• Korean Journal of Head & Neck Oncology
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• v.30 no.1
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• pp.1-4
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• 2014

배경 및 목적 타액선 선양낭성암종은 느린 성장 속도와 늦은 원격 전이를 특징으로 하는 드문 상피성종양이다. 본 연구는 다양한 임상 병리학적 변수를 통해 선양낭성암종의 원격 전이에 영향을 주는 인자를 조사하고자 하였다. 대상 및 방법 1999년 10월부터 2011년 12월까지 본원 이비인후과에서 타액선 선양낭성암종으로 진단되어 치료 받은 44명(남자 19명, 여자 25명)을 대상으로 원격전이를 유발하는 위험 인자를 조사하였다. 8명의 환자는 배제 기준에 따라 제외하였다. 환자의 평균 연령은 54세였다. 환자의 병리 보고서, 종양의 크기, T 병기, 수술 절제연의 종양 존재 유무, 신경 조직 침습, 림프절 전이가 조사되었다. 결 과 15명의 환자가 원격전이가 있었으며 21명은 원격 전이가 없었다. 원격 전이를 유발할 수 있는 여러 인자들을 비교하였을 때, 원격 전이는 수술 절제연의 종양 세포 잔존(p=0.014), 종양의 크기(p=0.038), 진행된 T 병기(p=0.024)가 통계적으로 유의하게 연관성이 있었다. 림프절 전이와 신경 조직 침습은 원격 전이와 연관이 없었다. 결 론 종양의 크기, 진행된 T 병기, 수술 후 절제연의 종양 세포 잔존은 원격 전이의 예측 인자로 생각된다. 따라서 이에 해당하는 환자의 경우 더욱 철저한 관리 및 경과 관찰을 요한다.

• Korean Journal of Head & Neck Oncology
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• v.13 no.2
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• pp.221-227
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• 1997

The authors reviewed 106 cases of parotid gland tumor at Presbyterian Medical Center seen during the past 10 years between January, 1986 and December, 1995. The results were obtained as follows; 1) 86 cases(81.1%) were benign tumors and 20 cases(18.9%) were malignant tumors. 2) Overall male and female sex ratio was 1 : 1.4. 3) For benign tumors, the mean age was 47.9 and for malignant tumors, the mean age was 43.4. 4) Clinical manifestations in benign tumors were palpable mass in 86 cases(100%), pain in 6 cases(6.9%), facial nerve palsy in 2 cases(2.3%), lymphadenopathy in 1 case(1.2%); and in malignant tumors, palpable mass in 20 cases(100%), pain in 7 cases(35%), facial nerve palsy in 2 cases(10%) and lymphadenopathy in 3 cases(15%). Thus, the presence of pain, facial nerve palsy and lymphadenopathy suggest malignant tumors. 5) Operative procedures in benign tumors included superficial parotidectomy in 53 cases(61.6%), total parotidectomy in 10 cases(11.6%), local excision in 23 cases(26.7%); and in malignant tumors, superficial parotidectomy in 3 cases, total parotidectomy in 1 case, local excision in 1 case, superficial parotidectomy with supraomohyoid neck dissection in 6 cases, total parotidectomy with supraomohyoid neck dissection in 8 cases, total parotidectomy with radical neck dissection in 1 case. 6) Postoperative complications in benign tumors were transient facial nerve palsy in 14 cases, Frey's syndrome in 2 cases. In malignant tumors complications included transient facial nerve palsy in 3 cases and permanent facial nerve palsy in 1 case. 7) Pleomorphic adenoma was the most common benign parotid tumor and mucoepidermoid carcinoma was the most common malignant tumor. 8) In our review of 20 patients with malignant parotid tumors, all patients who received supraomohyoid neck dissection and postoperative radiation therapy remain alive from 1986 to 1995 years. Two deaths in this series were adenoid cystic carcinoma patients who failed to receive postoperative radiation therapy. These series of cases have been studied in order to determine whether supraomohyoid neck dissection and postoperative radiation therapy may have further therapeutic effect.

