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이형신(Hyoung Shin Lee),홍종철(Jong Chul Hong),유태현(Tai Hyun Yu),이환호(Hwan Ho Lee) 대한두경부종양학회 2006 대한두경부 종양학회지 Vol.22 No.2
Schwannomas are benign tumors arising from the nerve sheaths of peripheral, autonomic and cranial nerves. Between 25% and 45% of all schwannomas occur in the head and neck region but only 4% involve the nasal cavity and paranasal sinus. Moreover, schwannoma of the pterygopalatine fossa is extremely rare. We present a case of schwannoma of the pterygopalatine fossa in a 43-year-old woman. The patient was surgically managed with endoscopic transnasal approach combined with transantral approach. After 16 months, the patient shows no evidence of recurrence.
이형신(Hyoung Shin Lee),이건수(Keon Su Rhee) 대한소아신경학회 1996 대한소아신경학회지 Vol.3 No.2
Cerebral radiation necrosis is classified according to the time of appearance of symptoms after therapy. Acute injury appears during radiation therapy as a transient worsening of symptoms and has little prognostic significance. Early delayed injury occurs a few weeks to 3 months after therapy and also is transient in most cases. By contrast late radiation injury, which occurs a few months to 10 or more years after therapy, is irreversible, progressive, and sometimes fatal, and constitutes the major, dose-limiting complication of cerebral irradiation. There are two main forms of late radiation injury : focal necrosis and diffuse white matter injury. Authors experienced a case of pontine glioma with radiation necrosis on left temporal lobe about 2 months after radiation therapy of total 4300rad. We presented this case with a brief review of literatures.
갑상선 수술 전 환자의 불안 정도가 수술 후 음성에 미치는 영향 : 예비연구
이형신(Hyoung Shin Lee),이상신(Sang Shin Lee),김화빈(Hwa Bin Kim),오다솔(Dasol Oh),김지수(Ji Su Kim),전석원(Suk Won Jeon),김성원(Sung Won Kim),이강대(Kang Dae Lee) 대한두경부종양학회 2017 대한두경부 종양학회지 Vol.33 No.2
Background and Objectives: Voice change after thyroidectomy may develop without injury of recurrent laryngeal nerve. Psychogenic or emotional factors related to voice change after thyroidectomy has been rarely studied. In this study, we sought to analyze the impact of anxiety on early state of post-thyroidectomy voice change. Materials and Methods: We made a retrospective chart review of 36 patients who underwent thyroidectomy for papillary thyroid carcinoma and voice exam before surgery, 2 weeks after and 1 month after surgery. All patients included in the study answered a questionnaire for State-Trait Anxiety Inventory ; STAI-KYZ (form Korean YZ). Clinico-pathologic factors and parameters of voice analysis were reviewed to analyze correlation to the anxiety index. Results: No differences were identified between clinicopathologic factors and preoperative parameters of voice analysis between patients with higher and lower level of anxiety. Noise to harmonic ratio (NHR) was higher in those patients with higher level of anxiety, 2 weeks after surgery (p=0.043). However, none of the parameters showed any difference 1 month later. Conclusion: With limited number of patients and short period of follow up, significant impact of preoperative anxiety on postoperative voice change after thyroidectomy could not be identified in this preliminary study.
