• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.22 no.1
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• pp.47-51
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• 2011

Background and Objectives: Vocal polyps arc one of the most frequent benign laryngeal diseases. They arc usually found at the midpoint of the vocal fold. They are mainly caused by vocal overuse. Vocal polyps arc usually removed surgically. Generally, age-related changes to speech are attributed to change in anatomy and physiology of the speech mechanism. These changes result in increased variability in the acoustic properties of speech with age. Still, not 'all studies of age-related changes in speech have taken differences between the young group and adult group after laryngeal microsurgery into account. The aim of this investigation was to compare improvement of acoustic analysis in young patients and elderly patients with vocal polyps, before and after the laryngeal microsurgery. Materials and Method: One hundred and twenty-eight patients who underwent laryngeal microsurgery for vocal polyps from 2008 through 2011 were reviewed retrospectively. 105 of the 128 patients under age 60 were classified as adult group (AG), and remaining 23 patients as elderly group (EG). The speech of AG and EG were evaluated before and after surgery for identification of differences for age group across measures of fundamental frequency (F0), Jitter, Shimmer and Maximum phonation time (MPT). Results: There were not significant differences between two groups for improvement of F0, Jitter, Shimmer, NHR, and MPT before and after surgery. The findings suggest that elderly group compares quite well with adult group in effectiveness of surgery. However, comparison between elderly group and young group (Age under 40) there was significant difference of improvement in Jitter and Shimmer. Conclusion: In general, the results of the present research showed significant improvement in vocal quality after phonosurgery of vocal polyp in both elderly and adult group. However, comparison of improvement between elderly group and young group, there were significant differences of improvement in jitter and shimmer. Therefore, in treatment planning of elderly group, we should consider age related changes of vocal cord.

• Archives of Plastic Surgery
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• v.49 no.5
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• pp.617-632
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• 2022

Tracheoesophageal puncture (TEP) and voice prosthesis insertion following laryngectomy may fail to form an adequate seal. When spontaneous closure of the fistula tract does not occur after conservative measures, surgical closure is required. The purpose of this study was to summarize the available evidence on surgical methods for TEP site closure. A comprehensive search across PubMed, Web of Science, SCOPUS, and Cochrane was performed to identify studies describing surgical techniques, outcomes, and complications for TEP closure. We evaluated the rate of unsuccessful TEP closure after surgical management. A meta-analysis with a random-effect method was performed. Thirty-four studies reporting on 144 patients satisfied inclusion criteria. The overall incidence of an unsuccessful TEP surgical closure was 6% (95% confidence interval [CI] 1-13%). Subgroup analysis showed an unsuccessful TEP closure rate for silicone button of 8% (95% CI < 1-43%), 7% (95% CI < 1-34%) for dermal graft interposition, < 1% (95% CI < 1-37%) for radial forearm free flap, < 1% (95% CI < 1-52%) for ligation of the fistula, 17% (95% CI < 1-64%) for interposition of a deltopectoral flap, 9% (95% CI < 1-28%) for primary closure, and 2% (95% CI < 1-20%) for interposition of a sternocleidomastoid muscle flap. Critical assessment of the reconstructive modality should take into consideration previous history of surgery or radiotherapy. Nonirradiated fields and small defects may benefit from fistula excision and tracheal and esophageal multilayer closure. In cases of previous radiotherapy, local flaps or free tissue transfer yield high successful TEP closure rates. Depending on the defect size, sternocleidomastoid muscle flap or fasciocutaneous free flaps are optimal alternatives.

