Tuberculous cervical lymphadenitis is one of common cause of neck mass in young adult in Korea. Tuberculous cervical lymphadenitis known as scrofula was being treated by the 'Royal Touch' in the 5th century and by surgery in the 17th century, yet the principle of the treatment is still controversal. We report the clinical evaluation and therapeutic result about 121 tuberculous cervical lymphadenitis. The result were as follows: 1) The annual incidence(1985-1994) was 30.5 % (37 cases: 1985-1986), 17.7 % (21 cases: 1990-1992). 19.8%(24 cases: 1994). 2) The age of highest incidence was 20-29 year old age group in 41.3% (50 cases) and female predominated over male by 1.8 : 1. 3) The duration of disease was less than 6 months, in 85.9% (104 cases). 4) The most commonly involved LN group was superficial cervical group in 69.4% (84 cases), and difference between Rt & Lt, was not significant. 5) The most common symptom and local finding(P/E) were, painless swelling of LN in 74.3 % (90 cases) and single mass in 59.5 % (72 cases). 6) In seasonal variation, 85.9% (104 cases) was spring and summer. 7) Procedures except biopsy for evaluation were chest PA, AFB smear & culture(sputum), Mantoux test, USG, CT and, Associated extracervical tuberculous lesions were lung, axilla, breast. 8) In operation method (involving biopsy), Excision was 68.5 % (83 cases), neck dissection was 6.6% (8 cases). 9) The Modality, Duration and side effect of antituberculous medication: INH-Rifampin­Ethambutol was 66.1 % (88 cases), duration was 1 year in 84.3% (102 cases), side effects were severe GI trouble (24.8%), liver function damage (3.3%). 10) 3 cases recurred on the same site after 2 yrs(2 cases) and 4 months(1 case) and its treatment was curretage or I & D, with antituberculous medication.

This study was retrospectively reviewed and analysis of postoperative local complication on all patient undergoing thyroid operation of 242 cases of thyroid disease, at Department of General Surgery, Chosun University Hospital from January 1988 to December 1992. The result were follow: Postoperative local complication are as follow; 52 cases of transient hypocalcemia, 7 cases of thansient hoarseness, 3 cases of permanent hypocalcemia, 2 cases of permanent hoarseness, and other local complication were postoperative bleeding with airway obstraction, hematoma, infection. In pathologic classification according to complicative patients; The most common frequency of complication in benign disease was Graves' disease with 13 cases(54.2%), and the most frequency of complication in malignance disease was follicalar adenocarcinoma with 7 cases(53.9%). The frequency of complication according to operation procedure were unilateral lobectomy in 31 cases(19.9%), subtotal thyroidectomy in 15 cases(39.5%), near total thyroidectomy in 12 cases (44.4%), and total thyroidectomy in 10 cases(55.6%). There was a significant relationship between extent of operative procedure and frequency of complication. The incidence of local complication after thyroid resection was 57 of 196(29.1%) in the benign disease that was 15 of 26(57.7 %) in the intrathyroidal carcinoma and 13 of 20(65.0%) in the extrathyroidal carcinoma. There was significant different in frequency of local complication according to invasion and malignance of pathologic lesion. The most frequent complication after thyroid resection is transient hypocalcemia ; 39 of 196(19.9%) in the benign disease, 7 of 26(26.9%) in the intrathyroida1 carcinoma, and 6 of 10(30.0%) in the extrathyroidal carcinoma. Their complication rate increased in direct relationship to the invasion and malignance of pathologic lesion, but there was no statistically significant. Transient hypocalcemia was encountered in 52 cases of the total 242 patient(21.9%) ; 29 of 156(18.6%) after unilateral lobectomy, 9 of 38(23.7%) after subtotal thyroidectomy, and 5 of 18(27.8 %) after total thyroidectomy. The relation ship between temporal hypocalcemia and the extent of surgery was not statistically significant.

We analyzed the results of ethanol sclerotherapy in 47 patients with cystic thyroid lesion. Cytologic study showed all of the lesions to be benign. The patients were followed clinically and ultrasonically I month and 3 or more months after ethanol sclerotherapy. If the cystic lesions recurred, repeated treatment was offered. In 4 patients with pure cystic lesion, all of the patents had almost total resolution of the cystic lesions. In 43 patients with mixed cystic lesion, 16(37.2%) patients had almost total resolution of the cystic lesions, 10(23.3%) patients showed a decrease' in the cystic lesion of <50%, but 11(25.6%) patients it did not change in size. Overall, in 30(63.8%) patients the cystic lesion decreased in size. Eleven patients who were not effective by sclerotherapy or follicular proliferation by cytology were converted to surgery. Although no severe complication were observed, there were complication of severe pain in I patient and a drunken feeling in I patient. If the malignancy must be excluded by repeated cytologic examination of aspirated fluid, we consider instillation of ethanol into the cystic lesions of the thyroid to be a simple, safe, economical and effective treatment.

