• Archives of Craniofacial Surgery
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• v.22 no.1
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• pp.66-70
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• 2021

Isolated head and neck metastasis of renal cell carcinoma (RCC) is relatively rare and metastasis to the temple area is very rare. Here, we present the case of a 51-year-old man who was diagnosed with RCC 2 years earlier and had a contralateral metastatic temple area lesion. The patient who was diagnosed with renal cell cancer and underwent a nephrectomy 2 years ago was referred to the plastic surgery department for a temple mass on the contralateral side. In the operative field, the mass was located in the temporalis muscle with a red-to-purple protruding shape. Biopsy of the mass revealed a metastatic RCC lesion. Computed tomography imaging showed a lobulated, contoured enhancing lesion. Positron emission tomography/computed tomography imaging showed high-fluorodeoxyglucose uptake in the right temporalis muscle. The patient underwent wide excision of the metastatic RCC including the temporalis muscle at the plastic surgery department. Skeletal muscle metastasis of head and neck lesions is extremely rare in RCC. Isolated contralateral temporalis muscle metastasis in RCC has not been previously reported in the literature. If a patient has a history of malignant cancer, plastic surgeons should always consider metastatic lesions of head and neck tumors. Because of its high metastatic ability and poor prognosis, it is very important to keep this case in mind.

• Korean Journal of Head & Neck Oncology
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• v.33 no.2
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• pp.1-8
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• 2017

Cancer is the disease of aging and Korea is one of the fastest aging country in the world. Older patients have decreased organ function and stress tolerance, therefore are at high risk of functional decline and developing complication from cancer and cancer treatment. Before beginning cancer treatment, it is important to assess patients' life expectancy, whether the patient is likely to die of cancer or of other comorbidity, and also the risks with cancer treatment. In order to estimate patient's physiologic age, it is recommended to perform geriatric assessment and implement appropriate geriatric intervention together with meticulous supportive care, when planning cancer treatment for older patients. In a resource limited country such as Korea, two step approach of applying screening tool followed by geriatric assessment can be more efficient. Geriatric assessment is used to predict toxicity from cancer treatment such as surgery, radiotherapy, and chemotherapy, predict survival, and also to aid treatment decision. Number of randomized trials are ongoing to compare usual care versus oncogeriatric care, and with these results we expect to improve outcome of older patients with cancer.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.8
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• pp.4571-4576
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• 2013

Background: Depression is a comorbid disabling problem and potentially affects patient likelihood of survival. The aims of this study were to recognize the characteristics of depression and investigate associated predictor factors in patients with oral cancers. Methods: A cross-sectional and correlational design was used to collect data for this study conducted in northern Taiwan. A set of questionnaires was used to measure depression, symptom distress, performance status, social support, and demographic and disease-related information. Logistic regression was conducted to determine important factors predicting depression. Results: A total of 132 oral cancer patients participated in this study. Of these, 18.2% were identified as depression cases. The patient average performance status score was 90 or higher. Patients reported mild-to-moderate levels of symptom distress. The majority of social support was from families. Religious belief, alcohol use, symptom distress, and social support from family were found to be important factors predicting depression. Patients with religious belief with alcohol use reported greater symptom distress, and those with lower levels of social support from families were significantly more likely to develop depression. Conclusions: Clinicians should assess patient emotional status and manage symptoms in a timely manner to enhance coping abilities. Supportive care provides assurance during the acute survivor phase.

• Korean Journal of Head & Neck Oncology
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• v.33 no.2
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• pp.67-70
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• 2017

We present a metastatic carcinoma from the breast to the neck soft tissue around common carotid artery, with a rare finding of voice change. A 60 year-old female patient presented with voice change for 7 months. Neck ultrasound revealed a soft tissue mass between internal jugular vein and common carotid artery. Result of fine needle aspiration biopsy was a metastatic carcinoma. Computed tomography and magnetic resonance image revealed $2.5{\times}3.0cm$ sized irregular marginated soft tissue mass in right lower neck encasing common carotid artery and internal jugular vein. Surgical resection was performed and pathologic result with immunohistochemical analysis confirmed the diagnosis of a metastatic invasive ductal carcinoma originated from breast.

