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Low-Grade Fibromyxoid Sarcoma Arising in Posterior Nasal Cavity: Case Report and Review of the Literature.

Jung Heob SOHN ; Kijin LEE ; Kyoung Rai CHO

Korean Journal of Otolaryngology - Head and Neck Surgery.2018;61(11):624-629. doi:10.3342/kjorl-hns.2018.00437

Low-grade fibromyxoid sarcoma (LGFMS), a soft tissue tumor that has high recurrence and metastasizing potential, rarely occurs in the head and neck region. Therefore, the treatment for LGFMS in the facial area is challenging in terms of cosmetic and functional maintenance. The authors report a case of LGFMS in the posterior nasal cavity. It was completely removed in parallel with the nasal endoscopic and oral approach, but the lower margin was closed by preserving the soft palate. The patient is well without any recurrence or metastasis after 5 years of follow-up.
Follow-Up Studies ; Head ; Humans ; Nasal Cavity* ; Neck ; Neoplasm Metastasis ; Palate, Soft ; Recurrence ; Sarcoma*

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Two Cases of Mucosal Bridge Crossing the Membrane of Vocal Folds.

Chan Min JUNG ; Eun Jung LEE ; Jae Yol LIM ; Hong Shik CHOI

Korean Journal of Otolaryngology - Head and Neck Surgery.2018;61(11):619-623. doi:10.3342/kjorl-hns.2017.00367

Mucosal bridges of vocal fold have been described as a parallel band to vocal folds with the presence of sulcus vocalis. However, the type of mucosal bridge crossing each vocal fold has not been well documented in the literature. Herein, we present two cases of mucosal bridge found in the vocal fold connecting the mid-portions of true vocal folds. Two patients who had no history of laryngeal trauma, surgery or oro-tracheal intubation visited our clinic due to voice change. Laryngoscopic examination revealed that they had a mid-portion mucosal band without any other mucosal lesions. Two patients underwent laryngomicrosurgery with pulsed dye laser. After the surgery, they showed significant improvement of voice quality.
Humans ; Intubation ; Laryngoscopy ; Lasers, Dye ; Membranes* ; Vocal Cords* ; Voice ; Voice Disorders ; Voice Quality

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A Case of a Central Giant Cell Granuloma in the Right Zygomatic Bone.

Jong Yeop SEONG ; Seong Min JIN ; Jae Gu KIM ; Dong Hoon LEE

Korean Journal of Otolaryngology - Head and Neck Surgery.2018;61(11):615-618. doi:10.3342/kjorl-hns.2017.00255

The central giant cell granuloma is a benign tumor seen generally in the mandible, but rarely in other cranial bones. Herein, we present a 51-year-old man with central giant cell granuloma in the right zygomatic bone. Physical and radiologic examinations of the central giant cell granuloma in the zygomatic bone showed that specific and preoperative diagnosis is usually difficult. Therefore, clinicians should consider the possibility that central giant cell granuloma may occur in the zygomatic bone mimicking other more frequently observed lesions.
Diagnosis ; Giant Cells* ; Granuloma, Giant Cell* ; Humans ; Mandible ; Middle Aged ; Zygoma

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A Case of Lymphoepithelioma-Like Carcinoma in the Thyroid Gland.

Young Jin LOH ; Hyungi GIM ; Jong Chul HONG

Korean Journal of Otolaryngology - Head and Neck Surgery.2018;61(11):611-614. doi:10.3342/kjorl-hns.2017.00199

Lymphoepithelioma-like carcinoma exhibits immunohistochemically similar features to lymphoepithelioma and commonly occurs in the skin, salivary gland, breast, lung, gastrointestinal tract, liver, urinary tract, prostate, vulva and vagina. Lymphoepithelioma-like carcinoma from the thyroid gland is extremely rare. We recently experienced a case of lymphoepithelioma-like carcinoma of thyroid gland in a 28-year-old female, who presented a thyroid nodule that was suspicious of papillary carcinoma. We report this unusual case of lymphoepithelioma-like carcinoma of thyroid gland with a brief review of literature.
Adult ; Breast ; Carcinoma ; Carcinoma, Papillary ; Female ; Gastrointestinal Tract ; Humans ; Liver ; Lung ; Prostate ; Salivary Glands ; Skin ; Thyroid Gland* ; Thyroid Nodule ; Thyroidectomy ; Urinary Tract ; Vagina ; Vulva

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Bozola Flap for Oral Cavity Reconstruction in Patients with Tongue Cancer.

