Background : Though papillary microcarcinoma(PMC) of thyroid gland is known to have very favorable long-term prognosis, the recurrence in the neck and distant metastasis have been often reported. The predictive factors of node metastasis and tumor recurrence in clinical course were investigated to define surgical decision or guidelines in surgery of papillary microcarcinoma. Methods : The authors conducted a retrospective analysis of 216 patients of PMC treated with surgery at Department of Surgery, Busan Paik Hospital for the period from 1997 to 2007. Of these patients, 58 cases showing cervical lymph node metastasis at initial surgery were studied. Results : In overall 216 patients, the sex ratio of male to female was 1 : 9.3(male 21, female 195 cases), the mean age at the time of diagnosis was 44.7 years and the median tumor size was 6.61mm. Neck lymph node metastasis was found in 58 patients(26.9%), thyroid capsular invasion was 56 cases(25.9%), multifocality and bilaterality were found in 32(14.8%) and 29 cases(13.4%), respectively. Through statistical analysis, sex, capsular invasion, ETE, and tumor size(>5mm) were considered to be predictive factors of cervical lymph nodes metastasis. Of them, capsular invasion was the most predictive indicator of cervical lymph node metastasis on multivariate analysis. Nodal recurrence was observed in 6 of 58 patients of node positive at initial surgery. Conclusion : The cervical lymph node metastasis is known to be a risk factor of prognosis in PMC of thyroid gland. The results of this study showed four statistically significant independent predictive factors of cervical lymph node metastasis in PMC : capsular invasion, tumor size(>5mm), ETE, and sex. On multivariate analysis, capsular invasion was a great influencing factor in prediction of lymph node metastasis. Basically, patients who has predictive factors of cervical lymph node metastasis should have a thorough investigation, and close surveillance for nodal status is required in follow-up.

Background and Objectives : Parathyroid adenoma is a rare disease in Korea, but the incidence of parathyroid adenoma has gradually increased due to generalized measurement of serum calcium and imaging study according to wide spread public health screening program. In previous researches, the analysis of clinical aspects were insufficient due to a few cases. The purpose of this study was to assess the clinical analysis of surgically treated parathyroid adenoma with hyperparathyroidism. Methods : We reviewed the medical records of nineteen cases of parathyroid adenoma with hyperparathyroidism. Initial symptom to visit hospital, hypercalcemia associated medical symptom, surgical outcome and complication were investigated. Serum total calcium, parathyroid hormone, phosphate, alkaline phosphatase were checked before and after surgery. Imaging study was performed with combination of radionuclide parathyroid scan, ultrasonography and neck CT scan. Results : The initial symptoms were no symptom(6/19), pelvic pain(5/19), muscular weakness (3/19), bone pain(3/19) and palpable neck mass(2/19) in order of frequency. Serum total calcium, parathyroid hormone decreased and phosphate increased after surgery than before surgery statistically significantly. Sensitivities of parathyroid scan, neck ultrasonography and neck CT as preoperative localization test were 88.2%, 72.7%, 73.3% each. The most common postoperative complication was transient hypocalcemia(9/19). Conclusion : Similar to previous study, parathyroid adenomas have numerous clinical features and surgical treatment via unilateral approach with preoperatively localized single parathyroid adenoma was successful. In our study, parathyroid adenoma was predominantly detected by elevated serum calcium level with no clinical symptom so we need to evaluate parathyroid adenoma, if serum calcium elevated.

Objectives : We evaluated the use of FDG PET/CT for the identification of cervical nodal metastases of SCC of the oral cavity and oropharynx with histological correlation. Material and Methods : We reviewed 46 medical records, from January 2004 to July 2007, of patients who underwent FDG PET/CT and CT/MRI for SCC of the oral cavity and oropharynx before surgery. We recorded the lymph node metastases according to the neck level affected and the system used for the imaging-based nodal classification. Results : The FDG PET/CT had a sensitivity of 75.6% and a specificity of 96.7% ; it had a higher sensitivity than the CT/MRI for identification of cervical metastases on the side of the neck(26/28 vs. 20/28, p=0.031) and at each of the cervical levels(34/45 vs. 26/45, p=0.008). There was a significant difference in the $SUV_{max}$ between the benign and malignant cervical lymph nodes($3.31{\pm}3.23$ vs. $4.22{\pm}2.57$, p=0.028). The receiver-operating-characteristic (ROC) curve analysis for differentiating the benign from the malignant cervical lymph nodes, showed that the area under the curve(AUC) of the FDG PET/CT was 0.775. The cut-off value for the $SUV_{max}$ was 2.23 based on the ROC curve. There was a significant correlation between the $SUV_{max}$ and the size of the cervical lymph nodes(Spearman r=0.353, p=0.048). Conclusion : FDG PET/CT images were more accurate than the CT/MRI images. In addition, the $SUV_{max}$ cut-off values were important for evaluating cervical the cervical nodes in the patients with SCC of the oral cavity and oropharynx.

