Head and neck squamous cell carcinoma has emerged as the sixth most commonly occurring cancer worldwide and despite advances in diagnostics and therapeutics, the treatment results and survival outcomes still remain poor, especially in advanced cancers. Due to the complexity of the local anatomic structures and the importance as vital functioning organs, the head and neck area following conventional treatment modalities such as surgery, chemotherapy, or radiotherapy often result as a devastating consequence both esthetically and functionally. In order to minimize the treatment related sequelae and at the same time maximize treatment effect, tumor-specific molecular targeted therapy has become an area under active research. Several molecular targeted agents, including the representative epidermal growth factor receptor (EGFR)-inhibitors have been developed and its therapeutic effects investigated. However, therapeutic resistance has newly risen as a main problem following targeted therapy due to a variety of resistance mechanisms. This review article looks at the major acquired resistance mechanisms following targeted agents administration including EGFR inhibitors and many others and strategies to overcome the resistance to achieve precision medicine.
Carcinoma, Squamous Cell ; Drug Therapy ; Head and Neck Neoplasms* ; Head* ; Molecular Targeted Therapy ; Neck ; Radiotherapy ; Receptor, Epidermal Growth Factor

Pharyngocutaneous fistula is a readily encountered complication that occurs after surgery for laryngopharyngeal cancer. The development of pharyngocutaneous fistula increases hospitalization, delays postoperative adjuvant treatment, and can lead to serious complications such as wound infection and carotid artery rupture. Transoral robotic surgery (TORS) is actively being performed as a standard procedure for surgery of pharyngeal and laryngeal cancers. Many reports verified that TORS is advantageous in terms of perioperative outcomes such as decreased hospitalization and reduced rate of postoperative complications, free flap reconstruction, and tracheostomy or gastrostomy tube dependence relative to open surgery. However, careful selection of patients is mandatory and there are some critical points to consider in optimal treatment outcomes. Recently, we experienced a 47-year-old patient with tonsillar cancer who underwent lateral oropharyngectomy by TORS and radical neck dissection. Unfortunately, multiple pharyngocutaneous fistulae occurred following postoperative concurrent chemoradiotherapy (CCRT). Multiple phrayngocutaneous fistulae following TORS and postoperative CCRT have not been reported in the literature. Therefore, we report this case with a brief discussion supported by a review of the relevant literature.

Reprogramming of cellular metabolism is an important, emerging, and universal hallmark of cancer which has received considerable attention during the recent era of cancer research. Cancer cells show characteristic alterations in glucose metabolism in order to fulfill the needs of biosynthesis for tumor proliferation and growth. However, under certain circumstances such as invasion and metastasis, cancer cells are prone to metabolic stress and will require different strategies to meet the high energetic demand from cancer progression. From various metabolic rewiring mechanisms, cancer cells adopt other metabolic pathways with alternative nutrient sources. Therefore, targeting cancer metabolism holds promising but great challenge caused by the metabolic plasticity of cancer cells. This review will discuss characteristic cancer metabolism in detail with special focus on lipid metabolism which is gathering increasingly keen interest, in order to find novel therapeutic approaches to head and neck cancer. By understanding and exploiting the synthesis, oxidation, and storage of fatty acids, we could investigate potential strategies to block cancer proliferation and progression.

Spontaneous cervical hematomas could lead to life-threatening complications, and aneurysms, retopharyngeal abscesses, parathyroid adenomas, laryngeal cysts, and neurogenic tumors should be distinguished as possible underlying causes. Symptoms accompanying spontaneous cervical hematoma include cervical swelling, ecchymosis, dysphagia, dyspnea and hoarseness. We recently experienced a case of spontaneous cervical hematoma in a 52-year-old woman, who initially presented with cervical swelling after severe coughing two days ago. Resultingly parathyroid adenoma was finally confirmed after mass excision. Therefore, we present this unique case with a review of the literature.

The aim of surgery for vestibular schwannoma is to accomplish complete tumor removal while preserving facial function and hearing ability. The middle cranial fossa approach represents one such surgical approach for resection of vestibular schwannoma with hearing preservation. As more experience has been gained with this approach, hearing preservation rates have increased. However, even if gross tumor removal is done completely, residual tumor can show regrowth microscopically. Such residual vestibular schwannoma may be treated by different options. We present a case of residual vestibular schwannoma treated with revision middle cranial fossa approach to preserve facial function and hearing ability.
Cranial Fossa, Middle ; Facial Nerve ; Hearing ; Neoplasm, Residual ; Neuroma, Acoustic

