• Archives of Plastic Surgery
• /
• 제49권3호
• /
• pp.378-396
• /
• 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 Radiology
• /
• 제22권4호
• /
• pp.596-603
• /
• 2021

Objective: To evaluate the feasibility and diagnostic performance of ultrasound (US)-guided fine-needle aspiration cytology and core-needle biopsy (US-FNAC/CNB) for the diagnosis of laryngo-hypopharyngeal masses. Materials and Methods: This was a single-center prospective case series. From January 2018 to June 2019, we initially enrolled 40 patients with highly suspicious laryngo-hypopharyngeal masses on laryngoscopic examinations. Of these, 28 patients with the mass involving or abutting the pre-epiglottic, paraglottic, pyriform sinus, and/or subglottic regions were finally included. These patients underwent US examinations with/without subsequent US-FNAC/CNB under local anesthesia for evaluation of the laryngo-hypopharyngeal mass. Results: Of the 28 patients who underwent US examinations, a laryngo-hypopharyngeal mass was identified in 26 patients (92.9%). US-FNAC/CNB was performed successfully in 25 of these patients (96.2%), while the procedure failed to target the mass in 1 patient (3.8%). The performance of US caused minor subclinical hematoma in 2 patients (7.7%), but no major complications occurred. US-FNAC/CNB yielded conclusive results in 24 (96.0%) out of the 25 patients with a successful procedure, including 23 patients with squamous cell carcinoma (SCC) and 1 patient with a benign mass. In one patient with atypical cells in US-FNAC, additional direct laryngoscopic biopsy (DLB) was required to confirm SCC. Among the 26 patients who received US-FNAC/CNB, the time from first visit to pathological diagnosis was 7.8 days. For 24 patients finally diagnosed with SCC, the time from first visit to the initiation of treatment was 25.2 days. The mean costs associated with US-FNAC/CNB was $272 under the Korean National Health Insurance Service System. Conclusion: US-FNAC/CNB for a laryngo-hypopharyngeal mass is technically feasible in selected patients, providing good diagnostic performance. This technique could be used as a first-line diagnostic modality by adopting appropriate indications to avoid general anesthesia and DLB-related complications.

• Radiation Oncology Journal
• /
• 제15권4호
• /
• pp.321-329
• /
• 1997

목적 : 두경부 암 환자에서 경부 림프절 전이 가능성이 높아지는 것은 원발병소의 해부학적위치 및 특성, 원발병소의 크기 즉 병기와 조직병리학적 종류 따라 영향을 받는다. 두경부 암 환자에서 경부 림프절의 전이 양상은 다른 나라에서 분석, 연구되어 있고, 현재 두경부 암 환자 치료와 처치를 이를 기조로 하여 사용한다. 그러나, 두경부 암 환자에 대한 경부 림프절 전이에 대한 우리나라 환자의 통계는 없어 이번 통계를 시행하게 되었다. 대상 및 방법 : 1981년 11월부터 1995년 12월까지 본 병원 방사선 종양학과에 내원한 환자중초사가 가능한 997명을 대상으로 하였다. 조사는 방사선 종양학과에 내원시 면밀한 경부 촉진과향께 컴퓨터 단층 촬영영상 상에서 확인을 하였다. 환자는 크게 경부 림프절 전이가 있는 군과 전이가 없는 군으로 나누었고, 경부 림프절의 병기는 미국 암 연합회에서 추천한 방식에 의하였다. 원발병소의 위치 및 주위로의 침윤 등은 면밀한 관찰과 촉진, 컴퓨터 단층 촬영 영상, 수술소견 및 조직병리학 소견을 참조하였다. 결 과 :방사선 종양학과에 방사선 치료를 위해 내원한 997명 중 416명$(42\%)$에서 경부 림프절 전이를 뽀였고, 581명$(58\%)$에서 전이를 보이지 않았다. 경부 림프절 전이를 보인 림프절의 병기분포를 관찰한 결과 다음과 같았다. Hl : 106$(25.5\%)$, N2a 100$(24\%)$, N2b :68$(16.4\%)$, N2c : 69$(16.6\%)$, N3 :73$(15\%)$. 두경부 암 환자에서 원발병소의 빈도는 다음과 같다. 후두암 : 283$(28.5\%)$, 부비동암 : 152$(18\%)$, 구인두암: 144$(14.5\%)$, 비인강암: In$(12\%)$, 구강암 :92$(9\%)$, 하인두암:71$(7\%)$, 타액선암:$58(6\%)$, 미지원발부위암:31$(3\%)$, 피부암: $14(2\%)$. 두경부 암 환자 중 가장 경부 림프절 전이가 높은 원발병소는 비인강암$(71\%)$으로 나타났고, 다음은 하인두암$(69\%)$, 구인두암$(64\%)$, 구강암$(39\%)$ 순이었다. 경부 림프절 전이를 보였던, 416명 중에서는 구인두암 92명$(22\%)$, 비인강암 8f명$(21\%)$, 후두암 79명$(19\%)$의 순이였다. 병리조직학적으로 가장 빈도가 높을 것은 편평상피암증으로 전체 환자 중 $65.4\%$을 차지하였고, 다음은 악성 림프종이 109명으로 $11\%$였다. 결론 : 두경부 암 환자에서 경부 림프절 전이의 양상이 외국 통계와 비교 매우 유사하게 나타났으며, 원발병소의 해부학적 특성에 따라 경부 림프절 전이가 좌우되며 원발병소의 병기가 진행됨에 따라 경부 림프절 전이 빈도도 증가 되며 또한 경부 림프절의 병기도 증가되는 것을 관찰 할 수 있었다.

