The pathophysiology of Gastroesophageal reflux disease (GERD) has been known that it is developed when the offense-primarily the gastric acid-pepsin content of the refluxate-overcomes a 3-tiered esophageal protective defense. consisting of antireflux mechanisms, luminal clearance mechanisms, and tissue resistance. Laryngopharyngeal reflux (LPR), which is known as an extraesophageal variant of GERD, has been considered to be developed by transient lower esophageal sphincter relaxation (TLESR), direct mucosal injury by gastric contents, more sensitive mucosa compared to esophagus, and absence of buffering effect and aggravation of the injury due to pepsin. However, hypothesis of the pathophysiology in both entities are numerous and still lack of understanding for being a theory. There is no conflict that understanding the pathophysiology is necessary for resolving the problems of these diseases and numerous studies and results have been releasing. This review could provide clinicians dealing with GERD and LPR with applicable new information and help for overcoming the clinical obstruction.

Transnasal esophagoscopy allows. the upper aerodigestive tract, from the nasal cavity to the gastric cardia to be examined in the outpatients department. It is well tolerated by patient with topical anesthesia alone and no sedation or patient preparation is required. The technique is easily learned and performed in the otolaryngologist and highly cost efficient. It is a useful tool for accurate diagnosis and can be used in a variety of office-based procedures.

Gastroesophageal reflux disease (GERD) is a common disorder caused by the reflux of gastric contents into the esophagus. According to the recent classification, GERD can elicit esophageal and extraesophageal syndromes. Laryngopharyngeal reflux (LPR) is defined as laryngeal symptoms with laryngeal inflammation caused by the acid reflux. The prevalence of GERD and LPR is increasing during the past decades in Korea and management of GERD and LPR is a challenging issue in clinical practice. Proton pump inhibitor is the most effective drug in the treatment of GERD. Most patients with LPR are given a 2-month trial of a proton pump inhibitor (PPI), however, there is still little evidence on the diagnosis or the treatment of LPR. During the last years concern have been raised regarding the risk of averse events related to long-term use of PPI. We review the recent update on medical treatment of GERD/LPR.

The prevalence of gastroesophageal reflux disease(GERD) has been increased recently in Korea. Most patients who have GERD are well treated by medication. But patients who have suboptimal disease control under medical therapy are needed further treatment. Nowadays minimally invasive surgery using laparoscopy and thoracoscopy has become popular in the operation of GERD although antireflux surgery is vary. Antireflux surgery is a well-documented, effective therapeutic alternative to control GERD.

Background: The aim of this study was to compare a novel mannose receptor-binding agent(Technetium-99m human serum albumin, $^{99m}Tc$-MSA) with $^{99m}Tc$-phytate for sentinel node mapping in patients with esophageal cancer. Material and Method: Twenty patients with clinical stage T1N0m0 or T2N0M0 esophageal cancer that were candidates for esophagectomy were enrolled. Endoscopic injection of $^{99m}Tc$-MSA or $^{99m}Tc$-phytate was administered at the peri-tumor region before surgery in 10 patients. The radioactive lymph nodes were identified with a handheld gamma probe after lymph node dissection. Results: The patient's age and the sex ratio of both groups were similar. The clinical stage, tumor location, and operative technique did not differ. The total number of dissected lymph nodes did not differ ($28.5{\pm}9.12$ in MSA group, $32.2{\pm}11.24$ in phytate group, p=0.430). The sentinel node was identified in all cases in both groups. The number of sentinel nodes per patient was $2.7{\pm}1.57$ in the MSA group, which was significantly greater than the $1.7{\pm}0.88$ in the phytate group (p=0.036). Five out of 20 patients whose sentinel nodes could be identified had metastases; however, neither group had any false-negative results for sentinel node identification. Conclusion: Sentinel nodes were detected more frequently with MSA than with phytate.

