• Korean Journal of Head & Neck Oncology
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• v.5 no.1
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• pp.39-46
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• 1989

Kimura's Disease is a chronic inflammatory and proliferative condition producing subcutaneous masses especially in the head and neck area. This report of our experience with 5 patients with this disease is the first in the Korean surgical literature. Kimura's Disease is thought to be part of the larger spectrum of the entity known as angiolymphoid hyperplasia with eosinophilia (ALHE). It is characterized pathologically by hyperplastic lymphoid follicles, eosinophilic infiltration, and vase 비 ar proliferation. It produces masses which are most common in the area of the parotid, submandibular gland and upper neck. These masses occupy the subcutaneous tissues but also extend into salivary tissue and into upper neck nodes. One of our patients had masses in the groin. The tumors are extremely vascular due to the presence of new proliferative vessels and sinusoids. The average age of our 5 patients was 35, but all but one case were younger than 38 years of age. The male: female ratio was 3 : 2, and the average duration of symptoms was 5,2years. All patients had peripheral blood eosinophilia. All had multiple masses, sometimes symmetrical. The management was surgery alone in one case, surgery and steroids in one case, surgery and radiotherapy in two cases, and all three modalities in one case. The relationship of this entity to ALHE and our experience in the management of this disease are presented. A clinicopathological discrepancy alerted us to the existence of Kimura's Disease. A nineteen-year old male presented with subcutaneous masses over both mastoid areas present for 3 years (Case III). When biopsy on each side was reported as 'eosinophilic granuloma' we submitted the slides to an internationally expert pathologist. Symmetrically occurring tumors in the peri-parotid subcutaneous areas did not fit any category of neoplasm or granuloma known to us. The diagnosis, made by Dr. Gist Fan at the Ochsner Clinic, was Kimura's Disease. We found two additional cases in a review of soft tissue eosinophilic granuloma previously reported at Presbyterian Medical Center, and since then have diagnosed two new cases. These five cases constitute the basis for this, the largest series to be reported in Korea. These vascular, tumor-like lesions of the skin, subcutaneous areas and subjacent structures of the head and neck have been a variety of names, such as angiolymphoid hyperplasia with eosinophilia, eosinophilic hyperplastic lymphogranuloma, angioblastic lymphoid hyperplasia with eosinophilia, histioid hemangioma, and epithelioid hemangioma. The history of this disease spectrum dates back to 1937 when Kimm and Szeto (1) reported 7 cases of 'eosinophilic hyperplastic lymphogranuloma' in the Proceedings of the Chinese Medical Journal. In 1948 Kimura and his associates(2) reported additional cases in Japan under the title 'On the unusual granulation combined with hyperplastic changes of lymphatic tissue.' From then until 1966 several hundred cases were reported in China and Japan. The first report from the West was by Wells and Whimster(3) in the British Journal of Dermatology, in 1969. These authors coined the term, angiolymphoid hyperplasia with eosinophilia (ALHE). Since that time a debate has ensued as to whether Kimura's Disease and ALHE are distinct entities, or whether Kimura's is part of the larger spectrum of ALHE, perhaps a later or advanced phase. From the clinical perspective, surgeons should be aware of the diagnosis of Kimura's Disease not only as part of the differential diagnosis of head and neck tumors but also because these