구강암의 수술적 접근과 재건

안순현(Soon-Hyun Ahn) 대한두경부종양학회 2023 대한두경부 종양학회지 Vol.39 No.1

The primary treatment of oral cavity cancer is still surgery. By discussing the surgical treatment of oral cavity cancer, the basic concept of head and neck surgery could be thoroughly reviewed. The oral cavity is defined as the hard palate and the anterior 2/3 of the tongue. With appropriate reconstruction, most defects can be repaired without a significant change in quality of life, unlike in the oropharynx or hypopharynx, where aspiration problems frequently occur. The selection of a surgical approach that can provide an appropriate field of view to obtain a resection margin of 5 mm or more has become the core of head and neck surgery. The role of prophylactic neck dissection is also well established in oral cavity cancer patients. Mandibulotomy for access to the oral cavity or mandibulectomy due to cancer invasion requires bony surgical techniques, and reconstruction also requires bone tissue reconstruction techniques as well as soft tissue. Therefore, oral cancer surgery is the most important primary area where all techniques of head and neck surgery are mobilized.

갑상선 결절에서 초음파 유도하 중심생검의 역할

유윤종(Yoon-Jong Ryu),안순현(Soon-Hyun Ahn) 대한두경부종양학회 2015 대한두경부 종양학회지 Vol.31 No.1

Fine needle aspiration cytology(FNAC) holds a main role in assessing thyroid nodules. But nonnegligible rate of thyroid cytology is reported as uncertain, indeterminate or inadequate for diagnosis. Recently, the microhistologic evaluation by core needle biopsy(CNB) under ultrasound sonographical guidance has been reported to show high accuracy for the diagnose of thyroid nodules. Aim of this review was to furnish the state of the art of this topic by summarizing previous published data about indication, diagnostic performance, and complication of CNB in thy-roid lesions compared with FNAC

양측 후이개 종물로 발병한 Kimura씨 병 1예

김윤중(Yoonjoong Kim),전형원(Hyoung Won Jeon),김민수(Min-soo Kim),안순현(Soon-Hyun Ahn),정우진(Woo-Jin Jeong) 대한두경부종양학회 2014 대한두경부 종양학회지 Vol.30 No.2

Kimura’s disease is a chronic inflammatory disease with unknown etiology. The most common clinical presen-tation of Kimura’s disease is non-tender unilateral mass in the head and neck area, but bilateral involvement has rarely been reported. Histopathological confirmation should be taken for the diagnosis. Various management op-tions are available, including surgical excision, steroid therapy, and radiotherapy. We report a male patient diagnosed as Kimura’s disease involving bilateral retro-auricular region. Simultaneous bilateral neck involvement is an ex-tremely rare finding. For cosmetic reasons, the patient was treated surgically, with satisfactory postoperative results. When evaluating patients with mass lesion in bilateral parotid/retro-auricular area, Kimura’s disease should be con-sidered as differential diagnosis.

혀의 재건을 위한 부피 및 표면적의 측정

박하나로(Hanaro Park),김희진(Heejin Kim),정우진(Woo-Jin Jeong),안순현(Soon-Hyun Ahn) 대한두경부종양학회 2011 대한두경부 종양학회지 Vol.27 No.1

Purpose:Anterolateral thigh and radial forearm flap is the most important fasciocutaneous flap widely used for reconstruction of tongue. One important purpose of flap is replacing the volume of tongue but still there is no data about the surface area and volume to be reconstructed after glossectomy. In this paper, surface area and volume is estimated from the 3-dimensionally reconstructed MRI images to see which flap is more ideal and to give the reference value for reconstruction. Materials and Methods:With coronal MRI image, tongue including only the intrinsic muscle is delineated in every section and reconstructed 3-dimensionally and calculated the volume and surface area to be reconstructed according to the degree of glossectomy. This volume and surface area was compared with the volume of anterolateral thigh and radial forearm flap. Results:The volume and surface area to be reconstructed in hemiglossectomy was 39.0±4.0cm 3 and 31.8±2.7cm 2 respec-tively. The average thickness of anterolateral thigh flap is 9.4±2.8mm and that of radial forearm is 3.8±1.0mm. Comparing the curve of tongue surface area and volume with the volume of flap, the anterolateral thigh flap has more ideal volume to replace the defect. Conclusions:The surface area and volume requested for reconstruc-tion could be suggested and the anterolateral thigh flap has more ideal volume for reconstruction of glossectomy defect.