Ji Hye KWAK ; Gil Joon LEE ; Jin Ho SOHN ; Dongbin AHN

Korean Journal of Otolaryngology - Head and Neck Surgery.2018;61(11):605-610. doi:10.3342/kjorl-hns.2018.00171

BACKGROUND AND OBJECTIVES: The purpose of the present study was to evaluate the usefulness of a posterior-based buccinator myomucosal flap (the Bozola flap) for the reconstruction of oral cavity defects after tongue cancer resection. SUBJECTS AND METHOD: Fifteen patients who underwent from 2014 to 2016 reconstruction of the oral cavity with a Bozola flap after surgical management of tongue cancer were enrolled in the study. Patient characteristics, surgical outcomes, and complications associated with the Bozola flap were evaluated. RESULTS: The flap was successfully harvested and transferred in all patients. The mean flap harvesting time was 25.3 min. The donor site was closed primarily in 14 patients, and a buccal fat pad flap was used in one patient. Although partial necrosis of the flap occurred in two patients, no other major complications were noted. CONCLUSION: The results of this study demonstrate that the Bozola flap is a good option for reconstruction of moderate sized oral cavity defects in tongue cancer patients.
Adipose Tissue ; Humans ; Methods ; Mouth Mucosa ; Mouth* ; Necrosis ; Reconstructive Surgical Procedures ; Tissue Donors ; Tongue Neoplasms* ; Tongue*

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BRAF(V600E) Mutation is a Strong Preoperative Indicator for Predicting Malignancy in Thyroid Nodule Patients with Atypia of Undetermined Significance Identified by Fine Needle Aspiration.

Hye Rang CHOI ; Bo Yoon CHOI ; Jae Hoon CHO ; Young Chang LIM

Korean Journal of Otolaryngology - Head and Neck Surgery.2018;61(11):600-604. doi:10.3342/kjorl-hns.2018.00199

BACKGROUND AND OBJECTIVES: This study aimed to identify a reliable preoperative predictive factor for the development of thyroid cancer in patients with atypia of undetermined significance (AUS) identified by fine needle aspiration biopsy (FNAB). SUBJECTS AND METHOD: This was a retrospective cohort study. Two hundred and ninety-nine patients diagnosed with AUS by preoperative FNAB who underwent curative thyroid surgery at our institution between September 2005 and February 2014 were analyzed. Clinical, radiological and molecular features were investigated as preoperative predictors for postoperative permanent malignant pathology. RESULTS: The final pathologic results revealed 36 benign tumors including nodular hyperplasia, follicular adenoma, adenomatous goiter, nontoxic goiter, and lymphocytic thyroiditis, as well as 263 malignant tumors including 1 follicular carcinoma and 1 invasive follicular carcinoma; the rest were papillary thyroid carcinomas. The malignancy rate was 87.9%. The following were identified as risk factors for malignancy by univariate analysis: BRAFV600E gene mutation, specific ultrasonographic findings including smaller nodule size, low echogenicity of the nodule, and irregular or spiculated margin (p < 0.05). Multivariate analysis revealed that only BRAFV600E mutation was a statistically significant risk factor for malignancy (p < 0.05). When BRAFV600E mutation was positive, 98.5% of enrolled patients developed malignant tumors. In addition, the diagnostic rate of malignancy in these cases was approximately 16-fold higher than BRAF-negative cases. CONCLUSION: Patients with AUS thyroid nodules should undergo BRAFV600E gene mutation analysis to improve diagnostic accuracy and if the mutation is confirmed, surgery is recommended due to the high risk of malignancy.
Adenoma ; Biopsy ; Biopsy, Fine-Needle* ; Cohort Studies ; Goiter ; Humans ; Hyperplasia ; Methods ; Multivariate Analysis ; Pathology ; Retrospective Studies ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule* ; Thyroiditis, Autoimmune

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Scoring Methods of Polysomnography for Diagnosis of Sleep Apnea in Adolescents.

