Chang Myeon Song

Endoscopic resection of the submandibular gland via a hairline incision: A new surgical approach†

Submandibular gland excision is traditionally performed by the transcervical approach. To avoid or reduce visible scarring and nerve injury, diverse innovative surgical trials have been reported. Here we report a patient who had an endoscopic submandibular gland resection via a hairline incision.

Treatment modalities and outcomes of olfactory neuroblastoma

To analyze the clinical features of olfactory neuroblastoma (ONB) and compare the treatment results according to various treatment modalities, and to validate various staging systems.

In response to Endoscopic resection of the submandibular gland via a hairline incision: A new surgical approach

We appreciate your comments and are grateful for the discussion regarding our article titled Endoscopic Resection of the Submandibular Gland Via a Hairline Incision: A New Surgical Approach. We totally agree with the idea that some people are too preoccupied with the way their body looks. However, that is the reason why many surgeons are searching for new approaches to reduce visible scars. Transoral submandibular gland (SMG) resection might be a good option for patients with benign SMG tumors who do not want a visible neck scar. However, the transoral approach can cause postoperative complications, such as lingual nerve paresis and limitation of tongue movement caused by scar contracture, especially in contraindicated cases. In one study, the neurologic complication of the lingual nerve was observed in most of the patients, and 68% reported mild limited movement of the tongue that resolved within 1 month of surgery and was attributed to edema of the lateral tongue and the floor of the mouth rather than injury to the hypoglossal nerve. Moreover, selection of the proper patient with the necessary jaw opening, mandibular size, and tongue mobility should be considered for a successful transoral approach. Our approach might also have some relative contraindications. For example, it would hardly be indicated in patients with malignant SMG tumors or in patients with a prominent sternocleidomastoid (SCM) muscle. We believe that alternative approaches to the SMG are feasible; however, they should be tailored to the individual patient based on factors such as pathology, patient preferences, availability of technology, and the experience and skill of the surgeon. Actually, we have performed endoscopic resection of a neck mass via a hairline incision on four patients. Two cases were pleomorphic adenomas of the SMG and the other two were second branchial cleft cysts. We have already mentioned these cases in the Discussion section of the article. There was no complication or sequela in relation to sensory or motor function. The sensory nerves, including the greater auricular nerve, are left on the fascia covering the SCM muscle. In the retro-auricular hairline incision approach, the marginal mandibular nerve can be safely preserved either by direct identification of the nerve along the mandibular angle from the parotid gland or by upward retraction after ligation of the facial vein. In our case series, the marginal mandibular nerve had been preserved by upward retraction of the facial vein, which had been divided and sealed by an ultrasonic scalpel. Although fine needle aspiration cytology with/without ultrasonography for salivary gland tumors has lower diagnostic accuracy than for tumors arising from other sites, it is one of the routine diagnostic tests for salivary gland tumors in our institute. Due to unavoidable circumstances, however, the patient failed to have the test and was diagnosed with a benign mixed tumor on the basis of findings from ultrasonography and neck computed tomography scan. We believe that a benign mixed tumor or pleomorphic adenoma in the SMG can be resected safely using an endoscopic approach via a hairline incision. Additionally, limited SMG resection for pleomorphic adenoma in the SMG has been reported as feasible as partial or limited parotidectomy for a benign tumor arising from the parotid gland.

Efficacy of current regular follow-up policy after treatment for head and neck cancer: Need for individualized and obligatory follow-up strategy

The purpose of this study was to report the efficacy of routine follow‐up after head and neck cancer treatment.

Clinical Analysis of Acinic Cell Carcinoma in Parotid Gland

Objectives Acinic cell carcinoma (AciCC) is a rarely encountered malignancy in parotid gland. Because AciCC is rare and was recently recognized as the entity of malignancy, AciCC has been difficult to study. We aimed to analyze the diagnosis and treatment experience for this malignancy in our hospital. Methods We retrospectively reviewed medical records of the 20 patients with AciCC of parotid gland diagnosed from 1990 to 2009. The preoperative computed tomography scan, preoperative fine needle aspiration cytology (FNAC) and intraoperative frozen section results were compared with the final diagnosis. The survival and recurrence were analyzed with the cancer stages and treatment modalities. Results There were 10 males and 10 females, with a mean age of 44.4 years, ranging 8-77 years. The AJCC tumor stage distributions of the patients were 70%, 15%, and 15% for stages I, II, and IV, respectively. The sensitivity of FNAC and intraoperative frozen section was 26.7% and 50.0% respectively. The 10-year survival rate was 90.9% with a mean follow-up of 111 months, ranging 17-251 months. The 10-year disease free survival rate was 74.2% and the mean duration of recurrence from initial surgery was 92.3 months. Conclusion AciCC of the parotid gland is a rare malignancy that has features of less aggressive behavior, and good prognosis. Intraoperative frozen section examination may be helpful in the diagnosis of AciCC of the parotid gland because of the low sensitivity of preoperative computed tomography scan and FNAC. Surgery with adjuvant postoperative radiotherapy is satisfactory for disease control.

Analysis of genetic expression in the soft palate of patients with obstructive sleep apnea

Abstract Conclusion: Genetic dysregulation may be associated with development of obstructive sleep apnea (OSA). Objectives: Genetic expression was investigated in the soft palate of patients with OSA to evaluate the biomolecular characteristics of the tissue where airway obstruction actually occurs. Methods: Soft palate mucosa was obtained during uvulopalatal flap surgery. Three patients with apnea/hypopnea index (AHI) >30/h and three simple snoring patients with AHI < 5/h were enrolled. After total RNA was extracted and amplified, gene expression levels were determined by microarray analysis, and relative signal intensities for each gene were evaluated. Results: Of the 45,034 genes analyzed, 137 were up-regulated in OSA patients compared with simple snorers and 95 were down-regulated. Gene network analysis showed that genes related to RNA interference and transcription were most commonly involved in the functional pathophysiology of OSA. In particular, genes encoding proliferating cell nuclear antigen and proteasome 26S subunit ATPase 6 were functionally connected with other genes.

Serial computed tomographic and positron emission tomographic properties of injection material used for vocal fold augmentation.

This study aimed to demonstrate the radiological properties of hyaluronic acid (HA) and calcium hydroxylapatite (CAHA) on serial computed tomography (CT) and positron emission tomography (PET) scan.