• Archives of Plastic Surgery
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• v.46 no.5
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• pp.449-454
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• 2019

Background Most patients with head and neck cancer successfully undergo oncologic resection followed by free or local flap reconstruction, depending on the tumor's size and location. Despite effective curative resection and reconstruction, head and neck cancer patients still face a high risk of recurrence and the possibility of a second primary cancer. Moreover, surgeons hesitate to perform sequential reconstruction following curative resection for several reasons. Few large-scale studies on this subject are available. Therefore, we retrospectively evaluated the outcome of sequential head and neck reconstruction to determine the possible risks. Methods In total, 467 patients underwent head and neck reconstruction following cancer resection at our center from 2008 to 2017. Of these cases, we retrospectively reviewed the demographic and clinical features of 58 who had sequential head and neck reconstruction following resection of recurrent cancer. Results Our study included 43 males (74.1%) and 15 females (25.9%). The mean age at the initial operation was $55.4{\pm}15.3years$, while the mean age at the most recent operation was $59.0{\pm}14.3years$. The interval between the first and second operations was $49.2{\pm}62.4months$. Twelve patients (20.7%) underwent surgery on the tongue, and 12 (20.7%) had procedures on the oropharynx. Thirty-four patients (58.6%) received a sequential free flap reconstruction, and 24 patients (41.4%) were treated using locoregional flaps. No cases of flap failure occurred. Conclusions Our findings suggest that patients who need additional operations with recurrent head and neck cancer could optimally benefit from sequential curative resections and reconstructions.

• Korean Journal of Bronchoesophagology
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• v.4 no.1
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• pp.142-147
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• 1998

Retained wooden foreign bodies following penetrating trauma are a difficult diagnostic problem. However, penetrating wooden foreign bodies of head and neck have the potential for misinterpretation or failure to detect such foreign bodies on CT. Given the likelihood that such a miss will result in an abscess or neurovascular injury, we present the method with higher window settings, they had a higher attenuation with a unique striated internal architecture and different Hounsfield numbers readily differentiate air and non-air hypodense material such as fat, or possibly wood. Being aware of the potential appearance of wood, we may also find CT useful in excluding small retained fragments in postoperative patients with persistent symptoms. This article presents two cases in which wooden foreign bodies of head and neck were present with CT evaluation.

• Archives of Plastic Surgery
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• v.48 no.5
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• pp.511-517
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• 2021

The use of free flaps is an essential and reliable method of reconstruction in complex head and neck defects. Flap failure remains the most feared complication, the most common cause being pedicle thrombosis. Among other measures, thrombolysis is useful when manual thrombectomy has failed to restore flap perfusion, in the setting of late or established thrombosis, or in arterial thrombosis with distal clot propagation. We report a case of pedicle arterial thrombosis with distal clot propagation which occurred during reconstruction of a maxillectomy defect, and was successfully treated with thrombolysis using recombinant tissue plasminogen activator. We also review the literature regarding the use of thrombolysis in free flap surgery, and propose an algorithm for the salvage of free flaps in head and neck reconstruction.

• Radiation Oncology Journal
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• v.32 no.3
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• pp.125-131
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• 2014

Purpose: We reviewed treatment outcomes and prognostic factors for patients with salivary ductal carcinoma (SDC) treated with surgery and postoperative radiotherapy from 2005 to 2012. Materials and Methods: A total of 16 patients were identified and 15 eligible patients were included in analysis. Median age was 61 years (range, 40 to 71 years) and 12 patients (80%) were men. Twelve patients (80%) had a tumor in the parotid gland, 9 (60%) had T3 or T4 disease, and 9 (60%) had positive nodal disease. All patients underwent surgery and postoperative radiotherapy. Postoperative radiotherapy was delivered using 3-dimensional conformal radiotherapy or intensity-modulated radiotherapy. Locoregional failure-free survival (LRFFS), distant failure-free survival (DFFS), progression-free survival (PFS), and overall survival (OS) were calculated using the Kaplan-Meier method. Differences in survival based on risk factors were tested using a log-rank test. Results: Median total radiotherapy dose was 60 Gy (range, 52.5 to 63.6 Gy). Four patients received concurrent weekly chemotherapy with cisplatin. Among 10 patients who underwent surgery with neck dissection, 7 received modified radical neck dissection. With a median follow-up time of 38 months (range, 24 to 105 months), 4-year rates were 86% for LRFFS, 51% for DFFS, 46% for PFS, and 93% for OS. Local failure was observed in 2 patients (13%), and distant failure was observed in 7 (47%). The lung was the most common involved site of distant metastasis. Conclusion: Surgery and postoperative radiotherapy in SDC patients resulted in good local control, but high distant metastasis remained a major challenge.

