• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.8 no.2
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• pp.143-149
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• 2005

Purpose: The aim of this study was to evaluate the significance of pH monitoring at two levels, hypopharynx and esophagus in gastroesophageal reflux. Methods: 29 patients with pathological gastroesophageal reflux were classified into two groups: Group I had recurrent respiratory symptoms and Group II had not recurrent respiratory symptoms. The ambulatory pH monitoring was performed at the hypopharynx and the esophagus simultaneously with two channel catheter for 18~24 hr. The pathological reflux was defined when the percent of time that pH was below 4.0 exceeding the 95th percentile of normal value. Hypopharyngeal reflux was defined as the pharyngeal pH drops below 4. Results: 39 patients were performed pH monitoring at the level of hypopharynx and esophagus for 24 hours. Among 7 patients with chronic respiratory symptom, 6 patients (85.7%) have pathological esophageal reflux. Among 32 patients without chronic respiratory symptom, 23 patients (71.8%) have pathological esophageal reflux. Thus 29 out of 39 patients (74%) have pathological esophageal reflux. In the Group I, all parameters except the longest episode showed significant differences between hypopharyngeal and esophageal pH monitoring. None of parameters showed significant differences between group I and II in the pharyngeal pH monitoring. Conclusion: Regardless of presence of respiratory symptoms, the pH monitoring at the pharyngeal level in patients with gastroesophageal reflux did not showed any differences compared with the esophageal pH monitoring. Therefore we may reconsider the usefulness of hypopharyngeal pH monitoring in patients with chronic respiratory symptoms.

• The korean journal of orthodontics
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• v.25 no.1 s.48
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• pp.19-29
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• 1995

This study was performed to compare the size of soft palate, tongue and airway according to the types of the malocclusion and evaluate the correlation between the size of soft palate, tongue, airway and dentofacial skeleton respectively. The sample of this study was 98 malocclusion female patients between the ages 12 and 17 years. The lateral cephalometric radiographs were taken and the distance, angle, ratio and area of the dentofacial skeleton, soft palate, tongue and airway were measured and evaluated statistically. The results obtained were as follows: 1. There was significant difference in SNB, ANB, facial angle, facial convexity, A-B plane angel, Y axis to FH, SN-MP, Wits appraisal, ODI and APDI according to the types of malocclusion. 2. The hyoid bone was more posteriorly positioned in Class II malocclusion group than other two groups and superio-inferior position of the hyoid bone was not different according to the malocclusion types. 3. The nasopharyngeal area of Class II and Class III malocclusion group was smaller than that of Class I malocclusion group, and the pharyngeal area of Class II malocclusion group was smaller than that of Class I and Class III maocclusion group. There was no difference of the area of the soft palate, tongue, oropharynx and hypopharynx according to malocclusion types. 4. The ramal height and mandibular body length(Go-Me) showed positive correlation with the area of tongue, nasopharynx, oropharynx, and pharynx. SNA did not correlated with the area of tongue and airway but SNB showed positive correlation with the area of hypopharynx and pharynx. The anterior, posterior facial height, upper and lower central incisor position to facial plane showed positive correlation with tongue area.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.10
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• pp.4147-4152
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• 2014

