• Proceedings of the KOR-BRONCHOESO Conference
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• 1991.06a
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• pp.30-30
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• 1991

성대마비 이비인후과 영역에서는 비교적 빈번하게 관찰되는 질환으로 대부분은 미주신경과 그 분지인 반회신경이 경정맥공에서 후두까지의 주행중에 생긴 질환에 의하여 이차적으로 발생하거나, 드물게는 윤상갑상연골 관절의 고정에 의사여 발생하게 된다. 임상적인 진단은 간접후두경이나 화이버옵틱후두경 검사법에 의하여 간단하게 내려질 수 있으나, 그 발생원인은 다양하며, 임상적인 양상 및 그에 따른 치료 원칙도 다르게 나타난다. 이에 연자들은 1986년 1월 1일부터 1990년 12월 31일까지 5년간 국립의료원 이비인후과에 내원한 환자중 성대마비로 진단된 환자 61례에 대한 후향적 기록 분석에 의해 성별, 원인별, 측별, 성대의 위치, 및 그에 따른 치료방향에 대하여 비교 검토하여 다음과 같은 결과를 보였다. 1)성별은 남녀비가 3:2로 남자가 많았으며, 연령별 분포는 20대에서 70대까지 비교적 균등하였으나 50대(23.0%)에서 가장 많은 분포를 보였다. 2)원인으로는 원인불명이 16례(26.2%), 갑상선수술 8례(13.1%), 폐결핵과 기관내삽관후 각각 6례(9.8%), 폐암 5례(8.2%) 순이었다. 3)마비된 성대의 측별 분포는 편측성이 51례(83.6%), 양측성이 10례(16.4%)이며, 편측성중 좌측이 37례(60.6%)로 가장 많았다. 마비된 성대의 위치는 부정주위가 33례(54%)로 가장 많았다. 4)즉 증상은 단지 애성만 있었던 례가 31례(50.8%), 호흡곤란 혹은 기도흡인등을 동반한 애성이나, 애성을 동반하지 않은 례도 있었다(3례). 증상 발현후 병원 내원까지 기간은 2개월이내가 가장 많았다. 5)16례에서 수술적 처치가 시행되었거나(9례), 혹은 자연치유가 관찰되었는데(7례) 편측성마비때 갑상연골성형술 2례, 양측 마비때 후두외접근법에 의한 피열연골절제술 4례, 레이저를 이용한 피열연골절제술 2례, 승모판 협착증에 의한 편측성 성대마비에서 개심술후 성대마비 회복 1례, 자연 치유는 7례에서 관찰되었으며 6례에서는 증상발현후 6개월이내에 회복되었다.

• Journal of Chest Surgery
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• v.39 no.11 s.268
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• pp.815-821
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• 2006

Background: Carotid endarterectomy is an effective treatment modality in patients with severe carotid artery stenosis, but it may result in serious postoperative complications, We analyzed the results of the carotid endarterectomy performed in our institution to reduce the complications related to the card endarterectomy. Material and Method: We analyzed retrospectively the medical records of 74 patients(76 cases) who underwent carotid endarterectomy for carotid artery stenosis by a single surgeon from February 1996 to July 2004. Result: There were 64 men and 10 women. The mean age of the patients was 63.6 years old. Carotid endarterectomy only was performed in 63 cases, carotid endarterectomy with patch angioplasty in 8 cases, and carotid endarterectomy with segmental resection of internal carotid artery and end to end anastomosis in 5 cases. Intra-arterial shunt was used in 29 cases. The mean back pressures of internal carotid arteries checked after clamping common carotid arteries and external carotid arteries were $23.48{\pm}10.04$ mmHg in 25 cases with changes in electroencephalography(group A) and $47.16{\pm}16.04$ mmHg in 51 cases without changes in electroencephalography(group B). There was no statistical difference in the mean back pressure of internal carotid arteries between two groups(p=0.095), but the back pressures of internal carotid arteries of all patients with changes in electroencephalography were under 40 mmHg. When there was no ischemic change of electroencephalography after clamping common carotid artery and external carotid artery, we did not make use of intra-arterial shunt regardless of the back pressure of internal carotid artery. Operative complications were transient hypoglossal nerve palsy in four cases, cerebral hemorrhage occurred at previous cerebral infarction site in two cases, mild cerebral infarction in one case, hematoma due to anastomosis site bleeding in one case, and upper airway obstruction due to laryngeal edema probably caused by excessive retraction during operation in two cases. One patient expired due to cerebral hemorrhage occurring at previous cerebral infarction site. Conclusion: Carotid endarterectomy is a safe operative procedure showing low operative mortality. We suggest that intra-arterial shunt usage should be decided according to the ischemic change of electroercephalography regardless of the back pressure of internal carotid artery. Excessive retraction during operation should be avoided to prevent upper alway obstruction due to laryngeal edema and if upper airway obstruction is suspected, prompt management is essential.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.31 no.1
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• pp.19-26
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• 2020