lesions are indolent, and generally require conservative surgical removal as part of the management program. CASE I. A 37-year-old female company employee presented in August 1982 with submental swelling of 12 years' duration and with inguinal swelling of 7 years' duration. The submental mass measured 5x5cm. and the inguinal mass was 8x4cm. in size. Peripheral eosinophilia varying from 14% to 40% was found. On August 20, 1982, the submental mass was removed and a superficial groin dissection was done. In May 1983 an intraoral lesion of the palate was removed. The patient is free of disease. CASE II. A 23-year-old unemployed man visited this hospital for the first time in July, 1984, with swelling of the right cheek present for 6 years. The mass was soft and ill-defined but measured 10x20cm. and extended from the submandibular upper neck to the zygomatic arch, and from the mastoid to the cheek, over the parotid gland. Eosinophilia varying from 27% to 29% was noted in the peripheral blood. On March 21, 1986, the lesion was resected. The procedure comprised an extended superficial parotidectomy from the temporalis fascia to the upper neck. Post-operatively radiotherapy 3000 rad tissue dose was administered using the 6 MeV linear accelerator. The patient remains free of disease. CASE III. A 19-year-old student came to the clinic with masses over both mastoid areas, present 3 years. On the right there were two adjacent lesions, one over the mastoid, the other in the upper jugular level of the neck. On the left it was a single mass over the mastoid. Eosinophilia varied from 13 to 32% in the peripheral blood, and 11.6% in the bone marrow. Incisional biopsy revealed 'eosinophilic granuloma' and a trial of predisolone was employed. The mass increased in size so a small dose of radiation (600 rads) was used, with substantial regression,. The lesion on the left was excised and follwed by 1000 rads radiotherapy. Finally recurrent tumor on the right side was removed on November 5, 1985. The patient remains free of disease. CASE N. A 29-year-old local merchant had had swelling of both upper necks since childhood. At the time of his first visit on March 17, 1986, the right submandibular mass measured 5x3.5cm. and the ,right upper neck and parotid tail mass measured 2.5cm. On the left there were masses in the upper neck, the largest of which measured 2.5cm, and of the parotid tail, 2.0cm. in size.(See Fig. 1) Peripheral eosinophilia of 39% was recorded. Left side partial parotidectomy and resection of the upper neck and subdigstric mases was done on May 2, 1986. The mass involving the right parotid tail and upper neck nodes was removed on Angust 7,1986. Postoperatively the patient was placed on prednisolone 30 mg. per day. No definite masses are palpable. CASE V. A 66-year-old housewife informed us, at the time of her first visit in May, 1986, that she had had multiple neck masses since 10 years ago. On the right side there was a 2.5cm. subcutaneous mass of the upper neck, over the upper jugular chain. On the left there was a 9x4.5cm. mass involving the entire parotid, the post-auricular area and the upper neck. A third mass presented in the submental area and measured 3.5cm. (See Fig. 2) Eosinophilia of 51% was noted in the peripheral blood. partial excision of the left upper neck lesion and complete excision of the submental mass were performed on june 6, 1986. post-operatively she was placed on 20 mg. of prednisolone daily, but when the mass re-grew after two months she was referred to Radiation Therapy for a 2500 rad course of treatment. A barely palpable thickening remains.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.16 no.1
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• pp.81-91
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• 1986

