• 대한두경부종양학회지
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• 제32권2호
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• pp.29-33
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• 2016

A 65-year-old male visited hospital in the state of tracheostomal recurrence 1 year after total pharyngolaryngectomy. Extensive recurrence around stoma or paratracheal, superior mediastinal area is challenging in treatment, especially in securing airway. We performed mediastinal tracheotomy through resection of unilateral manubrium, some part of sternal side of clavicle and $1^{st}$ rib as the salvage operation for recurrent laryngeal cancer. This procedure could be risky, thus very careful patient selection is required because of a tortuous postoperative course. We would like to present the case that anterior mediastinal tracheostomy could be needed as appropriate palliative means of airway construction in the patients with recurrent laryngeal cancer with lower neck extension with literature review.

• 대한후두음성언어의학회지
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• 제31권2호
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• pp.92-95
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• 2020

Tracheal granuloma, the most commonly reported sequela of pediatric tracheotomy. A variety of techniques are available for the management of tracheal granuloma. Potassium-titanyl-phosphate (KTP) laser has been previously established as an acceptable technique for removal of laryngeal surgery, which emits a green light with a wave length of 532 nm, which is well-absorbed by hemoglobin and can coagulate and vaporize tissue. The ability to deliver laser energy through a flexible glass fiber makes the technique convenient for use with a rigid bronchoscope, overcoming problems with intraluminal access encountered with earlier attempts at CO2 laser therapy for this problem. Another advantage of KTP laser is the avoidance of the risks and morbidity associated with an open procedure. We report our surgical technique KTP laser in the management of tracheal granuloma removal into the tracheostomy site. KTP laser is good tool for management of tracheal granuloma with low incidence of complications.

• 대한후두음성언어의학회지
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• 제12권1호
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• pp.11-16
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• 2001

Background and Objectives : A burn injury to the glottis differs from a burn injury to the trachea, bronchi, and lung parenchyma, in that thermal injury does not occur to any significant degree below the level of the larynx, due to the effective cooling of air by the upper airway and to reflex closure of the vocal cords from a blast of hot air. Therefore, the laryngeal inhalation injury give rise to airway problem and voice change. The objectives of this study is to assess management of laryngeal inhalation injury and voice change after management. Materials and Methods : Voice choses and laryngeal injuries of eight laryngeal inhalation patients were analyzed through questionnaire, voice dynamic laboratory, and laryngeal stroboscopy. Operative management was performed to five patients for airway patiency and vocal cord movement on laryngeal pathology ind voice therapy was performed to all patients. One-year after, voice changes and laryngeal injuries were reanalyzed with same methods. Results : Vocal breathiness, decreased voice intensity, reduced voice range, and easy fatigability were major complaints of laryngeal inhalation patients. Glottic stenosis were developed to five of eight patients, and vocal cord atrophy, bowing were developed to others. Vocal cord mucosal waves were significantly decreased in all patients. Jitter(%), Shimmer(dB) were increased and Maximal phonation time(MPT) was decreased. One-year after, subjective voice changes and objective voice parameters were improved. And vocal cord mucosal waves were recovered in all patients. Conclusions : Subjective voice quality and objective voice parameters were improved after operative management for laryngeal pathology and voice therapy. And we observed recovery of vocal fold mucosal waves by laryngeal stroboscopy. We think that early preventable tracheotomy is necessary to reduce the laryngeal contact injury in laryngeal inhalation patients.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제35권6호
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• pp.499-501
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• 2009

Because sublingual region is well-vascularized and sublingual artery is passed throughout this region, it should be careful not to perforate lingual cortex when placing dental implant on mandible. A 83-years-old male complained severe sublingual hematoma, hemorrhage and dyspnea came our outpatient department. He had received dental implant placement in the same day. He needed hemostasis and airway control. If soft tissue of sublingual region and the artery are injured, it may result in life-threatening excessive hemorrhage. In dental implant surgery, especially mandible, we should recognize the accurate shape of mandible and anatomy of sublingual region. It is important to stop anticoagulant agent before surgery. When a patient has airway obstruction, the operator should manage airway quickly.

• 한국의료질향상학회지
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• 제14권1호
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• pp.55-59
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• 2008

Background : The purpose of inner cannula is to protect the upper air way and permit air to pass freely, in addition, to provide endotracheal suction, artificial respiration and to maintain adequate oxygen saturation. The tube needs to be sterilized for maintenance and cleanness of air way and for prevention of bronchospasm. However, it has been reported that there is no guideline for sterilization and many hospitals conduct their own sterilization methods, for example, once a day(13's general hospital), three times a day(The Catholic University of Korea ST Mary's hospital) or even no cleansing. Consequently, the QI team of our hospital suggested the SOP(standard operating procedure) of sterilization and evaluate cost and time effect in nursing. Method : 1) Benchmarking of 13's neurosurgery department of general hospital in Seoul 2) Investigation of test records of sputum culture from patients with intubation for tracheotomy 3) Check of results of O2 Sat. monitoring to confirm of maintaining opened air way Result : 1) Improvement of process: decrease of excess sterilization of inner cannula (from 3 times a day to once a day) 2) Cost effects: saving over 10 million won per one year 3) Providing better nursing: time effects (30 min a day) permit to conduct more nursing activities Conclusion : It can get Cost and time effects in nursing with improved sterilization method of inner cannula. It needs to do research on improvement of the monthly exchange protocol of outer cannula and provide supporting data for the proper exchange schedule. The result of additional microorganism detection from patients with new process needs to be evaluated further more.