Background and Objective Endoscopic airway dilation is the primary treatment for pediatric subglottic stenosis (SGS) due to its feasibility and non-invasiveness. The aim of this study is to evaluate the risk factors for the failure of endoscopic airway dilation in pediatric patients with SGS. Materials and Methods This study reviewed medical records of 38 pediatric patients had endoscopic dilation from a single and tertiary referral center, retrospectively. The success of the endoscopic dilation procedure was defined as no dyspneic symptom without tracheostomy or laryngotracheal reconstruction. Demographic profiles, underlying disease, and Myer-Cotton SGS severity grade were recorded. Success rates and risk factors for the failure of treatment were analyzed. Results The SGS patients with severity grade I was most common. After mean 1.8 numbers of procedures, there were 23 patients (60.5%) in the success group and 15 patients (39.5%) in the failure group. Age, sex, underlying diseases, and SGS severity grade were not significantly different between two groups. In patients who had multiple endoscopic procedures, the failure group showed SGS deteriorated after procedures in 66.7%, compared to 11.1% of the success group. In multivariable analysis, a long-term intubation (≥1 month) was identified as an independent risk factor for failure of endoscopic dilation procedure. Conclusion Although endoscopic dilation procedure is safe and effective for the management, repetitive endoscopic dilation may not give clinical benefit in patient with long-term intubation. Other airway procedures must be considered in those group of patients.

• Journal of Chest Surgery
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• v.36 no.4
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• pp.267-272
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• 2003

Background: Common treatment modalities for tracheal stenosis include conservative methods such as repeated balloon dilatation, removal of obstructive material through bronchoscopy and T-tube insertion as well as operative treatment methods. Recent advances in surgical approaches through tracheal resection and end-to-end anastomosis have been reported to give better functional and anatomical results. Material and Method: Between March 1990 and July 2002, 41 patients who received tracheal resection and end-to-end anastomosis at Asan Medical Center, University of Ulsan were studied retrospectively. Result: The causes for tracheal resection and end-to-end anastomosis included 26 cases of postintubation stenosis, 10 cases of primary tracheal tumors (3 benign, 7 malignant), 1 case of endobronchial tuberculosis, 2 cases of traumatic rupture, and 2 cases of tracheal invasion of a thyroid cancer, Of the 41 patients who received tracheal resection and reconstruction, 29 received tracheal resection and end-to-end anastomosis, and 12 received laryngotracheal anastomosis with cricoid or thyroid cartilage resection. Four of these patients received supralaryngeal release. The average length of the resected trachea was $3.6{\pm}1.0$cm. Of the 41 patients who received tracheal resection and end-to-end anastomosis, 30 (73.2%) experienced no postoperative complications, and 8 (19.5%) experienced granulation tissue growth and/or minor infections which improved after conservative management. Good or satisfactory results were therefore achieved in 92.7%. Complications included repeated granulation tissue growth in 7, wound infection in 2, anastomotic site dehiscence in 2, restenosis resulting in dyspnea on exertion in 1, and repeated postoperative aspiration requiring retracheostomy in 1. There was no early postoperative mortality. There were 3 cases of hospital death. Conclusion: In cases of proper length of tracheal lesion, excellent results were obtained after tracheal resection and end-to-end anastomosis. But, granulation tissue growth is so serious complication, it is necessary for continuous study and efforts to prevent it.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1976.06a
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• pp.87.4-88
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• 1976

