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Background and Objectives Scalp angiosarcoma is a rare but aggressive vascular malignancy. It is often found in the advanced state and tends to cause distant metastasis at an early stage. There is no consensus on a treatment modality, although wide excision followed by adjuvant therapy is currently used. The purpose of this study was to analyze the treatment results and disease progress pattern of scalp angiosarcoma in a single institution.Subjects and Method We enrolled patients who diagnosed with scalp angiosarcoma at Asan Medical Center from March 2011 to September 2019. Disease course and prognostic factors were analyzed by estimating overall survival rate and disease free survival.Results A total 12 patients were enrolled in this study. The median overall survival was 16.0 months. The 3-year-survival rate was 10.6%, and the median disease free survival was 5.0 months. On the average, it took 11.4 months till death after recurrence.Conclusion Although wide surgical excision and multiple adjuvant therapies are employed, scalp angiosarcoma showed frequent recurrences and metastasis which led to poor outcomes. Further investigations for scalp angiosarcoma are necessary to improve treatment outcomes.

Invasive larynx or pharyngeal fungal infections are rare. We report an invasive fungal laryngopharyngitis patient who complained of a persistent sore throat after an allogenic bone marrow transplant and a haploidentical stem cell transplant. An antifungal gargle was used after finding necrotic changes extending from the right soft palate to the aryepiglottic fold. Biopsy and culture suggested a fungal infection with suspicious mucormycosis. Imaging showed the right oropharynx, supraglottis, and the parapharnygeal space were involved. After initiating liposomal amphotericin B for 4 days, wide excisional debridement, and a partial pharyngectomy with an anterolateral thigh free flap including the deep fascia were performed. Amphotericin B and posaconazole were used subsequently. Pathology assessment indicated invasive mucormycosis. There was no recurrence for 9 months. Mucormycosis is a fatal opportunistic infection often seen in immunocompromised patients. Rapid detection, radical resection, and reconstruction can save the patient from a life-threatening fungal infection of the laryngopharynx.

Objectives: Immediate facial nerve substitution or graft technique has been used for the repair of facial nerve defects occurring as a result of tumour dissection. However, some patients report unsatisfactory outcomes, such as difficulty in maintaining resting or smiling symmetry, due to persistent flaccid facial palsy. Here we evaluated the functional outcomes of transferring the masseteric branch of the trigeminal nerve to the facial nerve adjunct to facial nerve graft. Methods: We reviewed the medical records of seven patients who underwent facial reanimation surgery between 2014 and 2016. The patients were divided into two groups according to the type of facial reanimation surgery: group A, masseteric nerve innervation with interposition graft; group B, interposition graft only. The postoperative resting symmetry and dynamic movement were compared. Results: Facial contraction was first observed in group A at 4 months and in group B at 7.3 months. Most of the patients achieved reliable resting symmetry; however, one patient in group B exhibited unsatisfactory facial weakness on the affected side. Group A patients showed better dynamic movement than group B patients. Eye closure, oral excursion and oral continence were better in group A than in group B patients. Smile symmetry in both groups was similar due to hyperkinetic movement in group A patients and flaccidity in group B patients. Conclusions: Dual innervation of the masseteric branch of the trigeminal nerve improves the dynamic movement of paralysed facial muscles and shortens the recovery period in patients with iatrogenic facial palsy.

Metastatic lymph node (LN) burden is one of the most important prognosticators in human solid cancers, but has rarely been examined in laryngeal and hypopharyngeal cancers (LHC). We evaluated the nodal factors predictive of recurrence and survival in patients with LHC. This study included 141 consecutive patients who underwent primary surgery and neck dissection for previously untreated LHC at our tertiary referral centre. Nodal factors included the presence of pathological LN metastasis, number of positive LNs, LN ratio, and extra-nodal extension (ENE). Our proposed N classification was analysed by recursive partitioning analysis and compared with the AJCC and other N classifications using the c-index. Univariate and multivariate Cox proportional hazard regression analyses were used to define significant predictors of post-treatment disease-free survival (DFS) and overall survival (OS). Of the 141 patients, 66 (46.8%) had positive LNs, and 27 (19.1%) had ENE. In multivariate analyses, the number of positive LNs was strongly associated with DFS and OS outcomes (P

