Sang Joon Lee

Recurrent laryngeal nerve (RLN) injury is a serious complication of thyroid surgery. Intraoperative neural monitoring allows functional assessment of the RLN during dissection, but first-side loss of signal (LOS) during planned bilateral thyroidectomy creates a difficult intraoperative dilemma. Misinterpreting false LOS may lead to unnecessary staged procedures, while overlooking true LOS risks bilateral vocal fold paralysis. This structured narrative review, based on a focused PubMed search (2000-2026), addresses the practical management of first-side LOS in three steps. First, when LOS occurs, the surgeon must systematically exclude false causes such as equipment failure, endotracheal tube malposition, and residual neuromuscular blockade before accepting LOS as genuine. Second, once confirmed, the injury mechanism (traction versus structural), signal loss pattern (segmental versus global), and any intraoperative recovery on continuous monitoring help estimate the likelihood of postoperative vocal fold palsy. Third, in benign bilateral disease, current evidence generally supports staged thyroidectomy as the safest default to avoid bilateral RLN dysfunction. Immediate contralateral completion may still be considered in high-priority situations such as invasive thyroid cancer or impending airway compromise, following individualized risk-benefit assessment. First-side LOS should be treated as a structured decision point, and standardized troubleshooting combined with careful interpretation of monitoring data can support safer and more transparent surgical judgment.

Verrucous carcinoma of the larynx is a rare, well-differentiated variant of squamous cell carcinoma that is locally invasive but rarely metastasizes. However, diagnosis can be difficult because superficial biopsies often fail to demonstrate the characteristic pushing border of verrucous carcinoma. Consequently, multiple biopsies may fail to establish a definitive diagnosis. Surgical excision remains the primary treatment. We present a case of a 54-year-old man who required several years to achieve a definitive diagnosis of verrucous carcinoma and whose lesion recurred repeatedly despite multiple excisions. This case emphasizes the importance of obtaining adequately deep and wide biopsy specimens for the accurate diagnosis of verrucous carcinoma. It also illustrates the therapeutic dilemma in the management of glottic verrucous carcinoma, as aggressive excision may compromise vocal function, whereas conservative excision increases the risk of recurrence.

Background and Objectives Post-thyroidectomy hematoma is reported in about 0.7%- 2.1% of patients who underwent thyroidectomy. A drain is frequently placed after surgery to prevent swelling and hematoma. This study aims to compare clinical differences and postoperative complications depending on the presence or absence of a drain, and to identify the factors affecting hematoma after thyroidectomy.Subjects and Method This is a retrospective study of patients who underwent conventional thyroidectomy from March 2019 to Jun 2023. We examined patient’s age, gender, underlying diseases, use of antithrombotic drug, surgery type, thyroid volume, length of hospital stay and postoperative complications (hematoma and vocal cord palsy) by examining medical records.Results Of 587 patients enrolled in the study, the drain was placed in 369 (62.9%) patients, and not in 218 (37.1%) patients. The mean age, incidence of hypertension and Grave’s disease comorbidity, antithrombotic drug use, number of patients who underwent neck dissection, thyroid volume, operating time, and length of hospital stay were significantly higher in the drain placed group (p<0.05). But there was no significant difference in the ratio of vocal cord palsy and hematoma occurrence between the two groups. In logistic regression analysis, diabetes, the use of antithrombotic drugs, neck dissection, and larger thyroid volume were identified as risk factors for the occurrence of hematoma (p<0.05).Conclusion Surgeons tended to place the drain in patients with high bleeding tendency after thyroidectomy, but there was no difference in the incidence of hematoma according to drain placement. Rather, patients’ length of hospital stay increased due to the placement of drain.