The statistcal study was done on 81 cases of the foreign bodies in the food passages (73 cases) and air passages (8 cases), who had visited the Dept. of Otolaryngology of Kyung Hee Medical Center and treated endoscopically, from Nov. 1971 to Mar 1976. The results were as follows, 1) The incidence of esophageal foreign bodies (73 cases) in order of frequency was coin (61 cases; 83.6%), bone (6 cases; 8.2%), food particles (3 cases; 4.1%), discs (2 cases), and other metals (l case). The incidence of foreign bodies in the air passages (8 cases) was food particles (3 cases; 37.5%), pointed metal (2 cases; 25%), plastic pencil cap (l case), plastic ring (1 case), and wood piece (1 case) in order. 2) In sex distribution, 51 cases (62.9%) were males and 30 cases (37.1%) were females, and the ratio between males and females was about 1.7 : 1.3. In the age incidence, 69 cases (82.5%) of all foreign bodies were under 5 years of age, and especially, coin cases were 59 cases (96.7%) and the highest was 8 years of age, lowest was 11 months of age. 7 cases (87.5%) of all airway foreign bodies were under 10 years of age. 4) The ratio between the food passages(73 cases) and the air passages (8 cases) was about 9 : 1. In the location of the foreign bodies of the food passages, 66 cases (90.4%) were in the first esophageal narrowing, 5 cases (6.9%) in the second narrowing, and 2 cases (2.7%) in the third narrowing. In the air passages, the frequent sites were trachea (5 cases; 62.5%), larynx (2 cases), and bronchus (1 case) in order. 5) In duration of lodgement, 63 cases (86. 3%) of esophageal foreign bodies were removed within 24 hours, and one case was removed within 16 days. The number of cases lodged within 24 hours were 4 cases (50%). in the air passages and one case was removed within 18 days. 6) In treatment, 37 cases (50.7%) of esophageal foreign bodies were extracted by modified upper esophagoscopy, 33 cases (42.5%) by esophagoscopy under the local anesthesia, 3 cases (4.1%) by esophagoscopy under the general anesthesia. 8 cases of the coin cases were passed into the stomach during the endoscopic examination. Laryngeal foreign bodies (2 cases; 25%) were extracted by laryngoscopy under the local anesthesia. 2 cases (40%) of tracheal foreign bodies by Bronchoscopy with tracheotomy under the local anesthesia, 3 cases (60%) by Bronchoscopy under the general anesthesia, and bronchial foreign body (1 case) by open thoracotomy under the general anesthesia, at the Dept. of Chest surgery.

• Korean Journal of Head & Neck Oncology
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• v.26 no.1
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• pp.27-29
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• 2010

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.

• Korean Journal of Bronchoesophagology
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• v.9 no.2
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• pp.69-73
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• 2003

Various flaps are using for reconstruction of esophageal defect. The choice of reconstruction is depended to the oncologic needs of the situation. If the entire esophagus or significant part of the thoracic esophagus is involved by tumor, then total esophagectomy and gastric pull-up or colon transposition is indicated. But for most hypopharyngeal tumors, laryngopharyngeal tumors, and cervical esophageal tumors, segmental resection of these area and replacement with a jejunal fee or forearm free flap has become the standard technique. The authors have experienced a case of total pharyngo-laryngo-esophago-gastrectomy and colon transposition in a patient of esophageal cancer following partial esophagectomy and gastic pull-up due to corrosive esophageal stricture. We report this case with brief review of the literatures.