• 수면정신생리
• /
• 제6권2호
• /
• pp.110-115
• /
• 1999

목 적: 수면무호흡증 환자들에서 수면 중 구강내 기구의 착용이 수면 중 기도의 크기와 airway collapsibility에 미치는 영향을 알아보기 위하여. 방 법: 9명의 폐쇄성 수면무호흡(obstructive sleep apnea) 환자들에서 구강내 기구를 착용하기 전과 후에 수면다원검사와 axial airway CT를 시행하였다. 상기도의 다섯 곳(retropalatal-high, retropalatal-low, retroglossal, epiglottis, hypopharynx levels)에서 axial CT를 시행하였는데, 각 위치에서 수면무호흡 상태에서 하나의 axial CT image를 얻고, 정상적인 수면호흡 중에 1초 간격으로 10장의 axial CT images를 연속적으로 얻었다. 이와 같은 방법으로 구강내 기구를 착용하기 전과 후에 airway CT를 각각 2회 실시하였다. 각 CT 영상에서 기도의 횡단면적(cross-sectional area)을 측정하여서 구강내 기구의 착용 전과 후에서 기도 횡단면적의 최소 크기, 최대 크기 및 airway collapsibility의 측정치를 비교하여 유의한 변화가 있는지 알아보았다. 결 과: 수면무호흡 중에 가장 흔하게 좁아지는 부위는 retropalatal-low level이었다. 정상 수면호흡 중에 retropalatallow level의 최소 기도면적이 구강내 기구에 의하여 유의하게 넓어졌다(p=0.011). 평균 airway collapsibility는 retropalatal-low level에서 가장 높았다. 구강내 기구는 retropalatal-low level(p=0.021) 뿐만아니라 epiglottis level(p=0.038)에서도 유의하게 airway collapsibility를 감소시켰다. 결 론: 이상의 결과를 종합하여 보면 구강내 기구는 일부 환자에서 수면 중 기도의 최소면적을 넓히고, airway collapsibility를 낮추어서 수면무호흡을 예방할 수 있음을 시사한다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제38권1호
• /
• pp.20-28
• /
• 2012

Introduction: The objective of this research was to determine the incidence of oral cancer in Korea. Materials and Methods: The classifications of oral and maxillofacial cancer (OMFC) that we used are based on possible locations of OMFC: lip, tongue, mouth, salivary glands, tonsil, oropharynx, nasopharynx, hypopharynx, pharynx unspecified, and nose, sinuses. Results: 1) There were 2,848 OMFC cases, accounting for 1.6% of all cancers. The male to female ratio was 2.72:1. 2) The estimated crude rates (CRs) were 5.7 overall, 8.4 for males, and 3.1 for females. The age-standardized incidence rates (ASRs) were 4.6 overall, 7.3 for males and 2.3 for females. 3) The incidence of mouth cancer was highest. The mouth and salivary glands were the most frequent sites for cancer among males and females, respectively. 4) Patients who were 40 years or older accounted for 91% of OMFC cases, with the highest proportion of cases in the 60-69 year-old age group for both sexes. 5) Tongue cancer was the most prevalent OMFC overall. Nasopharyngeal cancer was highest among males, and salivary gland cancer was highest among females. 6) From 2004 to 2008, the relative 5-year survival rate of OMFC patients was 57.5%. There was a trend of increasing survival among OMFC patients during the study period. The survival rate for females (69.3%) was much higher than that for males (53.1%). Conclusion: Social and personal efforts should be required to increase the survival rates of OMFC patients and Korean national cancer management policy should establish new measures for economic and social management and support.