갑상선 절제술 후 발생하는 주관적인 음성 기능 저하의 위험 요인에 대한 연구
이형신(Hyoung Shin Lee),김성원(Sung Won Kim),박찬우(Chan woo Park),김창회(Chang Hoi Kim),김서빈(Seo bin Kim),임수진(Su jin Lim),이강대(Kang Dae Lee) 대한두경부종양학회 2016 대한두경부 종양학회지 Vol.32 No.1
Background and Objectives: Quality of voice may be deteriorated after thyroidectomy without any injury to recurrent laryngeal nerve. While there have been several studies showing the change of acoustic parameters after thyroidectomy, factors related to deteriorated voice quality have been rarely studies. In this study, we sought to analyze the factors associated to deteriorated voice quality after thyroidectomy. Materials and Methods: We made a retrospective review of 35 patients who underwent thyroidectomy for papil-lary thyroid carcinoma. Voice analysis including acoustic analysis, voice handicap index 10 (VHI-10), and GRBAS score was conducted before and 3 months after surgery. Patients were grouped according to the amount of increase in VHI-10 after surgery ; group A (ΔVHI<7) and group B (ΔVHI≥7). Clinicopathologic factors associated to patients of group B were analyzed and changes of parameters from acoustic analysis in each group were evaluated. Results : Patients of group B were associated with age ≥ 45 years (p=0.025) and showed borderline association to total thyroidectomy (p=0.075) and tumor size ≥ 1cm (p=0.086). Multivariate analysis demonstrated that those with age ≥ 45 years were independently associated to deteriorated quality of voice (p=0.014, HR=18.38). Patients of group B were also associated to significant deterioration of high pitch (p<0.001) and Grade score with borderline significance (p=0.054). Conclusion: Patients older than 45 years may have higher risk of deterioration of quality of voice after thyroi-dectomy based on increase of VHI-10 score (ΔVHI≥7). Association with deterioration of high pitch should also be considered in these patients.
이형신(Hyoung Shin Lee) 대한신경모니터링학회 2023 Journal of Neuromonitoring & Neurophysiology Vol.3 No.1
Intraoperative neuromonitoring (IONM) for the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve during thyroidectomy may be helpful to identify and preserve the nerves and let the surgeon predict the postoperative neural function. International Neural Monitoring Study Group (INMSG) recently presented the recommended training course for IONM during thyroidectomy. Based on such training course provided by an expert group, trainees may conduct standardized IONM and experience the technique's advantages. This review article presents the recommended guidelines to prepare for a training course in IONM during thyroidectomy.
이형신(Hyoung Shin Lee) 대한신경모니터링학회 2022 Journal of Neuromonitoring & Neurophysiology Vol.2 No.1
Intraoperative neuromonitoring (IONM) during thyroid surgery may be beneficial to identify and preserve the recurrent laryngeal nerve or the external branch of superior laryngeal nerve. However, false positive or false negative outcomes during IONM has been considered as limitations and lead to failure of successful IONM. To minimize such failures, experts in IONM during thyroid surgery have suggested to follow the standardized procedure of IONM, which begins and ends with supra-threshold vagal stimulation. In this article, tips to follow the procedure will be introduced with review of related studies.
바늘 전극을 이용한 갑상선 수술 중 신경모니터링 문제 해결 1례
이형신(Hyoung Shin Lee),이강대(Kang Dae Lee) 대한신경모니터링학회 2021 Journal of Neuromonitoring & Neurophysiology Vol.1 No.1
False positive loss of signal or decrease in amplitude may lead to inappropriate interpretation of the intraoperative neuromonitoring (IONM) during thyroidectomy. Needle electrode has been introduced as an alternative method to conventional electromyogram (EMG) tube, preventing such problem with less medical cost. In this brief case report, we introduce the usefulness of needle electrodes to be applied during IONM for thyroidectomy with a conventional EMG tube, when false positive decrease of amplitude is identified. Needle electrodes may be helpful to predict the vocal cord function in such cases and let the surgeon decide the surgical extent in patients with thyroid cancer.
반회후두신경을 침범한 갑상선 유두암 환자에서 수술 중 신경감시의 적용
이형신(Hyoung Shin Lee) 대한신경모니터링학회 2024 Journal of Neuromonitoring & Neurophysiology Vol.4 No.1
Intraoperative neuromonitoring (IONM) has been widely applied for thyroidectomy in patients with papillary thyroid carcinoma (PTC) to identify and preserve the recurrent laryngeal nerve (RLN). Moreover, IONM may be helpful to predict the postoperative function of the vocal fold and provide rationales to decide the extent of surgery, including staged operation. However, the usefulness of IONM in patients with PTC involving the RLN has not been well introduced. Invasion of the PTC to the RLN may have lesser impact on survival of the patient compared to that to the trachea or esophagus. Therefore, preservation or resection of a functioning nerve involved by cancer may be a controversial issue. In this article, usefulness of IONM in patients with PTC involving the RLN will be reviewed based on recent related studies and guidelines.
