Nodular thyroid disease is a common clinical problem. The problem in clinical practice is to distinguish malignant or potentially malignant tumor from harmless nodules. The cases of thyroid nodule surgically managed at Department of General Surgery, Soon Chun Hyang Univ. Hospital during the period Jan. 1985 to July. 1992 were reviewed retrospectively. To assess method of distinguishing malignant from benign lesions of the thyroid gland, we reviewed 162 patients with thyroid nodule. There were 61(37.7%) malignant nodules and 101(62.3%) benign nodules. According to the review, distinguishing the benign from the malignant nodule with history, physical examination, clinical manifestation, and duration of illness was not suggested sufficiently. In ultrasonogram of 73 cases, 57.5% of nodules were solid, 20.6% were cystic, 21.9% were mixed solid and cystic. Of these, 28.5% of the operated solid lesions, 12.5% of the mixed lesions, and only 6.7% of the cystic lesions were malignant. Thyroid scanning of 82 cases revealed cold nodules in 60 patients(73.2%), of which 26 cases were malignant(36.6%) 137 patients underwent fine needle aspiration cytology(FNAC), and these results were as follow: sensitiviey was 70.6%, specificity was 93.0%, false-positive rate was 14.3%, and false-negative rate was 15.8%. 41 patients underwent frozen biopsy, and the results as follow: sensitivity was 80.0%, specificity was 89.7%. Neither scintigraphy nor ultrasonogram has sufficient specificity to distinguish benign from malignant nodule. But FNAC and frozen biopsy have sufficient accuracy to differentiate benign from malignant nodule. In the benign nodules, the most common type of operation was total lobectomy (60.4%). Of the malignant nodules, total thyroidectomy with or without modified radical neck dissection was performed in 30 cases(49.2%). We conclude that the single technique used to determine the differential diagnosis of a thyroid nodule are unrealiable. It is therefore essential to combine all avaiable clinical and laboratory information.

The indolent course of most thyroid papillary carcinomas, even the presence of regional lymph node metastasis, make them unique among human malignant head and neck cancers. Age, sex, extracapsular invasion and anaplastic change are known to be correlated with prognosis. The purpose of this study is to clarify the significance of DNA content analysis as a prognostic factor. Twenty five thyroid papillary carcinomas were possible to be examined by flow cytometric analysis using fresh surgical specimens and three nodular hyperplasias and seven follicular adenomas were included as control group. The results were as follows: l) All of twenty five thyroid papillary carcinomas showed diploidy. 2) S-phase fraction was $1.94{\pm}2.77%$ in normal control group and $2.60{\pm}2.66%$ in papillary carcinoma group. The proliferation index was $8.44{\pm}3.89%$ in normal control and $7.70{\pm}3.63%$ in papillary carcinoma group with even low value. 3) Age, sex, extracapsular spread and lymph node metastasis showed no significant difference. In conclusion, low proliferative activity of thyroid papillary carcinomas are thought to be related with good prognosis.

During a 9-year period(March 1985 to February 1994), 111 consecutive total thyroidectomies and modified or radical neck dissections were performed at 81. Vincent Hospital, Catholic University Medical College, for benign and malignant disease. There were three permanent complications, persistent hypoparathyroidism, in total thyroidectomies. Overall complications were observed 20(62.5%) in benign diseases, 47(59.5%) in malignancy. In benign and malignant thyroid diseases. the complications were transient hypoparathyroidisms (28.8%), transient hoarsenesses(21.6%), wound infections (3.6%), bleedings(3.6%), and permanent hypoparathyroidisms(2.7%). Our experience suggests that the morbidity of total thyroidectomy relates primarily to the extracapsular extension, necessitating en bloc exision accompanied by additional lymph node dissection. The low incidence of permanent complications in thyroid disease suggests the feasibility of total thyroidectomy as the operation of choice when surgeons are familiar with the technique and indications.

