Real-Time Video-Assisted Retrieval of Airway Foreign Body in Very Young Pediatric Patients

장전엽,박준오,류준선,정한신 대한이비인후과학회 2014 Clinical and Experimental Otorhinolaryngology Vol.7 No.4

Objectives. Advancements in medical endoscopy and techniques of rigid bronchoscopy for foreign body removal have en- abled higher diagnostic accuracy, reduced morbidity and precise manipulation. However, in pediatric patients, endo- scope-combined forceps may be too big to fit into the small sized airway. Here we present our method of endoscope assisted rigid bronchoscopy in pediatric patients and compare the clinical benefits with conventional naked-eye rigid bronchoscopy. Methods. We used a 2.7 mm, 0° straight endoscope and small caliber grasping forceps with 3.0 to 4.5 mm sized rigid bron- choscopy for very young (<3 years of age) patients of foreign body aspiration. As an assistant held the rigid broncho- scope in situ, the operator could manipulate the endoscope and forceps bimanually. With endoscopic guidance, the foreign body retrieval was performed carefully. The clinical advantages were compared between our endoscope-as- sisted method (n=29) and the conventional bronchoscopy method (n=33) in terms of operation time and recovery (hospital stay). Results. Bimanual endoscope-assisted rigid bronchoscopy method was technically feasible and safe. The operation time was less, compared to the conventional technique and the patients recovered more quickly. In all cases, our method com- pletely removed the foreign body without need of a second bronchoscopy procedure. Conclusion. Bimanual endoscope-assisted retrieval of airway foreign body in very young age pediatric patients was superi- or to the conventional naked-eye method concerning accurate manipulation and safety.

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.

Quadruple Primary Malignancies in an Old Male Smoker Treated with Cooperative Surgery

장전엽,차원재,김현성,조정수,왕수건 대한이비인후과학회 부산,울산,경남 지부회 2015 임상이비인후과 Vol.26 No.2

The patients with head and neck cancers are frequently elderly with history of smoking that may harbor possibilities of multiple primary malignancies. Recent use of PET-CT as an initial diagnostic tool facilitates the finding of unexpected primary malignancies. Here we present a case of quadruple primary malignancies treated with cooperative surgery. A 66 year-old male presented with sore throat. He was identified as a current smoker and had a history of alcohol ingestion. Physical examination followed by office-based biopsy revealed supraglottic squamous cell carcinoma. Imaging studies including PET-CT found multiple suspicious malignant lesions involving thyroid gland, esophagus, sigmoid colon as well as the larynx. Further multidisciplinary consultation suggested that all of the evaluation lesions were primary malignancies without evidence of systemic spread. The patient underwent cooperative surgery ; supraglottic partial laryngectomy with neck dissection for supraglottic cancer, left hemithyroidectomy for thyroid cancer, Ivor Lewis operation for esophageal cancer, lower anterior resection for colon cancer. Careful postoperative care was provided without a complication. Office-based observation has been ongoing without an evidence of recurrence.

Fiberoptic Laryngeal Microsurgery in Patients with Cervical Spine Disease

장전엽,김효성,백지석,김해규 대한이비인후과학회 부산,울산,경남 지부회 2014 임상이비인후과 Vol.25 No.2

Laryngeal microsurgery using suspension laryngoscope is a common procedure for benign laryngeal lesions. However, suspension laryngoscope could not always guarantee adequate exposure of the vocal cord in patients having stiff neck. Here we present a novel operative method to overcome difficult laryngeal exposure in patients with cervical spine diseases. A 71-year-old man presented with hoarseness. Laryngeal evaluation showed a vocal polyp located at the anterior portion of right true vocal cord. He previously underwent partial laminectomy of cervical and thoracic vertebrae for ossified ligamentum flavum. During operation, suspension rigid laryngoscope was not able to be introduced at the true vocal cord level due to a limited neck extension caused by spine immobilization and further concern was taken for potential damage of spinal cord. We performed fiberoptic laryngeal microsurgery assisted with McGRATH® portable video laryngoscope and successfully removed the vocal polyp. Fiberoptic laryngeal microsurgery assisted with McGRATH® portable video laryngoscope might be an alternative approach in selected patients of difficult laryngeal exposure especially due to cervical spine disease.