Objectives : In parotidectomy, facial nerve dissection technique had been evolved for its safety. Surgical landmarks are important and good guides to facial nerve detection. Conventional exposure and release of the nerve requires hemostat for elevation of parotid tissue from nerve and #11 blade for cutting the parotid away from the nerve. Material and Methods : The rolling the parotid tissue over the nerve after dissecting with Metzembaum scissors instead of knife, lessen pulling trauma and nerve cutting by knife. Eleven superficial parotidectomies since June 2009 were done with rolling technique and preliminary report is presented. Results : Total 11 parotidectomies were done using proposed technique with tolerable complications(temporary facial dysfunction in 4 cases). Conclusion : Rolling method using metzembaum scissors could be applied to parotid operation.

Necrotizing sialometaplasia was defined by Abrams et al. in 1973 as a reactive necrotizing inflammatory process involving minor salivary glands. Prior to recognition of necrotizing sialometaplasia as a benign, self-limited lesion, it was all too often diagnosed as either squamous cell carcinoma or mucoepidermoid carcinoma and had been improperly treated because of its clinical and histological resemblance to malignancy. We report two cases of necrotizing sialometaplasia. One case involved a 56-year-old female who developed a necrotizing sialometaplasia in association with palato-pharyngeal flap wound after excision of soft palate cancer and reconstruction. Another case involved a 55-year-old male who had a soft palate mass.

Tracheostomal stenosis after total laryngectomy is brothersome problem to surgeon and patient. To prevent tracheostomal stenosis, tension around the tracheostoma must be released. Advancement flap, V-Y inset and Z-plasty were suggested as solution to tracheostomal stenosis. But such methods need elevation of superior flap and it is very difficult when the patients received radiotherapy and has high change of developing pharyngocutaneous fistula. We suggested new stomaplasty technique which named "Modified Fish-Mouth Technique" that does not need to elevate superior skin flap.

Tracheo-gastric fistula is a very rare late complication of total laryngopharyngoesophagectomy with gastric pull-up procedure. It usually occurs after transhiatal esophagectomy, but it has only rarely been reported after total laryngopharyngoesophagectomy with gastric pull-up procedure. Chronic irritation and gastric ulcer may be the cause of tracheogastric fistula. To prevent fistula formation, active management of gastric ulcer and avoidance of mucosal irritation are necessary. We report a case of a tracheogastric fistula which occurred two years after total laryngopharyngoesophagectomy with gastric pull-up procedure that maybe occurred by chronic irritation and gastric ulcer.

Non-lymphoid mesenchymal neoplasms of salivary gland origin are rare, accounting for 1.4% of major salivary gland tumors. Of this group 30% were hemangiomas. Hemangiomas are the most common benign tumors in children, but are rare in old ages. 90% of hemangiomas arise in the first three decades of life. Hemangiomas are classified as capillary(including juvenile type), cavernous, or mixed in type. Salivary gland hemangioma is more common in the parotid(90%) and extremely rare in submandibular gland. We present two adult patients, 69 and 60 years of age, who were referred for palpable mass in the parotid area and submandibular area, respectively. After surgical removal of the lesion, histopathologic examination showed characteristic feature of cavernous hemangioma. The rarity of such a lesion in these locations in old ages have prompted this case report.

Ectopic hamartomatous thymoma is a rare benign tumor of the lower neck occurring in the male adult predominantly. The origin of this tumor has been debated, but it is now believed to arise from remnants of the cervical sinus of His from early development. They are composed of epithelial, adipocytic, and spindle cells in variable amounts. Recognition of ectopic harmatomatous thymoma is important and needs to be differentiated from high-grade sarcomas such as synovial sarcoma or glandular malignant peripheral nerve sheath tumor. We here report on a case of ectopic hamartomatous thymoma arising in the left lateral neck of 33-year-old male patient.

Hemangiomas are the most common benign tumors or tumor-like malformations of blood vessels or blood filled cavernous spaces. Hemangiomas of the oral cavity represents 14% of all hemangiomas. Most hemangiomas are detected by one year of age and most commonly occurred in the lips, tongue, buccal mucosa and palate. But hemangiomas are sometimes reported in adults. We report one case of extensive hemangioma of the tongue in adult. Our case is a 48-year-old male who presented with a hemangioma occupying entirely two-third of the tongue. Treating those lesions pose a challenge to the surgeon. This paper discusses one case of extensive tongue hemangiomas treated with alcoholic sclerotherapy with satisfactory results supporting this particular approach in the management of these lesion.

Accessory tragus is an uncommon congenital anomaly of the external ear. The tragus derives from the first branchial arch. The accessory tragus can be found along the entire course of embryonic migration. Usually it appears as a small papules arising near the tragus, but rarely, along an imaginary line drawn back from the tragus to the angle of the mouth, or along the anterior edge of the sternocleidomastoid muscle and the sternoclavicular region. We experienced a case of accessory tragi on the suprasternal region in an 9 year-old-boy.