Background and Objectives: Adenoid cystic carcinoma of salivary glands is characterized by insidious growth over many years, local recurrences, and distant metastasis and classified to three distinct histologic subtypes: tubular, cribriform, and solid. The solid type is known to have the worst prognosis. However, histopathologic heterogeneity is observed in tumors from the same patient. We have attempted to elucidate the genotypic differences, characterized by polysomies of chromosome 17, in adenoid cystic carcinoma according to the phenotypic histopathologic heterogeneity. Materials and Methods: Fluorescence in situ hybridization was performed on formalin-fixed paraffin blocks from seven patients with head and neck adenoid cystic carcinoma, using the centromeric $\alpha$-satellite probe of chromosome 17 to detect nuclei exhibiting polysomy. The difference in polysomeric chromosome expression in cribriform, tubular, solid type and type I, II, III according to the Szanto classification was analyzed. Results: Polysomy of chromosome 17 was found in 15.28% of the cribriform type, in 15.68% of the tubular type, and in 18.87% of the solid type. The proportion of polysomy was statistically higher in the solid type than in the cribriform type(p<0.05), and the proportion of polysomy increased progressively from type 1 to type 3, but this trend was statistically insignificant(p>0.05). Conclusion: We suggest that there may be genetic variations in tumor from the same patient depending on the histopathologic heterogenetiy in adenoid cystic carcinomas.

Objectives: To determine the tumor interstitial fluid pressure(TIFP) in patients with head and neck cancerand predict radiotherapy outcome.Materials and Methods: In 12 biopsy proven primary head and neck cancer patients with accessible by direct inspection and palpation, and of sufficient thickness(>1cm) to permit accurate needle placement, we measured TIFP at cervical lymph node before and during radiotherapy using a modified wick-in-needle technique. Tumor size was measured clinically and radiologically. Results: The mean preradiotherapy TIFP was 23.4mmHg. Preradiotherapy TIFP had significant relationship with tumor size(p=0.0009). Preradiotherapy TIFP was not different between complete response group and partial or less response group(p=0.114). Radiotherapy outcome was not different between group with above and group with below average TIFP(p=0.09). Conclusion: The mean TIFP was elevated with 23.4mmHg before radiation therapy. Preradiotherapy TIFP had significant relationship with tumor size. It is not definitive that TIFP could be prognostic indicator of radiation response.

Objectives: Epstein-Barr virus(EBV) is a B-lymphotrophic virus with a tumorigenic potential. EBV infection has been recognized as the main cause of nasopharyngeal carcinoma and Burkitt's lymphoma. Bcl-2 protein expression is known to be up-regulated by the EBV-latency associated antigen latent membrane protein(LMP). The aim of this study was to determine the incidence of EBV in squamous cell carcinomas of the larynx and the relationship between the presence of EBV and bcl-2 expression. Patients and Methods: From January 1994 to December 1977, 35 patients with primary squamous cell carcinoma of the larynx were studied. EBV genome DNA was surveyed by polymerase chain reaction(PCR) assay and then compared the results of in situ hybridization(ISH) for EBER1 using digoxigenin-tailed oligonucleotide probe. The expression of bcl-2 protein was studied by immunohistochemistry(IHC) using bcl-2 monoclonal antibody. Results: By PCR, EBV genome was detected in 22 of 35(62.9%) squamous cell carcinomas of the larynx. Nineteen of 35 cases(54.3%) showed a positive nuclear staining for EBER1 in tumor cells by ISH. Three cases showed positivity in inflammatory cells by ISH and one of them showed a positive staining of both tumor cells and inflammatory cells. Eighteen of 32 specimens(62.5%) were positive for bcl-2 protein. There was no significant correlations between the presence of EBV DNA and bcl-2 expression. Conclusions: It could be concluded that high incidence of EBV in the laryngeal cancer tissue may indicate a probable role of EBV in the development of laryngeal carcinoma.

