Treatment Outcomes of Patients with Head and Neck Squamous Cell Carcinoma of Unknown Primary / 전남의대학술지

The purpose of this study was to evaluate clinical characteristics and treatment outcome of patients with head and neck squamous cell carcinoma of unknown primary (HNSCCUP), treated according to the method of our hospital. Six patients with histopathologically and radiologically confirmed HNSCCUP January 2010-December 2016 were enrolled in this study. All patients underwent radical neck dissection involving level I-V, bilateral tonsillectomy, and diagnostic esophagoscopy and postoperative radiotherapy (RT), with or without concurrent chemotherapy. There were no major complications resulting from surgical intervention. Duration of follow-up was 56.3±20.2 months (range, 28-82 months). There was no recurrence or late detection of primary site of HNSCCUP. All patients with HNSCCUP except one were alive, at the time of the last follow-up. The other patient had no recurrence of HNSCCUP, but died of colon cancer at 58 months postoperatively. We have successfully treated patients with HNSCCUP by performing radical neck dissection, bilateral tonsillectomy, and diagnostic esophagoscopy and postoperative RT with concurrent chemotherapy, and recommend using this method as the main treatment method.

The Efficacy of Nasal Surgery on Pharyngeal Airway / 대한이비인후과학회지

Background and Objectives@#Nasal surgery is known to improve the quality of life in patients with obstructive sleep apnea; however, its effect on the airway structure is little known. This study attempted to identify the impact of nasal surgery on the pharyngeal airway structure.Subjects and Method We enrolled in the study patients who underwent nasal surgery from July 2015 to March 2018 due to nasal obstruction with severe snoring or sleep apnea. Patients with palate surgery or previous history of airway surgery were excluded. Demographic factors, symptoms regarding nasal obstruction, sleep study, preoperative cephalometry, and postoperative 3-month cephalometry were taken into account and analyzed. We also performed a subgroup analysis according to the severity of sleep apnea. @*Results@#Sixty-three patients were enrolled in this study. Soft palate thickness showed no significant change. Pre and postoperative soft palate thickness were 10.82±3.00 and 11.11±3.35 (p=0.261), respectively. However, the pharyngeal airway space was enlarged via nasal surgery from 12.05±3.35 to 13.04±3.35 (p=0.006), respectively. The subgroup analysis showed that the pharyngeal airway was mainly enlarged in the patients with lower Apnea-Hypopnea Index (AHI). @*Conclusion@#Although nasal surgery does not reduce soft palate thickness, it can enlarge the pharyngeal airway space. The effect of surgery would be more prominent in patients with AHI of lower than 15 event/hour (p=0.005) as nasal surgery alone does not affect the pharyngeal airway of patients with AHI greater than 15.

Giant Low-Grade Fibromyxoid Sarcoma in the Neck / 대한이비인후과학회지

Low-grade fibromyxoid sarcoma (LGFS) is a soft tissue tumor that rarely occurs in the head and neck region. It occurs mainly in the proximal extremities and the trunk and is prevalent in the young and middle-aged adults. In the present case, LGFS was present at an atypical location and at an unusual age. The treatment of choice for LGFS is radical wide surgical excision with a clear margin. Long-term follow-up is essential for all patients with LGFS, as it has the potential for late recurrence or metastasis.

Comparison of Skin Graft for the Defect of the Radial Forearm Free Flap / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#This study compared two types of skin graft reconstruction for the defect of the radial forearm free flap. SUBJECTS AND METHOD: Ten cases of split-thickness skin graft (STSG) harvested from the thigh were analyzed. Also, ten cases of full-thickness skin graft (FTSG) harvest from the inguinal area applied with vacuum-assisted closure (VAC) system were analyzed. @*RESULTS@#The defect size of the radial forearm was increased more in the STSG group than in the FTSG group (p<0.05). Skin grafts were recovered completely sooner in the FTSG group than in the STSG group although it was not statistically significant (p=0.082). Five complications (pruritus, hypertrophic scar) were found in the donor site in the STSG group (p<0.05). FTSG gave better scores according to the Vancouver Scar Scale in terms of pigmentation, pliability, and height (p<0.05). @*CONCLUSION@#FTSG harvested from the inguinal area with the application of VAC system has many advantages for the defect of the radial forearm free flap although it is usually used for smaller size defects than for STSGs.

Comparison of Skin Graft for the Defect of the Radial Forearm Free Flap / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study compared two types of skin graft reconstruction for the defect of the radial forearm free flap. SUBJECTS AND METHOD: Ten cases of split-thickness skin graft (STSG) harvested from the thigh were analyzed. Also, ten cases of full-thickness skin graft (FTSG) harvest from the inguinal area applied with vacuum-assisted closure (VAC) system were analyzed. RESULTS: The defect size of the radial forearm was increased more in the STSG group than in the FTSG group (p<0.05). Skin grafts were recovered completely sooner in the FTSG group than in the STSG group although it was not statistically significant (p=0.082). Five complications (pruritus, hypertrophic scar) were found in the donor site in the STSG group (p<0.05). FTSG gave better scores according to the Vancouver Scar Scale in terms of pigmentation, pliability, and height (p<0.05). CONCLUSION: FTSG harvested from the inguinal area with the application of VAC system has many advantages for the defect of the radial forearm free flap although it is usually used for smaller size defects than for STSGs.

Early Recognition of Malignant Hyperthermia with Capnography: A case report / 대한마취과학회지

Malignant hyperthemia is an autosomal-dominant inherited disorder of the skeletal muscle cell charac terized by a hypermetabolic response to all commonly used inhalational anesthetics and depolarizing muscle relaxants. The clinical syndrome includes muscle rigidity, hypercapnia, tachycardia and myoglobinuria as result of increased carbon dioxide production, oxygen consumption and muscle membrane breakdown. Early recognition and vigorous treatment are very important factors to determine patient's prognosis in malignant hyperthermia. However, it is very difficult to diagnose malignant hyperthermia during anesthesia because malignant hyperthermia presents with multiple nonspecific signs and laboratory findings of variable intensity and time course during and after exposure to anesthetic agents. We report a case of malignant hyperthermia which was diagnosed early using capnography before the appearance of hyperthermia and successfully treated. The malignant hyperthermia episode developed 20 minutes after induction of anesthesia with thiopental sodium, pancuronium, isoflurane, N2O and O2. When we suspected episode, we could not observe any classical signs of malignant hyperthermia except unexplained tachycardia and elevated end-tidal CO2. We discuss here the usefulness of capnography in early recognition of malignant hyperthermia and the importance of early recognition in prognosis.