Objectives The current study aims to determine the correlation between nutritional status upon presentation and disease severity, as well as treatment and survival outcomes. Methods Patients who were diagnosed with deep neck infection, underwent at least one surgical drainage/debridement, and had more than 1 week of hospitalization at a tertiary medical center from 2007 to 2015 were retrospectively included. Thereafter, initial serum albumin, C-reactive protein (CRP), and body mass index (BMI) were reviewed. Results A total of 135 patients were included in the final analysis. Accordingly, the proportion of patients with simultaneous mediastinitis (21.0%), necrotizing fasciitis (12.9%), disease extent >1 cervical level (72.6%), mean CRP (22.4 mg/dL), mean length of hospitalization (25.0 days), and mean 1-week follow-up CRP (7.2 mg/dL) was significantly higher in the hypoalbuminemia group (initial serum albumin 1 cervical level (2.12), initial serum CRP over 20 mg/dL (3.79), hospitalization of more than 14 days (4.10), 1-week follow-up CRP over 5 mg/dL (3.78), and increased duration for an over 50% decrease in initial CRP (2.70) (all P

Despite the excellent prognosis of early glottic cancer (T1-T2), the significance of preoperatively measured tumor thickness has not been elucidated. We evaluated the role of tumor thickness measured using computed tomography (CT) as a predictive factor for recurrence of early glottic cancer after transoral laser microsurgery (TLM).The medical records of 134 patients who were diagnosed with early glottic squamous cell carcinoma and underwent TLM were reviewed. Age, sex, clinical stage, preoperative biopsy, anterior commissure involvement, CT findings, recurrence, and overall survival were evaluated.Seventy-three patients (54 T1a, 2 T1b, and 17 T2) were enrolled. Tumor thickness on pathology increased proportionally with increased tumor thickness on CT. The recurrence-free survival (RFS) and overall survival rates were 82.2 and 91.2%, respectively. Upon univariate analysis, RFS was affected by the type of cordectomy, tumor differentiation, margin involvement, anterior commissure involvement, impaired vocal fold mobility, and tumor thickness ( 4 mm) on CT scan (all p 0.01). Among the relevant covariates, an involved or close resection margin [hazard ratio (HR) 19.2; 95% confidence interval (CI) 3.5-105.6; p 0.01], impaired vocal cord mobility (HR 8.5; 95% CI 1.45-49.2; p = 0.02), and pathological tumor thickness ( 4 mm) (HR 6.0; p = 0.02) were predictive of RFS.Tumor thickness may be another predictive factor for recurrence in early glottic cancer. Before TLM, reviewing the extent of tumor thickness will help to improve local control in cases of early glottic cancer.

Background The Korean Society of Thyroid Head and Neck Surgery established a nationwide multicenter registry of anaplastic thyroid carcinoma (ATC) and evaluated the prognostic factors and treatment outcomes of ATC. Methods The present study enrolled 329 patients who were diagnosed with ATC between January 2000 and December 2012 at 19 medical centers in Korea. Survival outcomes were evaluated according to various clinical factors and treatments. Results Multivariate analysis identified age ≥70 years old, the presence of initial clinical symptoms, distant metastasis, and treatment modality as significant risk factors (p

Objective De novo cancers of head and neck area in solid organ transplantation recipients show standardized incidence ratio (SIR) of 3.8. Immunosuppression following transplantation is suggested to play as a crucial factor in pathogenesis of secondary malignancy. Prognosis of head and neck cancer arising in solid organ transplantation recipients is proven to have poor prognosis. The incidence, risk, prognosis, and survival of de novo malignancy of head and neck area in solid organ transplantation recipients in single-tertiary medical center followed up for 20 years. Methods A retrospective medical record review of the patients who received solid organ transplantation in Asan Medical Center from 1997 to 2016 was conducted. Patients confirmed as de novo malignancy in the head and neck area after organ transplantation were included, and presented as in the case-series format. Patients with previous history of head and neck malignancy, irradiation history of head and neck area, cutaneous malignant lesion, hematopoietic malignant lesion, malignancy of thyroid and parathyroid gland and metastatic lesions newly developed in head and neck area were excluded. The incidence of head and neck malignancy in South Korea were reviewed from the National Cancer Information Center of South Korea. For the statistical analysis, standardized incidence ratio (SIR) was obtained with 95% confidence interval. Results Solid organ transplantation recipients show 20 times higher incidence of de novo cancer of head and neck area compared to general population. Of 13 de novo head and neck malignancy arising after solid organ transplantation, 2 (15.4%) patients were unable to withstand definitive management due to poor general condition. 2 (15.4%) patients had loco-regional recurrence, 1 (7.7%) patient with distant metastasis, and 3 (23.1%) patients died of cancer progression. Conclusion Immunosuppression following solid organ transplantation gives a twenty-fold increased risk for the development of de novo head and neck cancer. A more precise and frequent checkup on head and area should be planned, suggesting a multi-disciplinary approach in combination with organ transplantation team.