The medicinal leech, Hirudo medicinalis, has been used for salvage of the venous-congested flap following reconstructive surgery, with increasing frequency during the last two decades. Medicinal leech therapy is a safe, efficacious, economical, and well-tolerated intervention. The flap salvage with leeching occurs in approximately 70% of cases, and leeches need to be used as early as possible. At the time of the bite, evacuation of blood and injection of the leech saliva products, including anticoagulants and inhibitors of platelet aggregation, maintain capillary circulation of the flap, and then venous capillary return is established across the wound by angiogenesis. One of the salivary products, hirudin, represents the first parenteral anticoagulant introduced since the discovery of heparin. We analyzed two cases in which flap salvage with leeching was attempted, and reviewed medicinal leech therapy on the basis of our experiences and literature review. This has not been documented in the head and neck surgery literature in our country.

Background and Objectives: Various flaps are using for reconstruction of hypopharyngeal and esophageal defect. However, complication and indication of each flap are not fully analyzed. Patient and Methods: Records of 52 hypopharyngeal cancer patients who had surgical treatment and 13 other head and neck cancer patients who underwent hypopharyngeal and/or esophageal reconstruction with flap were retrospectively analyzed. Eighty three percent(54 cases) of patients needed reconstruction other than primary pharyngeal closure. Five split thickness skin graft, 1 pectoralis major myocutaneous flap, 20 forearm free flap, 13 jejunal free flap, 15 gastric pull up were used. Result: Flap failure was noted in 2 cases who had subsequent gastric transposition. Wound dehiscence and fistula were most common problem of forearm free flap. Most fistulas were developed in patients with conduit type reconstruction of forearm flap while there wasn't any fistula in patient with patch type reconstruction. Stenosis of lower anastomosis was the frequent problem of jejunal transfer. Gastric pull-up has frequent com-plication of stomal stenosis. All but three patients had reached oral feeding postoperatively. Conclusion: Based on this study, forearm flap is effective in partial hypopharyngeal defect while jejunum is the choice for circumferential defect. Gastric pull-up is for combined esophageal defect.

Objectives: Angiocentric T-cell lymphoma of the head and neck is an angiocentric and angiodestructive lymphoreticular proliferative disorder. It has been treated with various treatment modalities, but its prognosis is poor and the treatment modality is controversial. We performed this study to suggest a treatment modality with improved results. Materials and Methods: We studied 40 cases of pathologically confirmed angiocentric T-cell lymphoma from July 1984 to December 1996, 35 cases of which showed complete response after initial treatment. All the patients were divided into two groups according to treatment modality. 15 cases received radiotherapy alone (Group I) and 20 cases received radiotherapy after five cycles of CHOP-Bleo chemotherapy(Group II). We analyzed the subsites of tumor, stage, treatment modality and treatment outcome and causes of failure for each group, and compared the three-year no evidence of disease(NED) between the two groups. Results: The three-year NED of a combined chemoradiotherapy was higher than that of a radiotherapy alone (p=0.0478). The three-year NED according to groups and stage were as follows: Group I=6/15(40.0%), stage IE=5/10(50.0%), stage IIE=1/5(20%), Group II=13/20(65.0%), stage IE=9/13(69.2%), stage IIE=4/7(57.1%). Radiotherapy alone is not well effective for the nasal cavity lymphoma extended to paranasal sinus and the palate. Conclusion: We are unable to provide clear guidelines for treatment, but recommend the initial treatment with oral alkylating agents and steroids followed by radiotherapy for Ann Arbor stage II tumors and stage I of the palate lymphoma and the nasal cavity lymphoma extended to paranasal sinus.

Background and Objectives: The most commonly used incision for parotidectomy is modified Blair incision, but it has unsatisfactory cosmetic result due to long exposed scar in the neck. Therefore, we introduce an alternative approach with more acceptable scar named modified facelift incision. We report it's techniques, indications and disadvantages with our experiences. Materials and Methods: During the 1999, 15 patients were underwent parotidectomies using modified facelift incision. We studied the postoperative complications and the cosmetic results respectively. Results: There were 11 benign tumors, 3 malignant tumors, and 1 chronic inflammation. Total parotidectomy was performed in 2 malignant tumors and chronic parotitis patients. The others has superficial parotidectomy. In terms of operation field, there was no difference between classical incision and facelift incision. Partial facial nerve palsy was noted in 2 cases, who required sacrifice of branches of facial nerve because of malignant tumor invasion. There were no specific complications associated with this type of approach. Postoperative cosmetic results were satisfactory in all cases. Conclusion: Modified facelift incision provides better cosmetic result than conventional incision without narrowing of operation field. We believe that it is a safe alternative approach to all parotidectomy cases especially to women and patient with keloid skin. The only limitation of this incision is poor adaptability for combining neck dissection.

