These guidelines aim to establish the standard practice for diagnosing and treating patients with differentiated thyroid cancer (DTC). Based on the Korean Thyroid Association (KTA) Guidelines on DTC management, the “Treatment of Advanced DTC” section was revised in 2024 and has been provided through this chapter. Especially, this chapter covers surgical and nonsurgical treatments for the local (previous surgery site) or regional (cervical lymph node metastasis) recurrences. After drafting the guidelines, it was finalized by collecting opinions from KTA members and related societies. Surgical resection is the preferred treatment for local or regional recurrence of advanced DTC. If surgical resection is not possible, nonsurgical resection treatment under ultrasonography guidance may be considered as an alternative treatment for local or regional recurrence of DTC. Furthermore, if residual lesions are suspected even after surgical resection or respiratory-digestive organ invasion, additional radioactive iodine and external radiation treatments are considered.

Pediatric differentiated thyroid cancers (DTCs), mostly papillary thyroid cancer (PTC, 80-90%), are diagnosed at more advanced stages with larger tumor sizes and higher rates of locoregional and/or lung metastasis. Despite the higher recurrence rates of pediatric cancers than of adult thyroid cancers, pediatric patients demonstrate a lower mortality rate and more favorable prognosis. Considering the more advanced stage at diagnosis in pediatric patients, preoperative evaluation is crucial to determine the extent of surgery required. Furthermore, if hereditary tumor syndrome is suspected, genetic testing is required. Recommendations for pediatric DTCs focus on the surgical principles, radioiodine therapy according to the postoperative risk level, treatment and follow-up of recurrent or persistent diseases, and treatment of patients with radioiodine-refractory PTCs on the basis of genetic drivers that are unique to pediatric patients.

Differentiated thyroid cancer demonstrates a wide range of clinical presentations, from very indolent cases to those with an aggressive prognosis. Therefore, diagnosing and treating each cancer appropriately based on its risk status is important. The Korean Thyroid Association (KTA) has provided and amended the clinical guidelines for thyroid cancer management since 2007. The main changes in this revised 2024 guideline include 1) individualization of surgical extent according to pathological tests and clinical findings, 2) application of active surveillance in low-risk papillary thyroid microcarcinoma, 3) indications for minimally invasive surgery, 4) adoption of World Health Organization pathological diagnostic criteria and definition of terminology in Korean, 5) update on literature evidence of recurrence risk for initial risk stratification, 6) addition of the role of molecular testing, 7) addition of definition of initial risk stratification and targeting thyroid stimulating hormone (TSH) concentrations according to ongoing risk stratification (ORS), 8) addition of treatment of perioperative hypoparathyroidism, 9) update on systemic chemotherapy, and 10) addition of treatment for pediatric patients with thyroid cancer.

The primary objective of initial treatment for thyroid cancer is minimizing treatment-related side effects and unnecessary interventions while improving patients’ overall and disease-specific survival rates, reducing the risk of disease persistence or recurrence, and conducting accurate staging and recurrence risk analysis. Appropriate surgical treatment is the most important requirement for this purpose, and additional treatments including radioactive iodine therapy and thyroid-stimulating hormone suppression therapy are performed depending on the patients’ staging and recurrence risk. Diagnostic surgery may be considered when repeated pathologic tests yield nondiagnostic results (Bethesda category 1) or atypia of unknown significance (Bethesda category 3), depending on clinical risk factors, nodule size, ultrasound findings, and patient preference. If a follicular neoplasm (Bethesda category 4) is diagnosed pathologically, surgery is the preferred option. For suspicious papillary carcinoma (suspicious for malignancy, Bethesda category 5), surgery is considered similar to a diagnosis of malignancy (Bethesda category 6). As for the extent of surgery, if the cancer is ≤1 cm in size and clinically free of extrathyroidal extension (ETE) (cT1a), without evidence of cervical lymph node (LN) metastasis (cN0), and without obvious reason to resect the contralateral lobe, a lobectomy can be performed. If the cancer is 1-2 cm in size, clinically free of ETE (cT1b), and without evidence of cervical LN metastasis (cN0), lobectomy is the preferred option. For patients with clinically evident ETE to major organs (cT4) or with cervical LN metastasis (cN1) or distant metastasis (M1), regardless of the cancer size, total thyroidectomy and complete cancer removal should be performed at the time of initial surgery. Active surveillance may be considered for adult patients diagnosed with low-risk thyroid papillary microcarcinoma. Endoscopic and robotic thyroidectomy may be performed for low-risk differentiated thyroid cancer when indicated, based on patient preference.

Purpose: The aim of this study was (1) to compare the reverse engineering technique with other existing measurement methods and (2) to analyze the effect of implant angulations and impression coping types on implant impression accuracy with reverse engineering technique. Materials and methods: Three different master models were fabricated and the distance between the two implant center points in parallel master model was measured with different three methods; digital caliper measurement (Group DC), optical measuring (Group OM), and reverse engineering technique (Group RE). The 90 experimental models were fabricated with three types of impression copings for the three different implant angulation and the angular and distance error rate were calculated. One-way ANOVA was used for comparison among the evaluation methods (P < .05). The error rates of experimental groups were analyzed by two-way ANOVA (P < .05). Results: While there was significant difference between Group DC and RE (P < .05), Group OM had no significant difference compared with other groups (P > .05). The standard deviations in reverse engineering were much lower than those of digital caliper and optical measurement. Hybrid groups had no significant difference from the pick-up groups in distance error rates (P > .05). Conclusion The reverse engineering technique demonstrated its potential as an evaluation technique of 3D accuracy of impression techniques.