Melanoma of the mucous membrane is a rare condition and has the worse prognosis than that of any other sites. It is usually asymptomatic in early stage and difficult to find out the primary lesion by visual examination, and these facts lead to delay in diagnosis and reduce the curability. The major factor of failure in treatment of melanoma is local recurrence rather than regional spread. Because the radical procedure is difficult in head and neck lesion due to anatomical limitation, radiation therapy and chemotherapy can be used in the treatment of local recurrence. We experienced two cases of nasopharyngeal melanoma in advanced stage and treated them with radiation therapy and/or chemotherapy. And both patients showed relatively favorable response to these palliative treatments.

Localized non-Hodgkin's lymphomas of head and neck are generally treated with radiation therapy with or without chemotherapy and the results of treatments are favorable, but the recurrences in the primary site or distant sites are a major contributor to failure, We experiened 19 cases of localized non-Hodgkin's lymphomas for 4-year period and retrogradely analized them. We treated patients with Ann Arbor stage I and low grade histology in Working formulation with radiation therapy and patients with Ann Arbor stage II, moderate to high grade histology or extensive tumor size with combination chemotherapy, The complete responses were occurred in 15 of 19 patients (radiation therapy, 5/6 (83.3%); chemotherapy 10/13(76.9%)). 3 relapses were occurred; 2 were in local relapses and 1 was in distant leptomeningeal relapse and the counter-therapeutic modalities were successful in 2 cases. Our results suggest that Ann Arbor stage is significant prognostic factor and appropriate staging with extensive methods is important to improve the results of treatment.

Sebaceous carcinomas of the eyelids are uncommon but lethal tumors. Lesions are usually seen in the elderly, predominantly women. The meibomian glands of the tarsus are the most frequent site of origin. Less commonly, the tumor arises in other sebaceous glands, e.g., the gland of Zeis, eyebrow or caruncle. Regardless of the location, sebaceous malignancies must be considered aggressive neoplasms with a potential for regional and distant metastasis. Diagnosis may be difficult, given the low incidence and inconsistencies in histopathologic classification. Treatment requires wide surgical excision with removal of involved regional lymph nodes and exenteration is reserved for those patients with orbital involvement or diffuse intraepithelial neoplasia. Opinions are divided regarding the use of postoperative irradiation or chemotherapy. Recently we experienced 46-year-old male patient with a 12-month history of painless, firm nodule and conjunctivitis due to sebaceous carcinoma of the left upper eyelid. After surgery, serial sections of the entire conjunctiva and eyelids showed a positive cut margin in medial and lateral border. We report herein this patient that supports irradiation as the postoperative treatment of these tumors in selected patients with a review of literatures.

저자들은 14례의 구인두암례에서 원발병소를 절제한 후 그 결손을 대흉근피판을 이용하여 동시에 재건하였다. 합병증으로는 근피판의 전괴사가 1례, 부분괴사가 3례, 창상감염이 1례, 혈종 2례, 하악골수염 및 불유합이 각 1례, 공여부위의 혈종이 1례 있었다. 인두피부누공 3례는 피판의 전괴사 및 부분괴사의 3례이었으며 변연절제(debridement)시 인두피부누공을 만든 예이었다. 8례에서는 합병증이 없었으나 6례에서 총 12건의 합병증이 발생하였다. 대부분의 합병증은 변연절제를 제외하고는 이차적인 재건술식 없이 치유되었다. 편도주위의 결손은 재건을 필요로하는 면적은 많으나 그 부피가 작아 재건이 어려웠으며 경부피부 혹은 구강 등 타 부위보다 합병증이 많음을 경험하였으나 대흉근피판은 안전하고 쉽게 사용할 수 있는 유용한 재건방법이었으며 특히 구강과 경부가 통하는 경우에도 경동맥을 안전하게 보호할 수 있는 방법이었다. 하지만 편도주위의 재건에는 피판이 필연적으로 접히게 되므로 대흉근피판의 부피가 큰 것이 단점으로 사료되었다. 따라서 편도주위의 재건에 있어서는 대흉근의 두께 및 피하조직의 두께, 근피판의 적응, 디자인, 술기, 수술후 처치 등 선택에 보다 신중을 기해야 할 것으로 사료되었다. 이를 위하여 저자들이 사용하는 bilobular모양이 피판의 부피를 줄일 수 있는 한 방법으로 사료되었다.