• 대한기관식도과학회지
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• 제15권2호
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• pp.42-48
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• 2009

Background and Objectives : Obstructive laryngeal cancers have to be managed with tracheostomy, which has been reported with increased local or stomal recurrence. Stomal recurrence after treatment of laryngeal cancer is one of the most serious issues in the management of laryngeal cancer. Prognosis of locally advanced laryngeal cancer in patients with previous tracheostomy is evaluated. Materials and Methods : Between 1996 and 2007, 174 patients with previously untreated advanced laryngeal cancer(stage III, IV) were enrolled. Overall survival(OS) and disease specific survival(DSS) according to the presence of previous tracheostomy were compared. OS and DSS of the groups with different duration from tracheostomy to treatment were compared. Results : Among 174 patients with advanced laryngeal cancer, previous tracheostomy was performed in 24 patients. Of 24 patients, there were stomal recurrences in 5 patients. DSS of previous tracheostomy group and that of the other group were statistically different(p=0.001). There was statistical significant difference between OS of groups which start treatment more than 14 days after tracheostomy and within 14 days(p=0.03). Conclusions : If possible, Previous tracheostomy should be avoided and if it is inevitable, the elective treatment should be recommended at least within 2 weeks.

• 대한두경부종양학회지
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• 제12권2호
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• pp.224-229
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• 1996

Head and neck arteriovenous malformation usually forms huge mass, cause profuse bleeding or potenially compromise the airway. This bleeding is vulnerable to be uncontrollable and life­threatening. Sometimes it has a high mortality. Although surgical resection is possible in some cases, the morbidity such as a defects of soft tissue is very high and its reconstruction is very difficult. The authors report an 11 year old female patient in whom occlusion of arteriovenous malformation with glue after transcutaneous embolization made a satisfactory results. At the beginning, she was transferred for massive oral bleeding. The bleeding was persistent and it was not possible to remove the packing in spite of many times of embolizations through feeding arteries. The massive bleeding trom the left upper alveolar mucosa compromised the airway and tracheotomy was done. Whenever the hypovolemic shock was occurred in a short time, blood transfusion and cardiopulmonary resucitation were done. To embolize the vascular mass of arteriovenous malformation, as a final trial before operation, the spinal needle was administered through the left upper gingiva under the fluoroscopy. The glue was injected on the target. The bleeding was stopped and we have noticed the absence of nidus on follow-up angiography after 3 weeks. We experienced that some cases of arteriovenous malformation in head & neck revealing the bleeding could be treated with transcutaneous embolization instead of surgical resection.

• Asian Pacific Journal of Cancer Prevention
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• 제15권14호
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• pp.5787-5791
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• 2014

Background: With increasing survival periods and diversification of treatment methods, treatment of critically ill cancer patients has become an important factor influencing patient prognosis. Patients with cancer are at high risk of infections and subsequent complications. This study investigated the incidence and factors contributing to the development of ventilator-associated pneumonia (VAP). Materials and Methods: This retrospective study investigated the incidence of VAP and factors leading to infection in patients admitted to the intensive care unit (ICU) of a cancer center from January 1, 2012 to December 31, 2013. Results: The incidence of VAP was 2.13 cases per 1,000 days of intubation, and 13 of 288 patients (4.5%) developed VAP. Lung cancer was the most common cancer associated with VAP (N=7, 53.9%), and longer hospital stays and intubation were associated with increased VAP incidence. In the group using a "ventilator bundle," the incidence was 1.14 cases per 1,000 days compared to 2.89 cases per 1,000 days without its use; however, this difference was not statistically significant (p=0.158). Age (${\geq}65$, OR=5.56, 95% confidence interval [CI]=1.29-23.95), surgery (OR=3.78, 95%CI=1.05-13.78), and tracheotomy (OR=4.46, 95%CI=1.00-19.85) were significant VAP risk factors. The most common causative organisms were methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (N=4, 30.8% each), followed by Acinetobacter baumannii and Candida albicans (N=2, 15.4% each). Conclusions: The incidence of pneumonia among critically ill cancer patients is highest in those with lung cancer, but lower than among non-cancer patients. The length of hospital stay and time on mechanical ventilation are important risk factors for development of VAP. Although not statistically significant, "ventilator bundle" care is an effective intervention that delays or reduces incidence of VAP. Major risk factors for VAP include age (${\geq}65$ years), surgery, and tracheostomy, while fungi, gram-negative bacteria, and multidrug-resistant organisms were identified as the major causative pathogens of VAP in this study.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1983년도 제17차 학술대회연제순서 및 초록
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• pp.14.3-14
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• 1983

