Somatostatin 피하주사를 추가한 보존적 방법으로 치료된 경부 절제술 후 발생한 유미 누공 2예

안동빈,이동준,손진호,윤상필 대한이비인후과학회 2012 대한이비인후과학회지 두경부외과학 Vol.55 No.11

The use of somastostatin in chyle fistula that occurs after neck dissection is a new approach that has been reported in few cases. We report two cases of chyle fistula that occurred after neck dissection, which were successfully managed with somatostatin subcutaneous injection. Somatostatin treatment resulted in an immediate reduction of chyle leakage in both patients, and might have contributed to the reduction of patients’ morbidity and duration of hospital stay. However, optimal treatment regimen with somatostatin is unclear because of its limited case and various administration methods. Further studies are required to clarify the usefulness and optimal regimen of somatostatin injection in the treatment of chyle fistula following neck dissection.

단일기관에서의 미분화 갑상선암에 대한 경험

안동빈,손진호 대한이비인후과학회 2012 대한이비인후과학회지 두경부외과학 Vol.55 No.1

Background and Objectives Although anaplastic thyroid carcinoma (ATC) accounts for less than 2% of all thyroid malignancies, it contributes to 14-50% of deaths related to thyroid tumors. However, there is no definite treatment. The aim of the study is to review our experience of ATC at our own university clinic to look for clues for the management of ATC. Subjects and Method The medical record of 15 patients with ATC treated in our clinic between 1997 and 2010 were retrospectively reviewed. Results Five (33.3%) patients underwent no curative treatment but biopsy or tracheostomy. Complete surgical resection was possible in only one patient. Six patients underwent debulking surgery with or without adjuvant treatment. One and two patients were treated with radiation therapy alone and concurrent chemoradiation therapy (CCRT), respectively. Despite various treatment regimens, there are surviving patients at the time of present evaluation. The mean survival was 253.1 days and median survival was 128 days. Only two patients had survived longer than a year. Each patient had been treated with complete surgical resection and CCRT with doxorubicin, respectively. In univariate analysis, there was no association between survival duration and various clinico-pathological parameters. However, old age (≥65), history of pre-existing thyroid nodule, and radiation therapy was significantly associated with survival duration in multivariate analysis. Conclusion Most ATC was unresponsive to ongoing treatment modalities in our clinic. However, we experienced that a certain treatment was effective in some patients. For the goal of forming a generally effective treatment regimen for ATC, we suggest a prospective multicenter study to be performed on the basis of present study.

갑상선 유두암의 측경부 재발에서 포괄적 경부 림프절절제술과 비교한 제한적 경부 림프절절제술의 치료 성적

안동빈,이선재,박선균,손진호,박준식 대한이비인후과학회 2011 대한이비인후과학회지 두경부외과학 Vol.54 No.1

Background and Objectives Therapeutic comprehensive neck dissection has been recommended for the patients with recurrent papillary thyroid carcinoma (PTC) confined to the neck after initial total thyroidectomy. However, the benefit of comprehensive neck dissection to remove asymptomatic metastatic lymph node towards improving clinical recurrences or survival is largely unproven. We analyzed the pattern of recurrence in the lateral compartment of neck and evaluated the possible application of limited lymph node dissection against comprehensive neck dissection. Subjects and Method A retrospective review was carried out for 43 patients who underwent surgical treatment for recurrent PTC in the lateral neck from 2000 to 2005, and their clinicopathological results were stratified according to the extent of surgery into two groups, the limited surgery group and the comprehensive surgery group. Results Recurrence rate in lateral neck after initial total thyroidectomy was 14.5% (43/ 296), and the most common level of recurrence was level IV (50.9%). Although limited surgery group showed a tendency toward more frequent recurrence after treatment of the first recurrence than did the comprehensive surgery group, this tendency had no statistical significance. Moreover, no patients in either group have died of PTC during over a mean follow-up period of 80 months. In the aspect of factors associated with surgical morbidity, such as operating time, duration of admission, and complication, the limited surgery group had superior results when compared to the comprehensive group. Conclusion The benefit of comprehensive neck dissection concerning recurrence and survival was not verified in the present study hence a more preservative approach could be applied to selective patients with recurrent PTC in the lateral compartment of neck.