We evaluated the efficacy and outcome of intracordal auricular cartilage injection in patients with unilateral vocal fold paralysis. Our interest developed from findings of a canine model study that reported that histologic characteristics of cartilage were preserved 2 and 3 years after intracordal autologous cartilage injection. Between May 2002 and July 2010, 29 patients with breathy dysphonia caused by unilateral vocal fold paralysis underwent intracordal auricular cartilage injection. Each subject underwent preoperative and postoperative perceptual assessments, acoustical voice analysis, and videostroboscopy. Fourteen patients were male, and the mean age was 52-years old. Patients were tracked for a mean duration of 257 days. Injections were performed through a transoral approach under general anesthesia. Perceptual assessments by GRBAS scale, acoustic parameters of jitter, shimmer, noise-to-harmonic ratio, and maximum phonation time significantly improved at 3, 6, and 12 months after cartilage injection (p

Arteriovenous malformations (AVMs) are composed of abnormally connecting feeding arteries as well as draining veins and lack a regulatory system. Frequent recurrences and unpredictable behavior are their main problems. Potential mortality and morbidity associated with therapeutic procedures must be considered with these patients. Improper treatment often aggravates the condition, potentially rendering therapy more complex. A multidisciplinary approach, including an endovascular approach, surgical excision, and flap reconstruction, is considered to completely eradicate an AVM. This study introduces a complicated case of AVM with massive bleeding through the external auditory canal that was treated with a multidisciplinary approach.

Background The status of metastatic lymph nodes, including the size and extracapsular spread (ECS), in papillary thyroid cancer (PTC) has not been well established. This study evaluated the correlation between the specific status of central lymph node metastases (CLNM) and negative prognostic factors. Methods We reviewed 243 patients who underwent total thyroidectomy and neck dissection. The CLNM slides were reviewed and the relationship between the CLNM status and risk factors was analyzed. Results CLNM were found in 111 patients. ECS (+) was related to a large tumor, high number of CLNM, and large node (P

Objective To investigate the prognostic significance of lysyl oxidase (LOX) expression in laryngeal cancer. Study Design Retrospective chart review and histologic analysis. Setting Tertiary referral academic center. Subjects and Methods Patients (N = 100) underwent surgical treatment for laryngeal cancer and had tissue specimens available. Immunohistochemical staining for LOX was performed on laryngeal cancer tissue microarrays, and the proportion and intensity of staining were evaluated. Patients with LOX scores ≤6 were classified into the low LOX group, while those with scores6 were classified into the high LOX group. We analyzed the correlation between LOX expression and clinical factors as well as prognosis. Results LOX was predominantly expressed in the cytoplasm and nuclei of tumor cells. Kaplan-Meier analysis revealed that the high LOX group had worse overall survival and recurrence-free survival rates than the low LOX group ( P.05). LOX expression exhibited marginally significant correlation with lymph node metastasis. In the Cox regression analysis, LOX expression and lymph node metastasis were significant factors correlated with overall survival rate (odds ratio [OR] = 3.92, 95% confidence interval [95% CI]: 1.35-11.37, P = .012; OR = 1.96, 95% CI: 0.93-1.43, P = .024, respectively). LOX expression was related to distant metastasis free survival rate (OR = 7.72, 95% CI: 1.02-19.18, P = .048). Conclusion A high expression level of LOX is associated with lymph node and distant metastasis as well as poor prognosis among patients with laryngeal cancer.

Objectives Mesenchymal stem cells (MSCs) play an important role in the development and growth of tumor cells. However, the effect of human MSCs on the growth of human tumors is not well understood. The purpose of this study is to confirm the growth effect of palatine tonsil-derived MSCs (TD-MSCs) on head and neck squamous cell carcinoma (HNSCC) cell lines and to elucidate the mechanism of their action. Methods TD-MSCs were isolated from patient with chronic tonsillitis and tonsillar hypertrophy. Two human HNSCC cell lines (PNUH-12 and SNU-899) were studied and cocultured with isolated palatine tonsil-derived MSC. The growth inhibitory effect of MSCs on HNSCC cell lines was tested through methylthiazolyldiphenyl-tetrazolium (MTT) assay. The apoptosis induction effect of MSCs on cell lines was assessed with flow cytometry and reverse transcriptase (RT)-PCR. Results Palatine tonsil-derived MSCs exhibited a growth inhibitory effect on both cell lines. Cell cycle analysis showed an accumulation of tumor cells predominantly in G0/G1 phase with an increase in concentration of TD-MSCs, which was confirmed by increased mRNA expression of cell cycle negative regulator p21. Apoptosis of tumor cells increased significantly as concentration of cocultured TD-MSCs increased. Additionally, mRNA expression of caspase 3 was upregulated with increased concentration of TD-MSCs. Conclusion TD-MSCs have a potential growth inhibitory effect on HNSCC cell lines in vitro by inducing apoptotic cell death and G1 phase arrest of cell lines.