• Asian Pacific Journal of Cancer Prevention
• /
• 제13권12호
• /
• pp.6059-6062
• /
• 2012

Regional cancer epidemiology is an important basis for determining the priorities for cancer control in different countries worldwide. There is no reliable information about the pattern of head and neck cancer in western Nepal and hence an attempt was here made to evaluate the situation based on hospital data, which provide the only source in the western region of Nepal. A clinicopathological analysis of head and neck cancers treated between 2003 and 2006 in Manipal Teaching Hospital affiliated to Manipal College of Medical Sciences, Pokhara, Western Development Region, Nepal was performed. A total of 105 head and neck cancer cases were identified with a male to female ratio of 1.8:1. The median ages of male and female patients were 62 and 64 years, respectively. Ninety-seven (92.4%) of the cancer patients were suffering from carcinoma, three (2.9%) had blastoma, three (2.9%) had sarcoma, and two (1.9%) had lymphoma. The majority (61.9%) of carcinoma cases were squamous cell carcinoma followed by anaplastic carcinoma (7.2%). Of the carcinoma cases, the most common site of primary lesion was larynx (19.6%), followed by the thyroid (14.4%), the tongue and hypopharynx with 10.3% cases each. Comparative analysis among males and females did not reveal any sex difference in type of head and neck cancers. The head and neck cancer pattern revealed by the present study provides valuable leads to cancer epidemiology in western Nepal and useful information for health planning and cancer control, and future research in western Nepal.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권18호
• /
• pp.7891-7895
• /
• 2014

Background: Tobacco products continue to be used in large quantities in India despite the mandatory inclusion of pictorial health warnings (PHWs) on all tobacco packaging. The circumstances as to how people could continue the use of tobacco to the point of developing head and neck cancer despite enhanced awareness about the ill effects of tobacco is the main focus of this study. Materials and Methods: This study concerned patients with least 5-years history of tobacco use, having been diagnosed with histopathologically proven malignancies of the hypopharynx, larynx, oropharynx and oral cavity presenting at the Government Medical College-Haldwani, Nainital, India. A total of 183 patients were eligible for inclusion during July 1 2013 - June 30 2014. Of these, 59 patients used smoked tobacco exclusively, 22 patients used smokeless tobacco exclusively, and 102 patients used both forms of tobacco. Among users of smoked forms, 75.2% (n=121) were beedi users, and 24.8% (n=40) were cigarette users. Patients were asked direct questions as to whether they had noticed the presence of PHWs upon tobacco products. The reasons as to why PHWs were not effective in stopping the patients from tobacco use were investigated. Results: Of the 183 patients, 146 reported being aware about the presence of PHWs, and when they were asked reasons as to why they continued tobacco despite being aware of ill-effects, the commonest reason chosen (by 53.4%) was that patients had not regarded themselves as using tobacco heavy enough to cause cancer. Among the 36 patients who reported as being oblivious to the presence of PHWs on tobacco products, 63.9% reported that the products they used never displayed any PHWs, and 36.1% reported never having paid attention to the packaging. The awareness about PHWs was higher among cigarette smokers in comparison to beedi smokers (100% vs 76.1%, p=0.0002). Conclusions: Locally produced and marketed tobacco products such as beedis and oral tobacco often fail to display PHWs. The presence of PHWs without doubt enhances awareness about the carcinogenic risks of tobacco. However, enhanced awareness alone may not be enough, and as elucidated by this study, some persons continue to use tobacco to the point of developing malignancies. The need of the hour is the implementation of legal and economic sanctions discouraging the use of tobacco products.