Background and Objectives: To review efficacy of the fine-needle aspiration cytology(FNAC) in patients with salivary glands lesions. Materials and Methods: From January 1994 through June 1999, FNACs and surgical biopsies were carried out on 109 patients with salivary gland diseases. The medical records were reviewed retrospectively. Benign tumor was found in 81 patients, and malignant tumor was in 19 patients. Nine patients had inflammatory lesion. Results: In 6 of 109 cases the aspiration was inadequate. Of the remaining 103 patients, FNAC correctly diagnosed 87 lesions(84.5%). For benign tumor lesions, the accuracy was 91%(71/78), and for malignant lesions 55.6%(10/18). The accuracy for inflammatory lesions was 85.7%(6/7). Regarding the capacity to discriminate between neoplastic and nonneoplastic lesions, sensitivity, specificity and total diagnostic accuracy were 99%, 85.7% and 84.5% respectively. Regarding the capacity to discriminate between malignant and benign tumors, sensitivity and specificity were 55.6% and 97.4% respectively. FNACs misdiagnosed malignant tumors as benign lesions in eight patients, in which three were with adenoid cystic carcinomas. Carcinoma ex pleomorphic adenoma, malignant lymphoma and mucoepidermoid carcinoma 'were others. Conclusion: FNAC showed high accuracy to diagnose benign lesions in salivary gland diseases. But the accuracy was rather low for malignant lesions. If a salivary gland lesion was suspected for malignant tumor, other diagnostic methods such as tissue biopsy should be seriously considered.

Objectives: Primary malignant tumors in the salivary glands are relatively rare. Because of the rarity and the different histopathologic patterns, it is difficult to establish a uniform treatment strategy. The prime treatment of salivary gland malignancy is the surgery, but the role of radiotherapy has been under debate. Radiation therapy combined with conservative surgical procedures may be as successful and perhaps more rational treatment than radical surgery alone. The aim of this study is to evaluate clinical pattern, incidence, treatment modality and outcome of the salivary gland maligancy. Materials and Methods: The medical records of 32 patients with malignant neoplasm of salivary gland who treated at the Keimyung university Dongsan hospital were analyzed retrospectively. Results: The overall 5 year survival rate was 77.9% stage I : 100%, stage II : 75%, stage III : 66.7%, stage IV : 55.6%). The 5 year survival rate according to tumor grade was 100% in low grade malignancy, 71.8% in high grade malignancy. The 5 year survival rate according to treatment modalities was as follows: Surgery only group was 83.3%, combined treatment group with surgery and posoperative radiation was 74.6%. Conclusion: The factors affecting prognosis is variable, but the stage at the time of diagnosis, site of lesion, tumor grade, histologic subtype were important factors. Surgery was the prime treatment tool and postoperative radiotherapy was also imperative in higher stage patient, high grade tumor, or patients with positive surgical margin.