During the 7 years period from March 1987 to Febrary 1994, 344 patients with thyroid nodules, were admitted and operated at Department of Surgery, Collage of Medicine, Hallym university. We obtained following results: 1) The thyroid nodules were prevalent in female with ratio 1:17.1, both benign and malignant nodules were prevalent in the forth decade(37.8%:25.8%). 2) The duration of illness within 6 months was most common: 47.1% and within 1 years was 66.6%. 3) The most prominent symptoms & sign were palpable mass in anterior neck(96.8%). 4) The right-sided thyroid nodules were most common. 5) Thyroid scaning and thyroid function test were found to be not much value in differentiating malignancy. 6) Accuracy of the fine needle aspiration cytology was 75.5%. 7) There were 251 cases(73.0%) of benign and 93 cases(27.0%) of malignant nodules: most frequent benign nodule was adenomatous goiter(67.7%) and the most frequent malignant nodule was papillary adenocarcinoma (86.0%). 8) The most commonly performed surgical procedure was unilateral lobectomy with isthmectomy in both benign(41.0%) and malignant(33.3%). 9) Postoperative complications are as follows: transient hypothyroidism 22cases, transient hoaseness 16 cases, hypothyroidism 6 cases, wound infection 4 cases, hematoma 3 cases, permanent hoaseness 2 cases.

One hundred fifty four cases of branchial anomaly treated from January 1987 to July 1993 were analysed to determine clinical features, embryologic and anatomic types of the branchial cleft anomaly, to investigate the differences between adults and pediatrics, and to establish the appropriate treatment plan. The male to female ratio was not signifiacntly different in pediatric and adult patients. The mean symptom duration was 0.5 years(range 0.08-14 years) in pediatric patients and 1.67 years (0.7-7 years) in adult patients. The clinical presentations of these anomalies were lateral neck mass in 112(72.7%), infected discharge in 22(14.3%), non-infected discharge in 6(3.9%), and abscess in 14 cases(9.l%). Sites of the lesions were upper third of the neck in 93(60.3%), infraauricular in 35(22.7%), middle third of the neck in 17(11.0%) and inferior third of the neck in 9 cases(5.8%). The anatomic types were cystic form in 117(75.9%), sinus in 24(15.5%), and fistula in 13 cases(8.4%). Embryologic classification were 124 second branchial cleft anomalies(80.5%), 29 first branchial cleft anomalies(18.8%), and 1 third branchial cleft anomaly(0.6%). Immediate surgery under the uncontrolled infection in 17 cases result in 82.4% recurrent rate(14 cases), and 17.6% cure rate(3 cases). Delayed surgery under the controlled infection in 8 cases recurrent rate(1 case), and 87.5% cure rate(7 cases). In summary, the most common branchial cleft anomaly is second type cyst both in pediatric and adult group, delayed surgical exterpation after infection control with I & D or antibiotics may give a good chance for care and may reduce the recurrence.

Maxillary cancer is usually detected late, and the majority of patients have advanced($T_3\;or\;T_4$) diseases at the first diagnosis. It invades outside the maxillary antrum, superiorly the orbit, ethmoid sinus and the anterior cranial base, anteriorly the facial skin. If the cancer extends through the posterior antral wall, the pterygoid plates, pterygoid muscles and infratemporal fossa are to be involved that make the conventional maxillectomy impossible to remove all the involved structures in infratemporal fossa completely. So, more extensive surgical apprdoach is necessary. We report surgical experience using infratemporal fossa approach(lateral facial approach) in four cases of maxillary cancer and one case of hard palate cancer which extends through the posterior antral wall and involving pterygoid muscles, pterygoid plates and temporalis muscle.

To provide the wide and satisfactory surgical field is essential requirement for en-bloc resection of nasopharyngeal angiofibroma invading central skull base. The new design of the surgical approach to the skull base lesions was developed and described the details of this technique and its usefullness. We compared the usefullness of naso-maxillary approach to that of infratemporal fossa approach in cases of angiofibroma invading skull base. Our experience indicates that the naso-maxillary swing approach is better than lateral approach for the large nasopharyngeal angiofibroma. A new approach. naso-maxillary swing approach. is described.

The malignant tumor of nasopharynx occurs in china and other oriental contries as high incidence and its prognosis is relatively poor because of frequent intracranial extension and early metastasis. Traditional therapeutic modality of nasopharyngeal cancer was definite radiotherapy, but recently some cancer institute had tried combined modality with induction chemotherapy and reported it may be valuable. We report the clinical evaluation and therapeutic result about 28 nasopharyngeal cancer patients which were treated with 2 courses of induction chemotherapy(Cisplatin+5-FU) and radiotherapy. The results were as follows: 1) The 3 years and 5 years survival rate were 76% and 47% in total patients. 2) The 3 years and 5 years survival rate were 92% and 63% in T1, T2, T3 group, and 25% and 0% in T4 group. 3) The 3 year and 5 year survival rate were 100% and 60% in neck node negative group, and 60% and 40% in neck node positive group. 4) The 3 year and 5 years survival rate were 100% and 50% in stage I II group, and 71% and 44% in stage III, IV group.