Keu Sung LEE ; Seung Soo SHEEN ; Il Jae LEE ; Byung Joo CHOI ; Ji Ho CHOI ; Do Yang PARK ; Han Tai KIM ; Hyun Jun KIM

Korean Journal of Otolaryngology - Head and Neck Surgery.2018;61(11):593-599. doi:10.3342/kjorl-hns.2018.00080

BACKGROUND AND OBJECTIVES: Respiratory scoring guidelines for children and adults have been used for evaluating adolescents both in the 2007 and 2012 American Academy of Sleep Medicine (AASM) scoring manuals. We compared the scoring methods of polysomnography used in these scoring manuals, where pediatric and adult scoring rules were adopted for the diagnosis of sleep apnea in adolescents. SUBJECTS AND METHOD: 106 Korean subjects aged between 13 and 18 years were enrolled. All subjects underwent overnight polysomnography in a sleep laboratory. Data were scored according to both pediatric and adult guidelines in the 2007 and 2012 AASM scoring manuals. RESULTS: Both pediatric and adult apnea hypopnea index (AHI) using the 2012 method were significantly higher than those using the 2007 method. The difference in AHI compared between pediatric and adult scores with the 2012 AASM scoring system was markedly decreased from that with the 2007 method. There was a significant discordance in sleep apnea diagnosis between pediatric and adult scoring rules in the 2012 method. CONCLUSION: Both pediatric and adult rules were used for the diagnosis of adolescent sleep apnea in the 2012 method. However, there was significant discordance in the diagnosis between pediatric and adult scoring guidelines in the 2012 AASM manual, probably due to different cut-off values of AHI for the diagnosis of sleep apnea in pediatric (≥1) and adult (≥5) patients. Further studies are needed to determine a more reasonable cut-off value for the diagnosis of sleep apnea in adolescents.
Adolescent* ; Adult ; Apnea ; Child ; Diagnosis* ; Humans ; Methods ; Polysomnography* ; Research Design* ; Sleep Apnea Syndromes*

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Reduction of Isolated Zygomatic Arch Fractures with Gillies Approach.

Dong Keun SHIN ; Young Su KIM ; Woo Sub SHIM ; Hahn Jin JUNG

Korean Journal of Otolaryngology - Head and Neck Surgery.2018;61(11):588-592. doi:10.3342/kjorl-hns.2017.01109

BACKGROUND AND OBJECTIVES: The incidence of facial bone fracture is increasing. The zygomatic bone, due to its anatomical prominence, is the second most common site of all facial bone fractures. In this study, we present the clinical experiences of zygomatic arch fracture in a tertiary hospital and introduce the Gillies approach for reduction and its outcome results. SUBJECTS AND METHOD: We collected data from retrospective chart reviews of patients who underwent surgeries from 2010 to 2017 for zygomatic arch fractures at Chungbuk National University Hospital. Data were analyzed according to age, gender, cause of trauma, location of trauma, and clinical symptoms including trismus. All surgery was performed under general anesthesia and via the use of Gillies approach. The result of surgery was evaluated by postoperative facial computed tomography. RESULTS: Sixteen patients underwent surgery for zygomatic arch fracture. The patients had the average age of 41.3 years, a male predominance of 15:1 and physical assault as the most common cause of trauma. The time lag between injury and surgical reduction was 5.5 days. The surgical outcomes were assessed “good” in 14 cases and “moderate” in one case. Patients who had trismus preoperatively were resolved of it in all cases after operation. Postoperative complications were absent. CONCLUSION: The Gillies approach proved to be a relatively easy, safe, and reliable method, and its surgical outcomes was satisfactory in our experiences.
Anesthesia, General ; Chungcheongbuk-do ; Facial Bones ; Humans ; Incidence ; Male ; Methods ; Postoperative Complications ; Retrospective Studies ; Tertiary Care Centers ; Trismus ; Zygoma*

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Clinical Implication and Proposed Mechanism of Direction Changing Vibration Induced Nystagmus in Unilateral Vestibular Hypofunction.