양성침샘질환 수술에서 Thunderbeat<sup>TM</sup>와 Harmonic scalpel<sup>®</sup>의 유용성에 대한 비교연구
이형신,김성원,이강대,오다솔,김주현,고윤우,최은창,Lee, Hyoung Shin,Kim, Sung Won,Lee, Kang Dae,Oh, Dasol,Kim, Ju Hyun,Koh, Yoon Woo,Choi, Eun Chang 대한두경부종양학회 2018 대한두경부 종양학회지 Vol.34 No.1
Background and Objectives: Thunderbeat (TB) and Harmonic scalpel (HS) have been applied to variable head and neck surgery, which are useful for both coagulation and cutting of tissues. However, there have been no comparative studies covering the usefulness of these energy devices in surgery for major salivary gland. In this study, we analyzed the surgical outcomes of two devices in surgery for parotidectomy and submandibular gland (SMG) resection. Materials and Methods: A retrospective chart review of 90 patients including two groups (HS group, n=45 versus TB group, n=45) of patients matched for their patient factors was conducted. Clinicopathologic factors of the patients and surgical outcomes such as the operation time, intraoperative bleeding, amount and duration of drain, hospital stay and complications were compared between two groups. Results: There were no significant difference between two groups regarding the clinicopathologic factors and short-term surgical outcomes. Conclusion: Thunderbeat and HS are both effective and safe for parotidectomy and SMG resection in variable benign disease of major salivary gland.
홍종철,이형신<SUP>1<.SUP>,김성원<SUP>2<.SUP>,이강대<SUP>2<.SUP>,Jong-Chul Hong,Hyoung-Shin Lee,M.D.<SUP>1<.SUP>,Sung- Won Kim,M.D.<SUP>2<.SUP> and Kang-Dae Lee,M.D.<SUP>2<.SUP> 대한갑상선-내분비외과학회 2011 The Koreran journal of Endocrine Surgery Vol.11 No.3
Purpose: Vocal symptoms have been reported after thyroidectomy and even in the absence of injury to the recurrent laryngeal nerve or the external branch of the superior laryngeal nerve. The aim of this prospective study was to evaluate the subjective and objective voice changes in patients without laryngeal nerve injury after thyroidectomy. Methods: The subjects had undergone total thyroidectomy for differentiated thyroid carcinoma from November 2007 to December 2008. Twenty-eight subjects (males: 8, females: 20) were selected for this study. Voice analysis was prospectively evaluated in the subjects at the time of preoperation and postoperation (10.8 months for the males and 11.7 months for the females). A subjective analysis was done using the visual analogue scale (VAS, 0: no symptom, 10: severe symptoms) and objective analyses were determined by several parameters such as the fundamental frequency (Fo), jitter, shimmer and the noise to harmonic ratio (NHR) using the multi-dimensional voice program. Maximum phonation time (MPT)was performed as an aerodynamic test. Results: 3 patients (37.5%) among the males and 14 patients (70%) among the females had subjective postoperative voice change. The VAS showed a significant difference for the females (0 to 1.25±0.97, P<0.001), whereas no changes were shown for the males (0 to 0.88±1.25, P>0.05). The vocal parameters (Fo, jitter, shimmer, NHR) and MPT showed no significant changes for both the males and females (P>0.05). Conclusion: Subjective voice changes may occur after thyroidectomy without laryngeal nerve injury. Surgeons should take possible voice changes into consideration when informing patients before thyroidectomy. (Korean J Endocrine Surg 2011;11:175-178)