상악동 편평세포암종에 대한 상악절제술의 치료 결과

정한신(Han Sin Jeong),손영익(Young Ik Son),정만기(Man ki Chung),민진영(Jin Young Min),오재원(Jae Won Oh),홍상덕(Sang Duk Hong),이현석(Hyun Seok Lee),백정환(Chung Hwan Baek) 대한두경부종양학회 2006 대한두경부 종양학회지 Vol.22 No.1

Background and Objectives: Maxillectomy is the mainstay of treatment for malignant tumors of the maxillary sinus(MS). Nevertheless, few have been reported on the surgical outcomes of maxillectomy for malignant tumors of MS in Korean literature. Based on our clinical experience, the authors aimed to present the treatment outcomes of maxillectomy for squamous cell carcinomas(SCC) of MS. Subjects and Methods: We reviewed the medical records of 26 cases of maxillectomies with see of MS, who were treated from 1995 to 2004 at Samsung Medical Center. Most patients(73.1%) were locally advanced stage(T3 or T4a) at initial presentation. Total maxillectomy was performed in 18 cases, which is the most frequent procedure(69.2%). We analyzed the treatment outcomes of see of MS and several variables includeing tumor stage and resection margin to identify predictors for treatment failure after maxillectomy. Follow-up duration ranged from 7 to 89 months with a mean of 33 months. Results: Treatment failure occurred in 7 cases(26.9%), among which 3 were salvaged. Three of 26 maxillectomies(11.5%) showed the positive or close(less than 5mm) resection margin in their posterior resection sites; however it did not coincide with the site of recurrence after radiation therapy. Among patients who had been followed up for more than 6 months, disease-free 3 year survival rate was 100.0% in T1 and T2, 76.2% in T3, 60% in T4a, and 69.6% in total. Conclusion: Even though most of see of MS were detected at locally advanced stage, maxillectomy with or without postoperative radiation therapy for resectable MS see(T1-T4a) provided the acceptable treatment outcome(70%, 3Y disease-free survival rate).

연축성 발성장애 환자에서 냉동 보관한 보툴리늄 독소 주입술의 효과

박신홍,소윤경,정한신,손영익,Park, Shin-Hong,So, Yoon-Kyoung,Jeong, Han-Sin,Son, Young-Ik 대한후두음성언어의학회 2007 대한후두음성언어의학회지 Vol.18 No.1

Objectives: The aim of this study is to compare the efficacy of fresh versus frozen reconstituted botulinum toxin type A (BTX-A) for the treatment of adductor type spasmodic dysphonia. Materials and Methods: After reconstitution with normal saline, BTX-A was used within 4 hours or it was kept frozen in a consumer grade freezer at about $-25^{\circ}C$ for up to 4 months. Thirty patients with spasmodic dysphonia were randomly assigned and treated with the either fresh or frozen BTX-A. About 83% of injections resulted in a satisfactory outcome with 5.3 months of mean action duration. Treatment outcomes and side effects of total 161 injections were compared along the duration of keeping BTX-A frozen. Results: There were no statistical differences in the duration of action, self-rated satisfaction score, and the duration of hoarseness and/or aspiration between fresh and frozen BTX-A treated groups. No significant side effects were observed and the frozen BTX-A were proved to be free of bacterial contamination. Conclusion: After being reconstituted and kept frozen, BTX-A may be safely used for more than 4 months without significant loss of its effectiveness or additional side effects.

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.

외이도 악성 종양 21례의 치료 경험

정종인(Jong In Jeong),조양선(Yang Sun Cho),추호석(Ho Suk Chu),홍성화(Sung Hwa Hong),정원호(Won Ho Chung),백정환(Chung Hwan Baek),정한신(Han Sin Jeong),정만기(Man Ki Chung) 대한두개저학회 2009 대한두개저학회지 Vol.4 No.1

Background and Objectives:The malignances of external auditory canal(EAC) are very rare diseases and have very poor prognosis. Numerous staging systems have been proposed to classify patients before treatment. To treat the diseases, multimodal therapy is performed. The aim of this study was to review our experiences of the treatments for the malignances of EAC, and to propose most effective treatments according to the stage. Subjects and Method:Twenty-one patients with the malignances of EAC diagnosed between November 1994 and December 2009 were analyzed. The patients were analyzed according to the Pittsburgh staging system and histopathological findings. Results:The number of patients staged as T1, T2, T3, and T4 were 4, 2, 2, and 13, respectively. Surgical treatments were performed in 13 patients using lateral temporal bone resection, subtotal temporal bone resection. Initial or postoperative radiotherapies were performed in 13 patients. After the treatment, the mean disease free survival periods of 5 patients (23.8%) who are still alive without the disease was 27.8 months, and 4 patients (19%) expired within the mean periods of 11.8 months. Conclusion:We suggest that en-bloc resection with or without radiation therapy is the best treatment for the malignancies of the external auditory canal. A positive resection margin or residual tumor should be considered as worst prognostic factor.

