Yong Seop Lee

Change of Acoustic Parameters Before and After Treatment in Laryngopharyngeal Reflux Patients

Objectives: To evaluate the usefulness of acoustic parameters as an indicator of laryngopharyngeal reflux (LPR) treatment efficacy.

The Significance of Laryngopharyngeal Reflux in Benign Vocal Mucosal Lesions

OBJECTIVE: To determine the significance of laryngopharyngeal reflux (LPR) in benign vocal mucosal lesions. STUDY DESIGN AND SETTING: A case-control study at the tertiary referral medical center. SUBJECTS AND METHODS: From April 2003 to December 2006, we studied 110 patients with benign vocal mucosal lesions who had undergone 24-hour ambulatory double pH monitoring. The control group included 200 patients who had undergone ambulatory 24-hour double-probe pH monitoring due to laryngopharyngeal reflux-related symptoms without specific findings of benign vocal mucosal lesions. Reflux symptom index and reflux finding score were measured. We compared the prevalence of pathologic laryngopharyngeal reflux and various parameters of the pH monitoring such as total reflux number, fraction time of pH below 4 in various positions, and DeMeester scores. RESULTS: The prevalence of pathologic laryngopharyngeal reflux was 65 percent in the control group, 66 percent in vocal nodule group, 75 percent in the vocal polyp group, and 90 percent in the Reinkes edema group. Patients with Reinkes edema had a significantly higher prevalence of pathologic laryngopharyngeal reflux than controls (P = 0.016). LPR was associated with a significantly increased risk of Reinkes edema (odds ratio: 4.846, 95% confidence interval 1.093∼21.492). Total reflux number and DeMeester scores in the Reinkes edema group and fraction time of pH below 4 in the supine position in the vocal polyp group were significantly higher than those in the control group. CONCLUSION: Laryngopharyngeal reflux might play a role as an etiologic factor in Reinkes edema and vocal polyps.

Is it necessary to preserve the posterior branch of the great auricular nerve in parotidectomy

Objectives To evaluate the necessity of preserving the posterior branch of the great auricular nerve during parotidectomy. Study Design and Setting Forty-six patients undergoing parotidectomy were prospectively analyzed. Twenty-four patients had preservation of the posterior branch of the great auricular nerve; in the remaining 22 patients the nerve was sacrificed. A sensory index score was defined as the area involved multiplied by the intensity grade of sensory loss. Quality-of-life was evaluated with a questionnaire. Results The sensory index score was significantly higher in the sacrificed group as compared with the preserved group at both 1 week (41.87 vs 62.11) and 1 month (24.91 vs 46.11) after parotidectomy. The sensory deficit improved over time in both groups, and after 12 months only minimal sensory loss remained. Quality-of-life was not significantly different between the groups. Conclusions Irrespective of preservation of the posterior branch of the great auricular nerve, sensory deficit improved over time. Therefore, preservation of the posterior branch of the great auricular nerve might not be necessary during parotidectomy.

Impact of chronic rhinosinusitis and endoscopic sinus surgery on bone remodeling of the paranasal sinuses.

Background Osteitis or bone remodeling is one of the distinct radiological findings in chronic rhinosinusitis (CRS). Bone remodeling of the paranasal sinuses can be affected by many factors including age, sex, chronic inflammation, and surgery. The aim of this study was to investigate radiological evidence of mucosal and bone remodeling and to assess the impact of recurrent rhinosinusitis after surgery on remodeling in patients with CRS. Methods Controls (n = 25) and patients with CRS undergoing primary (n = 25) and revision (n = 15) endoscopic sinus surgery (ESS) were included in this study. Bone remodeling of the ethmoid sinus was checked by the presence of new bone formation (NBF) and measurement of bone density (HU). Bone remodeling of the maxillary sinus was measured by the vertical and horizontal lengths at maximal cross-sectioned CT images. Results Lund-Mackay scores were significantly increased in the revision ESS group (p = 0.009) and NBF+ group (p = 0.014). NBF was significantly increased in the revision ESS group compared with the primary ESS group (odds ratio = 0.127; CI, 0.029–0.562; p = 0.006). There was a significant difference in ethmoid bone density among controls, primary, and revision ESS (p = 0.0001). The maximal sizes of the maxillary sinus were significantly decreased in CRS groups when compared with controls (p < 0.05). Conclusion In the revision ESS group, soft tissue and bone remodeling may be greater than in the primary ESS group.

