• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.29 no.1
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• pp.9-13
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• 2018

Postoperative airway aspiration is not uncommon in patients with head and neck cancer. Airway aspiration has serious consequences, such as swallowing disorders, nutrition-related health problem, or reducing the quality of life due to maintenance of tracheal or nasogastric tubes. The postoperative oropharyngeal defect due to the surgery may interfere with normal swallowing reflex, or the laryngeal dysfunction caused by radiation therapy may cause severe airway aspiration, which may lead to complications such as dyspnea and pneumonia. Complete removal of the disease is also important in the treatment of head and neck cancer, but it is necessary to select a method to avoid and predict the occurrence of airway aspiration according to the treatment method. The most important factor to prevent airway aspiration after surgery is to preserve the proper volume of the oropharynx and to preserve at least one of the cricoarytenoid joint function. It is also the most effective way to reduce additional complications by seeking appropriate surgical treatment according to airway aspiration status. The purpose of this study is to review the operative methods that can induce airway aspiration and consider the prevention and treatment strategy through review of the literature.

• Korean Journal of Head & Neck Oncology
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• v.23 no.1
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• pp.15-20
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• 2007

Background and Objectives：Supraglottic partial laryngectomy is oncologically sound surgical procedure for selected cases of laryngeal cancer which maintains physiologic speech and swallowing without permanent tracheostoma. The purpose of this study is to evaluate the oncologic and functional results of supraglottic partial laryngectomy and neck dissection for supraglottic cancer. Materials and Methods：Between 1991-2005, Twenty-three supraglottic cancer patients, underwent supraglottic partial laryngectomy, were studied retrospectively. There were 5 patients with cT1, 14 with cT2, 4 with cT3 and 11 patients with cN0, 1 with cN1, 10 with cN2, 1 with cN3. All patients underwent neck dissection and postoperative radiotherapy was added to twenty patients. They were reviewed with respect to primary subsites, extended subsites, treatment result, survival rate, factors affecting the prognosis, postoperative complication, time of decannulation and oral diet, and postoperative voice. Results：Among eleven patients with clinically negative node, six patients had pathologically positive nodes. So occult metastasis was 54.5%. Two patients recurred at cervical lymph node and one had distant metastasis to lung. Local and regional control were 100% and 91.3%. The overall 3-year and 5-year survival rate were 84%, 78%, respectively. Nineteen cases were squamous cell carcinomas and four were basaloid squamous cell carcinomas. Basaloid subtype was significantly affected to survival. Decannulation and oral feeding were possible in 100%. Conclusions：Supraglottic partial laryngectomy is oncologically safe and functionally good procedure in supraglottic cancers. Elective neck dissection is beneficial in management of occult cervical metastasis.

• Korean Journal of Head & Neck Oncology
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• v.11 no.2
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• pp.167-172
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• 1995

Pharyngocutaneous fistula(PCF) is one of the complications following total laryngectomy in laryngeal and hypopharyngeal cancer. Fistula lead to delayed wound healing, more serious complications such as carotid blow-out, prolonged hospitalization, significant patient morbidity and occasional mortality. Identification of patients at high risk for fistula formation, appropriate preventive measures, and appropriate management are the head and neck surgeon's responsibility. So we analyzed the clinical data of pharyngocutaneous fistula which was developed after total laryngectomy. Following results were obtained: 1) Occurrence of PCF increases with salvage surgery compared to curative surgery. 2) Early detection and effective management of PCF are the key factors to decreasing the hospitalization period. 3) Constructing a pharyngostoma seems to be an ideal method of preventing dangerous complications and ultimately closing the fistula. 4) Simultaneous reconstruction is necessary in the high risk group.

• Korean Journal of Head & Neck Oncology
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• v.11 no.2
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• pp.158-166
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• 1995

Planning of the skin incision is one of the most important point for safe removal of the head and neck cancer. The fact that so many types of incisions exist is strong testimony that there is hardly one incision that fits all situation. Factors that influence the choice are adequate exposure, changeability to other types of neck dissection, optimal exposure of the primary site and/or opposite side of the neck, and safety of the neck flap and cosmesis. Laryngeal and hypopharyngeal carcinomas are the most common tumor of the head and neck, even though there are so many diverse situation exist, there must be an optimal approach to each case. From 1992 to 1994 surgical approaches used for laryngeal and hypopharyngeal carcinoma at the Severance Hospital were reviewed. Types of surgical approaches, its pitfall, advantage and disadvantages were reviewed.

• Korean Journal of Head & Neck Oncology
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• v.16 no.2
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• pp.220-223
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• 2000

Mucosal melanoma of the head and neck is a rare and usually lethal disease. Primary laryngeal malignant melanoma(LMM) are exceedingly rare tumors that morphologically are readily confused with more common types of laryngeal cancer. Treatment of choice for LMM is complete surgical excision and elective lymph node dissection is usually not recommended. The use of radiation or chemotherapy is generally thought to have no effect on local or distant disease and currently used as adjuvant therapy. The prognosis is extremely poor. We have experienced a 61 year old male patient with symptoms of foreign body and lump sense in throat. A dark pigmented polypoid mass was found on the right aryepiglottic folds with normal mobility of vocal cord. Total laryngectomy was performed under the diagnosis of malignant melanoma. Bone scan revealed multiple bony metastasis on ribs and lumbar vertebrae after 5 months of operation. There have been no evidence of recurrence at primary area. The patient died after 8 months of operation.

