Traumatic pyriform sinus perforation is a very rare complication of endotracheal intubation. Forced insertion of endotracheal tube can tear pyriform sinus mucosa. Pyriform sinus perforation can result in deep neck infection which may be potentially lethal. We report a case of pyriform sinus perforation secondary to traumatic intubation, which was successfully treated with primary closure.
Intubation ; Intubation, Intratracheal ; Mucous Membrane ; Neck ; Pyriform Sinus

THE AIM OF STUDY: The transseptal-transsphenoidal approach (TSA) for pituitary tumors may alter nasal functions, including nasal respiration and olfaction. The aim of this study was to investigate the efficacy of TSA in terms of nasal functions. MATERIALS AND METHODS: Twenty two cases of pituitary tumors, managed at Seoul National University Hospital from May 1997 through March 1998, were included in this prospective study. Nasal functions were evaluated preoperatively and 2 months after the operation through symptom questionnaires, rhinomanometry, acoustic rhinometry and the butanol thres-hold test. RESULTS: The subjective nasal symptoms, including nasal obstruction and olfaction, were not changed following the operation in 72% and 86% of the cases, respectively. In the objective findings, total nasal resistance was not grossly changed after the operation, however, cross-sectional areas at C-notch and 3.3 cm from the anterior nasal spine increased significantly after the operation. Mucosal response to a topical vasoconstrictor after the operation was less effective than before the preoperation. CONCLUSION: TSA for pituitary tumors may be a safe and effective technique in preserving nasal functions subjectively and objectively.
Nasal Obstruction ; Pituitary Neoplasms ; Prospective Studies ; Respiration ; Rhinomanometry ; Rhinometry, Acoustic ; Seoul ; Smell ; Spine ; Surveys and Questionnaires

Salivary function in mammals may be defective for various reasons, such as aging, Sjogren's syndrome or radiation therapy in head and neck cancer patients. Recently, tissue-specific stem cell therapy has attracted public attention as a next-generation therapeutic reagent. In the present study, we isolated tissue-specific stem cells from the human submandibular salivary gland (hSGSCs). To efficiently isolate and amplify hSGSCs in large amounts, we developed a culture system (lasting 4-5 weeks) without any selection. After five passages, we obtained adherent cells that expressed mesenchymal stem cell surface antigen markers, such as CD44, CD49f, CD90 and CD105, but not the hematopoietic stem cell markers, CD34 and CD45, and that were able to undergo adipogenic, osteogenic and chondrogenic differentiation. In addition, hSGSCs were differentiated into amylase-expressing cells by using a two-step differentiation method. Transplantation of hSGSCs to radiation-damaged rat salivary glands rescued hyposalivation and body weight loss, restored acinar and duct cell structure, and decreased the amount of apoptotic cells. These data suggest that the isolated hSGSCs, which may have characteristics of mesenchymal-like stem cells, could be used as a cell therapy agent for the damaged salivary gland.
Amylases/genetics/metabolism ; Animals ; Antigens, CD/genetics/metabolism ; Apoptosis ; Cell Differentiation ; Humans ; Male ; Mesenchymal Stromal Cells/*cytology/metabolism ; Radiation Injuries, Experimental ; Rats ; Rats, Wistar ; *Regeneration ; Salivary Glands/cytology/injuries/physiology/*surgery ; *Salivation ; *Stem Cell Transplantation

BACKGROUND AND OBJECTIVES: Regional recurrence of head and neck squamous cell carcinoma (HNSCC) is the most common single type of treatment failure, and thus a challenging problem for the clinician. When planning management of regional recurrence, the grave outcome of the recurrence itself, and benefits and morbidity owing to the intervention must be taken into account. We analyzed the factors affecting salvage treatment outcomes of regional recurrence in head & neck squamous cell carcinoma. SUBJECTS AND METHOD: A retrospective analysis of medical records over a 10 year period (1994-2003) was conducted. Sixty-two patients with regional and locoregional recurrence were identified. Patients with local recurrence or distant metastasis were excluded. RESULTS: The median age of the population was 62 years. Sixty percent of the cases were regional, and the remainders were locoregional recurrences. The median time of recurrence was 16 months with an overall survival rate of 46.1%. Recurrence in a surgically virginal neck was associated with a favorable outcome. Factors associated with poor outcomes were node positive at initial presentation, neck dissection at initial treatment, recurrence at contralateral neck, incorporation of chemotherapy for salvage treatment, and subsequent recurrence after salvage treatment. CONCLUSION: In the management of patients with regional recurrence of HNSCC, the factors mentioned above should be taken into consideration regarding patient selection, salvage management plan, and patient counseling.
Carcinoma, Squamous Cell* ; Counseling ; Drug Therapy ; Head and Neck Neoplasms ; Head* ; Humans ; Medical Records ; Neck Dissection ; Neck* ; Neoplasm Metastasis ; Patient Selection ; Recurrence* ; Retrospective Studies ; Survival Rate ; Treatment Failure ; Treatment Outcome