• Archives of Plastic Surgery
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• v.49 no.3
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• pp.378-396
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• 2022

Several reconstructive methods have been reported to restore the continuity of the aerodigestive tract following resection of pharyngeal and hypopharyngeal cancers. However, high complication rates have been reported after voice prosthesis insertion. In this setting, the ileocolon free flap (ICFF) offers a tubularized flap for reconstruction of the hypopharynx while providing a natural phonation tube. Herein, we systematically reviewed the current evidence on the use of the ICFF for reconstruction of the aerodigestive tract. A systematic literature search was conducted across PubMed MEDLINE, Web of Science, ScienceDirect, Scopus, and Ovid MEDLINE(R). Data on the technical considerations and surgical and functional outcomes were extracted. Twenty-one studies were included. The mean age and follow-up were 54.65 years and 24.72 months, respectively. An isoperistaltic or antiperistaltic standard ICFF, patch flap, or chimeric seromuscular-ICFF can be used depending on the patients' needs. The seromuscular chimeric flap is useful to augment the closure of the distal anastomotic site. The maximum phonation time, frequency, and sound pressure level (dB) were higher with ileal segments of 7 to 15 cm. The incidence of postoperative leakage ranged from 0 to 13.3%, and the majority was occurring at the coloesophageal junction. The revision rate of the microanastomosis ranged from 0 to 16.6%. The ICFF provides a reliable and versatile alternative for reconstruction of middle-size defects of the aerodigestive tract. Its three-dimensional configuration and functional anatomy encourage early speech and deglutition without a prosthetic valve and minimal donor-site morbidity.

• Korean Journal of Head & Neck Oncology
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• v.32 no.2
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• pp.5-8
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• 2016

Background and Objectives: The aim of this study was to evaluate the safety and the feasibility of thyroidectomy for aged (${\geq}75$ years old) thyroid cancer by reviewing postoperative morbidity and pathologic characteristics. Materials & Methods: The clinical records of patients submitted to thyroid operation between 2014 and 2015 with histopathological diagnosis of thyroid cancer were analyzed. Clinical variables included age, gender, preoperative symptom, final pathology, length of stay, comorbidities, American Society of Anesthesiologists score, postoperative complications, and mortality. Results: There were 30 patients aged more than 75 years old, and only one patient passed over with postoperative pneumonia. There were 8 male and 22 female patients. Half of the patients presented with symptoms such as palpable mass (33.3%), voice change (6.7%) and dyspnea (6.7%). The pathologic diagnosis was thyroid cancer in all cases. The median postoperative hospitalization time was 4 days. There was one perioperative mortality case observed in this study. Conclusion: Thyroid surgery in patients 75 years or older can be performed except extensive surgical resection. Aggressive histology and extent of surgery may be an important factor of perioperative mortality and morbidity.

• Archives of Reconstructive Microsurgery
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• v.2 no.1
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• pp.62-69
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• 1993

Recently, conservative and bloodless operative procedures have been focused, so that endoscopic laser have been used. However application of endoscopic laser surgery for laryngeal lesion is capable for followings: (1)capability of delivery through an operating microscope, (2) vaporization of ultraspot. $CO_2$ laser which has been used, has limitations for voice improvement because of 700 micron beam spot. KTP-532 laser which is capable of delivery through an operating microscope vapore 200 micron ultraspot has developed and applied to microlaryngeal surgery. We have experienced 60 cases who were contracted with hoarseness(53 cases of benign lesions vocal nodule 13, vocal polyp 13, bilateral diffuse polyposis of vocal cords 11, intracordal cyst 8, vocal papilloma 5, laryngocele 1, laryngeal stenosis 2 and 7 cases of malignant lesions : laryngeal carcinoma stage I and II) since 1991. We operated them with KTP-532 Laserscope(3 Watt/0.05 sec., pulsed or continuous. San Jose, Calif, USA). Forty eigh cases(90.6%) of 53 bengin laryngeal lesions and 4 cases(57.1%) of malignant lesions were significantly improved in their voices. There were a few complications and technical problems, but laser surgery alone had a limitation to eradicate the disease.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.27 no.2
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• pp.126-129
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• 2016

Rhabdomyosarcoma is an uncommon type of soft tissue malignant neoplasm characterized by undifferentiated mesodermal tissue. Sarcomas account for approximately 1% of all laryngeal neoplasm and rhabdomyosarcomas are the rarest sarcoma found in the larynx. When the sarcoma involves the larynx, radical surgery such as laryngectomy has been considered. With recent advances of combined therapy, however, it can be treated by conservative surgeries followed by postoperative radiotherapy and/or pulse chemotherapy. With reviews of literature, we report a 47-year-old patient complaining of husky voice and throat discomfort who was finally diagnosed as rhabdomyosarcoma of the vocal fold and successfully treated by laser cordectomy followed by adjuvant chemoradiotherapy.