Purpose: The purpose of the study was to evaluate the sensitivity, specificity and accuracy between the FNAC and intraopevative frozen biopsy based upon the Final histologic diagnosis. Method: Authors studied 232 cases of thyroid nodule operated at Department of Surgery, College of Medicine, Chosun University, from January 1992 to December 1998. The medical records of these patients were studied retrospectively. The cytology of FNAC and the frozen section was compared to the final histologic diagnosis. 232 cases were analysed in regard to correlation of FNAC diagnosis and Intraoperative frozen section with final pathology, preoperative thyroid scan, thyroid function test, ultrasonography, final histopathology of the specimens, and surgical operation methods. 174 cases who underwent FNAC for diagnosis before operation, and Intraoperative frozen-section biopsy were classified according to whether the clinical diagnosis was benign, suspicious or malignant and evaluated the specificity sensitivity and accuracy. Result: Comparing with final histopathology, FNAC as a diagnostic test for thyroid nodules demonstrated an accuracy of 81.3%, a sensitivity of 87.5%, a specificity 86.5% with a false positivity of 2.9%, false negativity of 4.3%, respectively. and Intra-operative frozen section demonstrated an accuracy of 86.8%, a sensitivity of 87.5%, a specificity 92.1%. In the benign lesion, there was no difference in accuracy between FNAC(95.6%) and frozen section(95.1%) but, in the suspicious malignant lesion, frozen section(46.2%) was superior to FNAC(32.0%), and in the malignant disease, FNAC(97.1%) was superior to frozen section(92.3%). Conclusion: Intraoperative frozen section biopsy is useful in patients undergoing surgery for a thyroid nodule with a 'suspicious' malignant lesion and could reduce inadequate extensive excision without missing malignancy and second operation and help to determine the resection margin. It adds no information in patients with a diagnosis of malignancy following FNAC assessment and is of limited use in those in whom a benign lesion is diagnosed.

Objectives: To demonstrate effective diagnostic method and proper management of recurrent thyroid cancer through to compare treatment and surveillance of $I^{131}$ scanning detected recurrence and clinically detected recurrence. Material and Methods: We retrospectively analyzed clinical information about 46 patients who has recurrent thyroid cancer of 298 patients who have been primarily operated due to thyroid cancer in PMC at the over 10 years between 1986 and 1995. We examine incidence of recurrence due to pathologic types, site of recurrence, disease free interval, detection method of recurrence, and also treatment and progression of recurrence. A patients in which the clinical examination was entirely negative and the $I^{131}$ scan demonstrated either a new area of $I^{131}$ uptake or an increased area of concentration, compared to the previous scan, was designated as a recurrence detected by $I^{131}$ scan only. Recurrences that were obviously by physical examination or chest x-ray, etc were considered clinically detected recurrence, regardless of the the results of the thyroid scan. Results: Mean of disease tree interval(DFI) is 36months. When mean DFI of $I^{131}$ scan detected recurrence is 28months, whereas mean DFI of clinically detected recurrence is 47months. In statiscal analysis, p-value is 0.043 as significantly. In progression of recurrent patient, NED is 28case, AWD is Sease, DOD is 13case. Among the 13case, scan detected recurrence is lease of 20 patients(5%), whereas clinically detected recurrence is l2case of 26 patient(46%). In statiscal analysis, p-value is 0.003 as significantly. Conclusion: Early detection of the recurrent thyroid cancer by $I^{131}$ scanning leads to good progress compare with detection by clinical examination. NED: No Evidence of Disease AWD : Alive With Disease DOD : Dead Of Disease DOC: Dead of Other Cause

Objectives: With the recent advances and increasing use of imaging techniques in examination of the neck, the incidence of incidentally discovered thyroid carcinoma has been increasing. This study was carried out to evaluate the clinicopathologic characteristics of incidental thyroid carcinomas and to find optimal therapeutic strategies for these lesions. Materials & Methods: From Jan. 1988 to Aug. 1998, 1,053 patients were operated on for thyroid cancer, of whom 127(12.1%) had incidentally discovered thyroid cancers which were identified during routine health checkups(n=40), diagnostic procedures for unrelated medical conditions(n=39) and mass screening for thyroid cancer(n=48). The preoperative diagnosis was obtained by ultrasound-guided FNAB and the extent of surgery was determined based on frozen section examinations, as well as prognostic factors and gross findings at the time of surgery. Results: There were 6 men and 121 women with a mean age of 45.9 years. Histopathological diagnosis included papillary carcinomas(n=1l9), follicular carcinomas(n=6), poorly differentiated carcinoma(n=l) and medullary carcinoma(n=1). Thirty patients(23.6%) had multifocallesions. The mean diameter of the tumors was 1.1 cm(0.2-3.4 cm). Capsular invasions were found in 53 patients(41.7%) and nodal metastases in 41(32.3%). The surgical procedures used were: 90 less-than total thyroidectomies and 37 total thyroidectomies with central neck node dissection. Lateral neck dissection was added in 5 patients. According to TNM staging, 79 patients(63.2%) were at stage I, 15(12.0%) at stage II, 31(24.8%) at stage III and 0(0.0%) at stage IV. By AMES scoring system, 102 patients(81.6%) were in the low-risk group and 23(18.4%) in the high-risk group. And by MACIS scoring system, 103(86.6%) of 119 papillary thyroid cancer patients were less than 6. Conclusions: The clinicopathological characteristics of incidentally discovered thyroid carcinomas are similar to ordinary thyroid carcinomas. The treatment of choice should be individualized based on the particular clinical situation encountered, as in ordinary thyroid carcinomas.