• 대한두경부종양학회지
• /
• 제14권1호
• /
• pp.46-53
• /
• 1998

Background: Hypopharyngeal cancer represents about one-third the incidence of laryngeal cancer which is the most common cancer in head and neck area. Although there have been numerous reports regarding its clinical and statistical characteristics, more precise and ample data should be collected and analyzed in this country. Objectives: This study was designed to evaluate the pattern and patient's profile of the hypopharyngeal cancer, and we reviewed the treatment outcomes to search for an index of treatment modalities. Materials and Methods: The authors retrospectively analyzed 73 cases of hypopharyngeal cancer treated at Yonsei Medical Center during the 10-year period from 1985 to 1994. Five-year survival rate was calculated according to the primary site, clinical stage and treatment modality. Results: The incidence was predominated in male by 9 to 1 and peak incidence was 6th and 7th decades. Pyriform sinus was the main primary site(80.8%) followed by posterior hypopharyngeal wall(13.7%) and postcricoid area(5.5%). Advanced stage cancers(87.7%) were more common than early stage cancers. Radiotherapy(60.3%) was the most commonly used as primary treatment modality. Neck node metastasis was early occurred even in early stage cancers(61.5%), and overall rate of neck node metastasis was 69.9%. All surgical cases received procedures more than total laryngectomy and partial pharyngectomy. The most common cause of death was primary failure(81.5%) and it was highest in radiotherapy group. Five-year survival rate was significantly high in surgery group(90.9%). The overall 5-year survival rate of hypopharyngeal cancer was 30.3%. Conclusion: High index of suspicion should be required for early diagnosis. Also, surgery may be recommended for the primary treatment modality in advanced stage cancers.

• Archives of Plastic Surgery
• /
• 제33권4호
• /
• pp.407-412
• /
• 2006

Purpose: Various attempts of reconstruction for pharyngoesophageal defects after ablative surgery have been made to restore the function of the pharyngoesophagus. A fabricated tubed radial forearm free flap or free jejunal free flap was used when the width of remnant pharyngeal wall was less than 50% of the normal width. However there are many disadvantages such as stricture, saliva leakage and fistula formation on tubed radial forearm free flap. The jejunal free flap has the problem such as short pedicle, poor tolerance of ischemic time, wet voice and delayed transit of swallowed food due to the uncoordinated contraction. The authors studied the utility of patch-type radial forearm free flap using the remnant posterior pharyngeal wall of the hypopharynx. Methods: Retrospective reviews in Severance Hospital were made on 25 patients who underwent reconstruction surgery with patched radial forearm free flap because of the hypopharyngeal cancer between 1996 and 2005. The patients of Group I had the narrow posterior pharyngeal wall and its width was less than 3centimeters after the tumor was resected. Those of Group II had the partial pharyngectomy and the width of the remnant pharynx was larger than 3 centimeters. Results: Seven patients belonged to the group I and the flap of this group had 100% survival rate. One case of fistula and no swallowing discomfort due to stricture was reported. The Group II including 18 patients also had the 100% flap survival rate. Neither fistula nor stricture was seen but the lower diet grade was checked. Conclusion: The patch type radial forearm free flap using the remnant pharyngeal wall have the advantage of the radial forearm free flap, and furthermore this flap is the safe reconstructive method even if the width of the remnant pharyngeal wall is less than 30% of that of normal pharynx.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권8호
• /
• pp.3721-3729
• /
• 2014

Background: Cancer is becoming the most important public health burden around the globe. As per the GLOBOCAN 2008 estimates, about 12.7 million cancer cases and 7.6 million cancer deaths were estimated to have occurred in 2008. The burden of cancer cases for India in the year 2020 is calculated to be 1,148,757 (male 534,353; female 614,404) compared to 979,786 in 2010. The pattern of cancer incidence is varying among geographical regions, esophageal cancer for example being high in China, lung cancer in USA, and gallbladder cancer in Chile. The question remains why? Is it due to the diversity in genome pool, food habits, risk factor association and role of genetic susceptibility or some other factors associated with it? In India, the North East (NE)-India region is seeing a marked increase in cancer incidence and deaths, with a very different cancer incidence pattern compared to mainland India. The genome pool of the region is also quite distinct from the rest of India. Northeastern tribes are quite distinct from other groups; they are more closely related to East Asians than to other Indians. In this paper an attempt was made to see whether there is any similarity among the pattern of cancer incidence cases for different sites of NE-India region to South or East-Asia. Materials and Methods: Principal Component Analysis (PCA), Hierarchical Cluster Analysis (HCA), Pearson Correlation coefficient test was assessed to evaluate the linkage of North-East India region to other regions. A p value <0.05 was considered as statistically significant. Results: The results clearly shows that there are similarities in occurrence of cancer incidence patterns for various cancer sites of NE-India with South and East-Asian regions, which may lead to the conclusion that there might be a genetic linkage between these regions.