OBJECTIVES: Chondroradionecrosis (CRN) of the larynx is a rare but fatal complication of radiotherapy. We determined the optimal diagnostic methodology and management of laryngeal CRN in six patients. METHODS: We retrospectively reviewed the records of six patients with Chandler grade IV laryngeal CRN who had received prior radiotherapy (mean total radiation dose, 66.7+/-4.5 Gy) at a tertiary care hospital. Two patients underwent transoral laser microresection of their laryngeal carcinoma plus postoperative radiotherapy. All patients underwent endoscopy, computed tomography (CT), positron emission tomography (PET), removal of necrotic tissue, biopsy under suspension laryngoscopy, administration of antibiotics, and hyperbaric oxygen therapy (HBO). Their diagnostic and therapeutic results were assessed. RESULTS: CT showed CRN of the anterior larynx in three patients and CRN of the posterior larynx in three patients, with one patient having a false-positive result on PET. HBO consisted of a mean of 36+/-6 dives. After early debridement and HBO, five patients showed CRN improvement, but one had aggravation and subsequently underwent total laryngectomy. None of these patients showed local tumor recurrence on pathologic examination or during a mean follow-up of 24 months. CONCLUSION: Although CRN of the larynx may be detected by endoscopic and imaging work-ups, detection may require pathologic examination. Early debridement and HBO may effectively treat CRN, saving the functional larynx.
Anti-Bacterial Agents ; Biopsy ; Debridement ; Endoscopy ; Follow-Up Studies ; Humans ; Hyperbaric Oxygenation ; Laryngectomy ; Laryngoscopy ; Larynx ; Positron-Emission Tomography ; Recurrence ; Retrospective Studies ; Tertiary Healthcare

Boerhaave's syndrome is spontaneous transmural perforation of the esophagus, which occurs most often after forceful vomiting or retching. This commonly occurs in the lower third of the esophagus but spontaneous perforation of the pharynx or cervical esophagus is extremely rare. This case presented a 20-yr-old healthy man with spontaneous pharyngeal perforation after forceful vomiting who had no history of instrumentation, cervical trauma, or having eaten anything sharp. Cervical pain and crepitus were the early symptom and sign of pharyngeal perforation and the rupture was detected on gastrografin swallow and CT examinations. The rupture site was higher than the upper esophageal sphincter, differing from Boerhaave's syndrome. The patient was conservatively managed without significant morbidity and mortality. Although this may resolve without surgical intervention, the pharyngeal rupture should receive early detection and clinical attention for preventing potential morbidity by late diagnosis.
Delayed Diagnosis ; Diatrizoate Meglumine ; Esophageal Perforation ; Esophageal Sphincter, Upper ; Esophagus ; Humans ; Mediastinal Diseases ; Neck Pain ; Pharynx ; Rupture ; Vomiting

Organ preservation strategy in treatment of the head and neck cancer (HNC) has led to an increase in the use of primary chemoradiation in both laryngeal and extralaryngeal sites for recent two decades. Primary non-surgical chemoradiotherpay has replaced the traditional gold standard of surgery followed by postoperative radiation with saving the organ and no compromising oncological outcomes. In accompany with wide clinical extension of primary chemoradiation, organ preservation surgery through open transcervical or transoral route has been increasingly used in the patients with HNC at both primary and salvage settings. Minimally invasive transoral approach using lasers or robots has been more spotlighted as a sensible strategy for organ preservation of the HNC patients. There is, however, a paucity of randomized controlled clinical trial data comparing primary organ-preserving chemoradiation to organ preservation surgery. Future direction leads to conduct well-designed clinical trials to establish the functional and oncological benefits of the organ preservation surgery. This article reviews the role of organ preservation surgery in head and neck cancer.
Head ; Head and Neck Neoplasms ; Humans ; Microsurgery ; Organ Preservation ; Robotics

Three cases of cerebrospinal fluid (CSF) rhinorrhea and anterior skull base defects were successfully treated by applying mucoperichondrial free graft through the endonasal endoscopic technique. The causes of the skull base defects were trauma in two cases and endoscopic sinus surgery in one case. The defects were located in the sphenoid sinus in one case and the fovea ethmoidalis in two cases. In these cases, contralateral side septal mucoperichondrial free grafts were used to seal the defects and were supported with fibrin glue and Spongostan(R). Endoscopic repair with mucoperichondrial free graft appeared to be a safe and successful approach to the treatment of the anterior skull base defects.
Cerebrospinal Fluid Rhinorrhea* ; Cerebrospinal Fluid* ; Fibrin Tissue Adhesive ; Skull Base ; Sphenoid Sinus ; Transplants*