액와 단일절개 접근법을 이용한 내시경적 갑상선 절제술

김소영(So young Kim),유윤종(Yoonjong Ryu),정우진(Woo-Jin Jeong),안순현(Soon-Hyun Ahn) 대한두경부종양학회 2012 대한두경부 종양학회지 Vol.28 No.2

Background and Objectives:To assure the surgical completeness of the gasless endoscopic thyroidectomy via single incision axillary approach using flexible videoscope which provide wide angle and working space, we compared single incision axillary approach and axillo-areolar approach by means of clinical, surgical outcomes. Materials and Methods:From March 2011 to July 2012, 24 patients who had underwent endoscopic thyroid-ectomy via transaxillary approach were enrolled. Of total, 17 patients underwent single incision axillary ap-proach(group I) and the other 7 underwent axillo-areolar approach(group II). Results:Patient demographics, surgical indications were similar between the two groups. The operating time(group I 144.6min, group II 153.6 min ; p=.29), blood loss(group I : 55.4cc, group II : 35.7cc : p=.64), hospital stay(group I : 4.2days, group II : 4.4 days ; p=.65) were similar in the two groups. Overall, two patients in group I(2/17, 11.8%) experienced post-operative complications, including one hematoma and one seroma. Due to narrow working space, one patient was change to axillo-areolar approach during single incision axillary approach with 30° rigid endoscope. Conclu-sion:Single incision axillary approach is safe and effective similar to other endoscopic thyroidectomy methods using flexible videoscope. Different with 30° rigid endoscope, 10-mm flexible videoscope can put inside the ax-illary inicision site in different axis with endoscopic instruments. This difference in endoscopic axis help to pre-vent crash with endoscopic instrument.

갑상선 수질암으로 오인된 갑상선 부신경절종 1예

이상연(Sang Yeon Lee),이원용(Won Yong Lee),정우진(Woo Jin Jeong),안순현(Soon Hyun Ahn) 대한두경부종양학회 2012 대한두경부 종양학회지 Vol.28 No.2

Paraganglioma of the thyroid is a neuroendocrine tumor originating from the neural crest. To our knowledge, only 32 cases of thyroid paraganglioma(TP) have been reported to date. TP is difficult to distinguish from medullary thyroid cancer(MTC), hence correct diagnosis is seldom obtained preoperatively. Although immunohistochemistry is helpful for confirmation of TP, these markers are not specific for differential diagnosis between TP and MTC. Therefore, an index of suspicion is important when encountered with MTC with unusual features, or given pathology with neuroendocrine features and unusual immunohistochemical findings. The authors report a case of TP misdiagnosed as MTC at preoperative work-up and intraoperative frozen section analysis, with a review of the literature. The case depicts various immunohistochemical characteristics of the tumor.

진행된 이상와암의 광범위 수직인후두부분절제술 후 요전완 유리피판을 이용한 재건술 2예

문일준(Il Joon Moon),홍성룡(Sung Lyung Hong),김시환(Si Whan Kim),안순현(Soon Hyun Ahn) 대한두경부종양학회 2005 대한두경부 종양학회지 Vol.21 No.1

Wide vertical hemilaryngopharyngectomy with immediate glottic and pharyngeal reconstruction using a radial forearm free flap is reported in 1991 by Chantrain et al. This procedure was designed for the preservation of healthy hemilarynx and resection of pharynx with safe oncological margin in especially piriform sinus cancer or supraglottic cancer invading the hypopharynx. In the original paper, they used palmaris longus tendon for reconstruction of neoglottis. In other groups, they used rib cartilage instead of palmaris longus tendon. In this paper, we report two cases of piriform sinus cancer patients who treated with wide vertical hemilaryngectomy with radial forearm free flap reconstruction. In one case, the operation was performed as Chantrain et al described. But in another case, the ipsilateral forearm was impossible due to the positive Allen's test. So the contralateral forearm flap and rib cartilage graft was done. This reconstructive technique make large resection possible. As the dissection of thyroid cartilage and lateral displacement makes direct visualization and manipulation of piriform sinus lesions, sufficient resection margin in lateral and inferior pharyngeal wall cab be obtained.

