for the occasional sensation of a foreign body. Gadolinium-enhanced T1 weighted imaging showed a 5 cm-sized mass with central enhancement and hypointense portions, yet the radiological diagnosis was not clear. Transoral mass excision was performed with using electrocautery for making the diagnosis and for treating the mass. The microscopic analysis revealed gastric choristoma.

Picibanil Sclerotherapy for Intractable Chylous Leakage After Neck Dissection / 대한이비인후과학회지

undergo radical neck dissection. Subsequent chyle leakage can cause complications such as skin flap necrosis, orocutaneous fistula, electrolyte imbalance and protein loss. Chyle leakage is managed conservatively with total parenteral nutrition and mediumchain triglyceride diet or is treated surgically with leakage site ligation or thoracic duct ligation. Sclerotherapy can be one of the treatment options and tetracycline and povidone-iodine have been reported to be used as sclerosing agents. However, Picibanil sclerotheray for post-neck dissection chyle leakage has not been reported. This paper presents our experience in the management of a intractable chyle leakage which was irresponsive to conservative management and thoracic duct ligation, by successfully employing Picibanil.

Analysis on Diagnostic Approach, Management and Prognosis of Cervical Metastatic Carcinoma of Unknown Origin / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cervical metastasis of unknown origin (MUO) comprises 3-5% of all head and neck malignancy. Standardized diagnostic approach is not established and standard treatment regimen is not established either. The purpose of this study was to evaluate diagnostic approaches to detect the primary site in patients with neck mass of metastatic squamous cell carcinoma and analyze treatment modalities and their outcomes as well. SUBJECTS AND METHOD: Of 710 patients who had been diagnosed with squamous cell carcinoma of the head and neck site from Jan. 1992 through Dec. 2005, 73 patients were referred to or visited our clinic regarding the presence of neck mass. With retrospective review of the medical record, the diagnostic approaches were evaluated. Thirty patients, in whom the primary sites were not found after all, were included for analysis of treatments and outcomes. RESULTS: The diagnostic steps that revealed the primary sites were as follows: physical examination in 29 cases (39.7%), conventional imaging (CT or MRI) in 5 cases (6.8%), PET scan in 1 case (1.4%), OPD based directed biopsy in 3 cases (4.1%), and intraoperative directed biopsy in 5 cases (6.8%). Primary sites were not detected in 30 cases (41.1%). Complete remission was obtained in 24 patients, for whom 5-year disease free survival rate was 62.1%. CONCLUSION: Thorough physical examination and directed biopsy are strongly recommended for the diagnosis of MUO, but the diagnostic value of PET scan needs to be followed up with more cases.