• Korean Journal of Head & Neck Oncology
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• v.37 no.2
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• pp.105-109
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• 2021

Follicular thyroid carcinoma (FTC) is the second most common thyroid cancer, following papillary carcinoma. Metastasis to the orbital rim from FTC is very rare. We recently experienced a case of FTC with metastasis to the orbital rim in a 74-year-old woman, who initially presented with a huge thyroid mass and an asymptomatic solitary orbital rim lesion. The solitary orbital rim lesion was suspected to be a separate disease entity such as lymphoma from the preoperative imaging, but bone metastasis from FTC was finally confirmed after orbital rim resection and total thyroidectomy. During follow-up, the patient presented multiple bone metastasis, so the solitary orbital rim lesion was considered a clinical sign of systemic metastasis from FTC. Therefore, we present this unique case with a review of the literature.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.29 no.2
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• pp.67-69
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• 2018

The development of office-based, unsedated transnasal esophagoscopy (TNE) has proven to be a major technological advance and with time and experience the application of this technology is becoming more widespread. TNE has allowed otolaryngologists to perform a variety of diagnostic and therapeutic procedures in the office setting. Studies consistently demonstrate that the image quality and diagnostic capability of TNE is equivalent to conventional esophagoscopy. The modern TNE endoscopes offer high quality optics, air-insufflation, and irrigation capability through a 2-mm working channel, and the ability to perform biopsies and select procedures. In general, the role of TNE in the head and neck patient is three-fold : to screen for synchronous and metachronous esophageal squamous cell carcinoma (ESCC) ; to differentiate post-treatment changes/symptoms from malignancy ; and to perform certain office-based procedures. TNE offers many specific advantages to the head and neck patient that are not afforded by conventional esophagoscopy. Because of surgical and postirradiation changes, many HNSCC patients have trismus or neck stiffness preventing completion of conventional transoral esophagoscopy. Perhaps most importantly, TNE provides enhanced patient safety, increased tolerability, better practice efficiency, and cost savings. For these reasons, TNE has become a particularly useful tool in the otolaryngologist's armamentarium.

• Korean Journal of Head & Neck Oncology
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• v.27 no.1
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• pp.77-79
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• 2011

Tracheal diverticulum is very rare, that is usually an incidental finding at routine chest computed tomography scan. Differential diagnosis of tracheal diverticulum includes pharyngocele, laryngocele, Zenker diverticulum, apical lung hernia, blebs and bulla, and pneumomediastinum. Treatment options can be devided into medical and surgical. The majority of patients is asymptomatic and requires no specific intervention. We experienced one case of tracheal diverticulum in patient with tongue cancer and report it with reviews of literature.

• Archives of Craniofacial Surgery
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• v.21 no.5
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• pp.269-275
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• 2020

Background: The advance in microsurgical technique has facilitated a proper approach for reconstruction of extensive head and neck defects. For the success of free tissue reconstruction, selection of the recipient vessel is one of the most important factors. However, the vascular anatomy of this region is very complex, and a clear guideline about this subject is still lacking. In this study, we present our 30 years of experiences of free tissue reconstruction for head and neck defects. Methods: In this retrospective study, we analyzed a total of 138 flaps in 127 patients who underwent head and neck reconstruction using free tissue transfer following tumor resection between October 1986 to August 2019. Patients who underwent facial palsy reconstruction were excluded. Medical records including patient's demographics, detailed operation notes, follow-up records, and photographs were collected and analyzed. Results: Among a total of 127 patients, 10 patients underwent a secondary operation due to cancer recurrence. The most commonly used type of flap was radial forearm flap (n=107), followed by the anterolateral thigh flap (n=18) and fibula flap (n=10). With regard to recipient vessels, superior thyroid artery was most commonly used in arterial anastomosis (58.7%), and internal jugular vein (51.3%) was the first choice for venous anastomosis. The flap survival rate was 100%. Four cases of venous thrombosis were resolved with thrombectomy and re-anastomosis. Conclusion: Superior thyroid artery and internal jugular vein were reliable choices as recipient vessels. Proper recipient vessel selection could improve the result of head and neck reconstruction.