• Phonetics and Speech Sciences
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• v.1 no.3
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• pp.133-144
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• 2009

Pharyngeal flap surgery changes the space and shape of the oral cavity and vocal tract, and these changing conditions bring resonance change. The purpose of this study was to determine the most reliable and valuable parameters for evaluating hypernasality to distinguish two patients before and after pharyngeal flap surgery. Each patient was asked to clearly speak the vowels /a/, /i/, /u/, /e/, /o/ for voice recording. There were nine parameters: Formant (F1, F2, F3), Bandwidth (BW1, BW2, BW3), LPC energy slope ($\Delta$ |A2-A1/F2-F1|), and Band Energy (0-500 Hz, 500-1000 Hz) by each vowel. From the results of discrimination analyses on acoustic parameters, the vowels /a/, /e/ appeared to be insignificant but vowels /i/, /u/, /o/ appeared to be efficient in the separation. A 95%, 100%, and 100% recognition score could be reached when vowels /i/, /u/, and /o/ were analyzed. The results showed that F2, BW3, and LPC slope are more important parameters than the others. Finally, there is a relation between perceptual evaluation score and LPC energy slope of acoustic parameters by least square slope.

• Korean Journal of Head & Neck Oncology
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• v.21 no.1
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• pp.42-44
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• 2005

Metastatic tumors of the oral cavity are uncommon. Most of them are located in the mandible while only small percentage are found within the soft tissues. The common sites of metastases to the soft tissue of oral cavity were the tongue and gingiva and among the tongue, the base of tongue was most common. An explanation of the predilection may be due to a richer vascular supply within base of tongue. The authors have recently experienced a case of small cell lung carcinoma with base of tongue metastasis in a 81-year-old male who had foreign body sensation at swallowing and muffled voice for 2 months. So, we present this case with the review of literatures.

• Journal of Chest Surgery
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• v.38 no.5 s.250
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• pp.366-370
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• 2005

Background: In general, cardiac surgery has been performed via median sternotomy. During the past decade, improvements in endoscopic equipment and operative techniques have resulted in development of minimally invasive cardiac operation using small incisions. With the advent of a voice controlled camera-holding robotic arm (AESOP 3000, Automated Endoscope System for Optimal Positioning), cardiac surgery entered the robotic age. Material and Method: Between April 2004 and December 2004, a total of seventy eight patients underwent robotic cardiac surgery, of whom sixty four patients underwent robot-assisted minimally invasive cardiac surgery via 5cm right lateral minithoracotomy using voice controlled robotic arm, femoral vessels cannulation, percutaneous internal jugular cannulation, transthoracic aortic cross clamp. Other fourteen patients underwent MIDCAB via internal mammary artery harvesting using AESOP. Result: Robotic cardiac surgery were mitral valve repair in 37 cases, mitral valve replacement in 10 cases, aortic valve replacement in 1 case, MIDCAB in 14 cases, ASD operation in 9 cases, and isolated Maze procedure in 1 case. In mitral operation, mean CPB time was $165.3\pm43.1$ minutes and mean ACC time was $110.4\pm48.2$ minutes. Median length of hospital stay was 6 days (range 3 to 30) in mitral operation, 4 days (range 2 to 7) in MIDCAB, and 4 days (range 2 to 6) in ASD operation. For complications, 3 patients were required by reoperation for bleeding. There was no hospital mortality. Conclusion: Our experience of robot cardiac surgery suggests that many cardiovascular surgeons will be able to perform minimally invasive cardiac operations through small incisions with robot-assisted video-direction. Well-designed studies and close long-term follow-up will be required to analyze the benefits of robot-assisted operation.

• Proceedings of the KSLP Conference
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• 2006.12a
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• pp.158-158
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• 2006