A large lateral facial defects especially a through and through defect of the cheek remains as challenging field of reconstruction for the head and neck surgeons. Closure of these wounds is technically troublesome due to the magnitude and location of the soft tissue and skin defect, functional and aesthetic consideration. optimal cancer surveillance, and desire for good nourishment. Most traditional methods dealing with these defects, including split-thickness skin graft, local and regional flaps as well as musculocutaneous flaps have their limitations. We applied four different methods for these reconstruction in four cases. We utilized temporal muscle flap, forearm free flap and secondary healing for repair of mucosal defects, and medial base cervicopectoral flap, pectoralis major myocutaneous flap and cervicofacial flap for the reconstruction of external skin defects. In one case, both sides were reconstructed with single forearm free flap. In our experiences, secondary healing could be one of the useful method for mucosal repair in the defect between upper and lower gingivobuccal sulcus. However, forearm free flap was thought to be more ideal for the cases with mandibulectomy. For the external repair, the regional skin flap was considered to be superior to pectoralis major myocutaneous flap or forearm free flap especially on color matching.

Branchial cleft cyst is rarely encountered congenital neck disease. It is commonly believed that the branchial anomaly is persistance of remnant of the embryologic branchial apparatus. Among the patients visited Kyung Hee Medical Center with neck mass and inflammatory sign from January, 1980 to Aprial, 1994, we reviewed 26 cases of branchial cleft cysts confirmed by histopathologic findings with retrospective study on clinical aspects. The results are as follows: 1) There was no sex difference(14 male and 12 female), and most common between 2nd and 4th decade(21 cases, 80%). 2) Palpable mass was most common complaint(21 cases). In physical exam, the mass was non-tender, mobile and soft in most cases(over 80%). 3) The most common lesion site was anterior triangle in 15 cases. Along the SCM level, 21 cases were in upper 1/3, 2 cases in middle 1/3 and 3 cases in lower 1/3. 4) According to Bailey's classification, type II were 20 cases(76.9%), type I 5 cases(19.2%) and type III 1 case. 5) Among 28 cases, fistulous tract was found in 6 cases: one was complete type and 5 were incomplete type. 6) Among 26 cases before operation, 10 cases were diagnosed as branchial cleft cyst, 6 cases tuberculosis, 3 cases parotid tumor and 2 cases thyroglossal duct cyst. 7) Type of lining epithelium in histopathologic finding was stratified squamous epithelium in 22 cases(84.6%), mixed type in 4 cases(15.4%).

Clincal observation was made on 76 cases of thyroglossal duct cyst and fistula with brief review of literature. All of the cases were diagnosed and treated surgically in Kyung Hee University Hospital from 1971 to 1993. The following results were obtained. 1) Most cases were under 20 years old(72.3%). and 49(64.5%) cases were male and 27(35.5%) cases were female. 2) Morphologically cystic type were found in 60(78.9%) cases and fistula type were 16(21.1%) cases. 3) Fluctuating cystic mass and pus discharge from fistula on just below the hyoid bone at midline of anterior neck were most common symptoms and signs. 4) 9(11.8%) cases were recurrent type and 4(5.3%) cases were recurred twice, at the time of first visit. 5) There were 2(2.6%) cases of having connection with the thyroid gland which were identified grossly on the operation field. 6) The entire cases were operated according to the Sistrunk procedure under the general anesthesia. 7) There was no recurrence and other complication except 4(5.3%) cases of wound infection.

두경부 림프종은 두경부 림프절에 발생하는 호지킨씨병과 림프절외 림프종이 주종인 비호지킨 림프종 두종류가 있으며 이들 모두 완치율이 매우 높은 암종에 속하므로 병리학적 진단 후 정확한 병기분류를 위하여 권유되고 있는 검사들을 빠짐없이 실시하여야 된다. 조직학적 분류 및 병기가 결정된 후 내과종양의와 치료방사선의사 사이에 충분한 의 견교환을 거쳐 일차치료에 의한 근치를 유도키 위해 최선의 치료를 선택 실시함이 두경부 림프종 치료의 원칙이다.