소아 후두기관협착 환자에서 single-stage 방법의 후두기관재건수술

고문희,손영익,백정환,정한신,정만기,Ko, Moon-Hee,Son, Young-Ik,Baek, Chung-Hwan,Jeong, Han-Sin,Chung, Man-Ki 대한기관식도과학회 2007 大韓氣管食道科學會誌 Vol.13 No.2

Background and Objectives: Laryngotracheal stenosis and its reconstruction in children is a highly challenging field to airway surgeons, and the way of stenting after a reconstructive surgery is still controversial. The aims of this study were to analyze the single institutional experiences of laryngotracheal reconstruction (LTR) in the pediatric patients with laryngotracheal stenosis and to compare the outcomes of single-stage LTR (SSLTR) with conventional two-stage LTR (TSLTR) in these patients. Materials and Methods: Medical records of 14 children (mean age 4.1 years) were reviewed, who received 20 LTR including 6 revisions for their moderate to severe subglottic stenosis and/or combined posterior glottic stenosis. Of these 20 LTR, tracheostoma was temporarily maintained after LTR in 12 cases (TSLTR) or not in the other 8 cases (SSLTR). Results: Overall decannulation rate of LTR that were performed before and after the year of 2003 was 40% (4/10) and 70% (7/10) respectively. Decannulation rate was 42% (5/12) in TSLTR group and 75% (6/8) in SSLTR group (P = 0.197). Mean interval to decannulation after LTR was 9.8 months and 7.2 days in TSLTR and SSLTR groups respectively (P = 0.004). A number of additional touch-up procedures that were required after LTR was 4 in TSLTR and 2.7 in SSLTR group (P = 0.238). Major complication rate was similar in both groups (33% in TSLTR and 38% in SSLTR, P = 0.910). Conclusion: A laryngotracheal reconstruction in children is a technically demanding procedure and its outcome is largely dependent on the surgeon's experience. Albeit there was a tendency that SSLTR ofters a higher decannulation rate, less additional touch-up procedures and similar complication rates, a shorter interval to decannulation after LTR was the only advantage that was confirmed as statistically significant in this study.

조기(TNM Stage Ⅰ & Ⅱ) 구강 편평세포암종의 초치료 실패

이현석(Hyun Seok Lee),정한신(Han Sin Jeong),김태욱(Tae Wook Kim),손영익(Young lk Son),백정환(Chung Hwan Baek) 대한두경부종양학회 2005 대한두경부 종양학회지 Vol.21 No.1

Backgrounds and Objectives: Squamous cell carcinomas of the oral cavity(SCOC) in TNM stage I & II have relatively high chance to be cured compared to those in the advanced stage, but sometimes result in the treatment failure with poor prognosis. There have been few reports on the patterns of failure and the clinical courses for SCOC in stage I & II after the failure of initial treatment. This study is directed at identifying the clinical outcomes of stage I & II SCOC and the salvage rate after initial treatment and suggesting an optimal level of treatment by analyzing the patterns of failure. Material and Methods: The medical records of 36 patients with SCOC, initially diagnosed between 1995 and 2001 as TNM stage I & II were reviewed retrospectively. The patterns of failure, salvage treatment, clinical courses, and the survival of these subjects were analyzed. The minimum follow-up period of no-evidence of disease(NED) was 12 months with an average of 32.2 months. Results: Overall rate of the treatment failure in SCOC of stage I & II was 41. 7%(15/36 cases). Most of the treatment failure in the subjects with stage I tumors occurred in regional lymph node. Local failure was the most frequent form of failure in the subjects with stage II tumors after wide excision of primary tumor with elective neck dissection and/or radiation therapy. No significant correlation was noted between the safety margin and the local failure. Elective neck dissections in stage I & II SCOC had a tendency to reduce regional failure (p=0.055). The salvage rates at 24 months were 85.7% in stage I, and 37.5% in stage II. The 3-year survival rate after the failure of initial treatment was 55.0%. Conclusion: SCOC of stage I & II after the failure of initial treatment showed poor prognosis despite of the salvage treatments. This study implies that the elective neck dissections for regional lymph node should be required for SCOC of stage I & II to reduce the treatment failure.