Xerostomia, commonly known as dry mouth, is characterized by reduced salivary secretion, which can lead to various oral health issues and discomfort. In this paper, we propose a novel, non-invasive method for predicting xerostomia through the analysis of tongue images. To predict salivary gland secretion from tongue images, we collected images from patients who visited the hospital with complaints of dry mouth and measured their saliva secretion. Features were extracted from these tongue images, and correlation analysis was performed using machine learning techniques to assess the relationship between the extracted features and measured saliva secretion. We obtained tongue images and saliva secretion measurements from 176 patients. Images were cropped to 100 × 100 pixels, resulting in 462 features. The dataset was divided into training and test sets, consisting of 160 and 16 samples, respectively. The correlation coefficients for the training and test datasets were 0.9496 and 0.9415, respectively, while the correlation coefficient for the entire dataset was 0.9482. The estimated linear equation was y = 0.9244x + 2.1664. This study aimed to predict salivary gland secretion based on tongue images. By extracting features from color images and employing a neural network machine learning model, we estimated salivary gland secretion. With a sufficiently large dataset of tongue images, further advancements in regression analysis using deep learning techniques could enhance the accuracy of these predictions.

Seung Hoon Woo, Kun-Woo Kim, Phil-Sang Chung, Sang Joon Lee. Med Laser 2022;11:84-91. https://doi.org/10.25289/ML.2022.11.2.84

Background and Objectives Globus pharyngeus is one of the most common symptoms of patients visiting otorhinolaryngology out-patient clinic, and usually long-lasting, difficult to treat, and frequently recurrent. Mucomyst®, N-acetyl cysteine is an inhalation agent mainly used for mucolysis and reducing inflammation in airway via antioxidative effect. The purpose of this study was to evaluate the efficacy of inhaled Mucomyst® treatment in patients with globus pharyngeus refractory to proton pump inhibitor (PPI).Materials and Method We prospectively evaluated the efficacy of Mucomyst® in relieving symptoms of globus pharyngeus refractory to PPI in nine medical centers. Three hundred and three patients enrolled and finally 229 patients finished the inhaled Mucomyst® therapy for 8 weeks. We analyzed the change of Reflux Symptom Index (RSI), Reflux Finding Score (RFS), Visual Analogue Scale (VAS) for globus, and Globus Pharyngeus Symptom Scale (GPS) after use of Mucomyst® for 4 and 8 weeks.Results The GPS, RSI, RFS, and VAS score significantly decreased serially in patients who finished 8 week-inhalation treatment. The GPS improvement gap was significantly correlated with initial GPS (p<0.001) in multiple regression analysis.Conclusion Inhaled Mucomyst® therapy was effective for the reduction of both subjective and objective findings in refractory globus patients. This study might suggest new treatment option for patients with globus. However, further thorough studies would be needed to assess the real effect of inhaled Mucomyst® treatment as a standard treatment for globus.

Ji Hyeok Choi, Sang Joon Lee, Phil-Sang Chung, Seung Hoon Woo. Medical Lasers; Engineering, Basic Research, and Clinical Application 2021;11:61-4. https://doi.org/10.25289/ML.2022.11.1.61

Voice change is a common complaint after thyroid surgery and has a significant impact on quality of life. The Korean Society of Laryngology, Phoniatrics and Logopedics assembled a task force to establish guideline recommendations on education, care, and management related to thyroid surgery. The guideline recommendations encompass preoperative voice education, management of anticipated voice change during surgery, and comprehensive voice care after thyroid surgery, and include in-depth information and up-to-date knowledge based on validated literature. The committee constructed 14 key questions (KQs) in three categories—preoperative (KQ 1–2), intraoperative (KQ 3–8), and postoperative (KQ 9–14) management—and developed 18 evidence-based recommendations. The Delphi survey reached an agreement on each recommendation. A detailed evidence profile is presented for each recommendation. The level of evidence for each recommendation was classified as high-quality, moderate-quality, or low-quality. The strength of each recommendation was designated as strong or weak considering the level of evidence supporting the recommendation. The guidelines are primarily targeted toward physicians who treat thyroid surgery patients and speech-language pathologists participating in patient care. These guidelines will also help primary care physicians, nurses, healthcare policymakers, and patients improve their understanding of voice changes and voice care after thyroid surgery.