• The Korean Journal of Pain
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• v.28 no.2
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• pp.116-121
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• 2015

Background: To explore the relationship between persistent post-radiotherapy pain and locoregional recurrence in head and neck cancer patients. Methods: Five year retrospective data was reviewed of 86 patients of head and neck cancer treated with radiotherapy who continued to have pain at 6 weeks after completion of treatment. At follow-up after 3 months, these patients were stratified into: Group A (n = 39) constituted of patients whose pain subsided and Group B (n = 47) were patients who continued to have persistent pain. Results: At median follow-up time of 25 months (range: 8-47), one patient (2.6%) and 18 (38.3%) patients in group A and group B had locoregional recurrence respectively (P < 0.0001). Furthermore, group B patients had higher mean pain score levels as compared to group A (P = 0.03). Patients in whom pain subsided within 3 months had statistically much greater disease-free survival in comparison to those with persistent pain (P < 0.0001). Conclusions: Pain in head and neck cancer is an important symptom and should be considered a poor prognostic factor. In the current study, the majority of the patients with persistent pain had recurrent disease as compared to those in whom pain subsided within 3 months of post-treatment. It is suggested that patients with persistent pain need more intense follow-up and should be investigated thoroughly to detect recurrence at an early stage to provide a better quality of life.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.611-616
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• 2009

Purpose: The rate of fistulas occuring followed by resection of oral cavity, oropharyngeal, hypopharyngeal, and laryngeal cancer are reported to be 9 ~ 23% according to various documents. Neglected treatment of the fistula can result in a setback in proper treatment with restrictions in oral intake leading to delayed return to daily life. Furthurmore, in severe cases, it may injure important vessels and adjacent structures of the neck area. The author reviewed previously reported cases of treatment methods for fistulas recurring after diverse head and neck operations and with sharing the treatment experiments of our patients, we tried to present a treatment algorism for different fistula types. Methods: Our study was based on retrograde analysis of 64 patients who were clinically diagnosed with fistula after operation for cancer of the head and neck from 1997 to 2008 at Severance Hospital. Their primary sites of cancer were 8 oral cavity, 22 oropharynx, 25 hypopharynx, and 9 larynx. The patients were aged 45 to 75 years and the male to female ratio was 11 to 1. The patient's operation records and progress notes were evaluated for determination of degree of fistula and treatment methods. Results: Most fistulas were clinically suspected after postoperative 5 days and symptoms noted for detection of the fistula were erythema, purulent discharge, edema, tenderness, and fluctuation. The fistula was definitely diagnosed at postoperative 2 weeks with barium test and treatment method ranging from conservative management to operative procedure were applied to each patients. Total 21 patients were managed with conservative protocol. In 15 cases, direct repair of the fistula was done and more stable repair of the fistula was possible with using of TachoComb$^{(R)}$. Pharyngostoma was performed in 14 patients. Among them, 4 patients healed spontaneously, 5 patients were taken direct closure, 4 patients were taken pectoralis major musculocutaneous flap, and one patient was taken esophageal transfer. The other 14 patients were taken 11 pectoralis major musculocutaneous flaps and 3 free flaps without pharyngostoma formation. Conclusion: Fistula is a troublesome complication resulting after resection of head and neck cancer. Early detection and adequate treatment according to the period and condition of the fistula may prevent further complications and reduce the pain of the patient.