Distant metastasis to the lung in papillary thyroid cancer (PTC) is rarely detected, but it is known to be an important prognostic factor associated with survival. We investigated risk factors for lung metastasis in PTC.We performed a retrospective review of patients with PTC (n=977) who were treated from January 2006 to August 2009. Enrolled patients received radioablation therapy followed by a radioiodine whole body scan. Lung metastasis was screened out with whole body scan or positron emission tomography/computed tomography (PET/CT) and confirmed with chest CT. Age, gender, extrathyroidal extension, central lymph node metastasis, lateral lymph node metastasis, and bilateral lateral cervical lymph node metastasis (BLNM) were investigated to analyze the relationship with lung metastasis.In total, 949 patients were enrolled. The median age was 49 years (±13 years) with 829 women. Lung metastasis was found in 20 patients (2.1%). Patients were divided into three groups by tumor size (≤1 cm, 1-2 cm,2 cm); the groups comprised 47.3%, 28.5%, and 24.1% of the patients, respectively. BLNM was identified in 4.4% (n=43). In a univariate analysis, male gender, old age, large tumor, extrathyroidal extension, lymph node metastasis, lateral lymph node metastasis, and BLNM were significantly related to lung metastasis (P0.05). In a multivariate analysis, BLNM appeared to be the only significant risk factor for lung metastasis (P=0.026; odds ratio=10.219).BLNM may be a risk factor for lung metastasis. This indicates that careful examinations, including chest CT and positron emission tomography (PET), are recommended during the follow-up period when BLNM is suspected.

Sclerosing sweat duct carcinoma (SSDC) in the nose, a rare occurrence with no specific symptoms, is frequently confused with rhinophyma or other inflammatory disease. In this report, we describe a 64-year-old woman who presented with a mass on her nasal dorsum for 1 year. Initially, the tumor had been misdiagnosed as a rhinophyma and followed-up for 1 year. She was referred due to a persistent nasal and neck mass. Deep incisional biopsy was performed to produce sufficient tissue and the histopathologic results showed SSDC. We performed wide local excision and reconstruction using radial forearm musculocutaneous free flaps with a costal cartilage framework followed by bilateral neck dissection. SSDC is seldom recognized and is frequently clinically confused with benign syringoma prior to pathologic diagnosis. Wide and deep incisional biopsy is necessary for the correct diagnosis and successful treatment of SSDC.

Vocal fold paralysis (VFP) is a frequent complication of surgery of mediastinal structures. This study evaluated the characteristics and short-term treatment outcomes of injection laryngoplasty for unilateral VFP (UVFP) induced by mediastinal lesions.The enrolled patients (n = 60) underwent injection laryngoplasty once because of UVFP and were divided into two groups according to cause (group A, thyroidectomy and group B, mediastinal surgery). Voice analysis was performed preoperatively and at 1 month postoperatively. The glottal gap; the Grade, Roughness, Breathiness, Asthenia, and Strain scale; acoustic analysis; and aerodynamic results were measured.Group A and group B comprised eight and 52 patients, respectively. Group B patients were older than group A patients (P 0.05). The injected volume in group B (0.91 ± 0.23 mL) was larger than that of group A (0.38 ± 0.17 mL; P = 0.022). Group B (13.35 ± 4.69 units) showed a larger glottal gap than group A (6.64 ± 4.05 units; P = 0.017), and the glottal gap decreased after the procedure. In both groups, most preoperative acoustic parameters except roughness improved after injection laryngoplasty. The preoperative maximum phonation time of group B (2.87 ± 1.11 seconds) was shorter than that of group A (7.04 ± 2.58 seconds), and it improved after injection. Mean airflow rate improved significantly after injection in both groups.Mediastinal lesion-induced UVFP is associated with a larger glottal gap than that caused by an injury induced by thyroidectomy. Despite large glottal gap, injection laryngoplasty improves voice outcomes in such types of UVFP.

Objectives:Mesenchymal stem cells (MSCs) are multipotent progenitor cells that originally derived from bone marrow. Clinical use of bone marrow-derived MSC is difficult due to morbidity and low MSC abundance and isolation efficiency. Recently, MSCs have been isolated from various adult tissues. Here we report the isolation of adenoid tissue-derived MSCs (A-MSCs) and their characteristics.Methods:We compared the surface markers, morphologies, and differentiation and proliferation capacities of previously established tonsil-derived MSCs (T-MSCs) with cells isolated from adenoid tissue. The immunophenotype of A-MSCs was investigated upon interferon (IFN)-I3 stimulation.Results:Both T-MSCs and A-MSCs showed negative CD45, CD31 HLA-DR, and positive CD 90, CD44, and CD73 expression. A-MSCs were fibroblast-like, spindle-shaped non-adherent cells, similar to T-MSCs. Adipogenesis was observed in A-MSCs by the formation of lipid droplets after Oil Red O staining. Osteogenesis was observed by the formation of the ma...