미세 갑상선 유두암에서 반갑상선절제술 후 발견된 잠복성 다발병변의 임상적 의의

안동빈,손진호,김희진,정지윤,정훈 대한이비인후과학회 2014 대한이비인후과학회지 두경부외과학 Vol.57 No.3

Background and Objectives Occult multifocal diseases are often identified after hemithyroidectomy in patients with papillary thyroid microcarcinoma (PTMC). There has been considerable debate with regard to whether multifocal diseases actually behave more aggressively compared with unifocal diseases, particularly PTMC. The present study aimed at evaluating the clinical impact of occult multifocal diseases on the recurrence of PTMC treated with hemithyroidectomy. Subjects and Method We compared the clinicopathological characteristics and 5-year outcomes for 319 patients with unifocal PTMC patients and 29 patients with occult multifocal PTMC, all of whom were treated with hemithyroidectomy between January 2004 and December 2010. Results The incidence of occult multifocal disease was 8.4%, with a mean size of 0.28 cm. Although microscopic extrathyroidal extension (ETE) was more frequent in patients with occult multifocal PTMC as compared with that of unifocal diseases (41.4% vs. 23.2%, p=0.030), multifocality was not associated with age, primary tumor size, and concurrent Hashimoto’s thyroiditis. With respect to recurrence, there was no difference between the unifocal and multifocal groups during the mean 55.8-month follow-up period (4.4% vs. 10.3%, p=0.160). In addition, univariate and multivariate analyses revealed no meaningful association between recurrence and presence of occult multifocal diseases in patients with PTMC treated with hemithyroidectomy. Conclusion Although presence of occult multifocal diseases was associated with microscopic ETE, its clinical impact on disease recurrence was not significant in PTMC patients treated with hemithyroidectomy. Therefore, multifocality identified after hemithyroidectomy would not be an absolute indication for the completion of thyroidectomy in patients with PTMC. Korean J Otorhinolaryngol-Head Neck Surg 2014;57(3):166-71

일측 경부와 복부에 발생한 Rosai-Dorfman Disease 1예

안동빈,나경진 대한이비인후과학회 부산,울산,경남 지부회 2013 임상이비인후과 Vol.24 No.2

Rosai-Dorfman disease is a rare lymph node disorder characterized by abnormal proliferation of histiocytes and usually presents with bilateral cervical lymphadenopathy. This disease has been poorly understood by otolaryngologists because of its rarity. We report an unusual case of a 61-year-old woman with Rosai-Dorfman disease involving one side of the neck and the abdominal cavity, which distinguishes our case from previous reports. Her symptoms and image findings were consistent with that of a lymphoma. However, histopathological examination of the lymph node revealed emperipolesis, a characteristic feature of Rosai-Dorfman disease. After medical treatment with steroids for 2 weeks, the size of the lymph node decreased by 50%. Since the clinical course of Rosai-Dorfman disease varies from spontaneous remission to fatal outcomes, we believe that Rosai-Dorfman disease should be considered in the differential diagnosis of patients with cervical lymphadenopathy

레이저 성대 절제술을 시행한 조기 성문암 환자의 치료 결과 및 전암성 병변으로 부터의 악성 변환 관찰

안동빈,박지현,허성재,박창묵,정다정,남예모,손진호,박준식 대한이비인후과학회 2010 대한이비인후과학회지 두경부외과학 Vol.53 No.7

Background and Objectives Laser cordectomy has been widely acknowledged to have advantages for the treatment of early glottic carcinoma. This study was performed to assess the results of laser cordectomy for its oncologic safeness, time-effectiveness, and to report a few interesting precancerous cases that have progressed to glottic cancer. Subjects and Method Subjects (47) who had undergone laser cordectomy for the treatment of early glottic cancer from April 2006 to July 2009 were enrolled in this study. We analyzed the oncologic outcomes, the duration of hospital treatment after the surgery, and postoperative complications by reviewing of medical records. Results For 47 cases, the mean age was 66 years and the mean follow up period was 22.6months. The mean duration of treatment was 1.9 days. Among them, 24 cases were classified into T1a, 12 T1b, and 2 T2. Local recurrence was observed in 2 cases, so salvage treatments, such as radiation therapy or near total laryngectomy, were performed, and both of them were alive in the disease-free state. The most common complication was anterior commissure web, which was observed in 6 cases (15.8%), followed by granuloma observed in 5 cases (13.1%). Serious complications such as aspiration, respiratory distress, and dysphagia were not found in any of 47 cases. Also, we could observe 3 cases in which the precancerous glottic lesion had progressed to glottic carcinoma over a long period of time. Conclusion Laser cordectomy might be the treatment of choice for patient’s convenience because of its excellent oncologic outcomes, low morbidity, and time-effectiveness. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:425-9