Rosai-Dorfman disease is a rare disorder of unknown etiology and is usually associated with benign proliferation of hematopoietic and fibrous tissue that often manifests in the head and neck region. The most common clinical presentation of this entity is bilateral, nontender cervical lymphadenopathy, but an extranodal form of the disease may develop in up to 43% of patients. We report a case of extranodal Rosai-Dorfman disease occurring in the nasal cavity and the nasopharynx. A 25-year-old male visited the clinic with a complaint of nasal obstruction for several months. Mass originating from anterior portion of septum and nasopharyngeal cavity was observed by endoscopy. Endoscopic guided incisional biopsy of the lesion was performed. The histopathologic findings revealed clusters of large, foamy histiocytes with abundant clear cytoplasm, lymphophagocytosis, and heavy infiltration of lymphocytes and plasma cells, which are the key features of Rosai-Dorfman disease.
Adult ; Biopsy ; Cytoplasm ; Endoscopy ; Head ; Histiocytes ; Histiocytosis, Sinus ; Humans ; Lymphatic Diseases ; Lymphocytes ; Male ; Nasal Cavity ; Nasal Obstruction ; Nasopharynx ; Neck ; Plasma Cells

OBJECTIVES: A saccular cyst is defined as a dilated saccule of the larynx, filled with mucus, and is located between the false vocal cords and the thyroid cartilage. Although this uncommon laryngeal condition is benign in nature, it could lead to dyspnea, stridor, and airway obstruction, depending on its size and location. Furthermore, some saccular cysts have been associated with laryngeal carcinoma. This study aimed to characterize this rather uncommon laryngeal condition to aid in determining the proper management of this pathology. METHODS: Medical records were retrospectively reviewed of all patients with saccular cysts diagnosed and treated between 2006 and 2017 at a tertiary otolaryngologic care center. RESULTS: Seven patients with saccular cysts were identified (male:female=2:5; mean age, 34.1 years); two were pediatric patients. Surgical intervention was performed in all patients by laryngo-microsurgery using CO2 laser. There was no recurrence after the initial surgical treatment. CONCLUSION: Saccular cysts can be managed endoscopically using CO2 laser, without requiring an external approach. Therefore, an endoscopic approach should be actively considered for an optimal treatment outcome.
Airway Obstruction ; Dyspnea ; Humans ; Larynx ; Lasers, Gas ; Medical Records ; Mucus ; Pathology ; Recurrence ; Respiratory Sounds ; Retrospective Studies ; Saccule and Utricle ; Thyroid Cartilage ; Treatment Outcome ; Vocal Cords

A 46-year old man visited our outpatient clinic with complaint of foreign body sensation in throat after consuming raw freshwater fish 5 days ago. Laryngoscopic examination revealed a motile worm attached on posterior pharyngeal wall. The worm was removed using biopsy forceps under transnasal endoscopy and evidently identified as Clinostomum complanatum after microscopic examination. Patient’s subjective foreign body sensation of throat and hyperemia of laryngeal mucosa remained for approximately 2 weeks post-removal, which were eventually resolved after administration of non-steroidal anti-inflammatory drug and anti-refluxant drug for 2 weeks. Treatment was ended at three weeks since the first visit. C. complanatum infections in humans are rare, and only four cases have been reported in Korea. Symptoms resembling pharyngitis or laryngitis occurs by consumption of raw, infected freshwater fish and treatment is done by mechanically removing the parasite.
Ambulatory Care Facilities ; Biopsy ; Endoscopy ; Foreign Bodies ; Fresh Water ; Humans ; Hyperemia ; Korea ; Laryngeal Mucosa ; Laryngitis ; Parasites ; Pharyngitis ; Pharynx ; Sensation ; Surgical Instruments

Parapharyngeal space (PPS) tumors are extremely rare, composing only 0.5% of all head and neck tumors. The PPS is shaped like an inverted pyramid bounded by the skull base superiorly and hyoid bone inferiorly. Recently, we experienced a 55-year-old female patient who visited the clinic with a presumed PPS tumor that had been incidentally identified by neck MRI. The patient underwent surgery for the removal of tumor by transoral approach following tonsillectomy. However, contrary to the initial expectations, no tumors were visible at the operative field and only observed were the evidence of chronic inflammatory tissues within the removed tonsil. To date, chronic follicular tonsillitis mimicking a PPS tumor has not been reported in the literature. Therefore, we report this case with a brief discussion of points to consider supported by a review of relevant literature.

Odontogenic keratocyst (OKC) accounts for 3-11% of all odontogenic cysts. OKC is a benign intra-osseous odontogenic tumor, but what makes this cyst special is its aggressive behavior and high recurrence rate. OKC is relatively aggressive compared to other odontogenic cysts, but its malignant transformation is considered extremely rare. Squamous cell carcinoma associated with odontogenic keratocysts have rarely been reported in the medical literature. We recently experienced a case of a 63-year-old man finally confirmed with squamous cell carcinoma of the mandible, which was initially diagnosed as a benign odontogenic keratocyst. Surgical resection was performed as definitive treatment. Therefore, we present this unique case with a review of the literature.