Objectives:Although prognostic significance of central lymph node (CLN) metastasis in micropapillary thyroid cancer (microPTC) is controversial, thorough removal of metastatic LN may reduce the recurrence rate. Histological or clinical predicting factors for CLN metastasis have been studied to determine the adequate surgical extent or postoperative adjuvant therapy to eradicate metastatic LN. However, histological features inside primary tumor were not considered as a predicting factor for metastasis. In this study, we evaluated the relationship between specific histological findings of microPTC and CLN metastasis.Methods:We reviewed patients who underwent total thyroidectomy and central lymph node (CLN) dissection for microPTC from January to December 2011. Fibrotic change, growth pattern and architecture of tumors were used as histological factors. Histologic findings were classified according to the degree of fibrosis ( 50%) and growth pattern (well-defined/extracapsular spread (ECS)/spic...

Objectives:MicroRNAs can function either as tumor suppressors or oncogenes, and some miRNAs are associated with papillary thyroid cancer (PTC), such as miR-146b, miR-155, miR-221, and miR-222. We tried to detect miRNAs in serum and analyzed correlation between expression level.Methods:Serum was obtained from patients who underwent thyroidectomy with or without neck dissection from 2008 to 2009. Patients with benign nodule and PTC were divided. In PTC, patients were divided into 3 groups according to N stage. We investigated miRNA expression level by reverse transcription / quantitative PCR kit. It was expressed by log102(-ΔΔCT), and mean value was compared.Results:We obtained serum from 89 patients comprised of 19 benign nodules and 70 PTC. There were no differences between age or gender. MiR-146b and miR-155 were expressed −5.06 (±0.069) and −4.48 (±0.115), respectively in benign, compared to −4.79 (±0.0598) and −4.19 (±0.091) in PTC, respectively. Discriminating between benign and malignant nodule, AUC ...

Objective:To demonstrate a safe and effective method for complete resection of squamous papilloma in the nasopharyngeal surface of the soft palate. This technique was used on a patient in whom the papilloma had twice recurred following uvulopalatopharyngoplasty.Methods:Case report and review of the relevant literature.Results:The patient reported in this paper had recurrent squamous papilloma in the nasopharyngeal surface of the soft palate following uvulopalatopharyngoplasty. He also suffered from nasal regurgitation when drinking water. This lesion, which was difficult to access, was successfully treated via a transnasal endoscopic approach using powered instrumentation.Conclusion:This case report highlights a novel approach for the complete removal of a recurrent papilloma in a relatively inaccessible location. Compared with a transoral approach such as uvulopalatopharyngoplasty, the transnasal endoscopic approach using powered instrumentation could provide a safer, faster, easier and less invasive means of treating squamous papilloma in the nasopharyngeal surface of the soft palate, especially for a lesion that recurs following a transoral approach.

Background Adenoid cystic cancer arising in the salivary glands has distinctive features such as perineural invasion, distant metastasis, and a variable prognosis. In salivary gland cancer, c-kit, EGFR, and VEGF are representative molecular markers that may predict remnant and recurrent tumors. In this study, the expression of c-kit, EGFR, and VEGF in adenoid cystic cancer was evaluated, and the relationships between the expression of these markers and the clinical findings were investigated. Methods The medical records of 48 patients who were treated for parotid adenoid cystic cancer from January 1990 to January 2006 were reviewed. The tumor location, size, histological subtypes, perineural invasion, the resected margin status, and lymph node metastasis were assessed. Immunohistochemical staining and semiquantitative analysis of c-kit, EGFR and VEGF were performed. The relationship between the expression of each marker and the clinicopathological factors were analyzed. Results Positive c-kit immunostaining was present in 45 patients (94%), with weak positivity (+1) in 23, moderate positivity (+2) in 19 and strong positivity (+3) in three. Positive EGFR immunostaining was observed in 27 (56%), with weak positivity (+1) in 19 and moderate positivity (+2) in eight with no strong positive staining. Positive VEGF immunostaining was present in 42 patients (88%) with weak positivity (+1) in 12, moderate positivity (+2) in 17, and strong positivity (+3) in 13. Only the expression of VEGF was significantly higher in parotid gland tumors than in any other gland (P = 0.032). Marginal involvement was associated with strong VEGF expression (P = 0.02). No marker was significantly correlated with recurrence or the survival rate. Lymph node status was related to the survival rate. Conclusions The expression of c-kit, EGRF, and VEGF had no predictive value for recurrence or the prognosis of adenoid cystic cancer. Only the lymph node status was related to the prognosis.