Standard therapy for advanced head and neck cancer consists of a combination of surgery and radiation. However, survival of this patient population has not improved during the past 20 years. Many different multimodality treatment schedules have been proposed, and chemotherapy is often used with the intent of organ preservation. The present study was intended to establish the efficacy of concomitant chemoradiation with a single agent carboplatin in advanced head and neck cancers.The objectives were to investigate the feasibility of concomitant administration of carboplatin, monitor acute toxicity during radiotherapy, and determine subacute side effects, such as wound healing following surgery after chemoradiotherapy. A prospective study was conducted wherein a total of 40 patients with stage III and IV squamous cell carcinomas of oral cavity, oropharynx, hypopharynx and larynx were enrolled. All patients were treated with external beam radiotherapy and weekly carboplatin area under curve (AUC of 5). Radiotherapy was given in single daily fractions of 1.8-2 grays (Gy) to a total dose of 66-72 Gy. Salvage surgery was performed for any residual or recurrent locoregional disease. Neck dissection was recommended for all patients with neck disease showing less than a complete response after chemoradiation. A total of 40 patients were enrolled of whom 32 were males and 8 were females. Highest incidence of cancer was seen in the 5th-6th decades of life with a median age of 47.7 years. Oropharyngeal tumours constituted a maximum of 21 patients followed by hypopharynx in 10, larynx in 7 and oral cavity in 2. 80% of the patients had a neck node on presentation of which 40% had N2-N3 nodal status. TNM staging revealed that 58% of patients were in stage III and 43% in stage IV. Evaluation of acute toxicity revealed that 50% had grade II mucositis, 25% grade III mucositis, 2.5% grade IV mucositis. 50% of patients had grade I skin reactions, 65% of patients had grade I thrombocytopenia, and 24% of patients had grade I anaemia. After completion of treatment 65% of patients had complete response at the primary and regional sites, and 35% of patients had a partial response of whom 23% underwent neck dissection and 5% of them underwent salvage surgery at the primary site. At the end of one year there were six deaths and four recurrences and 70% were free of disease. Concurrent chemoradiation with carboplatin provided good locoregional control for locally advanced head and neck cancers. This regimen, although toxic, is tolerable with appropriate supportive intervention. Primary site conservation is possible in many patients. Chemoradiotherapy appears to have an emerging role in the primary management of head and neck cancers.

• Korean Journal of Head & Neck Oncology
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• v.7 no.2
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• pp.120-128
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• 1991

Reconstruction of the pharynx and cervical esophagus presents a tremendous surgical challenge to the Head and Neck Surgeon. Because life expectancy of patients with advanced carcinoma of the hypopharynx, and cervical esophagus is limited, treatment must be aimed at palliation. A variety of techiques have been proposed over the years with none proving entirely satisfactory. These techiques include prosthesis; skin graft; cervical flaps; tubed cutaneous and myocutaneous chest flaps; visceral reconstruction with stomach, colon. and jejunum; and jejunal free autografts. Many factors dictate the best method of reconstruction in any given clinical situation. The goal of the surgery is a one-stage reconstruction of swallowing function with minimal morbidity to allow as short a hospital stay as posible. Nine patients underwent the free jejunal autograft reconstruction of the pharyngoesophagus after the ablative surgery for the advanced hypopharyngeal cancer. Postoperative complications included one perioperative death, two abdominal wound dehiscences, two neck hematomas, one carotid rupture, one funtional dysphagia, one late strictures. There were no graft failure, no immediate stenosis and no fistula. An oral diet was started between days 8 and 16, with an average of 9 days and median of 8 days. Patients left the hospital between days 9 and days 38, with an average of 23.4 days and median of 23 days. This method of reconstruction is advocated as reliable palliative procedure with short-term follow-up. In conclusion, we at Korea Cancer Center Hospital are of the opinion that the free jejunal autograft offers an excellent, safe and relative easy method of the pharyngeal and cervical esophageal reconstruction with significant advantages over other techiques.

• Journal of Chest Surgery
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• v.30 no.1
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• pp.48-54
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• 1997

Between 1987 and 1995, eleven patients with severe chronic corrosive stenosis of the hypopharynx and esophagus underwent surgical restoration of digestive continuity at Inje University Seoul Palk Hospital. There were 7 male and 4 female patients aged from 21 to 47 years (mean, 34 years). The caustic material was acid in 6 patients and alkali in 5 patients. The esophagus was reconstructed using the right colon In 9 and left colon in 2. The cervical approach and the side of proximal anastomosis depended on the status of the pyriform slnus of the hypopharynx. In the neck, J-formed incision was made along the sternocleidomastoid muscle. The sternohyoid and thyrohyoid muscles were divided transversely to expose the thyroid cartilage. Hypopharyngeal opening for proximal anastomosis was made by reverse triangular formed resection of the thyroid cartilage after elevation of perichondrium. Immediately after operation, dysphagia and aspiration into trachea were common, so training of swallowing was required. Feeding gastrostomy was usually maintained for 3 months until restoration of swallowing function was confirmed . There was graft necrosis in 3 patients, who were treated with jejunal free graft. Revisional procedures for stenosis of cervical anastomosis in B patients consisted of widening of pharyngocecostomy site in 2 and resection of adhesive band in one. Return of normal swallowing assuring normal nutrition was obtained in 10 of 11 cases.