• Korean Journal of Bronchoesophagology
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• v.1 no.1
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• pp.55-63
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• 1995

Gastroesophageal reflux is thought to be an important etiology of the various upper aerodigestive tract disease. To investigate the role of gastric acid and pepsin as an etiologic factor of laryngotracheal stenosis, and the difference of injury by synthetic gastric juice between in ciliated respiratory epithelium and in squamous epithelium, experimental study was carried out using rabbits. Mucociliary transport affected by synthetic gastric juice was also studied in dogs. Synthetic gastric juice of low pH caused serious damage and Impairment of mucociliary transport in the epithelium of the larynx and trachea. Gastric acid played major role in the mucosal damage. Squamous epithelium of vocal folds and pharynx was more resistant to synthetic gastric juice than respiratory epitheium. In conclusion, gastroesophageal reflux may be an etiologic factor in the developement of laryngotracheal stenosis, so the adequate management is necessory In patients of laryngotracheal stenosis.

• Korean Journal of Bronchoesophagology
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• v.3 no.2
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• pp.261-269
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• 1997

When performing an endotracheal intubation or tracheotomy to an unconscious patient in emergent situations, one should consider the possibility of later complication of laryngo-tracheal stenosis which can result in difficulties in decannulation. Laryngo-tracheal stenosis is a bothersome problem developing as a complication of treatment by tracheotomy with a cuffed tube and long-term endotracheal intubation with assisted ventilation. One hundred twenty-three cases of laryngo-tracheal stenosis patients during the four yew period from May 1992 to April 1996 were restrospectively reviewed according to several parameters such as the duration of intubation, site of stenosis, treatment modality and, site of tracheostoma. The present report is an analysis of these materials to search for the possible etiologic factors and its proper preventive methods. It was desirable that the endotracheal intubation should be limited within 20 days at most. Tracheotomy performed by non-otolaryngologists has a tendency to be on a higher level of trachea. Technical precautions should be taken into consideration when doing a tracheotomy. The success rate of decannulation of tracheal T-tube was 78.8% and it required average 11 months.

• Korean Journal of Head & Neck Oncology
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• v.31 no.1
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• pp.18-21
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• 2015

기관을 침범한 갑상선 악성종양을 제거한 후에 성문하부에 비교적 큰 기관 결손이 발생할 수 있다. 단단문합술은 넓은 부위의 결손부를 재건하는 방법으로 널리 받아들여지고 있지만, 문합부 파열, 반회후두신경마비, 재협착 등의 합병증이 발생할 수 있다. 본 증례는 기도를 침범한 갑상선 유두암종을 제거한 후 윤상연골과 기관연골의 비교적 큰 결손부를 흉쇄유돌근 근골막피판을 사용하여 안전하게 재건한 사례이다. 55세 남자 환자가 기도를 침범한 갑상선 유두상암으로 내원하였으며 기도침범은 윤상연골(둘레의 약 30%)과 4개의 기관연골(둘레의 약 50%)을 해당하는 넓은 부위였다. 수술 전 기관절개술을 시행하여 주위 기관연골의 상태가 좋지 않아 단단문합술 시행 후 문합부 파열 가능성이 있다고 판단하여 흉쇄유돌근 근골막피판을 이용하여 재건하기로 계획하였다. 갑상선 절제술, 경부림프절 절제술, 흉쇄유돌근 근골막피판을 이용한 재건술을 시행하였으며 수술 후 12일째 별다른 문제없이 퇴원하였다. 환자는 수술 후 현재 22개월 간 기도 협착 등의 별다른 합병증 없이 지내고 있다. 흉쇄유돌근 근골막피판은 성문하부나 기관지 전외측벽의 비교적 큰 결손부를 재건하는 데 유용하게 사용될 수 있다.