• Korean Journal of Head & Neck Oncology
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• v.19 no.2
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• pp.127-132
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• 2003

Objectives: The best treatment for the malignant parotid tumor still remains to be defined, and a better knowledge about the tumor features that predict the treatment result is needed. The aim of this study is to evaluate the treatment outcomes and to suggest the optimal treatment modality for the parotid cancer. Materials and Methods: The clinicopathologic characteristics of 113 patients who were treated for parotid cancer from January 1990 to December 2002 were retrospectively analysed. Univalate analyses were performed to establish the prognostic influence of pateint age, gender, tumor size, histologic grade and lymph node metastasis. Results: The mean age was 46.4 years old (15-81 years) and. The male to female ratio was 1 : 1.1. The chief complaint was a palpable mass in 85%, pain was in 12.4% and facial nerve palsy was accompanied with 2.7%. The mean tumor size was 3.5cm in diameter. The most common malignant tumor was mucoepidermoid carcinoma (33.6%), followed by acinic cell carcinoma (15%), adenoid cystic carcinoma (11%), carcinoma expleomorhpic adenoma (11%), basal cell carcinoma (7%). The most common operative procedure was total parotidectomy (47.8%) and various types of cervical lymph node dissection were added in 69.9%. Postoperative radiotherapy was done in 61.1 %. Postoperative complications developed in 54 cases (47.8%), including 46 cases (40.7%) of facial nerve palsy and 9 cases (8%) of Frey's syndrome. Recurrences developed in 21 cases (18.6%) and deaths in 15 (13.3%). Cumulative survival at 5 year was 75.4%. Univariate analysis of clinical factors showed that histologic grade and positive cervical lymph node significantly influenced survival (p<0.05). Conclusion: These results suggests that the radical resection with lymph node dissection and postopertaive XRT would be necessary to improve the survival of the patients with high grade cancer or positive lymphnode metastasis.

• Korean Journal of Head & Neck Oncology
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• v.15 no.2
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• pp.182-188
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• 1999

Purpose: To investigate the treatment results' and patterns of failure according to the pathologic type of the parotid malignancy who were treated with radical sugery and postoperative radiation therapy. Materials and Methods: Fifty-two patients with various type of the parotid malignancy, who were treated with combined radical surgery and post-operative irradiation at Yonsei Cancer Center, between 1981 and 1995, were retrospectively reviewed after completion treatment, all but one patients were follow up with the median follow up period of 49 months. Results: We found that pathologically confirmed neck node metastasis rate was 28.8% all case and level II was most common site. Overall failure rate was 26.9%, local recurrence rate was 13.5%, node failure rate was 7.7%, and distant failure rate was 5.8%. Five-year disease free survival rate was 70.9%, and overall survival rate was 73.8%. Recurrence rate was low in adenoid cystic carcinoma and acinic cell carcinoma. However distant metastasis was very high in undifferentiated carcinoma. Local recurrence was main pattern of failure in mucoepidermoid carcinoma and nodal failure was frequently observed in adenocarcinoma. Conclusion: Individualized treatment plan may be required to improve a treatment outcome by pathologic subtype of the parotid malignancy.

• Korean Journal of Bronchoesophagology
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• v.4 no.2
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• pp.211-218
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• 1998

There have been few large scale surveys of salivary gland tumors, because the salivary gland tumors comprised less than 3 percent of all neoplasms of the head and neck. Also there is a problem that the incidences of specific types of tumors have the variation according to the geographic regions. ]'nother Korean reports about salivary gland tumor, they only treated about 100 cases only. Objectives : The purpose of this study is to identify the frequency and clinical characteristics of salivary gland tumors and to compare with other Korean reports. Materials and Methods : We had performed to analyze 387 cases of salivary gland tumors from 1983 to June 1997, were reviewed in histopathological and clinical aspects. The diagnoses of individual tumors were based on the World Health Organization classification. Tumors were analyzed according to the histologic type site, age and sex. Results : The majority (79.1%) of cases occurred in the major salivary glands and 20.9% in the minor. The parotid gland was the most frequent site with 52.4％ and submandibular glands with 26.3%. Benign tumors were 79.3% of the tumors and malignant tmon were 20.7%. The most frequent tumor was pleomorphic adenoma occupied 63.8% of the total and frequency percent of histologic type of 98 malignant tumors showed 35.7% of mucoepidermoid carcinomas, 24.5% of adenoid cystic carcinomas. Overall gender with female predominance with 1 : 1.4 of male to female ratio. The average age of patients was 42.8 years. The most frequent chief complaint was a palpable mass. The duration of the symptom was shorter in the malignant salivary gland tumors (26.7 months) than in the benign salivary gland tumors (38.2 months). Conclusion : Comparing to the previous Korean reports, the present study confirms that the incidence of salivary gland tumor was lower in the parotid gland, and was higher in the submandibular and minor salivary glands.