The author obtained the trans cranial radiographs of right and left side and the individualized lateral tomograms of right and left side after the analysis of submental vertex view from 8 young adults of 25-32 years with normal occlusion. The condylar position from 32 radiographs of normal TMJs were assessed with each measurement methods. All datas from these analyses were recorded and statistically processed with CYBER computer system. The results were obtained as follows. 1. In each measurement methods, the area measurements using the midpoint fossa and the midpoint condyle revealed the hightest concordance rate between the radiographic pairs. 2. In the subjective evaluation, the qualitative concordance existed in 44% and the full concordance existed in 25%, so it was found that concordance rates were relatively low between the radiographic pairs. 3. In each measurement methods, the area measurement using the midpoint fossa revealed the strongest correlation between the radiographic pairs. 4. The correlations between the area measurement using the midpoint fossa and subjective valuation revealed relatively strong value which is 0.926 in the trans cranial radiographic series and the lowest value which is 0.743 in the tomographic series.

• Journal of Korean Dental Science
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• v.5 no.2
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• pp.88-92
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• 2012

Also called necrobacillosis or postanginal sepsis, Lemierre's syndrome (LS) is an uncommon but potentially lethal complication of odontogenic infection. A 27-year-old male diagnosed with Ludwig's angina was transferred from a local hospital due to continuous fever and chills after incision and drainage under general anesthesia. The swelling of both submental and submandibular area subsided, but the fever and chills persisted. While generalized malaise improved, sepsis developed together with the deterioration of liver function. The chest computed tomography scan revealed multiple cavitations throughout both lungs, which were diagnosed as septic pulmonary embolism. After consulting the department of infectious diseases, the patient was treated with intravenous antibiotics focusing on vancomycin and additional antibiotics. After 3 weeks of treatment, the patient recovered completely. Despite its decreased mortality, dentists are not familiar with LS, and it is difficult to diagnose correctly. In this paper, we report a case and present a review of literature.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.18 no.4
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• pp.701-705
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• 1996

There are many kind of diagnostic entities in submandibular or neck masses, and we can set up treatment plan and estimate treatment result, prognosis by accurate diagnosis. By reasoning medical and dental history, physical examination, anatomical consideration of masses in submandibular or neck area, location of masses, laboratory and radiographic studies, we can formulate a clinical diagnosis or differential diagnosis. Although a clinical diagnosis might suffice in some instances, a definitive(microscopic) diagnosis is frequently required for proper treatment. In order to get some information about making accurate diagnosis and setting up appropriate treatment plan, we did clinical study and histopathologic classification of 82 patients who visited and were operated for submandibular masses at Department of Oral and Maxillofacial Surgery in Seoul National University Hospital from 1988 to 1992. The result were as follows : 1. Submandibular masses occured most frequently in forties and fifties, and there was no sex predilection. 2. Chief complaints were in order of mass, swelling, pain and consistency were soft mass, mobile hard mass, firm mass, diffuse swelling in descending order. 3. Most frequent pathologic finding was lymphadenitis. 4. Site of submandibular masses were submandible, neck, submental, retromandible in descending order, and there was no predilection between left and right side. 5. Accuracy rate between clinical impression and result was 51.2%.

• Archives of Plastic Surgery
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• v.32 no.3
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• pp.271-280
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• 2005

There are various types of flap in head and neck reconstruction. We chose the appropriate flap considering the indication and patient's condition. In case of conventional flaps, its type is decided according to the reconstruction site. In other words, the types of considerable flaps are limited in a way. But, perforator flaps can reduce donor limitation and harvest flaps depending on the condition of the recipient. Therefore, the flap is very useful for the head and neck reconstruction needed for 2-dimensional or 3-dimensional reconstruction. We report the 29 cases of perforator-based flap including 8 cases of latissimus dorsi perforator free flap, 5 thoracodorsal perforator free flap, 4 anterolateral thigh perforator free flap, 3 peroneal osteocutaneous perforator free flap and 9 submental perforator island flap for the head and neck reconstruction. Free flaps include 2 cases of chimeric pattern, 7 controlled resurfacing pattern, 4 3-D pattern, 3 dermoadiposal pattern, 1 folded pattern and 3 osteocutaneous pattern. The flaps were successfully used for the head and neck reconstruction. But one patient died during a follow up period because of the recurrence of tumor. Various perforator flaps(island/free pattern) can be highly competitive to the conventional flaps in the head and neck reconstruction, considering a thin character for resurfacing, more flexible and versatile option, variable composition, long pedicle with donor structures saved, and less prominent donor morbidity.

• Archives of Plastic Surgery
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• v.43 no.4
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• pp.374-378
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• 2016

Submandibular gland ptosis is a common impediment to obtaining superior surgical aesthetic results in neck lift surgery. Techniques for suspending the submandibular gland have been proposed, but these procedures have the drawbacks of disturbing the floor of the mouth mucosa and periosteum. We present an approach of submandibular gland suspension for the treatment of gland ptosis by employing a platysma and hyoid bone fascia cradle. Our technique was performed on cadaveric models. The platysma muscle and hyoid bone cradle for submandibular gland ptosis was created on the left side of the neck in two cadavers. A submental incision with sharp dissection was performed to raise a supraplatysmal flap. A subplatysmal plane was developed until the submandibular gland was identified. Sutures were used to pexy the platysma to the hyoid bone periosteum and deep cervical fascia, tightening the overlying muscle and in turn elevating the submandibular gland. Submandibular gland ptosis must be corrected in order to achieve exemplary aesthetic results. Our approach of creating a cradle with the platysma and hyoid bone avoids the potential complications of previously described sling procedures, while still maintaining the integrity of the gland and surrounding tissues.