Dong Han LEE ; Moo Kyun PARK ; Jun Ho LEE ; Seung Ha OH ; Myung Whan SUH

Korean Journal of Otolaryngology - Head and Neck Surgery.2018;61(11):580-587. doi:10.3342/kjorl-hns.2017.00885

BACKGROUND AND OBJECTIVES: We evaluated the clinical characteristics and vestibular function of patients with direction changing vibration induced nystagmus (DC VIN) and unilateral vestibular hypofunction and suggest clinical implication and a proposed mechanism of DC VIN. SUBJECTS AND METHOD: The records of 315 patients who underwent the VIN test were reviewed retrospectively. Among these, 18 patients (5.7%) showed DC VIN, and out of whom, 15 patients (4.8%) were diagnosed as unilateral vestibular hypofunction by caloric, rotation chair (RCT), and video head impulse test (vHIT). We analyzed the relationship between DC VIN and the dizziness characteristics, duration of disease, and the outcome of the vestibular function test. RESULTS: The mean age of 15 patients was 67.4±10.7 years and the mean duration of dizziness was 13.6±29.7 months. The caloric test revealed 25% of the patients to have significant canal paresis [Caloric vestibular neuritis (VN)], while 75% showed normal caloric response. However, unilateral vestibular hypofunction was observed by abnormal results in RCT or vHIT (Non-caloric VN). Seven patients showed ipsilateral DC VIN (nystagmus to vibrated side) and eight patients contralateral DC VIN (nystagmus to opposite side of vibration). Patients with ipsilateral DC VIN were shown to have a significant longer duration of dizziness than those with contralateral DC VIN. CONCLUSION: Although rare, DC VIN can also be found in patients with unilateral vestibular hypofunction. Patients with DC VIN had a mild vestibular asymmetry with Non-caloric VN or Caloric VN in the process of compensation. The mechanism of ipsilateral DC VIN seems to be due to the small amount of vestibular asymmetry, which is smaller than the interaural attenuation of vibration.
Caloric Tests ; Compensation and Redress ; Dizziness ; Head Impulse Test ; Humans ; Methods ; Paresis ; Retrospective Studies ; Vestibular Function Tests ; Vestibular Neuronitis ; Vibration*

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The Objective Test of Cochlear Dead Region Using Acoustic Change Complex: A Preliminary Report.

Soojin KANG ; Juhyun HAN ; Jihwan WOO ; Hee Sung PARK ; Il Joon MOON ; Kyusung CHOI ; Sung Hwa HONG

Korean Journal of Otolaryngology - Head and Neck Surgery.2018;61(11):573-579. doi:10.3342/kjorl-hns.2017.00976

BACKGROUND AND OBJECTIVES: Cochlear dead region (CDR) is a region in the cochlear where hearing loss has occurred due to damage to the inner hair cells and/or neurons. Recently, a subjective test involving a pure-tone test in the presence of threshold-equalizing noise (TEN) was introduced to identify CDR. However, for uncooperative patients, such a subjective method would be unsuitable and objective methods would be needed instead to detect CDR. The acoustic change complex (ACC) is an evoked potential elicited by changes in the ongoing sound. In this study, we developed an objective method of identifying CDR by combining ACC response with a TEN test, namely the TEN-ACC test, and investigated its feasibility in normal-hearing listeners. SUBJECTS AND METHOD: Ten normal-hearing subjects participated in this study. All subjects underwent both behavioral TEN test and electrophysiological TEN-ACC test. The stimuli for the TEN-ACC test consisted of TEN and embedded pure tones with different frequencies/signals to noise ratios (SNRs). To identify the thresholds, the range SNR of stimulation was varied from 0 to 20 dB, in stages of 4 dB. RESULTS: The ACC responses of all subjects who participated in this study were well elicited by stimuli developed for the TEN-ACC test. We confirm that the pure-tones embedded in TEN elicited the objective ACC response. CONCLUSION: The results of this study suggest that the novel TEN-ACC test can be applied to evoke ACC in normal-hearing listeners. Future research should incorporate hearing-impaired listeners to determine the feasibility of the TEN-ACC test as an objective method to identify CDR.
Acoustics* ; Evoked Potentials ; Hair Cells, Auditory, Inner ; Hearing Loss ; Humans ; Methods ; Neurons ; Noise

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