최근 10년간 후두전적출술을 시행하였던 159례 중 기공주변 재발이 발생하였던 12례에 대하여 후향적으로 분석함으로써 다음과 같은 결과를 얻었다. 1) 기공주변의 재발은 1차 치료종결후 평균 8.23개월에 발견되었으며, 발생빈도는 7.55%이었다. 2) 추정 원인은 광범위한 원발병소로 인한 부적절한 절재연, 기관절개술후 근치수술의 지연, 불완전한 림프전이절의 처리 순이었다. 3) 7례는 항암화학요법(국소 또는 전신적)과 고식적 방사선요법을 시행하였으며, 5례는 구제수술을 시행한 후 고식적 방사선요법 및 항암화학요법을 시행하였으나 구제수술을 받은 제 1형 1례를 제외하고는 모두 사망하였으며, 평균 생존기간은 $7.32{\pm}5.61$개월 이었다. 이상의 성적에서 기공주변의 재발 가능성이 높은 고위험군에 대하여는 광범위한 절제 후 적극적인 추적관찰과 더불어 과감한 구제수술로 생존기간을 연장할 수 있을 것으로 생각되었다.

It is the purpose of this paper to determine the relative frequency of the neoplastic vs. non-neoplastic disease in a series of surgically removed parotid and submandibular masses. The study was conducted a retrospective review of 249 consecutive, operated patients' records seen over a 9-year period from 1985 through 1993 at Department of Otolaryngology-Head and Neck Surgery, Korea Cancer Center Hospital. One hundred and fifteen patients had parotid mass and 134 patients had submandibular mass. All the specimen surgically removed were studied histopathologically. The numbers and percentages of patients are reported along with a pathological classification of the lesions encountered: neoplastic(benign, malignant) and non-neoplastic (inflammatory, non-inflammatory). There were 59 benign, 46 malignant, 6 inflammatory, 4 non-inflammatory in 115 parotid mass, and 33 benign, 48 malgnant, 47 inflammatory, 6 non-inflammatory in 134 submandibular mass. One-hundred-eighty-six of entire 249 patients had tumor involvement, for a 74.7% incidence of neoplasia. There was a neoplastic predominance in parotid mass(91.3%) and a relative inflammatory predominance in submandibular mass(35.1%).

Segmental mandibulectomy causes severe functional disability and cosmetic problem. Many methods of reconstruction have been used but none of these procedures provides the ideal solution. There has been increased interest in the possibility of preserving a portion of the mandible and still carrying out a adequate tumor resection. We experienced four cases of marginal with sagittal mandibulectomy in patients with floor of mouth. buccal. and soft palate carcinoma, and sagittal mandibulectomy in 8 patients with tonsillar carcinoma and a case of marginal mandibulectomy in tonsillar cancer patient. In all cases mandible facing the tumor were successfully resected and repair of the mandible. postoperative facial contour were satisfactory. We think. that these sagittal procedures are oncologically sound in its removal of tumor. biomechanically secure and maximize postoperative rehabilitation while maintaining the normal contour of the face.

We reviewed retrospectively 152 patients' records with salivary gland tumors confirmed histologically at Hanyang University Hospital from Jan. 1984 to Dec. 1993. The results obtained were as follows: 1) Sites of tumors were parotid gland in 102 cases(67%), submandibular gland in 29 cases(19%) and minor salivary glands in 21 cases (14%). 2) 113 cases(74%) were benign. and 39 cases(26%) were malignant. 3) The incidence of benign and malignant tumors were 81% & 19%, 69% & 31% and 48% & 52% in the parotid gland, the submandibular gland and the minor salivary glands respectively. 4) The most frequent histologic types of benign and malignant tumors were pleomorphic adenoma (64%) and mucoepidermoid carcinoma (11%) respectively. 5) The surgical procedures include superficial parotidectomy. total parotidectomy. extended total parotidectomy & neck dissection in the parotid gland. wide excision & neck dissection in the submandibular gland and wide excision, partial maxillectomy & neck dissection in the minor salivary glands. 6) The postoperative recurrence rate were 4.4% in benign tumors and 27% in malignant tumors.

