술 후 후두협착을 예방하기 위한 외래에서의 Mitomycin-C의 반복 국소적용

장전엽,이길준,손영익,Jang, Jeon-Yeob,Lee, Gil-Joon,Son, Young-Ik 대한후두음성언어의학회 2009 대한후두음성언어의학회지 Vol.20 No.1

Background and Objectives: Topical administration of mitomycin-C (MMC) has been reported to reduce or delay scar formation in airway surgery. However, it is not infrequent to experience recurrent stenosis or adhesion of operative wound even after a meticulous MMC application during the laryngeal surgery. Therefore we aimed to evaluate the effectiveness of repeated postoperative MMC applications and the technical feasibility of MMC applications to the laryngeal wound at an outpatient clinic. Methods: We reviewed medical records of 13 consecutive patients who received office-based MMC applications after laryngeal airway surgery at Samsung Medical Center, Seoul, Korea. The patients were grouped into 3 categories according to the site of surgical wound and the purpose of MMC application; group I : supraglottic stenosis (n=5), group II : cordectomy and arytenoidectomy site granulation prevention (n=3), Group III : laryngeal web prevention (n=5). Outcomes in each group and adverse effects of repeated MMC applications were evaluated. Results: Office-based MMC application was successfully performed one to four times with a week interval for each patient. No significant complications were observed except slightly decreased mucosal wave in one female patient who received 4 times of MMC application at the anterior commissure of vocal fold. Repeated MMC applications at the outpatient clinic resulted in wide or acceptable supraglottic airway in group I, clean wound healing without granulation formation in group II, and negligible or no web formation at the anterior commissure in group III. Conclusion : Office-based topical administration of MMC to the larynx was technically feasible. Postoperative repeated MMC applications were effective to reduce recurrent stenosis or adhesion of supraglottic structures, to prevent granuloma formation after laser arytenoidectomy and glottic web formation after anterior commissure resection.

후두전절제술 후 음성재활

장전엽,Jang, Jeon Yeob 대한후두음성언어의학회 2016 대한후두음성언어의학회지 Vol.27 No.1

Total laryngectomy remains as an important treatment option in selected patients with laryngopharyngeal cancers, which inevitably sacrifices naturally produced voice. Much effort has been devoted to voice restoration for these laryngectomized patients. Several ways of voice rehabilitation after total laryngectomy have been developed and utilized thus far, including tracheoesophageal shunt speech, esophageal speech, pneumatic speech aid, and electrolarynx. Of these, tracheoesophageal shunt speech appears to be the most effective voice restoration method, while other trials might also be useful in special situations. Nevertheless, each method has its own unique mechanisms of voice production, thus has its advantages and drawbacks in clinical setting. In this review, we discuss the currently available management options for the rehabilitation of laryngectomized voice.

구강암 환자의 경부 림프절 전이 및 림프절 피막 외 침범과 관련된 임상병리적 인자에 대한 고찰

한장규(Jang Gyu Han),김승일(Seung-il Kim),박범희(Bumhee Park),장전엽(Jeon Yeob Jang),신유섭(Yoo Seob Shin),김철호(Chul-Ho Kim) 대한두경부종양학회 2021 대한두경부 종양학회지 Vol.37 No.2

Background/Objectives: Extra-nodal extension (ENE) is one of the strongest prognosticators in oral cancers. Here we tried to evaluate clinicopathological factors associated with the presence of ENE. Materials & Methods: We retrospectively analyzed clinical information of 120 patients who diagnosed with oral cancer and received curative surgery at our hospital from Mar 2012 to Apr 2020. We comparatively analyzed clinicopathological factors associated with the presence of lymph node (LN) metastasis and ENE, respectively. Results: Variable factors of primary tumor characteristics such as lymphovascular invasion, perineural invasion, largest diameter of tumor, depth of invasion and maximum standardized uptake value were significantly associated with the presence of cervical LN metastasis. The largest diameter of tumor was statistically significant also in multivariate analysis for predicting the LN metastasis. Meanwhile, the association between primary tumor characteristics and the presence of ENE were not statistically significant except the primary tumor size. Importantly, factors associated with LN characteristics including the maximum diameter and number of metastatic LNs were significantly associated with ENE. Conclusion: In this study, several factors affecting cervical LN metastasis and ENE in oral cancer patients were identified. The ENE seems to be influenced by the status of the metastatic LNs, such as the number of metastatic LNs, rather than the characteristics of the primary tumor itself.