Objective: To investigate the patterns and predictive factors of central lymph node metastasis in patients with papillary thyroid cancer located in the isthmus.Method: Retrospective chart review. We evaluated 447 cases with solitary nodule out of 1257 patients with papillary thyroid cancer who underwent total thyroidectomy with bilateral central lymph node compartment dissection. The patients were analyzed in 2 groups: group I, patients with cancer located in the isthmus (n = 35) and group II, patients with cancer in other regions (n = 412). We evaluated the clinicopathological characteristics and predictive factors and compared the 2 groups.Results: The frequency of central lymph node(CLN) involvement was 52.1% (233 cases) in the patients with single nodule of papillary thyroid cancer. The frequency of papillary thyroid cancer located in the isthmus was 7.8% (35 cases). Mean age at diagnosis in group I and II was 45.3 years and 46.2 years, respectively (P = .892). Size, sex, extrathyroidal extension, and...

Objective: Nodal metastasis in PTC occurs in the central compartment of the ipsilateral neck and spreads laterally. Occult lateral neck metastasis can be predictable by lymphatic status of central compartment. This study was to evaluate the diagnostic accuracy of frozen biopsy for quantitative nodal evaluation of central neck metastasis.Method: A total of 264 patients with papillary thyroid cancer underwent total thyroidectomy with central compartment neck dissection as an initial operation. All fresh tissues from ipsilateral central neck dissection were examined by frozen biopsy for central neck metastasis with quantitative nodal analysis.Results: Among them, 134 patients (51% [134/262]) had central neck metastasis. The sensitivity and specificity of frozen biopsy for the detection of central neck metastasis were 100% and 99.2% in 264 patients who underwent total thyroidectomy with bilateral central neck dissection. The diagnostic accuracy for the number of metastatic ipsilateral central lymph nodes was ...

Papillary thyroid cancer (PTC) metastasizes to central lymph node (CLN). CLN metastasis is associated with high risk of locoregional recurrence and distant metastasis. The significance of the number of metastatic CLN has not been addressed. This study was designed to evaluate the clinical implication of the number of metastatic CLN in PTC.We reviewed the patients who underwent total thyroidectomy and CLN dissection with or without lateral neck dissection due to PTC, from March 2008 to June 2009. The relationships between the number of CLN and risk factors, including age, gender, tumor size, extrathyroidal extension, and lateral lymph node metastasis, were assessed. Patients were divided into three groups according to the number of CLN: group A = 0; group B = 1-2; and group C = ≥3.Of 258 patients enrolled in this study, 113 were in group A, 73 in group B, and 72 in group C. Extrathyroidal extension and lateral neck lymph node metastasis were related to increased rate of CLN metastasis (P 0.05). Tumor size increased as the number of CLN increased; group C had the largest tumor size (P 0.05). When evaluating the distribution of patients with extrathyroidal extension, group C had a significant odds ratio (4.213, P 0.05). When evaluating the distribution of lateral neck lymph node metastasis, groups B and C had significant odds ratio (14.353, 75.403, respectively, P 0.05).The number of CLN metastasis correlated with the negative prognostic factors, including tumor size, extrathyroidal extension, and lateral neck lymph node metastasis. This suggests that the number of CLN has prognostic implication.

Background Papillary thyroid carcinoma (PTC) frequently metastasizes to the regional neck; skip metastasis (metastasis to the lateral compartment in the absence of central disease) is uncommon. This prospective study was to evaluate the incidence of occult lateral neck metastasis (LNM) and elucidated the factors that predict LNM in PTC with central neck metastasis (CNM) by performing prophylactic selective lateral neck dissection (SND). Methods Sixty-two patients with PTC without clinical LNM underwent total thyroidectomy with central compartment neck dissection and prophylactic SND consecutively after ipsilateral CNM was confirmed by intraoperative frozen biopsy. Results The incidence of occult LNM in PTC was 55%. Patients with LNM had a larger primary tumor and more positive ipsilateral and bilateral central lymph nodes than patients without LNM. There were no differences between patients with and without LNM with regard to age and extrathyroidal extension. The incidence of occult LNM increased significantly as the number of metastatic ipsilateral and bilateral lymph nodes increased. Independent risk factors for occult LNM were tumor size and the number of positive bilateral lymph nodes (odds ratio [OR] = 1.449; OR = 1.110, respectively). The most common metastatic site was level III (68%: 23/34), followed by level IV (59%: 20/34) and level II (21%: 7/34). Conclusion The important risk factors for LNM in PTC are primary tumor size and the number of positive bilateral central lymph nodes. Prophylactic SND may be considered in selected patients with a large number of positive central lymph nodes and large tumors.