• Korean Journal of Head & Neck Oncology
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• v.9 no.2
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• pp.183-192
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• 1993

This study reports a prospective analysis of anatomical variations of recurrent laryngeal nerves during 300 thyroidectomies. During thyroidectomies for variable thyroid diseases. the course of recurrent laryngeal nerve was completely isolated from root of neck to the inferior comus of thyroid cartilage. In left side, nerve(53.7%) predominantly ran posterior to the inferior thyroidal artery(p<0.05) but in right side there was no predominant pattern. There were three nonrecurrent laryngeal nerves in the right side. About half of the cases in both sides(51.2% in right, 50.5% in left side) had one or more branches before terminating at cricothyroidal muscles. The average length of branches from inferior comus of thyroid cartilage to the origination of individual branch were l2.0mm in right side and 13.3mm in left side. In right side, majority(50.7%) of nerves ran though paratracheal space but difference did not reach the statistical but in left side, majority(88.3%) ran through tracheoesophageal groove and it was the dominant pattern(p<0.01), the overall status of passages of the nerve were relatively straight in left side(straight 87.8%, oblique 52.1%).

• Korean Journal of Head & Neck Oncology
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• v.20 no.2
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• pp.172-176
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• 2004

Background and Objectives: Standard treatment of locally advanced laryngeal, hypopharyngeal, and some oropharyngeal cancers includes total laryngectomy. In an attempt to preserve the larynx through induction chemotherapy, we designed induction chemotherapy followed by definitive radiation in patients with potentially respectable head and neck cancer to determine whether organ preservation is feasible without apparent compromise of survival. Materials and Methods: The twenty-six patients diagnosed advanced head and neck squamous cell carcinoma, Stage III or IV (AJCC 2002) and performed organ preservation protocols in Ajou university hospital from 1994 to 2001 were included in this study. Results: Neoadjuvant chemotherapy showed an overall response rate of 84.6% and a complete remission (CR) rate was 59.1% following neoadjuvant chemotherapy and radiation. Seven of thirteen patients were able to preserve their larynges for more than two years by chemotherapy and radiation. There were no treatment related mortality after 2 cycles of induction chemotherapy. Conclusion: Although Organ preservation protocol through neoadjuvant chemotherapy and radiation need more controlled randomized study, it was considered alternative treatment modality in advanced head and neck cancer.

• Korean Journal of Head & Neck Oncology
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• v.36 no.1
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• pp.9-14
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• 2020

Visual identification of recurrent laryngeal nerve (RLN) is considered as a gold standard of RLN preservation during thyroid surgery. Intraoperative neuromonitoring (IONM) is classified into the intermittent type and continuous type and helps surgeons identify the functional integrity of RLN and predict the postoperative vocal cord function. RLN injury during thyroid surgery is associated with tumor factors and surgeon factors. Tumor factors mean such as direct tumor invasion, adhesion of RLN to the tumor, and compression by a large thyroid tumor. Surgeon factors include nerve transection, stretching, thermal injury, and ligation injury. A recent meta-analysis reported that the IONM could reduce the RLN injury. Considering various nerve injury mechanism, we suggest that using both I-ONM and C-IONM together is more effective method in preventing nerve damage than using I-IONM alone.

• Korean Journal of Head & Neck Oncology
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• v.3 no.1
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• pp.55-63
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• 1987

A retrospective investigation of 52 cases of carcinoma of the larynx, who underwent total laryngectomy $\bar{c}\;or\;\bar{s}$ neck dissection at Pusan National University Hospital from 1978 to 1985, was performed. The results obtained were as follows: 1) There were 32 glottic(62.7%), 18 supraglottic(35.3%) and 1 subglottic(2.0%) carcinoma. 2) In stage grouping, stage ill was the most(64.7%) and then stage II, stage IV, stage I in order. 3) Overall rate of cervical metastasis was 29.4%. In glottic carcinoma, 0% of $T_1,\;40%\;of\;T_2,\;18%\;of\;T_3\;and\;25%\;of\;T_4$. In supraglottic carcinoma, there was 0% of $T_1,\;29%\;of\;T_2,\;56%\;of\;T_3\;and\;50%\;of\;T_4$. 4) The incidence of postoperative complication was 31.4% and stomal stenosis was the most(13.7%) 5) There were 8 cases of local recurrence and 3 cases of distant metastasis(2 cases in lung, 1 case in esophagus) among 40 cases which were able to follow up. 6) 3 year estimated survival rate for glottic and supraglottic carcinoma were 73.3 % and 85.7% respectively.

• Korean Journal of Head & Neck Oncology
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• v.3 no.1
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• pp.71-78
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• 1987

The supraglottic subtotal laryngectomy represents a conservation laryngeal procedure in which the upper portion of the larynx is removed without sacrificing the normal functions of the remaining larynx. The basis for this procedure rests in the embryologic derivation and consequent anatomic compartmentalization of the larynx and its lymphatics, which limit tumor spread. This procedure is performed for carcinoma involving the epiglottis and false cords, and can be extended to include carcinomas of the aryepiglottic fold and the anterior and lateral walls of the pyriform sinus and selected lesions involving the vallecula and base of the tongue. Recently the authors has experienced 4 cases of supraglottic cancer, which were performed supraglottic subtotal laryngectomy. One of which was died because of local recurrence, and the remaining cases were successful with satisfactory rehabilitation without local recurrence and impairment of voice and swallowing.