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Squamous cell carcinoma (SCC) of the lower lip is the most common malignant tumor, comprising 90% of all lip SCC. The typical picture of SCC of the lower lip is an ulcerated lesion with raised margins. Surgery is the treatment of choice for SCC of lower lip. After resection, reconstruction is important both aesthetically and functionally, because the lower lip is a prominent location in the face and it is where essential functions of the sphincter are carried out as in assisting mastication, swallowing, phonation, and expressing emotion. Depending on the location and size of the tumor, different types of flaps are used. We describe here a successful technique to reconstruct a large lower lip defect using a submental island flap and a mucosal flap for patients.
Purpose: To overcome the potential disadvantages of the use of foreign materials and autologous fat or collagen, we introduce here an autologous plasma gel for injection laryngoplasty. The purpose of this study was to present a new injection material, a plasma gel, and to discuss its clinical effectiveness. Materials and Methods: From 2 mL of blood, the platelet poor serum layer was collected and heated at 100°C for 12 min to form a plasma gel. The plasma gel was then injected into a targeted site; the safety and efficacy thereof were evaluated in 30 rats. We also conducted a phase I/II clinical study of plasma gel injection laryngoplasty in 11 unilateral vocal fold paralysis patients. Results: The plasma gel was semi-solid and an easily injectable material. Of note, plasma gel maintains the same consistency for up to 1 year in a sealed bottle. However, exposure to room air causes the plasma gel to disappear within 1 month. In our animal study, the autologous plasma gel remained in situ for 6 months in animals with minimal inflammation. Clinical study showed that vocal cord palsy was well compensated for with the plasma gel in all patients at two months after injection with no significant complications. Jitter, shimmer, maximum, maximum phonation time (MPT) and mean voice handicap index (VHI) also improved significantly after plasma gel injection. However, because the injected plasma gel was gradually absorbed, 6 patients needed another injection, while the gel remained in place in 2 patients. Conclusion: Injection laryngoplasty with autologous plasma gel may be a useful and safe treatment option for temporary vocal cord palsy.
Objectives. To introduce a new injection material for vocal fold diseases, which could be readily translated to clinical prac- tice, we investigated the effectiveness of platelet-rich plasma (PRP) injection on the injured vocal fold in terms of his- tological recovery. Methods. Blood samples were drawn from New Zealand White rabbits and PRP was isolated through centrifugation and separation of the samples. Using a CO 2 laser, we made a linear wound in the 24 vocal fold sides of 12 rabbits and in- jected each wound with PRP on one vocal fold side and normal saline (NS) on the other. Morphologic analyses were conducted at 2, 4, and 12 weeks after injection, and inflammatory response, collagen deposit, and changes in growth factors were assessed using H&E and masson trichrome (MT) staining and western blot assay. Results. PRP was prepared in approximately 40 minutes. The mean platelet concentration was 1,315,000 platelets/mm 3 . In morphological analyses, decreased granulation was observed in the PRP-injected vocal folds (P<0.05). However, the irregular surface and atrophic change were not difference. Histological findings revealed significant inflammation and collagen deposition in NS-injected vocal folds, whereas the PRP-injected vocal folds exhibited less (P<0.05). Howev- er, the inflammatory reaction and fibrosis were not difference. In western blot assay, increased amounts of growth factors were observed in PRP-injected vocal folds. Conclusion. Injection of injured rabbit vocal folds with PRP led to improved wound healing and fewer signs of scarring as demonstrated by decreased inflammation and collagen deposition. The increased vocal fold regeneration may be due to the growth factors associated with PRP.
Purpose: The aim of this study was to compare a negative pressure drain with a natural drain in order to determine whether a negative pressure drainage tube causes an increase in the drainage volume. Materials and Methods: Sixty-two patients who underwent total thyroidectomy for papillary thyroid carcinoma (PTC) were enrolled in the study between March 2010 and August 2010 at Gyeongsang National University Hospital. The patients were prospectively and randomly assigned to two groups, a negative pressure drainage group (n=32) and natural drainage group (n=30). Every 3 hours, the volume of drainage was checked in the two groups until the tube was removed. Results: The amount of drainage during the first 24 hours postoperatively was 41.68±3.93 mL in the negative drain group and 25.3±2.68 mL in the natural drain group (p<0.001). After 24 additional hours, the negative drain group was 35.19±4.26 mL and natural drain groups 21.53±2.90 mL (p<0.001). However, the drainage at postoperative day 3 was not statistically different between the two groups. In addition, the vocal cord palsy and temporary and permanent hypocalcemia were not different between the two groups. Conclusion: These results indicate that a negative pressure drain may increase the amount of drainage during the first 24-48 hours postoperatively. Therefore, it is not necessary to place a closed suction drain when only a total thyroidectomy is done.