PURPOSE: Well differentiated thyroid carcinomas are mostly curable diseases. Invasion of aerodigestive tract by thyroid carcinoma is rare. However, it is considered as a poor prognostic indicator of survival. Some studies showed that local invasion of thyroid carcinoma was the cause of death in many patients. Therefore, adequate local control of the tumor is critical to avoid the mortality as well as the morbidity of the disease. To find proper and adequate treatment modality of locally invasive thyroid carcinoma, we evaluated treatment modalities and outcomes in the patients with thyroid carcinoma with invasion of aerodigestive tract. METHODS: Forty patients with thyroid carcinoma invading aerodigestive tract who were treated from July 1989 through July 2002 were reviewed retrospectively. RESULTS: Direct intraluminal invasion of the thyroid carcinoma requires definitive resection of the aerodigestive tract. In case that the extent of tumor was thought to be limited to perichondrium or extraluminal invasion, tracheal shaving procedure was performed. Five-year and 10-year local control rates were 81.6% and 57.4%, respectively. Disease-specific survival rates of 5-year and 10-year were 90.1% and 81.1%, respectively. CONCLUSION: For the successful treatment of invasive thyroid carcinoma, the resection of the functional structures or the aerodigestive tract should be determined prudently according to the presence of the intraluminal invasion.
Cause of Death ; Humans ; Mortality ; Retrospective Studies ; Survival Rate ; Thyroid Gland* ; Thyroid Neoplasms*

BACKGROUND AND OBJECTIVES: Overexpression of cyclooxygenase-2 (COX-2), a rate-limiting enzyme in the generation of prostanoids from arachidonic acid, has known to be closely related to tumorigenesis, tumor growth, angiogenesis, and metastasis. Selective or non-selective COX-2 inhibitors have been used for the growth inhibition of cancers with preventative intents ; however, it has been suggested recently that cancer cells have COX-2-independent mechanisms. MATERIALS AND METHOD: Using MTT assat and cell counts, we observed the growth inhibition of SCC VII, CT-26 and B16F10 murine cancer cell lines when treated by celecoxib and indomethacin. SNU-1041 and HOK 16B were used as controls for comparing with the murine cell lines. The COX-2 expression of these cell lines was analyzed by western blotting and compared with the degree of inhibition by the drugs. RESULTS: The growth inhibition of the cell lines by the drugs was clearly demonstrated in a concentration-dependent manner and depended on the type of cell lines and test drug. The in vitro viability assay revealed that CT-26 expressing COX-2 protein was slightly inhibited but SCC VII and B16F10 without COX-2 expression were moderate-to-highly inhibited by the drug treatment. Celecoxib and indomethacin appeared to have no close relation with the COX-2 expression of cell lines in their growth inhibition. HOK 16B showed a resistance by concentrations less than 25 microM of celecoxib, which implies that celecoxib has a more selective effect on tumor cells and is safer than indomethacin. CONCLUSION: The growth of cancer cells was inhibited by celecoxib and indomethacin treatment, which depends on the type of cancer, treated drug, and its concentration. Their suppressive effect is not closely related to the COX-2 expression of cancer cells.
Animals ; Arachidonic Acid ; Blotting, Western ; Carcinogenesis ; Cell Count ; Cell Line* ; Cyclooxygenase 2 Inhibitors ; Cyclooxygenase 2* ; Indomethacin* ; Keratinocytes* ; Mice ; Neoplasm Metastasis ; Prostaglandins ; Celecoxib

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the efficacy of fine needle aspiration biopsy (FNAB) and frozen section biopsy in salivary gland malignancies. SUBJECTS AND METHOD: From January 1995 through December 2004, 462 patients underwent operation for salivary gland mass. Of these patients, FNABs and frozen section biopsies were performed in 262 and 241 patients, respectively. The medical and pathologic reports were reviewed retrospectively. Malignancies were found in 57 patients. RESULTS: The sensitivity and the specificity of FNAB to detect salivary gland malignancies were 50.9% and 94.1%, respectively. For the frozen section biopsy, the sensitivity and specificity rose to 90.7% and 99.0%, respectively. When the examination period was divided into period 1 (Jan, 1995-Dec, 1999) and period 2 (Jan, 2000-Dec, 2004), sensitivity showed a significant increase from 33.3% to 57.1%. With respect to pathologic types of the tumors, the sensitivity of FNAB was high in adenocarcinoma (88.9%, 8/9) but low in mucoepidermoid carcinoma (30%, 3/10) and carcinoma ex pleomorphic adenoma (33.3%, 3/9). CONCLUSION: FNAB alone cannot guarantee accurate diagnosis of salivary gland malignancies. Therefore, intraoperative frozen section biopsy is recommended to make an adequate decision for surgical extent. The clinical experience of pathologists is also an important factor in improving the accuracy of fine needle aspiration biopsy.
Adenocarcinoma ; Adenoma, Pleomorphic ; Biopsy* ; Biopsy, Fine-Needle* ; Carcinoma, Mucoepidermoid ; Diagnosis ; Frozen Sections* ; Humans ; Retrospective Studies ; Salivary Gland Neoplasms ; Salivary Glands* ; Sensitivity and Specificity