저자들은 1985년부터 1992년까지 연세대학교 의과대학 영동세브란스병원에서 치료한 병기 $T_1$성문암 환자 30례를 대상으로 임상적 분석을 시행하여 다음과 같은 결과를 얻었다. 1) 병기 $T_1$성문암의 경우 남여의 비는 29:1로 남자가 대부분이었으며, 60대에 호발하였다. 2) 전례가 편평상피암이었으며 조직학적 분화도가 좋았던 경우가 13례, 중간 분화도이었던 경우가 17례이었다. 3) 초치료로 방사선치료를 한 경우 25.9%에서 재발이 있었으며, 부분후두적출술을 시행한 2례중 1례에서 재발이 있었다. 4) 재발한 경우, 전례에서, 원발부위의 재발이었고 경부재발이 동반된 경우가 1례있었으며, 1년이내 재발이 흔하였다. 5)원발부위 재발의 경우 전연합(anterior commissure)에서 재발이 빈발하였다. 6) 5년 생존율은 81.5%로 이는 병기간, 병리조직학적으로 유의한 차이는 없었다.

Authors reviewed 73 cases of primary skin cancer arising from head and neck, including comparative clinical data of 63 cases of squamous cell carcinoma and basal cell carcinoma retrospectively. There was no significant sexual predilection in each type of cancer and 77% of all cases were occurred after age of 50. The data of occurring site and occupation(farmer; 41%) implied that sunlight exposure strongly concerned in development of skin cancer. Comparing the data of 63 cases of squamous cell carcinoma and basal cell carcinoma, authors found out no remarkable difference in mean diameter of primary lesion at first visit of clinic, but some difference in mean duration, the percentage of the cases less than 1 year­duration and percentage of T1 lesion with no statistical significance(p>0.05). Combination of surgery and radiotherapy had relatively lower recurrence rate (11%) than surgery alone (13%). Squamous cell carcinoma had higher recurrence rate(34%) and metastasis rate(28%) than basal cell carcinoma; 6% and 3%, respectively(p<0.05).

Since 1950s, fine needle aspiration(FNA) cytology has become increasingly popular and numerous reports have demonstrate its accuracy, safety and cost-effectiveness. To evaluate the role of diagnostic FNA cytology in the thyroid nodule, authors compared preoperative cytologic findings with postoperative histologic diagnosis in two hundred two thyroid nodules underwent surgical resection at Department of Surgery, Pusan Paik Hospital. from July 1990 to December 1993. FNA and thyroidectomy was performed primarily by one Head and Neck surgeon and specimen was interpreted by several pathologists. One hundred seventy two FNAs(85%) were interpreted as positive for benign lesion or carcinoma and thirty(15%, cystic in 25, non-cystic lesion in 5 cases) were unsatisfactory specimens for interpretation. The preoperative cytologic diagnosis of 172 cases revealed 'benign' in 112. 'suspicious cancer' in 10 and 'cancer' in 50 cases. Postoperative pathologic diagnosis showed 'nodular goiter' in 64. 'benign tumor' in 43, 'thyroiditis' in 4 and 'cancer' in 61 cases. The value of preoperative FNA diagnosis for thyroid cancer yielded a sensitivity of 85.2%, a specificity of 92.7%, false negative rate 5.2%, false positive rate 4.5% and positive predictive value and overall accuracy were 86.6% and 90.1% respectively. Preoperative rate of malignancy could be increased up to 35.5% by using FNA.

Proliferating cell nuclear antgen(PCNA) plays an important role in DNA synthesis in nucleoli and is highly conserved non-histone nuclear protein composed of 261 amino acid. and is considered to correlated with the cells proliferative state, because it is synthesized particulary during the proliferative period of late Gland S-phase. Therefore, PCNA index meaningfully increases in the active or proliferative kinetic cells. By the use of recently developed monoclonal antibodies against PCNA, the immunohistochemical staining methods can make possible. These staining methods are the useful and productive one for ascertaining the cell's proliferating abillity. Moreover, immunohistochemical staining method with a antiPCNA antibody has particulrar advantages as follows. By means of these methods, we can stain the tissue that was already fixed in formalin or paraffin wax. We can see with naked eye that which cell is, where is differentiated through a microscope. Lastly, it maintains the whole tissue architecture and makes a search for the correlation. As we have seen above, the immunohistochemical staining methods for PCNA have been studied as an impotant factor that can find the cell proliferative kinetics in malignancy and biologic behavior of tumors. To investigate of the proliferative activity in thyroid nodule, Authors evaluated cell proliferative activity by immunostaing for PNCA in 45 pathologically confirmed solitary thyroid nodule. The results were as follows. 1) The benign nodules were 25 cases(Adenomatous Goiter: 20 cases, Follicular adenoma: 5 cases) and malignant nodules were 20 cases(Papillary Ca : 14 cases, Follicular Ca : 4 cases, Anaplastic Ca : 2 cases). 2) The Most prevalent age groups were 4th decade(11 cases), and the next group was 5th decade. 3) The average PCNA labelling indices were as follows. Adenomatous goiter(I6.9%), Follicular adenoma(37.6%), papillary Ca(26.3%), Follicular Ca(8.8%) and Anaplastic Ca(86.7%). There were no significant differences in benign(20.4) and malignant nodules (28.8%) except anaplastic Ca(p=0.3226). 4) When the average tumor size 2cm in papillary Ca, the PCNA indices were 26.0% (below 2cm) : 26.6% (above 2cm) (p=0.9642). The PCNA incidies were 23.9% (with lymphatic spread) : 28.7% (without lymphatic spread) (p=0.7056). There were no signlficant differences in the above cases. In conclusion, there were no significant differences in cell proliferative activity by staining for PCNA between benign and malignat nodules except anaplastic Ca.