구강내 재건을 위한 안면 동맥 근점막 피판의 다양한 적용법

손영익(Young-Ik Son),백정환(Chung-Hwan Baek),정한신(Han-Sin Jeong),조재근(Jae Keun Cho),류광희(Gwanghui Ryu) 대한두경부종양학회 2013 대한두경부 종양학회지 Vol.29 No.2

Background:The purpose of this study is to review our experience with the variable applications of the facial artery muscolomucosal(FAMM) flap for oral cavity reconstruction following treatment for head and neck malig-nancies. Methods:We performed retrospect medical record review from January 2012 to June 2013. This flap technique was applied in 3 patients to reconstruct the defects of oral cavity induced by treatment for head and neck malignancies. Results:The defects and fibrosis occurred due to variable causes related to previous treat-ment for head and neck malignancies such as tumor resection and chemoradiation. Two patient suffered from defect on hard and soft palate and one patient suffered from trismus related to fibrotic scar band. We performed oral cavity reconstruction using FAMM flap even though these all patients had history of neck dissection surgery or radiation therapy. Conclusion:FAMM flap is an ideal option for reconstruction following treatment not only for primary tumor resection but also for defects induced by variable causes. Preoperative radiation and neck dis-section surgery, which are previously considered as some challenges, are no longer contraindication in our cases.

595nm Pulsed Dye Laser를 이용한 수술 흉터 치료 1예

박기남(Ki Nam Park),정만기(Man Ki Chung),정한신(Han-Sin Jeong),유승재(Seung Jae Yoo),전형기(Hyung-Ki Chun),김원석(Won Seok Kim),손영익(Young-Ik Son) 대한두경부종양학회 2006 대한두경부 종양학회지 Vol.22 No.2

Pulsed dye laser(PDL) is originally designed for the treatment of vascular lesions but also effective in im-proving the quality and appearance of surgical scars. Recently, 595nm Pulsed dye laser(V-beam laser), which has the advantage of deeper tissue penetration and lesser amount of purpura, is spotlighted as a new option for the treatment of surgical scar. The authors treated a surgical scar of a female patient with V-beam laser for 3 times between 4 and 12 weeks after surgery. Subjective satisfaction was improved with visual analogue scale (VAS) and objective improvements were found in parameters of vascularity, pliability and height with Van-couver Scar Scale(VSS). We report the effectiveness of V-beam laser in surgical scar of Asian patient and plan the prospective study with larger scale.

종양 절개생검 이후에 발생한 의인성 완전안면신경마비에서 즉각적인 안면신경마비 재건술에 대한 증례 1예

김종세(Jong-Sei Kim),조재근(Jae Keun Cho),정한신(Han-Sin Jeong),손영익(Young-Ik Son),백정환(Chung-Hwan Baek) 대한두경부종양학회 2013 대한두경부 종양학회지 Vol.29 No.2

Complete facial nerve palsy is emotionally and physiologically devastating condition. Management of patients with the facial nerve palsy poses significant challenges to achieve the goal of returning patients to their premor-bid state. We experienced a case of iatrogenic facial nerve palsy in a 66 year-old patient, who was diagnosed as facial nerve schwannoma with previous incisional biopsy. The author describes the management of this patient and reviews the literature.

경정맥 사구종 2예

소윤경(Yoon-Kyoung So),조양선(Yang-Sun Cho),정한신(Han-Sin Jeong),정수찬(Soo-Chan Jung) 대한두개저학회 2006 대한두개저학회지 Vol.1 No.2

Glomus jugulotympanicum is a slow growing tumor originating at the dome of jugular bulb. It is histologically benign, but can have an aggressive clinical course with involving neurovascular structures at the skull base and extending through dural barrier. The primary treatment of glomus jugulotympanicum is total surgical extirpation. However, it can cause injury of cranial nerves and major vessels at the cranial base. We present two cases of glomus jugulotympanicum and reviewed the surgical techniques with special emphasis on the manipulation of facial nerve and postoperative cranial nerve palsy.