• Radiation Oncology Journal
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• v.12 no.3
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• pp.323-329
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• 1994

Purpose: In supraglottic cancer, radiation therapy is used to preserve the laryngeal function but combined surgery and radiation therapy is required in advanced stage. The authors Present the results of radiation therapy alone and combined surgery Plus Postoperative radiation therapy for supraglottic cancer. Methods and Materials: A retrospective analysis was done for 43 patients with squamous cell carcinoma of the supraglottic larynx who were treated from Feburary 1982 to December 1991, in the Department of Radiation Oncology, Korea University Hospital. Patient distribution according to the AJCC staging system was as follows: I, 3($7.0\%$); II, 7($16.3\%$); III, 17($39.5\%$); IV, 16($37.2\%$). Patients' age ranged from 30 to 72 years(median 62). Follow up durations were from 21 to 137 months(median 27). Seventeen patients($39.5\%$) were treated by radiation therapy alone with radiation doses of 6840-7380 cGy and 26 patients($60.5\%$) were treated with surgery plus postoperative irradiation with doses of 5820-6660 cGy. Results: Overall five-year survival rate for all stage was $51.8\%$, with $100\%$ for Stage I and II, $47.3\%$ for Stage III, and $29.2\%$ for Stage III. The difference of the survival rate by stage was statistically significant(p=0.0152). Five-year survival rates were $100\%$ for locally confined tumor in the supraglottic larynx, $37.5\%$ for transglottic extension, $26.7\%$ for hypopharynx extension, and only two of 5 patients with both transglottic and hypopharynx extension were alive(p=0.0033). Five-year survival rates by neck node status were as follows: $55.0\%$ for NO, $64.3\%$ for N1, $50.0\%$ for N2, and all 2 of N3 were died of disease. Overall survival rate for radiation therapy alone group was $42.8\%$, and it was $56.7\%$ for surgery plus postoperative radiation therapy group with no statistically significant difference(p=0.5215). In Stage I and II, all Patients survived. In Stage III and IV, 5-year survival rate for radiation therapy alone group was $28.5\%$ and $43.4\%$ for surgery plus postoperative irradiation group(p=0.5103). Local control rate was $58.8\%$(10/17) for radiation therapy alone group and $73.1\%$ (19/26) for surgery plus postoperative irradiation group. Three patients from surgery plus postoperative radiation therapy group developed distant metastasis in lungs. Conclusion: Treatment results of radiation therapy alone was excellent in early stage supraglottic cancer. In advanced stage, even the difference was statistically not significant, the result of postoperative radiation therapy group was superior compared with radiation therapy alone group. Since 1992, concomitant chemoradiotherapy with hyperfractionated radiotherapy is being used to improve the result of the treatment and preserve the laryngeal function in advanced stage supraglottic cancer.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.16
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• pp.7045-7047
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• 2015

Background: Mean platelet volume (MPV) is a marker which has been investigated in many cancers but data for head and neck lesions are limited. We aimed to study the MPV levels in head and neck cancers as a diagnostic marker. Materials and Methods: A total of 96 head and neck cancer patients and 31 control patients who did not meet exclusion criteria were enrolled in the study. The cancer locations, the platelet and MPV levels at the first diagnosis time were collected. Results: The head and neck cancer location distribution between these patients was 2 (2.1%) buccal, 9 (9.4%) tongue, 6 (6.3) lip, 1 (1%) gingiva, 1 (1%) hypopharynx, 1 (1%) ear, 58 (60.4%) larynx, 2 (2.1%) maxilla, 2 (2.1%) nasal, 1 (1%) nasopharynx, 2 (2.1%) palatal, 3 (3.1%) primary unknown, 1 (1%) retromolar, 1 (1%) thyroid, 2 (2.1%) tonsil, and 4 (4.2%) salivary gland. MPV levels were significantly different between cancer and control group (p=0.002). The cut-off point for MPV predicting head and neck cancer is >10 fL (sensitivity=55.21, specificity=87.10). Conclusions: MPV level increase, a readily assessable parameter which does not bring extra costs can warn us regarding head and neck cancer risk.