The role of proton pump inhibitor in the treatment of laryngopharygneal reflux disease (LPRD) has been advocated, but there has been few reports dealing with large population based on time-related efficacy of rabeprazole. It was designed to assess the efficacy of rabeprazole and to evaluate which symptoms or findings varied significantly as medication sustained. Multiorgan, open-label cohort, prospective observational study was designed. We identified 1,142 patients with LPRD, and enrolled 455 patients, who participated fully in this survey and follow-up observation for 12 weeks. Reflux symptom index (RSI) and reflux finding score (RFS) were used to evaluate therapeutic efficacy. These parameters were evaluated at the 4th, 8th, and 12th weeks, respectively. Valid rate was used to explain improved proportion of patients after medication. The most common symptom was a globus sense in the throat. Posterior commissure hypertrophy was the most frequently encountered laryngoscopic finding. Female patients complained of heartburn and chest pain more than did male patients (P < 0.001), whereas male patients showed ventricular obliteration and erythematous changes more frequently than did female patients (P < 0.001). By RSI evaluation, scores gradually declined. Each item of the RSI improved at every visit (P < 0.001). Total RFS decreased progressively for 12 weeks and similar results were seen when every RFS item was individually examined. The proportion of patients who showed RSI and RFS falling by more than 50% after medication increased gradually as follow-up continued. This trend seemed to be significant (P < 0.001). Side effects of therapy were minimal. Despite the some constraints of an observational study, rabeprazole appeared to improve LPRD symptoms and signs. Prolonged medication at least 3 months may be beneficial to LPRD patients. Long-term medication effects require further evaluation.

Background In thyroid cancer, preoperative ultrasonography (US) is performed to detect the primary tumor and lymph node metastasis (LNM), which are related to prognosis. This study examined the relationships between specific US findings and LNM in micropapillary thyroid cancer (MPTC). Methods Data on 220 patients with solitary MPTC who underwent total thyroidectomy and neck dissection between 2008 and 2009 were evaluated retrospectively. We classified the US findings according to the nature, shape, echogenicity, extent, margin, and calcification of the primary tumor and evaluated the correlations between these findings and those of LNM. Results Hypoechogenicity (odds ratio = 2.331, P = 0.025) and marked hypoechogenicity (OR = 4.032, P = 0.016) of MPTC were risk factors for central LNM. All of the patients with lateral cervical LNM showed hypoechogenicity or marked hypoechogenicity. Hypoechogenicity (odds ratio = 5.349, P = 0.047) and other types of calcification (odds ratio = 2.495, P = 0.010) were significant risk factors for lateral cervical LNM. Conclusions Specific sonographic findings (hypoechogenicity or marked hypoechogenicity, and calcification) suggest LNM.

Facial nerve paralysis is one of the complications of parotid abscess. Although a few cases of benign tumor and inflammatory condition of parotid gland with the facial nerve paralysis have been reported, the occurrence of facial nerve palsy following parotid abscess without coexisting tumor is very rare. The mechanism of facial nerve paralysis is not clear, but facial nerve paralysis is usually improved after the treatment of parotid abscess. The treatment of parotid abscess is composed of antibiotics based on proper culture study and drainages. Most of parotid abscess is drained by surgical approach, but catheter drainage is also recommended for selected patients. Here, we report a case of parotid abscess treated by pig-tail catheter drainage. Korean J Otorhinolaryngol-Head Neck Surg 2014;57(6):415-9

Received March 27, 2013 Revised May 17, 2013 Accepted June 8, 2013 Address for correspondence Jin-Choon Lee, MD, PhD Department of OtorhinolaryngologyHead and Neck Surgery, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan 602-739, Korea Tel +82-51-240-7335 Fax +82-51-246-8668 E-mail ljc0209@hanmail.net Background and ObjectivesZZTo identify the relation between the preservation status of the parathyroid glands and the risk of hypoparathyroidism after total thyroidectomy and central lymph node dissection in papillary thyroid carcinoma. Subjects and MethodZZA retrospective review was carried out for the medical records of 63 patients with papillary thyroid carcinoma (PTC), who satisfied our inclusion criteria and received treatment at the Department of Otolaryngology-Head and Neck Surgery, Hospital from May 2010 to December 2011. Patients with PTC who underwent total thyroidectomy with central lymph node dissection (CLND) were included and grouped according to the number of preserved parathyroid glands as follows: Group 1 (with four intact glands), Group 2 (three intact glands), Group 3 (less than two intact glands). The total and ionized serum calcium and intact parathyroid hormone levels of each group were monitored after the surgery. Patients with postoperative symptomatic hypocalcemia were considered to have postoperative hypoparathyroidism and received calcium/vitamin D therapy. The hypoparathyroidism was considered to be permanent when calcium/vitamin D therapy was still required six months after surgery. ResultsZZOut of 63 cases of total thyroidectomy with CLND, 31 (49.2%) showed postoperative hypoparathyroidism as demonstrated by laboratory findings. Permanent hypoparathyroidism, however, was not observed in these cases. The development of hypoparathyroidism was not significantly related with the number of preserved parathyroid glands. ConclusionZZTo prevent postoperative hypoparathyroidism following total thyroidectomy and CLND, at least two parathyroid glands should be preserved in situ with an intact blood supply in order to prevent permanent hypoparathyroidism after the surgery. Korean J Otorhinolaryngol-Head Neck Surg 2013;56:431-5

