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Transoral thyroidectomy using the vestibular approach has achieved excellent cosmetic outcomes without leaving any visible scars. However, concerns have been raised on how to prevent complications, such as skin perforation and anterior jugular vein injury, especially in the learning period. This is because working space is generally created via blind and blunt dissection using a blunt dilator through small vestibular incisions unfamiliar to beginners. Herein, we explain an intraoperative real-time ultrasound technique employed in transoral thyroidectomy to safely elevate a skin flap while avoiding any damage to the flap and anterior jugular vein in the learning period.

Received June 13, 2015 Revised September 1, 2015 Accepted September 5, 2015 Address for correspondence Jeong Kyu Kim, MD, PhD Department of OtolaryngologyHead and Neck Surgery, Catholic University of Daegu School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea Tel +82-53-650-4071 Fax +82-53-650-4533 E-mail doctorjkkim@cu.ac.kr Background and ObjectivesZZThe choice of optimal treatment methods among various gland preserving procedures including transoral surgery, sialendoscopy and extracorporeal lithotripsy for submandibular stones is mainly determined by the size of the stone. We tried to assess the accuracy of ultrasonography (USG) and computerized tomography (CT) for the preoperative estimation of submandibular gland stone size. Subjects and MethodZZWe retrospectively reviewed the medical records of 251 patients who were treated for submandibular stones from January 2008 to December 2014. Eighty patients who checked both preoperative USG and CT were included. Preoperative USG and CT measurements of the submandibular stones were compared to postoperative measurements of removed stones. Effects of stone location and presence of acute infection on preoperative measurements were also assessed. ResultsZZThe mean submandibular gland stone size was 6.60±3.8 mm by USG, 7.23±4.0 mm by neck CT and 7.89±4.7 mm by the postoperative measurement. USG and CT showed good correlation with the postoperative measurement (correlation coefficient 0.912 and 0.940, respectively). The location of stone and presence of combined infection showed no significant impact on the accuracy of USG and CT measurement. ConclusionZZUSG and neck CT showed high accuracy for predicting submandibular gland stone size. However, it should be taken into consideration that the stone size could be greater than that shown by preoperative measurement. Korean J Otorhinolaryngol-Head Neck Surg 2015;58(12):865-9

1999년 처음 명명된 유두 갑상샘암종의 체모양-오디모양 변형(Cribriform-Morular Variant)은 조직학적으로 종양세포 들이 체모양 증식, 소포 구조 형성, 유두 형성을 하며 방추세 포들의 기둥모양 배열이 관찰되는 유형으로, 특히 가족샘종폴 립증(familial adenomatous polyposis)과 관련이 있는 것으로 보고되고 있다. 가족샘종폴립증은 5번 염색체에 위치한 adenomatous polyposis coli(APC) 유전자의 배선 돌연변이(germline mutation) 에 의해 발생하며 상염색체 우성으로 유전되는 질환으로, 대장 과 직장에 수백개에서 수천개의 선종성 용종을 동반하며 치 료하지 않을 경우 대장암 또는 직장암을 유발할 수 있다. 가 족샘종폴립증의 1~2%에서 갑상샘암을 동반하는데 대부분 이 유두 갑상샘암이며 이 중 일부가 체모양-오디모양 변형으로 보고되고 있는데, 가족샘종폴립증과 연관한 체모양-오디모 양 변형 증례는 국내외에서 드물게 보고되고 있다. 저자들은 갑상샘 종물을 보인 21세 여자 환자가 수술 후에 유두 갑상샘암종의 체모양-오디모양 변형으로 진단받고, 이후 가족샘종폴립증이 추가로 진단되어 대장전적출수술을 시행 한 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Received March 6, 2013 Revised April 15, 2013 Accepted April 22, 2013 Address for correspondence Jeong Kyu Kim, MD, PhD Department of OtolaryngologyHead and Neck Surgery, Catholic University of Daegu School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 705-718, Korea Tel +82-53-650-4071 Fax +82-53-650-4533 E-mail doctorjkkim@cu.ac.kr Background and ObjectivesZZTo compare the tuberculin skin test (TST) and the interferon γ release assay (IGRA) for the diagnosis of cervical tuberculous lymphadenitis (TL). Subjects and MethodZZA prospective comparison between the TST and the IGRA was performed in subjects who met the inclusion criteria for suspicious cervical TL. TL was confirmed by culture results and clinical diagnosis of TL was also made by histology, polymerase chain reaction and treatment response of the anti-tuberculosis drug. ResultsZZOf the 43 subjects enrolled, 11 subjects were confirmed as TL, nine subjects as clinical TL and 23 subjects as non-TL. The TST and the IGRA were all positive in TL. The agreement between the TST and IGRA was κ=0.40 in both clinical TL and non-TL. The sensitivity and specificity of the TST were 95.0% [95% confidence interval (CI), 92.1-97.9] and 39.1% (95% CI, 32.6-45.6), respectively. By comparison, the sensitivity and specificity of the IGRA were 85.0% (95% CI, 80.3-89.8) and 52.2% (95% CI, 45.5-58.8), respectively. ConclusionZZThe IGRA was more specific than the TST, while the TST was more sensitive than the IGRA. The higher specificity of IGRA could make IGRA play a useful adjunct role in the diagnosis for cervical TL. Korean J Otorhinolaryngol-Head Neck Surg 2013;56:354-8

악성종양 치료 방법의 하나로 방사선치료가 광범위하게 이 용되고 있으나, 방사선치료는 조사 범위 내에 조직의 악성 변 화를 초래할 수 있는 위험요소를 가지고 있다. 연골육종은 연 골에서 기원하는 종양으로 주로 장골, 골반, 늑골 등에서 발생 하며, 그 중 5~10%가 두경부에서 발생한다. 방사선치료 후에 이차적으로 생긴 두경부의 연골육종은 매우 드문 질환으로 국내에서는 아직 보고된 바가 없다. 연골육종은 그 형태와 발생부위에 따라 다양한 임상양상을 보이며, 치료 방법으로는 깨끗한 절제연을 포함하는 광범위절제술이 가장 중요하다. 방 사선치료나 화학약물요법 등의 효과에 대해서는 명확하게 밝혀지지 않았지만 수술이 불가능할 경우나 완전한 수술적 절제가 어려운 경우에는 방사선치료를 시행하여야 한다. 저 자들은 비인두 악성종양으로 진단받고 약물치료와 방사선치 료를 받은 후 별다른 문제없이 지내던 환자가 방사선치료 종 료 후 9년이 지나 방사선 조사 영역으로 포함되었던 접형골 및 사대에 연골육종이 발생한 환자를 경험하여 문헌고찰과 함께 보고하는 바이다.

Background and Objectives Ultrasonography represents the initial imaging modality of choice for the assessment of the parotid gland tumors. The aim of this study is to evaluate the role of ultrasonography in differential diagnosis of the parotid gland tumors. Subjects and Method Ultrasonography of the 49 patients with parotid gland tumors were retrospectively reviewed. Histology of all cases was confirmed after parotidectomy. The ultrasonographic features of the most common two histologies, namely, pleomorphic adenoma and Warthin’s tumor, were compared. Results Pleomorphic adenomas were usually solid and they showed lobulation and an exophytic growth. Warthin’s tumors usually contained a cystic component, and were usually oval without lobulation and confined to the parenchyma. One of two malignancies showed well-defined margins and five benign tumors showed ill-defined margins. Conclusion The ultrasonographic features should be cautiously used to discriminate among the various histologies of parotid gland tumors.