The neurilemmoma is a relatively uncommon benign neoplasm which is known to be originated from the schwann sheath of the nerve fiber. Parapharyngeal neurilemmomas may originate from any nerve traversing this space, but the vast majority arise from the vagus nerve and sympathetic chain. The neurilemmomas arising from the extracranial portion of the hypoglossal nerve are extremely rare. To our knowledge, the case we present is the ninth one to be reported occurring in the parapharyngeal space. Recently we experienced a case of parapharyngeal neurilemmoma arising from the hypoglossal nerve and so we report our case with a brief review of literatures.

Neurilemmomas are uncommon benign tumors originating from the schwann cells of various cranial nerves, spinal nerves, and autonomic nerves. About 25% of the disease is found in the head and neck region and the most common single site of origin is known to be the acoustic nerve. However neurilemmomas of the peripheral segment of the lingual nerve are extremely rare neoplasms. We recendy experienced a case of a benign neurilemmoma of the lingual nerve and this case may be the second to be reported in the literature.

Canalicular adenoma is a uncommon benign salivary gland tumor and it most frequently involves minor salivary gland of upper lip. It rarely occurs in parotid gland. The canalicular tumor of parotid gland can be manifestes clinically and pathologically as a multifocal lesion, which is not generally seen with other intraoral salivary gland tumors. Recently, we experienced a case of multifocal canalicular adenoma occurred on parotid gland in a 65-year-old woman and report it to support the view that canalicular adenoma occur rarely in parotid gland, and is recognizable entities.

Lipoma is a benign neoplasm composed of mature fat cells and usually circumscribed by a fibrous capsule. The fat cells are arranged in irregular lobules, partitioned by fibrous septa with supportive vascular channels. Lipoma of the oral cavity is uncommon, and has been reported to be infrequent in the literature in the world so far. An oral lipoma mainly occurs in the cheek and tongue. Surgical excision is the only treatment recommended, and prognosis is uniformly excellent. Recently we experienced two cases of lipoma of the oral cavity and removed the tumor completely by surgical excision.

Thyroglossal duct cyst is common midline mass, which is related to hyoid bone and may show signs of inflammation. Carcinoma arising in the thyroglossal duct cyst is rare, occuring in less than 1% of thyroglossal duct cyst. Papillary adenocarcinoma is the most common histologic type(75-85%). The initial treatement of choice is wide excision of the tumor bearing tissue(Sistrunk procedure), resection of associated lymph node alone is enough when they are small and isolated, but a modified neck dissection must be done if regional involvement is more extensive. Its prognosis is excellent(the incidence of regional lymph node metastasis is 7% compare to 89% for papillary cancer of thyroid gland proper).

Neurofibromatosis type I or Von Recklinghausen's disease can occur at any site in the body. It is characterized by multiple $c\'{a}fe\;\'{a}u\;l\'{a}it$ spots on the skin-more than six spots greater than 1.5cm-, neurofibromas of the peripheral and centarl nervous system, and variety of other dysplastic abnormalities of the skin, bones, endocrine organs, nervous systems, and blood vessels. It is an autosomal dominant trait disease with a frequency of 1 of 3000. Neurofibromatosis is known to be complicated by malignancies. Neurofibromatosis is progressive disease and shows a marked variations in expression in affected individuals. In this report we describe a male patient with neurofibromatosis type I developed in the parapharyngeal space. The patient had huge mass at left parapharyngeal space and inguinal area. We successfully treated the patient with surgery without complication.