갑상선 유두암의 외측 경부림프절 전이에 대한 수술 전 평가로서 CT의 역할

석준걸(Jungirl Seok),김형규(Hyung gu Kim),김윤중(Yoonjoong Kim),한규희(Kyu-Hee Han),안순현(Soon-Hyun Ahn) 대한두경부종양학회 2013 대한두경부 종양학회지 Vol.29 No.2

Background and Objectives:To assess the usefulness of computed tomography image before papillary thy-roid cancer surgery, focus on confirmation of lateral cervical lymph node metastasis not detected by ultrasonogra-phy. Material and Methods:From January 2008 to May 2009, total 150 patients who had undergone thyroid sur-gery and been confirmed papillary thyroid cancer pathologically were enrolled. They had taken neck computed tomography following the ultrasonography. Results:Computed tomography had found suspicious metastatic lat-eral neck lesion in 13 patients. After the image study, lateral neck lymph node dissection had been included in their surgical plan. Of these, only 7 cases were confirmed pathologically lateral neck lymph node metastasis(positive predictive value=0.54). Taken as whole 150 patients, additionally 4.7% of patients confirmed lateral neck lymph node metastasis by preoperative computed tomography. Conclusion:If preoperative ultrasonography was per-formed precisely, additional benefits that could be achieved by computed tomography were not much.

방사선 치료 유무 및 수술 범위에 따른 후두전절제술 후 인두피부누공 발생률 분석

김성동(Seong dong Kim),이여진(Yeo-jeen Yi),김민수(Min-soo Kim),정우진(Woo-Jin Jeong),안순현(Soon-Hyun Ahn) 대한두경부종양학회 2014 대한두경부 종양학회지 Vol.30 No.2

Background and Objectives:Pharyngocutaneous fistula is the most common complication after total laryn-gectomy. The objective of this study was to determine the incidence of pharyngocutaneous fistula after total laryn-gectomy in patients operated on in our department and to establish whether specific factors predispose to fistula formation. Materials and Methods:For 10 years(2003-2014), 49 cases of patients who were diagnosed with la-ryngeal cancer and underwent total laryngectomy in our department. Patients who underwent radiotherapy before the surgery was 24 cases(48.9%) of all total laryngectomy patients. And those who were needed flap reconstruc-tion because of extensive tumor involvement to hypopharynx were also 24 cases(48.9%), whereas primary closure were performed in 25 cases(51%). Results:The postoperative pharyngocutaneous fistula was found in 12 of the 49 patients(24.5%). The radiotherapy before surgery was a statistically significant factor that increase the inci-dence of postoperative fistulas(p=0.037). Large extent of surgery including flap reconstruction was almost statisti-cally significant factor of raising postoperative fistula rates(p=0.051). Conclusion:According to this study, the pres-ence of postoperative fistula seems to be influenced by previous radiotherapy and the extent of surgery. These could be the risk factors of pharyngocutaneous fistula after total laryngectomy.

횡격막 아래 장기에서 발생한 악성 종양의 경부림프절 전이 사례 분석

김진일(Jinil KIM),송슬기(Seulki SONG),석준걸(Jungirl SEOK),이민형(Minhyung LEE),한성준(Sung Jun HAN),정영호(Young Ho JUNG),안순현(Soon Hyun AHN),정우진(Woo-Jin JEONG) 대한두경부종양학회 2018 대한두경부 종양학회지 Vol.34 No.2

Background/Objectives: Cancers of the abdominal or pelvic organ rarely metastasize to the cervical lymph nodes. Although it indicates distant metastasis, perceivable prolongation of survival or cure may be possible in selected cases. We sought to identify patients with cervical metastasis from cancers below the diaphragm and identify patients who may benefit from aggressive treatment. Materials & Methods: From 2009 to 2017, patients with pathologically confirmed metastatic cervical lymph nodes originating from below the diaphragm were included for analysis. Patient demographics, cancer characteristics, treatment course, and clinical outcomes were analyzed. Results: 208 patients were identified. Left supraclavicular node (Virchow’s node) was the most frequently involved. Irrespective of treatment, survival for uterine cervical and ovarian cancers was significantly longer than that of other primaries. Patients with isolated cervical metastasis (oligometastasis) had significantly longer median survival compared to patients with concomitant bone, lung, brain, and mediastinal metastases. Conclusion: Although cervical metastasis from cancers of the abdominal and pelvic organ represent distant metastasis, patients with uterine cervix and ovary primary and oligometastatic lesions may benefit from aggressive treatment. Prudent patient selection and further investigation is warranted.