Background: Pediatric deep neck infection can cause critical complications in that they are seldom able to verbalize symptoms or cooperate with physical examination. The objective of this study is to identify the clinical characteristics according to age. Material and Method: A retrospective study was performed on 26 cases with pediatric deep neck infection during 12 years. Patients were classified infancy group (1-7 yr, 19.2%), preschool age group (7-15 yr, 30.8%) and school age group (15 yr-, 50%). We analyzed the age, sex, sites of abscess, predisposing factors, symptoms and compared onset, hospital date, laboratory and outcomes at each group. Results: In pediatric patients with deep neck infection, the age distribution was 18 males (69.2%) and 8 females (30.8%), the mean age was 7.4 years. The most common infection site was the anterior cervical triangle and submandibular space (19.2%). The most commonly known associated preceding disease was upper viral infection (34.6%), but we could not find the preceding diseases in most of cases (50%). Neck swelling (69.2%) was the most frequent symptom. The mean age of patients who performed neck CT was 8.23 years and neck US was 2.75 years. The younger patients were preferred to perform the neck US than the neck CT (p=0.022). The mean time from disease onset to admission was 9 days in the infancy, 5.5 days in the preschool aged and 5 days in the school aged group. The surgical treatment was performed in 30.8% of school aged, 62.5% of preschool aged and 100% of infancy group. Surgical treatment was preferred to younger patients (p=0.026). Conclusion: Abscess sites, size, and antibiotics susceptibility and especially patient age should be carefully considered in treating pediatric deep neck infection.

Background: Penetrating neck injuries are potentially dangerous and require emergency management because of the presence of vital structures in the neck. The risk of airway, vascular, neurological, and pharyngoesophageal injuries leads to many difficult diagnostic decisions. The purpose of this retrospective study is to evaluate our experience with management of penetrating neck injuries, and to assess treatment outcome. Material and Method: Forty-two consecutive patients were identified (26 patients from Korea university Ansan hospital, 16 patients from Guro hospital) as having penetrating neck injuries from 2003 to 2009. With review of medical records, variables were collected and evaluated including the location of injury, mechanism of injury, number of significant injuries, diagnostic modalities, duration of hospital stay and outcome. Results: The location of injury was zone I (lower neck) in 13 cases (31%), zone II (midportion of the neck) in 22 (52%), and zone III (upper neck) in 7 (17%). Injuries were caused by stab wounds in 23 patients, penetrating foreign bodies in 12. Among 35 patients who had deep injuries that violated the platysma, significant injuries, including major vascular (20), trachea (5) Pharyngoesophageal injuries (5) were identified in 24 patients. The mean hospital stay was 9.5 days. Conclusion: The penetrating trauma in the neck may show various degrees of severity. However, Cervical penetrating injury should not be underestimated in spite of the minimal width of the lesion.

Background: The esophageal perforation is related to high morbidity and mortality rates if the diagnosis and treatment are delayed. The aim of this study is to evaluate the affecting factors on outcome and prognosis of the patients who suffer from esophageal perforation. Material and Methods: Twenty-six patients were treated with esophageal perforation in our institute from Jan. 1992 to Feb. 2010. We retrospectively reviewed the results of treatment for esophageal perforation to understand the risk factors affecting survival in patients. Results: The subjects are 26 patients suffered with esophageal perforation and the mean age is $52{\pm}17.8$ years old. 16 esophageal perforations were caused spontaneously, 25 cases were treated surgically. The mortality rate is higher in the cases o pre-operative mediastinitis. Conclusion: The shortness time interval until the beginning of treatment should be achieved to reduce the incidence of fatal post-treatment morbidity and mortality.

Background: Montgomery T-tube is widely used to maintain airway in many cases. Market-available tubes are not always fit to the trachea of each patient and need some modification such as trimming. Complications do happen in prolonged use like tracheostomy tubes. To overcome above limitations, we designed custom-made T-tube using CT data with the aid of 3D reconstruction software. Material and Method: Boundaries were extracted from neck CT data of normal person and processed by surface rendering methods. Real laryngotracheal model and tracheal inner surface-mimicking tube model were made with plaster and rubber. The main tube was designed by accumulation of circles or simple closed curves made from boundaries. Stomal tube was made by accumulation of squares due to limitation of software. Measurement data of tracheal lumen were used to custom-made T-tubes. Tracheal lumen residing portion (vertical limb) was made like circular cylinder or simple closed curved cylinder. Stomal portion (horizontal limb) was designed like square cylinder. Results: Custom made T-tube with cylindric vertical limb and horizontal limb of square cylinder was designed. Conclusion: CT data was helpful in making custom made T-tube with 3D reconstruction technique. If suitable materials are available, commercial T-tube can be printed out from 3D printers.