후두 접촉성 육아종의 치료

고문희,손영익,장전엽,소윤경,정만기,Ko, Moon-Hee,Son, Young-Ik,Jang, Jeon-Yeob,So, Yoon-Kyoung,Chung, Man-Ki 대한후두음성언어의학회 2008 대한후두음성언어의학회지 Vol.19 No.2

Background: Laryngeal contact granuloma is an inflammatory hypertrophic granulation tissue arising at around the vocal process of arytenoid cartilage. Various approaches are currently used for the treatment, but a solid guideline has not been established. Objectives: We aimed to compare the each treatment modality in the hope of suggesting a guideline for the successful management of laryngeal contact granuloma. Method: Eighty-seven treatment cases of 56 patients were analyzed. Cases having recent intubation history were excluded from the study. All patients received vocal hygiene education. Proton pump inhibitors (PPI, N = 33) or H2 receptor antagonists ($H_{2}RA$, N =26) were used as a first-line treatment. Among the non-responders to $H_{2}RA$, 11 cases received PPI as a second-line therapy. Eight cases received botulinum toxin injection and 9 cases had laryngomicrosurgical removal. Results: As an initial therapy, response rate to PPI and $H_{2}RA$ was 60.6% and 38.5% respectively, which was not statistically different (p=0.091). Response rate of PPI as the second-line therapy was 36.3% (p=0.162 when compared to that of first-line PPI therapy). Response rate of Botulinum toxin injection was 75%. All cases of surgical removal recurred in a relatively short period (mean 1.9months). Conclusion: In patients having laryngeal contact granuloma, combined therapy with vocal hygiene education and PPI medication would provide more than 60% of therapeutic response. Botulinum toxin injection is highly effective even in non-responders to antireflux therapy. The only indications of surgery are to resolve diagnostic doubt or to treat acute airway compromise.

Post-Processing of High-Speed Video-Laryngoscopic Images to Two-Dimensional Scanning Digital Kymographic Images

차원재,왕수건,장전엽,김근효,이연우,Cha, Wonjae,Wang, Soo-Geun,Jang, Jeon Yeob,Kim, Geun-Hyo,Lee, Yeon-Woo The Korean Society of Laryngology 2017 대한후두음성언어의학회지 Vol.28 No.2

Background and Objectives : High-speed videolaryngoscopy (HSV) is the only technique that captures the true intra-cycle vibratory behavior of the vocal folds by capturing full images of the vocal folds. However, it has problems of no immediate feedback during examination, considerable waiting time for digital kymography (DKG), recording duration limited to a few seconds, and extreme demands for storage space. Herein, we demonstrate a new post-processing method that converts HSV images to two-dimensional digital kymography (2D-DKG) images, which adopts the algorithm of 2D videokymography (2D VKG). Materials and Methods : HSV system was used to capture images of vocal folds. HSV images were post-processed in Kay image-process software (KIPS), and conventional DKG images were retrieved. Custom-made post-processing system was used to convert HSV images to 2D-DKG images. The quantitative parameters of the post-processed 2D-DKG images was validated by comparing these parameters with those of the DKG images. Results : Serial HSV images for all phases of vocal fold vibratory movement are included. The images were converted by the scanning method using U-medical image-process software. Similar to conventional DKG, post-processed 2D DKG image from the HSV image can provide quantitative information on vocal fold mucosa vibration, including the various vibratory phases. Differences in amplitude symmetry index, phase symmetry index, open quotient, and close quotient between 2D-DKG and DKG were analyzed. There were no statistical differences between the quantitative parameters of vocal fold vibratory movement in 2D-DKG and DKG. Conclusion : The post-processing method of converting HSV images to 2D DKG images could provide clinical information and storage economy.

미세피판기법을 이용한 성대낭종제거술

안정민,최지은,이동근,장전엽,손영익,Ahn, Jungmin,Choi, Ji-Eun,Lee, Dong Kun,Jang, Jeon Yeob,Son, Young-Ik 대한후두음성언어의학회 2016 대한후두음성언어의학회지 Vol.27 No.1

Background and Objectives : Microsurgical resection of intracordal cysts is technically difficult and challenging because the wall of cysts may be tightly attached to underlying vocal ligament and/or overlying epithelium, and therefore their thin wall will easily rupture during surgical dissection. We aimed to evaluate the voice outcomes of standard microflap subepithelial resection and the recurrence rate depending on the intraoperative rupturing of the cyst. Materials and Methods : Medical records of Samsung Medical Center, Seoul, Korea, were reviewed for sixty-four consecutive patients who received surgical resection of vocal cyst using microflap subepithelial dissection technique between the year 2004 and 2013. Meticulous dissection was performed to completely remove the cyst wall while preserving the mucosa and the lamina propria as much as possible. Voice outcomes and recurrence rates were compared according to the type, size and the intraoperative rupture of cyst. Results : Presence or absence of cyst rupture was clearly described in the operation records of 41 patients. Intraoperative rupture of the cyst occurred in 32 of 41 (78%) patients. The recurrence was detected in 5 of 64 (7.8%) total cases and 4 of 32 (12.5%) cases of ruptured cyst, but not in 9 cases of intact extirpation. Rupture was more common in case of mucous retention cyst compared with epidermoid cyst (p=0.036). Subjective and objective voice parameters were measured at before and 3 months after surgery, which improved regardless of the cyst rupture. Conclusion : Although complete microsurgical extirpation of intracordal cyst while keeping the cyst wall intact is technically difficult, meticulous dissection with maximal preservation of surrounding tissue may warrant the improvement of voice outcomes.