• Archives of Craniofacial Surgery
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• v.16 no.3
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• pp.105-113
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• 2015

The main challenge in pharyngoesophageal reconstruction is the restoration of swallow and speech functions. The aim of this paper is to review the reconstructive options and associated complications for patients with head and neck cancer. A literature review was performed for pharynoesophagus reconstruction after ablative surgery of head and neck cancer for studies published between January 1980 to July 2015 and listed in the PubMed database. Search queries were made using a combination of 'esophagus' and 'free flap', 'microsurgical', or 'free tissue transfer'. The search query resulted in 123 studies, of which 33 studies were full text publications that met inclusion criteria. Further review into the reference of these 33 studies resulted in 15 additional studies to be included. The pharyngoesophagus reconstruction should be individualized for each patient and clinical context. Fasciocutaneous free flap and pedicled flap are effective for partial phayngoesophageal defect. Fasciocutaneous free flap and jejunal free flap are effective for circumferential defect. Pedicled flaps remain a safe option in the context of high surgical risk patients, presence of fistula. Among free flaps, anterolateral thigh free flap and jejunal free flap were associated with superior outcomes, when compared with radial forearm free flap. Speech function is reported to be better for the fasciocutaneous free flap than for the jejunal free flap.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.23
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• pp.10289-10292
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• 2015

Background: The involvement of HPV in oral and oropharyngeal carcinogenesis was first proposed in 2004, based on epithelial HPV tropism and detection of HPV genotypes in oral squamous cell carcinoma samples. While 60-70% of oropharynx tumors may be HPV-positive, only 10 to 19% of tumors of the oral cavity, larynx and hypopharynx appear to have HPV infection. The aim of the study was to evaluate HPV infection associated with oropharyngeal cancer. Materials and Methods: Seventy-eight cases were selected for p16 immunoexpression reactions, and demographic data were collected for comparisons. Results: Most patients were over 60 years old, and 64.1% were smokers. Immunohistochemistry results showed that 86.3% of cases stained positive for p16 protein. Conclusion: The oropharyngeal cancer profile at Erasto Gaertner Hospital presented a high index of smokers over 60 years as well a high number of p16+ tumors, for what we can not determinate the main etiologic factor, but can be aware of the number of patients that presented HPV infection. Since prevention is still the best way to deal with cancer disease, it is important to analyze the interaction of these two etiologic factors and how to detect lesions at an early stage.

• Korean Journal of Head & Neck Oncology
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• v.9 no.2
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• pp.193-199
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• 1993

The prognosis of supraglottic cancer is worse than that of glottic cancer. Supraglottic cancers by subsites have different microenvironment of cancer cells, locoregional spread patterns. Therefore we presume that high therapeutic efficacy, while preserving the organ, can be obtained when supraglottic cancer is treated effectively according to its biological behaviors. For the purpose of determination of clinical characteristics and causes of treatment failures by subsites of supraglottis, the authors analyzed 24 cases(stage III 14 cases, stage IV 10 cases) of supraglottic cancer which were managed mainly by surgery in our institute. The results were as follows; 1) The suprahyoid group had worse pathologic grades, more frequent spread to hypopharynx, more freguent recurrence at primary site, and better three-year survival rate than the infrahyoid group. 2) The infrahyoid group had more frequent spread to glottis, understaging, recurrence at cervical nodes than the suprahyoid group. 3) There was no differences in nodal metastasis by sub sites. These results suggest that the suprahyoid group may have more aggressive spread pattern but better prognosis than the infrahyoid group.