1) 선천성 갑상선 발육이상 환자 9명 모두, 경부종피를 호소하였으며, 이 중 1예는 연하통을 동반하였다. 2) 선천성 갑상선 발육이상을 세분하여보면, 이소성갑상선이 44.4%,편측발육부전 및 이소성갑상선을 동반한 경우가 33.3%였고, 편측발육부전을 보인 경우가 22.2%였다. 3) 이소성갑상선을 위치별로 보면 설기저부가 6예(85.7%-1예 중복됨), 갑상설관이 2예였다. 4) 정상 갑상선기능을 보인 경우가 77.8%였고, 갑상선기능저하증을 보인 경우가 22.2%였다. 정상기능을 보인 7명의 환자 중 4명에서 갑상선자극호르몬(TSH)이 증가되어 있었다. 5) 총 9명중 7명에서는 갑상선억제요법만 시행하였고, 2명에서는 갑상선억제요법에 반응하지 않아 절제술을 시행하였으며, 2명 모두 설갑상선이었다. 수술후 계속적으로 갑상선호르몬을 복용중이다.

The Horner's syndrome includes anisocoria as a result of miosis of the involved pupil with ptosis of the upper and lower lids, which results in slight narrowing of the palpebral fissure. Ipsilateral facial hyperemia and anhidrosis over the face and neck are less common features. The findings with Horner's syndrome are a result of the loss of sympathetic innervation to the ipsilateral eye and face. Recently we experienced 3 cases of Horner's syndrome that developed postoperatively and report briefly with literature.

Soft tissue sarcoma of the head and neck is not frequent neoplasm, accounting for less than 1% of all malignant neoplasm in the region. The histological varieties include osteogenic sarcoma, malignant fibrous histiocytoma, rhabdomyosarcoma, fibrosarcoma, tenosynovial sarcoma, angiosarcoma and chondrosarcoma. Rhabdomyosarcomas of the head and neck usually occur in children under the age of 10 years (over 70%) and rarely develop in adults over the age of 20 years. The prevalent sites of involvement include the orbit, nasal cavity, external ear, paranasal sinus and soft tissue of mouth and the primary location of tumor is considered to be one of the important prognostic factors. Before the 1960s, when surgical resection was the only method of treatment, the 5-year survival rate was less than 20%, but recently it has been greatly improved by the multimodality treatment, combining surgery with chemotherapy and radiation therapy. Here we treated a rhabdomyosarcoma woman with three cycles of high dose chemotherapy followed by radiation therapy. After the, completion of preoperative treatments, successful result of more than partial response was achieved. Three months later total maxillectomy and radical neck dissection was performed. There was no evidence of tumor infiltration in the resected tumor and regional lymphnodes but metastasized tumor cells in cervical lymphnodes were detected. Tumor cell infiltration was also found on the bone marrow biopsy to evaluate the pancytopenia which occurred during postoperative recovery. Two months later she died of secondary bone marrow failure. We think that this multimodality treatment combining pre-operative chemotherapy, radiotherapy and surgery might play an important role in curative resection and eyeball preservation in patients with rhabdomyosarcoma involving the eyeball.

Squamous carcinomas of the thyroid gland are extremely rare, and its clinical course is very aggressive. It has poor prognosis, similar to that of anaplastic carcinoma. These tumors are radioresistant and often rapidly fatal. It is considered to originate from the follicular epithelium at present. Recently, authors had experienced 63-years old female patient, proved to be primary squamous cell carcinoma of the thyroid. We report this patient with a review of a literature.