작은 전정신경 종양의 수술 및 감마나이프 치료의 치료성적 및 삶의 질 평가

박신홍(Shin Hong Park),조양선(Yang-Sun Cho),정규환(Kyu Whan Jeong),장전엽(Jeon Yeob Jang),류남규(Nam Kyu Ryu),정원호(Won-Ho Chung),홍성화(Sung Hwa Hong) 대한두개저학회 2007 대한두개저학회지 Vol.2 No.2

Objective : The aim of this study was to evaluate the treatment result and quality of life (QOL) in patients with intracanalicular to small-sized vestibular schwannoma (VS), who were managed with microsurgery or gamma knife radiosurgery (GKS). Methods : Medical records of 40 patients who were available on the telephone interview and were followed up more than 6 months after treatment for VS of Koss grade 2 or less from 1997 to 2007 were reviewed. Eighteen patients were treated with microsurgery via translabyrinthine approach and 22 patients were treated with GKS. We evaluated tumor control rate, complications and QOL. To evaluate the QOL, we used the Glasgow Benefit Inventory questionnaires with telephone interview. Result : The mean observation time was 26.85 months. Sixteen patients (88.89%) in microsurgery group did not develop recurrence of tumor. Twenty patients (90.91%) in GKS group were controlled with less than 140% volume increase. One patient in microsurgery group had facial nerve palsy (FNP) worse than House-Brackmann (H-B) Grade III at last follow-up, while no patient developed FNP worse than H-B grade III in GKS group. Although GKS group had higher score in GBI questionnaires, the difference was not significant in comparison with microsurgery group. Conclusion : In small VS, microsurgey and GKS showed similar tumor control and complication rate. Microsurgery group did not have worse QOL than GKS group.

연구개 및 구개수 암종의 광범위 절제 및 국소 점막근 피판 재건술 1예

구가영(Ga Young Gu),이혜란(Hye Ran Lee),장전엽(Jeon Yeob Jang) 대한두경부종양학회 2022 대한두경부 종양학회지 Vol.38 No.1

The soft palate of carcinoma limited to the uvular region is infrequent among oropharyngeal cancers. The oropharynx regulates swallowing and speech through dynamic motions. Failure to reconstruct after surgical resection of the oropharynx structure can lead to permanent velopharyngeal insufficiency. Therefore, suitable reconstruction is important in establishing proper functional outcomes while maintaining oncological safety. We present a case of a 66-year-old male who was diagnosed with oropharynx cancer limited in the uvula accompanied by lymph node metastasis. After surgical resection, reconstruction was performed with the united arrangement of bilateral palatal mucomuscular flap and superiorly based posterior pharyngeal flap. There was no aspiration or reflux after feeding and epithelialization completely occurred after 1 month postoperatively. We report a successful case that the reconstruction with the local flap described above could preserve proper oropharyngeal function after primary surgery in small-sized oropharyngeal cancer.

원발미상암으로 오인된 이하선 림프상피암종

고영혜(Young-Hyeh Ko),정한신(Han-Sin Jeong),장전엽(Jeon Yeob Jang),박준오(Jun Oh Park) 대한두경부종양학회 2013 대한두경부 종양학회지 Vol.29 No.2

Neck mass is a common manifestation from head and neck malignancy, most of which come from mucosal squamous cell carcinomas in the upper aero-digestive tract. However, once aspiration cytology suggests atypical malignant cells in the neck mass rather than metastatic squamous cell carcinomas, it is confusing to decide the adequate diagnostic work-ups and treatment planning. Here, we report a 29-year-old woman presenting with a growing neck mass mimicking malignancy of unknown origin, which was finally diagnosed as primary lympho-epithelial carcinoma in the parotid gland with multiple metastases to the lymph nodes. The patient underwent comprehensive neck dissection and total parotidectomy and the adjuvant radiation treatment was given. Our re-port highlight that the primary salivary gland cancer should be considered as the potential tumor origin in case of malignancy of unknown origin in the head and neck region and neck mass suggestive of atypical carcinomas.

혀뿌리에 발생한 림프절외 NK/T 세포 림프종 1예

하정호(Ha Jung Ho),한재호(Jae Ho Han),장전엽(Jeon Yeob Jang) 대한두경부종양학회 2020 대한두경부 종양학회지 Vol.36 No.2

Extranodal Natural Killer (NK)/T-cell lymphoma, nasal type, is a subtype of non-Hodgkin lymphoma, strongly associated with Epstein-Barr virus. Extranodal NK/T-cell lymphoma mostly affects the nasal cavity and there has been no report of the disease’s occurrence at the base of tongue. Here we report a case of 43-year-old man who presented with a diffuse ulcerative lesion at the base of tongue. Because the patient had oral bleeding, tracheostomy and lingual artery ligation was performed via a transcervical approach to control bleeding and protect the upper airway. We performed a deep biopsy through the lateral pharyngotomy approach, and finally, the patient was diagnosed with extranodal NK/T-cell lymphoma, nasal type. We report this rare case of extranodal NK/T cell lymphoma at the base of tongue with a literature review.