Cervical Sympathetic Chain Neurilemmoma with Postoperative Horner Syndrome / 대한이비인후과학회지

Neurilemmoma arising from the cervical sympathetic chain is not common. It is most often manifested as a solitary, benign, and slow-growing mass, and its malignant degeneration is rare. Recently, we experienced a case of schwannoma arising from cervical sympathetic chain. A 43-year-old woman presented a left neck mass that was found incidentally. Measuring approximately 3x3 cm, the mass was located medial to the left sternocleidomastoid muscle at the level of the carotid bifurcation. Fine needle aspiration biopsy was performed, but no diagnostic information was given. A computed tomography (CT) scan showed a heterogenous, poorly-demarcated mass in the left poststyloid parapharyngeal space, displacing the carotid artery anteriorly and the internal jugular vein laterally. Tumor was excised via transcervical approach. Postoperatively, the patient exhibited mild miosis with ptosis in the left eye. We report this case with a brief review of literature.

Clinical Analysis of the 22 Cases of Plunging Ranula / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The plunging ranula is a relatively uncommon phenomenon which represents a mucus escape reaction occurring from disruption of the sublingual salivary gland. We present a series of 22 patients treated at Korea University Hospital during a 20-year period. The purpose of this study was to examine the clinical characteristics of plunging ranula in order to provide our experience for its correct diagnosis and treatment. MATERIALS AND METHOD: A retrospective review of 22 patients with this condition was undertaken. Information was collected on age, sex, history of onset, predisposing factors, treatent, post-operative follow-up and outcome of treatment. RESULTS: The patients were all young adults with a median age of 19.8 years old. The sex distribution was male predominant with 15 men and 7 women. Except for one, no patients had any history of preceding trauma to the neck or oral cavity. Six patients had history of previous operation. Managements included 21 surgical approach and one sclerotherapy. There were no recurrences. One patient experienced transient paralysis of the marginal mandibular branch of the facial nerve postoperatively, but it was temporal and was sustained with no further complications. CONCLUSION: The incidence of plunging ranulas was not common. The precise etiology of its predisposition is unknown. Reoval of the sublingual gland via either a cervical or intraoral approach is important in the management of this condition.

A Case of Wegener's Granulomatosis Presenting as Facial Paralysis and Hearing Loss / 대한이비인후과학회지

Wegener's granulomatosis is a multi-system disease characterized by granuloma formation and necrotizing vasculitis. It classically presents with involvement of the upper, lower respiratory tracts and the renal system. However, locoregional disease is common and may include otological manifestations. In the past, it was fatal if untreated, with a mean survival rate of five months. Recently, because the diagnosis of this disease can be made earlier by measurement of the erythroctye sedimentation rate (ESR) and cytoplasmic anti-neutrophil cytoplasmic antibody (cANCA), the results of treatment have improved. This is a case report of Wegener's granulomatosis in an old woman who had bilateral hearing loss and left facial paralysis, and progressed to acute renal failure due to delayed diagnosis and treatment.

Expression of p53, mdm-2, nm23 and TGFalpha in Primary and Second Primary Cancers in Multiple Head and Neck Cancers / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Development of second primary cancer is an important biological characteristic of head and neck squmaous cell carcinoma. In the past, the development of second primary cancer has been explained by the field cancerization theory. However, recent reports support the common common clonal origin theory. Common clonal origin theory states that following the initial transformation, the progeny of the transformed clone spread through the mucosa and gives rise to the geographically distinct but genetically related tumor. The objective of this study is to compare the expression pattern of p53, mdm-2, nm23 and TGFalpha which are proteins involved in the development, growth and metastasis of tumor in primary and second primary cancers of multiple head and neck cancer. MATERIALS AND METHODS: Expression of p53, mdm-2, nm23 and TGFalpha were analysed by immunohistochemical study of 12 paraffin embedded sections from 6 patients (3 synchronous tumors, 3 metachronous tumors) who were surgically treated for multiple head and neck cancer. RESULTS: p53, mdm-2, nm23 and TGFalpha were expressed in the same pattern in 3 patients (50%) of primary and second primary cancers. CONCLUSION: In our study, we observed the same expression patterns in 3 cases; however, it was difficult to conclude based on this result alone the clonality relationship between primary and second primary cancer. We suggest that further studies using molecular biological techniques are needed to identify the early genetic events of carcinogenesis.

Possibility of Reciprocal Infections of Methicillin-Resistant Staphylococcus Aureus between Medical Personnel and Patients after Performing Middle Ear Surgery / 대한이비인후과학회지

BACKGROUND: The cases of Methicillin-Resistant Staphylococcus aureus(MRSA) infection after middle ear surgery, most of which are thought to be hospital acquired infection, are increasing recently in our hospital. MRSA infection is apt to be long lasting and to bring many complications because MRSA is resistant to aminoglycosides and cephalosporin as well as methicillin. There are many reports that medical personnel have a role to transmit that organisms to other patients. OBJECTIVES: To find and eradicate infection source and transmission route are both essential because medical personnel who contact MRSA infected patients can be a continuing transmission route. MATERIALS AND METHODS: Bacterial cultures from the noses and hands of medical personnel working in the department of Otolaryngology of Korea University Hospital were done and ribotyping through Southern blot technique was used to compare and prove an identical strain of MRSA organism between medical personnel and patients. RESULTS: As a result of ribotyping with EcoRI and HindIII, one distinct subtype(type I) was identified to be shared between medical personnel and patients. Among 30 medical personnel, 10 were carriers of MRSA. Seven MRSA isolates from these 10 medical carriers and 18 from 30 isolates of otorrhea shared the same type I ribotype. CONCLUSION: This finding reveals that MRSA transmission could occur between medical personnel and patients. Medical personnel should be aware of their possible role as a relay-stay of transmission of pathogenic organisms and should give efforts to prevent it.

Prognostic Significance of Extracapsular Spread in Metastatic Lymph Node of Head and Neck Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND: Lymph node metastasis in head and neck squamous cell carcinoma has been interpretated as a poor prognostic factor. However, N staging system which depends on the size and numbers of the metastatic lymph node has been reported to be insufficient as a prognostic factor. OBJECTIVES: To determine the value of extracapsular spread of metastatic lymph node as a prognostic factor and to evaluate the relationship of extracapsular spread and N staging system of metastatic lymph node. MATERIALS AND METHODS: From January 1990 to December 1993, 109 patients who received neck dissection for metastatic lymph node of head and neck squamous cell carcinoma were retrospectively studied for the presence of extracapsular spread according to N staging and compared the survival rates between the N staging system and the presence of extracapsular spread. RESULTS: Histopathologically, there were 17 cases(15.6%) of N0, 56 cases(51.4%) of N1, 25 cases(22.9%) of N2, and 11 cases(10.1%) of N3. Extracapsular spread in N1 was 30.4%, 64.0% in N2, and 90.9% in N3. Three year overall survival rate for N0 was 58%, 69% for N1, 48% for N2, 27% for N3, and 69% for 49 cases without extracapsular spread and 46% in 43 cases with extracapsular spread. CONCLUSION: Presence of extracapsular spread in metastatic lymph node of head and neck squamous cell carcinoma seems to have a significant value as a prognostic factor.