최근 급속히 증가 추세에 있는 각종 산업재해와 교통사고로 인한 심한 신체적 손상, 심혈관계수술 및 호흡계수술등을 받은 환자에서 기도유지를 위해 사용되는 기관내삽관과 기관절개위의 후유증 또는 두부외상으로 발생하는 외상성 기관협착의 빈도가 점차 높아짐에 따라서 이에 대한 치료로 기관성형술이 주목할만한 관심을 보여주고 있다. 기관성형술의 방법으로는 손상된 기관의 위치나 크기에 따라 여러 가지가 있으나 부분절제 및 단단문합술, 경부피변과 자가이식물질등을 이용한 재건술을 들 수 있다. 1965년 Grillo가 개에서 환상절제후 기관성형술을 시행한 이래 환상기관협착의 경우에는 부분절제및 단단문합술이 많이 이용되고 있다. 또한 자가이식물질로는 비중격, 늑골, 이개의 연골이 많이 사용되고 있으며, Consiglio와 Caputo가 이개연골을 이용하여 기관성형술을 시행한 이래 Morgenstein은 기관결손이 있는 환자에서 이개연골을 사용하여 혼합이식을 시행하여 성공적인 재건을 보고하였다. 이개연골이식은 이비인후과의사에게는 쉽게 채취하여 활용할 수 있고 친근감이 있는 장점이 있다. 최근 본교실에서는 5예의 기관협착증 환자에서 이개연골이식(2예), 부분절제후 단단문합술(3예)에 의한 기관성형술을 시행하여 좋은 결과를 얻었기에 문헌고찰과 함께 보고하는 바이다.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1991년도 제25차 학술대회 연제순서 및 초록
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• pp.26-26
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• 1991

기관 절개술은 절대적으로 필요한 수술 방법임에도 불구하고 경우에 따라서는 매우 심각한 합병증이나 후유증을 유발하고 있어 가능한 피하는 것이 좋으며 부득이하여 시술을 하더라도 그 적절한 시기를 정하기 어려운 경우가 많다. 특히 유소아에서는 최근에 개량된 삽관튜브의 출현으로 비교적 장기간의 기관삽관이 가능해지자 기관절개술의 적용예가 많이 감소하기는 하였으나 합병증이나 후유증을 너무 우려한 나머지 기관절개술을 기피하거나 적절한 수술시기를 놓쳐 더욱 어려운 입장에 처하게 되기도 한다. 저자들은 1977년도부터 1990년까지 세브란스 병원에서 기관절개술을 시행받은 15세이하의 유소아 환자 94례에서 기관절개술의 원인 질환과 적용시기 및 합병증을 알아보고 기관삽관과의 관계를 후향적으로 조사하여 다음의 결과를 얻었다. 1. 유소아 기관 절개술의 원인 질환은 두부외상이 28례(29.8%)로 가장 많았고, 신경계 질환 17례(18%), 기도 감염 10례(10.6%)의 순이었고 그 외 선천적 기형 종양, 외상, 감염 등으로 다양한 분포를 보였다. 2.기관 절개술전에 기관삽관을 시행하지 않았던 예는 18례(19.1%)이고 기관삽관을 시행했던 예는 76례(80.9%)이며, 38례(40.4%)는 일주이내에 기관절개술을 시행하였고 12례(12.8%)는 2주이내에, 8례(8.5%)는 3주이내, 6례(6.4%)는 4주이내에 시행하였으며 12례(12.8%)는 기관 삽관후 4주이후에 기관절개술을 시행하였다. 3.기관 절개술후, 합병증은 26례(27.7%)에서 있었고 육아조직 형성이 14례(14.9%) 였고 기관 협착이 12례(12.8%)의 순이었다. 4.인공 호흡기률 사용하였던 46례(48.9%)중 14례(14.9%)에서 합병증이 있었고, 인공 호흡기를 사용치 않았던 48례(51.5%)에서는 12례(12.8%)에서 합병증이 발생하였다. 5.삽관 발거를 시행할 수 있었던 예는 47례(50%)였으며, 기관 절개술후 1개월이내에 시행한 예가 21례(16%), 6개월이내 시행한 예가 16례(17%), 2년이내에 시행한 예가 6？(6.4%)였으며 2년 이후 시행할 수 있었던 예도 4례(4.3%) 있었다. 6.기관 절개술 환자중 26례(27.7%)는 원인 질환으로 결국은 사망하였으며, 21례(22.3%)는 삽관 발거를 하지 않은 상태에서 퇴원하여 추적이 불가능하였다.