Giant fibrovascular polyps are very rare benign esophageal lesions arising in the cervical esophagus. We present a case of a 70-year old man with a history of dysphagia. On esophagogram and computed tomogram, a large, sausage-like polyp (7.0 cm in greatest dimension) was identified in the cervical esophagus. Surgical resection of the polyp was successfully performed. Histologically, the polyp was composed of a mixture of highly vascularized fibrous tissue and benign adipose tissue. The fibrous tissue was loosely and densely collagenized and the surface was covered by squamous epithelium. The lesion was diagnosed as a giant fibrovascular polyp and the patient has shown no evidence of recurrence for 8 months after surgery.
Adipose Tissue ; Aged ; Collagen ; Deglutition Disorders ; Epithelium ; Esophagus* ; Humans ; Polyps* ; Recurrence

No abstract available.
Carcinoma, Squamous Cell* ; Thyroid Gland*

Plasmacytoma is a rare malignancy characterized by a monoclonal proliferation of plasma cells, and is generally classified into a solitary plasmacytoma of bone and extramedullary plasmacytoma. Extramedullary plasmacytoma of the head and neck usually involves submucosal tissues in the nasopharynx and paranasal sinuses. The hypopharyneal involvement of the tumor, however, is very uncommon. We report a case of hypopharyngeal plasmacytoma treated by chemoradiation therapy with a review of literature.
Head ; Hypopharynx* ; Nasopharynx ; Neck ; Paranasal Sinuses ; Plasma Cells ; Plasmacytoma*

Synovial sarcomas are rarely occurring, highly malignant tumors of mesenchymal origin. Most cases are confined to the extremities. Fewer than 100 cases of synovial sarcoma have been reported in the head and neck area. We experienced a 24-year-old male patient who first complained of globus sensation. Initial suspension laryngoscopic biopsy specimen of the primary lesion was consistent with hypopharyngeal synovial sarcoma. Surgical excision through lateral pharyngotomy approach and postoperative radiotherapy were performed. We report this rare case with a literature review.
Biopsy ; Extremities ; Head ; Humans ; Hypopharynx* ; Male ; Neck ; Radiotherapy ; Sarcoma, Synovial* ; Sensation ; Young Adult

BACKGROUND AND OBJECTIVES : Although surgery is the first choice of therapy for ranula, sometimes complete excision is very difficult. Therefore, nonsurgical therapies with less associated morbidity have been required for the treatment of ranula. This study examined the effectiveness of intracystic injection of OK-432 for treatment of ranula. SUBJECTS AND METHOD : Total 32 patients with ranula (24, intraoral type ; 8, plunging type) were treated with OK-432 sclerotherapy. Aspirated mucus of ranula was replaced with an equal volume of OK-432 solution of 0.01 mg/mL. The size of ranula was compared before and after sclerotherapy. RESULTS : Twenty five of 32 patients (78%) showed a complete response after sclerotherapy : higher in plunging ranula (88%) than in intraoral ranula (75%). Rupture of ranula developed in 8 of 25 patients (32%) with intraoral ranula within a few days after injection. Recurrence occurred in 3 patients during follow-up period of median 12 months (range 9-22 months) after last injection. There were no major side effects, scarring, or increased morbidity to surgery of the OK-432 injected lesions. CONCLUSION : The intracystic injection of OK-432 is highly effective as a primary treatment modality of ranula.
Cicatrix ; Follow-Up Studies ; Humans ; Mucus ; Picibanil* ; Ranula* ; Recurrence ; Rupture ; Sclerotherapy*

Small cell carcinoma mainly occurs in the lung and extrapulmonary primary small cell carcinoma is uncommon. In the head and neck region, small cell carcinoma most commonly arises in the larynx and has been reported in the nasal cavity, paranasal sinuses, tongue, salivary glands, esophagus, and trachea. We have recently experienced a case of primary small cell carcinoma of the supraglottis in a 69-year-old male. The patient was treated by sequential chemoradiotherapy. We reported this case with a review of the literature.
Aged ; Carcinoma, Small Cell* ; Chemoradiotherapy ; Esophagus ; Head ; Humans ; Larynx* ; Lung ; Male ; Nasal Cavity ; Neck ; Paranasal Sinuses ; Salivary Glands ; Tongue ; Trachea