갑상선 절제술 후 경부불편감의 경감을 위한 조기 경부운동의 효과 분석: 무작위 전향적 연구

장전엽,장영수,김은혜,문정환,손영익 대한갑상선학회 2014 International Journal of Thyroidology Vol.7 No.1

Background and Objectives: To evaluate the efficacy and safety of early neck exercises to reduce post-thyroidectomy symptoms and syndromes for patients undergoing thyroid surgery. Materials and Methods: One hundred patients who had undergone thyroid surgery were randomly assigned 1:1 to control (delayed exercise, initiating at postoperative 2 weeks) or early exercise group (initiating at postoperative 1 day). Questionnaire survey (voice, globus sense, neck discomfort, swallowing difficulty) and objective measurement (surgical wound adhesion, range of neck motion and scar scale) were performed at 2 weeks and 3 months postoperatively. Results: Compared to control, early exercise significantly decreased the degree of neck discomfort at 2 weeks after thyroid surgery (p=0.037) while other subjective symptoms including voice change, globus sense, and swallowing difficulty were not significantly different between the two groups. The degree of surgical wound adhesion was significantly decreased (p<0.001) and the range of motion was improved in early exercise group (p=0.010). In addition, the objective scores of Vancouver Scar Scale (VSS) were decreased in early exercise group compared to those of control group (p=0.020). Conclusion: Early neck exercises are safe and effective to reduce postoperative neck discomfort, wound adhesion, or hypertrophy of scar and to improve the range of motion in patients undergoing thyroid surgery.

두경부암의 림프절 전이 기전

장전엽 대한이비인후과학회 2016 대한이비인후과학회지 두경부외과학 Vol.59 No.4

Lymph node metastasis (LNM) is an important prognostic factor in head and neck cancer (HNC), which leads to recurrence and poor outcome. Despite the advances in multimodality treatment protocols, overall survival in patients with LNM remains limited, thus calling for the need of a more thorough understanding of the biology in metastatic process. In the past, LNM had been suspected to rely mostly on passive mechanistic impulse from primary tumor. However, recent discovery of new lymphatic markers, regulating growth factors, and cognate receptors, has elucidated the active biological regulation during metastatic cascades, which primarily involves primary tumor lymphangiogenesis, pre-metastatic niche formation, and sentinel LNM. In this review, we discuss recent literatures on the mechanisms of LNM in HNC that is expected to allow a better understanding of the disease as well as suggesting a potential clinical implication. Korean J Otorhinolaryngol-Head Neck Surg 2016;59(4):259-64

Voice Outcomes After Laryngeal Microsurgery With Adjunctive Steroid Injection for Reinke Edema

장전엽,김동영,이가영,박소형,이혜란,신유섭,김철호 대한이비인후과학회 2021 Clinical and Experimental Otorhinolaryngology Vol.14 No.3

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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.

Prediction of Lymph Node Metastasis by Tumor Dimension Versus Tumor Biological Properties in Head and Neck Squamous Cell Carcinomas

장전엽,김민지,류광희,최나연,고영혜,정한신 대한암학회 2016 Cancer Research and Treatment Vol.48 No.1

Purpose Lymph node metastasis (LNM) is a strong prognostic factor in many solid cancers, including head and neck squamous cell carcinomas (HNSCC), and LNM can be dependent upon primary tumor biology, as well as tumor dimension. Here, we investigate the relative risk of LNM in accordance to tumor dimension and biology in HNSCC subsites. Materials and Methods Medical data of 295 HNSCC patients who had undergone the initial curative surgery (oral tongue 174, oropharynx 75, hypopharynx 46) were analyzed to identify the significant predictive factor for LNM. Tumor volume and thickness were set as tumor dimensional vari- ables, and biological variables included lymphovascular, perineural invasion, and tumor differentiation. Statistical analyses were conducted to assess the predictability of LNM from variables, and subgroup analyses according to the tumor subsites. In addition, we evaluated the impacts of tumor dimension and biological variables on the treatment outcomes and survival in HNSCC subsites. Results The overall tumor dimension and biological variables had a similar impact on the prediction of LNM in HNSCC (area under the curve, 0.7682 and 0.7717). The prediction sensitivity of LNM in oral tongue cancer was mainly dependent on tumor dimension, while LNM in oro- and hypo-pharynx cancers was more influenced by biological factors. Survival analyses also confirmed that biological factor was more powerful in estimating disease-free survival of hypopharyngeal cancer patients, while tumor dimension was more significant in that of oral cancer patients. Conclusion Tumor dimension and biology have a significant, tumor subsite-dependent impact on the occurrence of LNM and disease-free survival in HNSCC.

Cochlear Implantation Using a Suprameatal Approach in a Case of Severely Contracted Mastoid Cavity

최지은,장전엽,조양선 대한청각학회 2014 Journal of Audiology & Otology Vol.18 No.3

Although cochlear implantation using posterior tympanotomy has been performed worldwide, other alternative approaches might be more beneficial and convenient in some selected cases. Of these, suprameatal approach was reported to be one of useful options in cases with narrow facial recess, anteriorly located facial nerve and an ossified cochlea. We describe a case of cochlear implantation using the modified suprameatal approach in a severely contracted mastoid cavity and suggest another indication of this approach.