Endoscopic above and below approach with frontal septotomy in a patient with frontal mucocele: a contralateral bypass drainage procedure through the frontal septum

Frontal sinus has complex anatomy and is the most difficult sinus to dissect under the nasal endoscope. In case of difficult accessibility through the frontal recess, we can make a detour to more invasive and external procedures to treat chronic or intractable frontal sinus diseases. However, these approaches usually need advanced surgical skills and sometimes can result in minor and/or major complications. Therefore, we developed a new surgical technique to treat frontal mucocele in a patient with severe new bone formation at the frontal recess and presented our experiences with literature review.

Orbital Apex Syndrome in a Patient with Sphenoid Fungal Balls

Orbital apex syndrome (OAS) is a rare disease that presents with a complex of symptoms, including ophthalmoplegia, ptosis and visual loss. Due to the poor prognosis, making a prompt diagnosis and administering the appropriate treatment must be initiated without delay if OAS is suspected. We report here on a case of a patient with sphenoid fungal balls, and he presented with acute visual loss and ophthalmoplegia.

Surgical management of tracheal invasion by differentiated thyroid cancer: how we do it.

Dear Editor, Differentiated thyroid carcinoma (DTC) is an indolent and slow-growing tumour that is potentially curable after surgery. However, DTC can also directly invade the surrounding tissues. As the aerodigestive tract is adjacent to the thyroid gland, it is susceptible to thyroid carcinoma invasion. Many authors have reported that local aerodigestive tract invasion is the leading cause of death from thyroid cancer related to uncontrollable local diseases. The extent of resection that should be used for patients with tracheal invasion remains controversial. Some studies support complete tumour resection with safe margins, whereas others support a conservative operation including a ‘shaving-off operation’ because the presumed positive microscopic margin can be treated by adjuvant treatment with I or external radiation therapy. We performed this study to determine the optimal surgical management of differentiated thyroid carcinomas that are adherent to or invading the trachea by comparing conservative and aggressive surgical treatments for the various stages of tracheal invasion and concluded that full thickness resection of the invaded trachea might minimise the recurrence rate in patients with tracheal cartilage invasion by DTC.

Change of telomerase activity in peripheral whole blood of head and neck squamous cell carcinoma patients before and after surgery: a pilot study

BackgroundThe purpose of this study was to evaluate telomerase activity in peripheral whole blood from head and neck squamous cell carcinoma (HNSCC) patients as a biomarker for diagnosis of HNSCC or detection of recurrence during follow-up.Materials and methodsTelomerase activity was measured from peripheral whole blood extracts by telomerase repeat amplification protocol (TRAP) in HNSCC patients before and after surgery and in a control group. Sixty-two HNSCC patients and 42 control subjects were included.ResultsTelomerase activity was found in 41 out of 62 (66.1%) HNSCC patients before surgery and in 8 out of 42 (19.0%) controls (p<0.001). Among 41 HNSCC patients who showed positive telomerase activity before surgery, 32 (78.1%) showed a conversion of telomerase activity to negative after surgery. In follow-up, 6 out of 8 (75%) showed conversion of telomerase activity from negative to positive after recurrence. Telomerase activity was changed to negative in 4 out of 6 (66%) recurred patients with positive telomerase activity after second surgery.ConclusionThe telomerase activity in peripheral whole blood extracts of HNSCC patients might be a useful biomarker for detecting recurrence after treatment. Further study with larger sample size using a more sensitive detection method of telomerase activity is necessary to verify these results.