Recurrent respiratory papillomatosis (RRP) is a benign tumor that occurs in the respiratory tract, especially in the larynx. The etiology of RRP is human papillomavirus (HPV). According to the age of occurrence, RRP is divided into childhood-onset and adult-onset types. Generally, childhoodonset RRP shows a high recurrence rate and diffuse involvement in the respiratory tract. Adult-onset RRP is more localized and appears more frequently as a solitary lesion. It may be the result of sexual transmission or the proliferation of latent HPV infections. At present, the treatment of choice for RRP is CO2 laser ablation. In addition, pulse dye laser or KTP (KTiOPO: potassium-titanyl-phosphate) lasers are also used. Nonsurgical adjuvant therapies can be applied in cases requiring repetitive surgery or with diffuse extensions. This review will introduce the clinical features of RRP and various treatment options including lasers.
A thyroglossal duct cyst (TGDC) is one of the most common causes of anterior midline neck mass. Successful management of a TGDC requires histopathology and an understanding of the embryogenesis of the thyroid. Traditional TGDC surgery uses a transcervical approach, which results in an external neck scar. In contrast to the surgical removal of a benign neck mass, TGDC surgery should include removal of the cyst, the hyoid bone, and the thyroid remnant track from the foramen cecum to the hyoid bone. Considering the embryological development of the TGDC, it was evident to us that an entirely transoral approach to the TGDC region was an option. Before its descent, the TGDC originates from the bottom of the tongue. The TGDC is located behind the strap muscles of the neck and the hyoid bone. Following this naturally predetermined access alongside the TGDC, we were able to develop a new surgical approach to the TGDC area and introduced the transoral TGDC excision.
현대 마취의들이 전자간증과 자간증의 마취 유도 및 유지에 있어 혈압 상승을 유발할 수 있는 약물들을 피함으로써 그에 의한 뇌실질 내 출혈 및 뇌경색에 의한 사망례는 드물어졌다. 본 교실에서는 태아곤란으로 응급 제왕절개술을 시행하기 위해 마취유도를 하던 중 뇌실질 내 출혈과 뇌경색으로 인해 사망한 자간증 환자를 경험하였기에 문헌적 고찰과 함께 보고한다. While the mordern anesthesiolosists prefer the drugs that may not elevate the blood pressure in preeclampsia and eclampsia, during induction and maintenance of anesthesia, the fatal case resulted of ICH and cerebral infarction rarely occur. We experienced a case of ICH and cerebral infarction due to eclampsia during inductuon of anesthesia for emergency Cesarian section. She was net awakened after cessation of the operation, and died of multiple organ failures from the complication of eclampsia.
Laryngeal surgery is a well established technique for the treatment of appropriate carcinoma of larynx. But the treatment of larynx cancer patients with surgical removal may result in some degree of dysphagia. Swallowing disorders depend on the site, the extent of surgical resection, and the nature of the surgical reconstruction. As a result, rehabilitation needs to be managed by professional with specific anatomical knowledge surgical procedure. The purpose of this article was to introduce the deglutition problem following laryngectomy. (JKDS 2013;3:1-6)
The use of a myomucosal flap from the buccinator muscle is a valuable reconstruction method for intraoral defects. In this paper, we report the clinical advantages of using a buccinator myomucosal flap for the treatment of partial mandibular defects caused by osteoradionecrosis. We implemented a buccinator myomucosal flap for the reconstruction of a partial mandibular defect in a 55-year-old man with tonsil cancer and partial mandibular defects caused by osteoradionecrosis. The total operating time was 90 minutes. Twelve months after the reconstruction, the patient remains free of disease. A buccinator myomucosal flap can be used for the reconstruction of partial mandibular defects caused by osteoradionecrosis. It is a reliable method for reconstructing small mandibular defects.