BACKGROUND AND OBJECTIVES: Airway problems frequently occur in neonatal patients requiring intensive care due to high prevalence of intubation history and congenital conditions that are linked to craniofacial or upper aerodigestive tract anomalies. However, many investigations on airway disorders have examined large populations of hospitalized children without focusing on those treated in the intensive care unit (ICU). Here we present the clinical features and outcomes in infants hospitalized with airway-related problems at the neonatal ICU. SUBJECTS AND METHOD: A total 69 patients were studied from May 2005 to December 2012, with each examined by an otolaryngologist while in neonatal ICU (NICU) for possible airway problems. Descriptive analysis was used in evaluating illnesses suffered and subsequent upper airway treatments. Factors associated with tracheostomy were identified by multivariate analysis. RESULTS: The median age of infants was 30 days (range, 1-237 days), with a male-to-female ratio of 1.38. The median gestational age was 35⁺³ weeks, and the mean birth weight was 2.35±0.89 kg. Overall, 40 patients had histories of intubation (median duration, 36 days; range, 1-204 days). The most common diagnosis in the upper airway exam was laryngomalacia (n=12), followed by subglottic stenosis (n=10) and micrognathia (n=8). Tracheostomy was performed in 38 patients (55.1%). In multivariate analysis, intubation history was identified as the only variable demonstrating a significant independent association with tracheostomy (p=0.006). CONCLUSION: Upper airway problems in NICU patients are due to a variety of disorders. Precise diagnosis and treatment is achievable through bedside and intraoperative assessments. Patients with a history of intubation are at increased risk of tracheostomy.

BACKGROUND AND OBJECTIVES: Mitomycin-C is becoming one of the most important agents in the treatment of glottic and subglottic stenosis. This study was conducted to investigate the clinical outcome of endoscopic management in glottic and subglottic stenosis patients using cold instruments and Mitomycin-C. SUBJECTS AND METHODS: A total of 47 patients with glottic and subglottic stenosis who were diagnosed and surgically treated in Seoul National University Children's Hospital from Jan. 2000 through Aug. 2003 were included. All were treated for endoscopic laryngomicrosurgery using cold instruments and bougienage. Thereafter, 0.4 mg/ml Mitomycin-C was directly applied for 5minutes on the surgical site. The surgical treatment outcome was retrospectively analyzed by reviewing medical records. RESULTS: All the studied patients showed improved airway stenosis and subjective symptoms, and twenty-one out of 47 patients have been decannulated successfully without any special complications. Mean number of operation for decannulation was 5.1, and the mean duration from the initial operation to decannulation was 17.3 months. CONCLUSION: Our data suggest that the use of cold instrumentation and topical mitomycin-C application might be a promising, initial choice of management in patients with airway stenosis.
Constriction, Pathologic* ; Humans ; Laryngostenosis ; Medical Records ; Mitomycin* ; Retrospective Studies ; Seoul ; Treatment Outcome

OBJECTIVES: The purpose of this study is to evaluate the effectiveness of skull base surgery on local control and survival of skull base lesions. In addition, the complications and their impact on the tumor control status as well as postoperative morbidity are considered. MATERIALS AND METHODS: We report our experience on 35 patients with skull base lesions. The patients were divided into two subgroups: (1) anterior skull base group (n=27) and (2) middle skull base group (n=8). RESULTS: For the anterior skull base group, the overall survival rate for malignant tumor (n=15) at 16 months was 53% without regard to histologic types. The overall operative mortality rate was 0% and the complication rate was 25% with craniofacial resection for control of neoplasm (n=20) and all of these complications were managed successfully without any sequelae. The technique of craniofacial resection was applied to the management of skull base trauma (n=4) and encephaloceles (n=3) successfully. The middle skull base group consisted of 5 patients with juvenile nasopharyngeal angiofibroma, and one patient each with malignant meningioma, meningioma, fibrous dysplasia, respectively. All JNA patients were managed with a combined intracranial and transmaxillary/transpalatal approach. Among them, 4 patients were cured and one patient developed a recurrence near the cavernous sinus. Surgical morbidity was minimal and there was no mortality. Facial translocation approach to the skull base was utilized in 2 patients. CONCLUSION: Craniofacial resection is a valid surgical technique for surgical management of tumors involving the anterior skull base and also can be applied to the treatment of selected trauma and malformations. The combined intracranial and transmaxillary/transpalatal approach is a safe and reliable method to remove nasopharyngeal angiofibroma with intracranial invasion.
Angiofibroma ; Cavernous Sinus ; Encephalocele ; Humans ; Meningioma ; Mortality ; Recurrence ; Skull Base* ; Skull* ; Survival Rate