• Journal of the korean academy of Pediatric Dentistry
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• v.46 no.1
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• pp.38-47
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• 2019

The most common cause of mouth breathing is obstacles caused by mechanical factors in upper airway. Mouth breathing could be consequently pathological cause of sleep-disordered breathing. Sleep-disordered breathing in children can cause growth disorders and behavioral disorders. The purpose of this study was to investigate relationship between upper airway and sleep-disordered breathing in children with mouth breathing. Twenty boys between 7 - 9 years old who reported to have mouth breathing in questionnaire were evaluated with clinical examination, questionnaires, lateral cephalometric radiographs, and portable sleep testing. This study assessed apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) for the evaluation of sleep-disordered breathing and was done to investigate the correlation between these values and the upper airway width measured by lateral cephalometric radiographs. There was no significant correlation with the size of the tonsils (p = 0.921), but the adenoid hypertrophy was higher in the abnormal group than in the normal group (p = 0.008). In the classification according to AHI and ODI, retropalatal and retroglossal distance showed a statistically significant decrease in the abnormal group compared to the normal group (p = 0.002, p = 0.001). As AHI and ODI increased, upper airway width tended to be narrower. This indicates that mouth breathing could affect the upper airway, which is related to sleep quality.

• Sleep Medicine and Psychophysiology
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• v.15 no.2
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• pp.94-99
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• 2008

The most common cause of obstructive sleep apnea syndrome (OSAS) in childhood is adenotonsillar hypertrophy. Adenotonsillectomy improves the symptoms quite well in most cases. However, some patients could experience the OSAS again after adenotonsillectomy, who might have several risk factors such as incomplete operation, misdiagnosis, combined anatomical malformation, sinusitis or chronic allergic rhinitis, obesity, initial severe OSAS, and early onset OSAS. We report a case of 11-year-old obese boy who presented with snoring for several years. He was obese with body mass index (BMI) of $26.3kg/m^2$ and also found to have fatty liver by ultrasonogram. Initial polysomnography (PSG) showed that he met the criteria of severe OSAS with the apnea-hypopnea index (AHI) of 70.5. He underwent adenotonsillectomy and symptoms improved immediately. Four months later symptoms were relieved with AHI of 0, but 1 year after the adenotonsillectomy he started to complain snoring again and the subsequent PSG results showed that OSAS has relapsed with AHI of 43. Paranasal sinus X-ray and physical examination showed sinusitis and re-growth of adenoid. Obesity was proved not to be a contributing factor because his BMI decreased to normal range ($23.1kg/m^2$) after diet control and regular exercise. Also, liver transaminase was normalized and fatty liver was disappeared on follow-up abdominal ultrasonogram. After treatment of sinusitis, symptoms were relieved with decreased AHI (8.5). This case suggests that simple adenotonsillectomy might not be the end of OSAS treatment in childhood. Patients who had adenotonsillectomy should be followed by subsequent PSG if symptoms recur. It is also important to be aware of risk factors in the recurrent OSAS for the proper intervention according to the cause.

• Tuberculosis and Respiratory Diseases
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• v.44 no.4
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• pp.766-775
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• 1997

Background : Primary malignant tumors of the trachea are extremely rare entities and account for a mere 0.1 per cent of all malignancies of the respiratory tract. Because of vague localizing signs, symptoms and a usually negative routine chest film, the patients with tracheal tumors are often treated for asthma or chronic obstructive pulmonary disease for considerable period of time before correct diagnosis. Method : We have made a review of the 17 cases of primary tracheal tumors in recent 15 years. We reviewed the clinical features including history of smoking and respiratory symptoms, the official readings of initial routine chest film, the cytologic examination of sputum, the time of delay in diagnosis, and the response according to the therapeutic modalities. Results : Eight out of 9 patients with squamous cell carcinoma(SCC) were above 50 years old, five out of 6 patients with adenoid cystic carcinoma(ACC) were below 50 years old. The most common location of primary tracheal tumors was the upper one-third of trachea in 8 cases(47%). The most frequent symptoms were dyspnea in 13/17 cases(76%) and then stridor or wheezing, cough. and sputum in order. The routine chest roentgenographic examinations were not helpful to diagnose tracheal carcinoma and the cytologic examinations of sputums were helpful to diagnose tracheal carcinoma in only one case with adenocarcinoma. The mean times of delay in diagnosis of patients with sec and ACC were 5 months and 24.9 months respectively. We had bronchial asthma in 8 cases(47%) and tracheal tumors in 4 cases(23%) as initial clinical impression. Conclusion : We would like to perform more comprehensive diagnostic tools(high KVP technique, the fibroptic bronchoscopic examination, chest CT scan etc.) in patients who had the suggestive points for the tracheal tumorse(1. unexplained hemoptysis or hoarsness, 2. inspiratory wheezing or stridor, 3. wax and waning of dyspnea according to changes of position, 4. progressive asthmatics unresponsive to antiasthmatic therapy) and radical resection of tumor or external radiation therapy with curative aim as possible.