Background: Tracheal deviations are encountered frequently in head and neck tumors especially in thyroid cancer. Dyspnea and stridor are symptom calling for surgery. The method of evaluation in tracheal deviation is not well established yet. This paper is aimed to suggest objective tools to evaluate tracheal deviation in relation to cervical vertebra. Material and Method: Ten cases of thyroid cancers were recruited retrospectively. Tracheal inner shadow and shape of cervical vertebra were reconstructed three dimensionally using 3D-doctor to compare position of trachea in relation to vertebral body. Extent of deviation was scored in relation to both lateral borders of vertebral body. Angles between trachea and spinous process were measured in axial CT and compared between study group and control group. Results: Deviation scores were statistically significant between study group (mean=1.1) and control group (mean=0) (p=0.0008). Deviation angles at maximal tumor size in study group (mean=160.3 Degrees) and deviation angles of control group (mean=177.1 Degrees) were statistically significant (p=0.0007). Angles at maximal deviation of three dimensional images ages in study group (mean=162.6 Degrees) and deviation angles of control group (mean=177.1 Degrees) were statistically significant (p=0.0089). Conclusion: Tracheal deviation can be evaluated using scoring of three dimensional images and measuring angle between trachea and vertebral spine.

Background: Laryngeal papillomatosis, which is cased by human papillomavirus, is the most common benign neoplasm of the larynx. However, the prognosis of this disease remains really unpredictable. The aim of this paper is to determine whether any clinical features at the time of diagnosis could predict its course. Material and Method: Eighty-six patients treated at our institution during the last 20 years were analyzed retrospectively. All patients had microsurgery under general anesthesia. All patients' follow-up period was more than 1 year. We divided the patients into 1) Juvenile versus adult group based on their age 20, 2) single surgical method with laser versus dual surgical method with laser and microdebrider group, and 3) single subsite versus multiple subsites group. And we compared the therapeutic outcome. Results: The recurrence rate was 100% (15 patients) in the JP group and 56% (40 patients) in the AP group. Juvenile versus adult group was the only independent prognostic factor by univariate, and multivariate analysis. Microdebrider resection technique and multiple subsites were not associated with treatment result. Time period from the first surgery to recurrence detection was different statistically only for the age group. The number of surgery in the JP group ranged from 1 to 31 (mean 8.8). In the AP group the number of surgery ranged from 1 to 25 (mean 3.7). It was statistically different. Conclusion: Prognosis for the laryngeal papillomatosis remains unpredictable. Only patients' age was the only independent prognostic factor.

Lemierre syndrome, also known as postanginal sepsis, is a severe complication of an acute oropharyngeal infection that result in septic thrombophlebitis of the internal jugular vein with subsequent septicemia. This disease is relatively rare, but it has significant morbidity and is potentially fatal. Early diagnosis based on computed tomography with contrast enhancement is mandatory and immediate treatment including intravenous antibiotics, anticoagulants, or surgical approach should be considered. We report a case of Lemierre syndrome after deep neck infection which was successfully treated using antibiotics and anticoagulants.

We report a case of actinomycotic infection in epiglottis. Actinomycosis in the head and neck area is relatively rare but extremely rare in the larynx. A 63-year old man presented with continuous discomfort of the throat while swallowing. He had a history of oral injury caused by a fish bone a few weeks prior. Upon Examination with a flexible laryngoscope, a whitish round mass was noted at the lingual surface of the epiglottis. Under local anesthesia, a punch biopsy was performed and showed the typical features of actinomycosis. The mass was removed using a Diode laser under suspension laryngoscope. Additive oral antibiotic therapy was done for 2 weeks. No definite recurrence was noted at the operation site and the patient is now free of disease.

Tetanus is a life-threatening infection that is rare in the developed country. Because of the rarity: of the disease, the clinician may be unfamiliar with the clinical presentation and unsuspecting of the diagnosis. However, tetanus can rapidly progress into lethal muscle spasms accompanied by respiratory insufficiency, and it has a mortality of 15 to 30%. The most common presenting symptom was trismus, followed by neck pain, dysphagia, generalized pain and facial muscle contractions. Dysphagia is a common symptom of tetanus, but not common as an initial symptom, the correct diagnosis and adequate therapy are likely to be delayed. Treatment involves administration of penicillin, tetanus immune-globulin, debridement of wounds, aggressive supportive care, and initiation of active immunization. We report an elderly woman presenting with dysphagia as an initial symptom of tetanus with review of literature.

Laryngeal hemangioma occurs mostly in infantile patients and infantile hemangiomas can be frequently seen in the subglottic area. So, respiratory distress is a main symptom in this entity. But adult hemangiomas are rare and can be seen in different locations such as in epiglottis, aryepiglottic fold, arytenoids and false and true vocal folds. Authors experienced a case of mixed hemangioma at the right aryepiglottic fold in a 42 years-old-man who was presented with snoring, throat foreign body sense for 3 months. So, we report this case with a review of the literature.