• Korean Journal of Head & Neck Oncology
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• v.11 no.1
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• pp.24-29
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• 1995

Melanoma of the mucous membrane is a rare condition and has the worse prognosis than that of any other sites. It is usually asymptomatic in early stage and difficult to find out the primary lesion by visual examination, and these facts lead to delay in diagnosis and reduce the curability. The major factor of failure in treatment of melanoma is local recurrence rather than regional spread. Because the radical procedure is difficult in head and neck lesion due to anatomical limitation, radiation therapy and chemotherapy can be used in the treatment of local recurrence. We experienced two cases of nasopharyngeal melanoma in advanced stage and treated them with radiation therapy and/or chemotherapy. And both patients showed relatively favorable response to these palliative treatments.

• Korean Journal of Head & Neck Oncology
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• v.22 no.2
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• pp.117-122
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• 2006

Background and Objectives : Thyroid carcinoma is the sixth commonest cancer in Korea and the papillary carcinoma is the most common type(88%) of the malignant thyroid tumors. Bulky DNA adducts formed by the carcinogens are repaired by DNA repair process, but failure to repair this DNA damage can cause mutations in oncogenes and tumor suppressor genes resulting in tumor formation. The xeroderma pigmentosum group C(XPC) gene is essential for this repair procedure and the XPC-PolyAT(PAT) polymorphisms may alter DNA repair capacity(DRC) and genetic susceptibility to cancer. Subjects and Methods : In a case-control study of 113 Korean patients with pathologically diagnosed thyroid papillary carcinoma and 65 control subjects, we investigated the association between the three XPC-PAT gene polymorphisms and thyroid papillary cancer susceptibility. Results : The frequency of the variant XPC-PAT allele was lower in the cases(0.349) than in the controls (0.423), but the difference was not significant(p=0.140). Using logistic regression adjusting for age and sex, risk for thyroid papillary cancer was not increased in the XPC-PAT-/+ and XPC-PAT+/+ compared to XPCPAT-/-(adjusted overall odds ratio[95% confidence intervals;95%CI]=0.52[0.26-1.03] and 0.62 [0.22-1.75], respectively; trend test, p=0.167). Conclusion : There are no relationship between the XPC-PAT polymorphism and the risk of thyroid papillary carcinoma in Korean population. Based on our results, XPC-PAT polymorphism do not modulate genetic susceptibility to thyroid papillary cancer.

• Korean Journal of Bronchoesophagology
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• v.13 no.1
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• pp.19-22
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• 2007

Background and Objectives: The Objective of this study was to compare the effectiveness of the needle aspiration method and the I&D method in the treatment of peritonsillar abscess. Materials and Methods: A prospective clinical study was performed on 83 patients. All the patients were hospitalized after random treatment with either I&D or needle aspiration alone, received the same intravenous antibiotic therapy. Among the 83 patients, 73 patients who could be observed for longer than 6 months and had not undergone a tonsillectomy during the follow-up period, were analyzed for treatment outcomes. Results: There was no statistically significant difference in the initial failure rate(p=0.572), the hospitalized days(p=0.956), the recurrence rate(p=0.531) for the needle aspiration(35 patients) and I&D groups(38 patients). But, The mean duration of fever were statistically different in the needle aspiration(1.51 hours) and I&D groups(3.05 hours) (p=0.031). Conclusion: Two methods are thought to be similar in effectiveness, except that duration of fever was longer in the I&D group than in the needle aspiration group. However, taking advantages of the needle aspiration method into consideration, the needle aspiration of peritonsillar abscess may be more appropriate than I&D as an initial method for peritonsillar abscess