양성 낭종성 갑상선 결절에서 두경부 외과의에 의해 시행되는 초음파 유도하 에탄올 절제술: 예비보고

안동빈,김희진,이재호,손진호 대한이비인후과학회 2015 대한이비인후과학회지 두경부외과학 Vol.58 No.4

Background and Objectives To evaluate the feasibility of ultrasound-guided ethanol ablation (US-EA) performed by a head and neck surgeon in benign cystic thyroid nodules. Subjects and Method This preliminary study enrolled five patients who underwent US-EA by a single head and neck surgeon for benign cystic thyroid nodules, which had been previously aspirated but recurred. Procedure time, success of targeting, volume reduction rate, satisfaction scores of the procedure, and complications were evaluated. Results The initial mean volume of cystic nodules was 8.3 mL (2.0-18.9). After US-EA, it decreased to 1.2 mL (0.4-3.5 mL) with the mean volume reduction rate of 85.5% (56.2-88.5%). The mean procedure time of surgeon-performed US-EA was 5.6 min (range, 3.7-7.3 min). The procedure was successfully carried out in all patients, with the mean satisfaction score of 7.6 (6-9). There were no major complications but transient burning sensation was reported in one patient. Conclusion US-EA can be performed by head and neck surgeons safely with favorable therapeutic results. This may improve surgeon’s treatment performance of benign cystic thyroid nodules and help achieve streamlined patient care without referring patients to other department.

비중격에 발생한 사구 종양 1예

안동빈,신창민,박지현,김정수 대한비과학회 2008 Journal of rhinology Vol.15 No.2

Glomus tumor is a benign tumor, which is believed to represent hyperplasia or harmatomatous development of the glomus body. It is relatively rare in the head and neck region, especially in the nasal cavity. Up to now, only about twenty cases of glomus tumor in the nasal cavity have been reported. We report a case of glomus tumor originating from the anterior portion of nasal septum, which was treated by local excision. Glomus tumor is a benign tumor, which is believed to represent hyperplasia or harmatomatous development of the glomus body. It is relatively rare in the head and neck region, especially in the nasal cavity. Up to now, only about twenty cases of glomus tumor in the nasal cavity have been reported. We report a case of glomus tumor originating from the anterior portion of nasal septum, which was treated by local excision.

변형 Blair 절개법과 변형 안면거상 절개법 및 흉쇄유돌근피판을 이용한 이하선 절제술의 비교

안동빈,김희진,최재혁,손진호 대한이비인후과학회 2015 대한이비인후과학회지 두경부외과학 Vol.58 No.1

Background and Objectives To evaluate the feasibility of a modified facelift incision with sternocleidomatoid muscular (SCM) flap as a first-line surgical approach for a parotidectomy by comparison with the modified Blair incision. Subjects and Method From March 2011 to February 2014, 66 patients who underwent parotidectomy were enrolled in the study and their medical records were reviewed retrospectively. Patients with suspicious malignant tumor, metastatic lymph node, and parapharyngeal tumor in the preoperative examination were excluded from the study. Patients and tumor profiles, surgical outcomes, complications, and cosmetic outcomes were studied to compare the modified facelift incision between the SCM flap group (n=32) and the modified Blair incision group (n=34). Results There were no significant differences between the two groups with respect to tumor location, tumor size, extent of surgery, operative times, postoperative drainage, and any type of complications. The modified facelift incision with SCM flap group had higher scar satisfaction scores than the modified Blair incision group (8.5 vs. 5.7, p<0.001). Conclusion Modified facelift incision with SCM flap can be used as a first-line surgical approach for parotidectomy in benign parotid tumor with better cosmetic outcome without increased complications.

Oncocytic Sialolipoma of the Submandibular Gland

안동빈,박태인,박준식,허성재 대한이비인후과학회 2014 Clinical and Experimental Otorhinolaryngology Vol.7 No.2

Sialolipoma, a rare tumor of the salivary gland, is a recently described variant of salivary gland lipoma. Oncocytic sialoli- poma was first described by Pusiol et al. in 2009. We report the case of an oncocytic sialolipoma of the submandibular gland in a 43-year-old female. Excision of the tumor was performed with preservation of the submandibular gland. The tu- mor had a thin, fibrous capsule and consisted of abundant adipose tissue, an oncocytic nodule, and scattered normal glan- dular structures surrounded by adipose tissue. Four cases of sialolipoma of the submandibular gland, including the present case, were reviewed. All 4 tumors were developed on the right submandibular glands, with a composition of adipose tissue as high as that of sialolipoma of the parotid gland; in contrast to previous reports, three cases were in females. As newly described tumor type, care should be taken to distinguish oncocytic sialolipoma from other salivary gland neoplasms such as simple lipoma, pleomorphic adenoma, or oncocytoma.