Synovial sarcoma is a rare mesenchymal tumor that usually occurs in the extremities of young adults. Only 10% originates from the head and neck region, where the hypopharynx and retropharynx are the most common involved. Fewer than 100 cases of synovial sarcoma have been reported in this area. The infratemporal region, by virtue of its relatively concealed location, is a difficult site to access. It is considered a mainstay to design an appropriate tech nique to provide maximum exposure with minimal morbidity and preserve hearing ability, which may be achieved by the subtemporal-infratemporal fossa approach. We experienced a 50-year-old female patient who was suffering from right infratemporal fossa mass. We report this rare case that was successfully removed via this approach with a literature review. � Korean J Otorhinolaryngol-Head Neck Surg 2012;55:444-8

Diffuse idiopathic skeletal hyperostosis(DISH)는 척추가 노화하면서 일어나며 주위 구조물의 압박에 의해 합병증을 일으키는 경추전부 골증식체와 연관이 있다. 대부분은 증상 없이 우연히 발견되는 경우가 많으나 배부경직감과 배부통증 및 압통을 보일 수 있으며, 진행된 경우는 척추강직에 의한 골절, 척추후종인대(posterior longitudinal ligament of the spine)의 골화에 의한 척수압박증상을 보일 수 있다. DISH는 특징적으로 인대와 건이 뼈에 부착되는 부위에 과 도한 신생골 증식을 보이는 특발성의 비염증성질환이다. 65 세 이상의 10%에서 나타나는 흔한 질환으로 1975년 Resnick 등은 Forestier씨 병으로 진단받은 환자가 척추이외의 골격에 서도 비정상적으로 과도한 골형성 변화를 보이는 것을 발견하 고, DISH라는 용어를 사용하여 Forestier씨 병이라는 용어를 대체하였다. 기본 병변은 척추의 전면과 측면인대 부착부위 의 석회화와 골화이다. 원발부위는 흉추와 요추이나 척추의 어느 부분에서도 발생할 수 있다. DISH 환자의 78%에서 경 추를 침범하며, 5번 6번 경추의 침범이 가장 흔하다. 저자들은 제 4경추 이하의 척추 앞 공간에 있는 석회화와 골 화의 분쇄 골절로 인한 인두강의 대량 출혈로 혈관조영술, 수 술적 지혈술 등으로 치료하였으나 성공하지 못하고 사망한 1예 를 경험하였고 이는 매우 드문 경우로 판단되어 문헌고찰과 함 께 보고하고자 한다.

ResultsZZIn detecting regional metastasis, the sensitivity and specificity of FDG-PET/CT were 66.67% and 97.25%, respectively, with the positive predictive value (PPV) of 40%, the negative predictive value (NPV) of 99.16%, and the accuracy of 96.77%. The sensitivity, specificity, PPV, NPV and accuracy of neck CT were 66.67%, 96.69%, 33.33%, 99.15%, and 95.96%, respectively. The suspicious distant metastasis (n=1) and second primary cancers (n=7) were observed in FDG-PET/CT. The true second primary cancers occurred at the colon (n=1) and the prostate (n=2). The other cases were proved to be false positive. Distant metastasis and second primary cancers were not detected by the conventional work-up tests. ConclusionZZThe regional metastasis detection rate of FDG-PET/CT was similar to those of the conventional work-up tests. However, compared to the conventional tests, FDG-PET/CT is useful for detecting distant metastasis or second primary cancers in patients with early glottic cancer. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:419-24 Key WordsZZPositron-emission tomography/computed tomography·Larynx cancer·Neoplasm metastasis·Second primary neoplasm.

Background and Objectives：It is difficult to treat recurred supraglottic cancer safely and preserve physiologic function of the larynx. This study was designed to review the clinical manifestations of recurrent supraglottic cancer and compare the results of each salvage treatments. Subjects and Method：During the period from Jan 2000 to Sep 2007, thirty recurrent supraglottic cancers were reviewed retrospectively. Their mean follow-up period was 30.8±20.1 months. We investigated initial treatment methods, stage, recurrent sites and salvage methods, and analyzed the oncological results including disease-specific survival and overall survival. Results：Ninety-seven percent of all recurrence occurred within 3 years and 76.7% of all recurrence were diagnosed at stage III-IV when recurrence was detected. Five-year disease-specific survival rate was 28.4% and five-year overall survival rate was 73.4%. Recurrence at the primary site showed significantly better overall survival rate than that at the lymph node, primary and lymph node recurrence, or distant metastasis (p=0.008). Patients who were salvaged with total laryngectomy had significantly better disease-specific survival rate and overall survival rate (p