• Korean Journal of Bronchoesophagology
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• v.4 no.1
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• pp.91-95
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• 1998

Background： Laryngeal cancer, the most common malignancy of head and neck, is being detected and treated in earlier and more effectively due to introduction of endoscope, continuous development of radiographic technology, and advancement in new surgical techniques such as laser surgery and conservation laryngeal surgery Objectives To compare the different treatment results for early laryngeal cancer to determine which methos provides the good prognosis. Materials and Methods： Retrospective study was done for 135 patients with early laryngeal squamous cell carcinoma(Stage I or II) who were treated at our institute between 1989 to 1996. There were 105 patients with glottic cancer(Stage I: 68 patients, Stage II：37 Patients) and 30 patients with supraglottic cancer(Stage I: 12 patients, Stage II：18 patients) Initial treatment included radiation therapy for 54 patients, endoscopic laser surgery for 8 patients, laryngofissure and cordectomy for 8 patients, vertical partial laryngectomy for 37 patients, supraglottic laryngecomy for 14 patients and supracricoid laryngectomy for 5 patiens, and total laryngectomy for 9 patients. Results : Salvage treatments, such as total laryngectomy, conservation laryngeal surgery, radiation therapy and neck dissection were performed for initial treatment failure with 9 patients after radiation therapy, 8 patients after conservation laryngeal surgery, 2 patients after endoscopic laser and 3 patients after total laryngectomy. Overall 3-year survival rate for glottic 71 was 92.4%, glottic f 84.3%, supraglottic 7172.7%, and supraglottic f was 63.%%. However, survival rate of the same stage was variable according to the choice of initial treatment. Conclusion New classification of the early laryngeal cancer was necessary and helpful for the choice of the initial treatment.

• Radiation Oncology Journal
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• v.33 no.3
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• pp.172-178
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• 2015

Purpose: To investigate clinical outcomes of synchronous head and neck and esophageal cancer (SHNEC). Materials and Methods: We retrospectively reviewed 27 SHNEC patients treated with curative intent at a single institution. The treatment modality for individual cases was usually determined on a case by case basis. Results: The median follow-up duration for the surviving patients was 28.2 months. The most common site of head and neck cancer was hypopharyngeal carcinoma (n = 21, 77.7%). The lower esophagus was the most common location of esophageal carcinoma (n = 16, 59.3%). The 2-year progression-free survival (PFS) and overall survival (OS) rates were 57.5% and 39.6%. Major pattern of failure was locoregional recurrence in the study patients. Esophageal cancer stage, the Eastern Cooperative Oncology Group (ECOG) performance status, and pretreatment weight loss were significant prognostic factors for OS in univariate analysis. Treatment-related death was observed in two patients, and one patient developed a grade 4 late treatment-related complication. Conclusion: Although the survival outcome for SHNEC is poor, long-term survival might be achievable with aggressive treatment with stage I-II esophageal cancer and good performance.

• Korean Journal of Bronchoesophagology
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• v.18 no.2
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• pp.56-59
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• 2012

Tracheo-innominate artery fistula (TIF) is a rare but catastrophic and almost always fatal complication of tracheostomy. TIF can occur anytime but is commonly present 3 to 24 days after tracheostomy. It can first manifest as massive bleeding around and through the tracheostomy tube, but it can also manifest as a small amount of blood with temporary spontaneous resolution. If TIF is suspicious, airway management and prompt surgical intervention are needed. In an 83-year-old man with CVA history 20 years earlier and who had recurrent aspiration pneumonia, tracheostomy was performed for respiratory management and ventilator support. On day 7 post-tracheostomy, the patient had bleeding from the tracheostoma. Immediate surgical exploration was performed to control the bleeding. A defect was seen at the post wall of the innominate artery. The erosive portion of the artery was sutured, but the patient died three weeks after the surgery due to rebleeding and respiratory failure. We present a patient who developed TIF after tracheostomy, with literature review.