• Korean Journal of Bronchoesophagology
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• v.6 no.2
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• pp.147-151
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• 2000

Background and Objectives： Metastasis to the submental and submandibular lymph nodes rarely occurs in squamous cell carcinoma of the larynx and hypopharynx. The aim of this study is to evaluate the effectiveness of level I neck dissection in squamous cell carcinoma of larynx and hypopharynx. Materials and Methods : Forty-three patients with pathologically positive cervical nodal involvement in squamous cell carcinoma of larynx and hypopharynx treated between 1989 to 1998 were reviewed. Fifteen patients were treated with neck dissection including level 1,28 patients were treated with neck dissection excluding the level 1. Results : The regional recurrence at the level I in patients treated with neck dissection excluding the level I, was shown in only one case (recurrence rate 3.6%), but this patient was efficiently managed with salvage operation and adjuvant radiotherapy. No recurrence was shown in patients treated with neck dissection including the level I. So, total recurrence rate at the level I was 2.3%. Conclusion : This study suggests that dissection of the level I is not justified in squamous cell carcinoma of larynx and hypopharynx even if metastasis to cervical lymph node was confirmed preoperatively (cN+).

• Journal of Chest Surgery
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• v.33 no.8
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• pp.688-692
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• 2000

Descending Necrotizing Mediastinitis(DNM) is a complication of oropharyngeal infections that can spread to the mediastinum. It is difficult to diagnose early because clinical and radiologic findings appear in the late stage of the infection. late diagnosis is the principal reason for the high mortality in DNM. An 18-year-old female admitted with Ludwig's angina from dental caries. Despite of combined antibiotics, dental extraction and drainge of submental abscess, infection spread to the cervical area. Chest computed tomogram revealed extension of the abscess to the pretracheal and periaortic space and development of bilateral pleural empyema. We performed bilateral cervical mediastinotomy and thoracotomy for drainage and debridement. Tracheostomy to secure the airway and postoperative pleural irrigation were performed. Postoperative course was uneventful and patient was discharged on the 40th postoperative day. It is important to perform chest CT scanning for early diagnosis of DNM when oropharyngeal infection spreads to the cervical area. Improved survival of patients with DNM implies early and radical surgical drainage and debridement via a cervical mediastinomy and thoracotomy.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.26 no.2
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• pp.65-73
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• 1996

The purpose of this study was to evaluate the clinical and computed tomographic features of 7 cases of maxillofacial gunshot injuries in the suicidal patients visited the emergency room, Capital Armed Forces General Hospital. The obtained results were as follows : 1. The gunshot wounds were directed from submental area to dorsum of nose(3 cases), frontal area(1 case), orbit(1 case), infraorbital area (1 case), and lateral to nasal wing(l case). The shape of inlet in gunshot wounds were round (diameter: l-3cm) and that of outlet were oval shape(size : inlet

• International journal of thyroidology
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• v.11 no.2
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• pp.189-193
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• 2018

A thyroglossal duct cyst (TGDC) is the most common congenital anomaly of the neck. However, carcinoma arising from TGDC is extremely rare. We report 2 cases of TGDC carcinoma. In the first case, a 21-year-old male patient complained of an anterior cervical mass; computed tomography (CT) and sonography revealed cystic mass that was suspected to be a TGDC. Sistrunk operation was performed. Papillary carcinoma was confirmed in pathologic examination. Additionally, he underwent total thyroidectomy and central neck dissection. After radioactive iodine ablation (RAI) was performed. In the second case, a 28-year-old male patient visited our out-patient department complaining of submental mass. He had already been diagnosed TGDC carcinoma 13 years ago and had undergone Sistrunk operation and total thyroidectomy. Malignancy was confirmed using fine-needle aspiration; thus, lateral neck dissection was performed and following this, he underwent RAI. Till date, no evidence of recurrence has been observed in these patients.