Purpose: The aim of this study was (1) to compare the reverse engineering technique with other existing measurement methods and (2) to analyze the effect of implant angulations and impression coping types on implant impression accuracy with reverse engineering technique. Materials and methods: Three different master models were fabricated and the distance between the two implant center points in parallel master model was measured with different three methods; digital caliper measurement (Group DC), optical measuring (Group OM), and reverse engineering technique (Group RE). The 90 experimental models were fabricated with three types of impression copings for the three different implant angulation and the angular and distance error rate were calculated. One-way ANOVA was used for comparison among the evaluation methods (P < .05). The error rates of experimental groups were analyzed by two-way ANOVA (P < .05). Results: While there was significant difference between Group DC and RE (P < .05), Group OM had no significant difference compared with other groups (P > .05). The standard deviations in reverse engineering were much lower than those of digital caliper and optical measurement. Hybrid groups had no significant difference from the pick-up groups in distance error rates (P > .05). Conclusion The reverse engineering technique demonstrated its potential as an evaluation technique of 3D accuracy of impression techniques.

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient's treatment goals.
Advisory Committees ; Bias (Epidemiology) ; Carcinoma, Squamous Cell ; Counseling ; Expert Testimony ; Humans ; Mouth Neoplasms ; Neck ; Republic of Korea

PURPOSE: The aim of this study is to evaluate the effects of various primers on the microtensile bond strength (µTBS) of resin cements to cobalt-chromium (Co-Cr) dental casting alloy. MATERIALS AND METHODS: Four adhesive primers (Universal primer, Metal primer II, Alloy primer, and Metal/Zirconia primer) and two resin cements (Panavia F2.0, G-CEM LinkAce) were tested. One hundred fifty Co-Cr beams were prepared from Co-Cr ingots via casting (6 mm length × 1 mm width × 1 mm thick). The metal beams were randomly divided into ten groups according to the adhesive primers and resin cements used; the no-primer groups served as the control (n = 15). After sandblasting with aluminum oxide (125 µm grain), the metal and resin cements were bonded together using a silicone mold. Prior to testing, all metal-resin beams were examined under stereomicroscope, and subjected to the µTBS test. The mean value of each group was analyzed via one-way ANOVA with Tukey's test as post hoc (α = .05) using SPSS software. RESULTS: The mean µTBS of all groups was ranged from 20 to 28 MPa. There is no statistically significant difference between groups (P > .05). Mixed failure, which is the combination of adhesive and cohesive failures, is the most prevalent failure mode in both the Panavia F2.0 and G-Cem LinkAce groups. CONCLUSION: The µTBS of all tested groups are relatively high; however, the primers used in this study result in no favorable effect in the µTBS of Panavia F2.0 and G-Cem LinkAce resin cement to Co-Cr alloy.
Adhesives ; Alloys ; Aluminum Oxide ; Fungi ; Resin Cements ; Silicon ; Silicones

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

PURPOSE: The purpose of this study was to analyze the effect of denture cleansers on Candida albicans biofilm formation over resilient liners and to evaluate compatibility between resilient liners and denture cleansers. MATERIALS AND METHODS: Acrylic resin (Lucitone 199(R)) and 3 resilient liners (COE-SOFT(TM), GC RELINE(TM) and SOFRELINER TOUGH TOUGH(R)) were incubated in denture cleansers (Polident(R) and Cleadent(R)) for 8 hours a day and in unstimulated saliva for 16 hours a day (n=25/gp) for 60 days. Two-way and three-way repeated measures ANOVA were performed to compare the surface roughness (Ra), pH and C. albicans binding level by radioisotope (alpha=0.05). The statistical significance of the relation between Ra and adhesion was evaluated by correlation analysis. RESULTS: The degree of Ra was significantly decreased in the following order: COE-SOFT(TM), acrylic resin, GC RELINE(TM) and SOFRELINER TOUGH(R). The immersion in denture cleansers significantly increased Ra of resilient liners, except for SOFRELINER TOUGH(R) in Cleadent(R). No significant differences in pH curves were observed among groups immersed in distilled water and denture cleansers. The binding levels of C. albicans were significantly decreased in the following order: COE-SOFT(TM), GC RELINE(TM), SOFRELINER TOUGH(R), and acrylic resin. The immersion in Cleadent(R) seemed to decrease C. albicans binding level on GC RELINE(TM) and SOFRELINER TOUGH(R). CONCLUSION: Based on the C. albicans binding levels results, it is not recommended to immerse COE-SOFT(TM) in denture cleansers, and GC RELINE(TM) and SOFRELINER TOUGH(R) should be immersed in Cleadent(R).
Biofilms* ; Candida albicans* ; Denture Cleansers* ; Hydrogen-Ion Concentration ; Immersion ; Saliva ; Water