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*

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*

BACKGROUND AND OBJECTIVES: It is hard to adequately define the clinical and histologic characteristics of laryngeal premalignant lesions that herald the potential for progression to invasive squamous cell carcinoma especially in the Korean population. The aim of this study was to analyze prognostic factors of laryngeal premalignant lesions in the Korean population. MATERIALS AND METHOD: A retrospective analysis was undertaken in 88 patients with laryngeal premalignant lesions. All were diagnosed with laryngeal keratosis and dysplasia on pathology. RESULTS: 66 patients showed keratosis, 12 patients mild dysplasia, 4 patients moderate dysplasia, and 6 patients severe dysplasia. Of the 88 patients available for follow up (ranging from 6 to 135 months), six patients (6.8%) developed invasive squamous cell carcinoma. Use of CO2 Laser was not associated with cancer progression (p=0.641). In contrast, grade of dysplasia was significantly associated with cancer risk (p=0.032). CONCLUSION: The laryngeal premalignant lesion represents a possible passage to cancer in a limited number of cases, but with a more probability for high degree dysplasia in respect to low degree dysplasia.
Carcinoma, Squamous Cell ; Follow-Up Studies ; Humans ; Keratosis ; Larynx ; Lasers, Gas ; Pathology ; Precancerous Conditions ; Retrospective Studies

Malignant peripheral nerve sheath tumor (MPNST) is defined as a malignant tumor arising from cells of the peripheral nerve sheath. The patients with neurofibromatosis type 1 (NF1) have the highest probability of developing MPNST. Even with wide surgical excision and adjuvant chemoradiation, the prognosis of MPNST is generally poor. We experienced a case of MPNST in a 38-year-old man with a long-standing NF1. He had a painless, infraauricular mass of 1 month duration. The patient underwent excision of the mass followed by total parotidectomy and modified neck dissection. Permanent pathologic sections confirmed MPNST. We report this case with a review of the literature.
Adult ; Humans ; Neck Dissection ; Neurilemmoma ; Neurofibroma, Plexiform* ; Neurofibromatoses* ; Neurofibromatosis 1* ; Peripheral Nerves* ; Prognosis

One of the common complications of parathyroid surgery is the development of postoperative hypocalcemia. Hypocalcemia may result from the redistribution of serum calcium as well as the insufficient supply of parathyroid hormone from the parathyroid tissues remaining after the parathyroidectomy. Hungry bone syndrome is postoperative hypocalcemia that takes place due to rapid redistribution of serum calcium to the bone and requires a long-term medical management. We have experienced a 34-year-old man who presented brown tumor in the left humerus and developed hungry bone syndrome after resection of a parathyroid gland adenoma. We report this case with a review of the literature.
Adenoma ; Adult ; Calcium ; Humans ; Humerus ; Hypocalcemia ; Parathyroid Glands ; Parathyroid Hormone ; Parathyroid Neoplasms* ; Parathyroidectomy

BACKGROUND AND OBJECTIVES: Although difficult laryngeal exposure (DLE) is a common problem encountered during rigid laryngoscopy, no anticipatory parameters have been formally noted as its reliable predictors. The purpose of this study is to identify physical and radiologic parameters to predict DLE according to a new classification of laryngeal exposure (LE score) suggested by authors. STUDY DESIGN: Fifty-eight patients underwent larygomicrosurgery were given LE score from grade 1 to 4 according to the glottic visualization on suspension laryngoscopy using a anterior commissure laryngoscope. Several parameters to predict DLE were investigated to compare DLE cases with control. SUBJECTS AND METHOD: All patients received physical and radiological examinations that encompassed the following sixteen measurements: sex, age, modified Mallampati index (MMI), body mass index (BMI), neck circumference, anterior mandibular height (AMH), hyoid-mental distance (HMD), thyroid-mental distance (TMD), horizontal thyroid-mental distance (HTD), vertical thyroid-mental distance (VTD), sternummental distance (SMD), vertical incisor-thyroid distance (VITD), horizontal incisor-thyroid distance (HITD), thyroid incisor angle (TIA), thyroid-mandible angle (TMA) at neutral and extended positions. Modified Cormack-Lehane score (MCLS) was obtained by an anesthesiologist. Mann-Whitney U test was used to compare the control with DLE group. RESULTS: The ages of patients ranged from 23 to 80 years with a mean of 48.7 years. The LE score was highly correlated with MCLS (r=0.676, p<.001). Among physical measurements, HMD at neutral position (p=.047) and TMD (p=.016), VTD (p=.005), SMD (p=.019) and VITD (p=.040) at extended position had a statistical significance. Among radiologic measurements, HMD (p=.008) and TMD (p=.005) at neutral position, and TMD (p=.037) and VTD (p=.034) at extended position had a statistical significance. CONCLUSION: The new classification is a reliable system to evaluate the extent of laryngeal exposure during suspension laryngoscopy. The physical and radiologic measurements can be helpful to predict the difficult laryngeal exposure.
Body Mass Index ; Classification ; Humans ; Incisor ; Laryngoscopes ; Laryngoscopy ; Neck ; Thyroid Gland

BACKGROUND AND OBJECTIVES: Adenoid cystic carcinoma of salivary glands has distinct characteristics of indolent but persistent growth, late onset of metastasis and eventual death of patients. We performed this study to find parameters affecting the recurrence and survival of patients with adenoid cystic carcinoma in salivary glands. SUBJECTS AND METHOD: A retrospective study was done on 55 patients who underwent surgery between 1990 and 2006. We analyzed the effect of patient's factors, characteristics of tumor and treatment modalities to local recurrence, distant metastasis and survival. RESULTS: There were 20 males and 35 females, with the median age of 50.2 years. The mean follow-up duration after treatment was 70.9 months. Patients who received surgery alone were 12 (22%), with radiation therapy were 34 (62%) and with concurrent chemoradiation therapy were 9 (16%). There were 7 patients who had local recurrence alone, 8 who had distant metastasis alone and 3 who had local recurrence with distant metastasis. There was no correlation between the above parameters and local recurrence. Distant metastasis was influenced by old age (p=0.018), lymph node involvement (p=0.005) and treatment with concurrent chemoradiation therapy (p<0.001). Eight patients died during the follow up period. Five-year overall survival rate was 88.2% and the disease-free survival was 72.9%. The multivariate analysis found that only lymph node involvement was associated with survival (p=0.043). CONCLUSION: Lymph node involvement was predictive of poor prognosis in salivary adenoid cystic carcinoma. Therefore, it is necessary to establish highly sensitive diagnostic tools with which surgeons can find lymph node involvement.
Adenoids ; Carcinoma, Adenoid Cystic ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; Male ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Salivary Glands ; Survival Rate