• Journal of Preventive Medicine and Public Health
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• v.33 no.3
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• pp.334-342
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• 2000

Objectives . This study was conducted in order to investigate the degree of recognition, acceptability, and altitude towards day surgery of patients who were hospitalized with diseases that were candidates for day surgery; in order to analyze the average length of stay for treatment of the ailments; and to analyze the percentage of patients who could be discharged on the same day after the surgery ,using the post-anesthesia discharge scoring system. Methods : Data was collected between February 1 and March 31, 1999 from 353 patients who received surgery for cataract, adenoid hypertrophy, inguinal hernia, strabismus, ptosis, cholelithiasis, hemorrhoid, or anal fistula, at a general hospital in Daegu city. The patients were interviewed and surveyed by a post-anesthesia discharge scoring system(PADS) in order to collect data on patient condition such as vital signs, activity and mental status, pain, nausea and vomiting, surgical bleeding, intake and output after the surgery. Results : Among the 353 patients, 52.7% were after of the day surgery and 52.7% were interested in day surgery. Of the respondents, 43.1% said 'my ailment was not serious and the surgery was simple' and 30.4% said 'according to my condition rest at home was desirable' as the reasons for wanting day surgery Alternatively, 56.5% of those declining day surgery said the 'uncertainty of staying home' was the reason. The greatest concern in discharging within 24 hours after surgery was a post-op emergency situation. On the other hand, the shortened hospitalization was the largest advantage of day surgery with 39.1% responding this way, followed by the savings in hospitalization costs (25.8%) and emotional stability (13.7%). The majority of those surveyed (47.6%) believed that discharge should be determined within 1-2 days after the surgery. The average hospital stay was 3.1 days for dischargeable ailments. Pain (45.6%), nausea and vomiting (10.5%), and headache (7.9%) were the common symptoms following surgery. The percentage of patients who were able to be discharged within 24 hours after surgery revealed 95.2% were dischargeable after approximately 3 hours, 99.2% dischargeable after 12 hours, and 100% dischargeable after 24 hours. Conclusions : According to the PADS score, the cataract extract and strabismus correction patients were eligible for day surgery and the further evaluation concerning the reason for delayed recovery of the other diseases is needed.

• Clinical and Experimental Pediatrics
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• v.51 no.3
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• pp.267-275
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• 2008

Purpose : To determine whether primary snoring could be distinguished from obstructive sleep apnea syndrome (OSAS) by clinical evaluation and symptom scores. Methods : 56 snoring and 20 asymptomatic subjects were recruited and polysomnography was used to confirm that there were 39 OSAS, 17 primary snoring, and 20 control subjects. We evaluated the size of the childrens adenoids and tonsils. Parents completed sleep disordered breathing scale (SDBS) and obstructive sleep apnea 18 (OSA-18) questionnaires for use as symptom scores, as well as an attention deficit hyperactivity disorder rating scale-IV (ADHD RS-IV). Results : There were no differences between primary snoring and OSAS in terms of tonsil and adenoid size, SDBS ($9.4{\pm}4.6\;vs\;10.8{\pm}4.5$), and OSA-18 score ($61.1{\pm}25.1\;vs\;71.2{\pm}8.4$). The patients with OSAS ($15.8{\pm}7.9$) and PS ($22.2{\pm}9.4$) had a higher ADHD RS-IV score than the control subjects ($2.9{\pm}3.3$). There was no difference in the ADHD RS-IV scores of patients with primary snoring and OSAS. Conclusion : We confirmed that clinical evaluation could not distinguish OSAS and primary snoring. In addition, our study suggests that primary snoring as well as OSAS is associated with attention deficit hyperactivity disorder.