Correlation between MRI and Operative Findings in Bell's Palsy and Ramsay Hunt Syndrome

PURPOSE: To investigate the correlation between gadolinium enhanced magnetic resonance image (MRI) results and surgical findings of facial nerves in Bell's palsy and Ramsay Hunt syndrome. MATERIALS AND METHODS: From 1995 to 2004, MRI was performed on 13 patients with Bell's palsy or Ramsay Hunt syndrome, who were offered with surgical decompression of the facial nerve through the middle cranial fossa approach. Gadolinium enhanced MRI was performed on all patients and the enhancement of the facial nerve was evaluated by radiology specialists. Operative findings including the degree of the facial nerve segment swelling were examined. Furthermore, the time interval from the onset of palsy to surgery was evaluated. RESULTS: Swelling of facial nerve segments was found in patients with enhanced facial nerves from MRI. The swelling of the facial nerve in the labyrinthine segment in particular was identified in all patients with enhanced labyrinthine segments in MRI. The intraoperative swelling of geniculate ganglion of facial nerve was found in 78% of patients with enhanced facial segment in MRI (p=0.01). The intraoperative swelling of tympanic segment was observed from fourth to ninth weeks after the onset of palsy. CONCLUSION: MRI enhancement of facial nerves in Bell's palsy and Ramsay Hunt syndrome is associated with the extent of intratemporal lesions of facial nerves, especially in the labyrinthine segment.

Experience of BAHA(Bone Anchored Hearing Aid) Surgery / 대한이비인후과학회지

For auditory rehabilitation in patients with hearing loss, air conduction hearing aids are primarily considered. However, when applying to patients with congenital atresia or chronic ear infection, limitations are expected and conventional bone conduction hearing aids may be used in these cases. Nevertheless, since bone conduction hearing aids also were found to have a number of drawbacks such as poor sound quality, high battery consumption, poor aesthetics, and headache by the pressure from the device against the skull, the bone anchored hearing aid (BAHA) has been introduced as an effective means to overcome such limitations. Whereas traditional bone conductors are transcutaneous and they works by exerting pressure against the skull, BAHA works percutaneously. Three cases of BAHA insertion surgery are presented along with the indications and surgical methods of BAHA surgery.

Marginal Adaptation Of The Conical Inner Crown Fabricated With Cad/cam / 대한치과보철학회지

This study was to evaluate the fabrication method and marginal adaptation of the conical inner crown fabricated with CAD/CAM.The informations on abutment teeth were transferred to a computer with a micro contact digitizer,which had a 50mum accuracy on the master die.A conical inner crown was designed on a computer and a real crown was machined based on this design using CAM. The marginal fit of a computer-machined conical inner crown was assessed using electron microscopy. Measurement of the marginal gap between the conical inner crown and the abutment was performed on four different locations (mesial,distal,buccal,and lingual surfaces)of the finish line. The evaluation was based on 10 test specimens. The results were as follow. 1.The mean marginal gap between the conical inner crown and abutment tooth was 83.2 +/-43mum,28.9%of the specimen showed marginal gap over 100 m. 2.The fabrication method using CATRS and CAM provided clinically acceptable marginal fitness compared to conventional casting method (p<0.05).

Pathologically Proven Level IIb Lymph Node Metastasis in Head and Neck Cancer: A Preliminary Report / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The spinal accessory nerve dysfunction is a serious sequela following selective neck dissections despite preservation of the spinal accessory nerve. The incidence of this complication is known to be 20%-30% and the primary cause of nerve dysfunction is known as significant traction during resection of level IIb lymph node group. To try to answer whether level IIb could be preserved, we evaluated the incidence of metastasis to level IIb lymph node from various types of the head and neck cancer. MATERIALS AND METHODS: Sixty patients who underwent surgery for their head and neck cancer as an initial treatment from February 1999 to July 2000 were prospectively evaluated. Histopathological evaluations for 106 neck dissection specimens were performed in 60 patients with the head and neck cancer. RESULTS: A total of 7 patients (11.7%) had metastasis to level IIb lymph node. All but one case had ipsilateral level IIb metastasis. All seven cases had multiple lymph node metastases to other levels, including level I, IIa, III, IV, or V. Occult metastasis to level IIb was noted in one case of 25 clinically proven N0 head and neck cancer patients (4%). Primary sites and pathologies with level IIb metastasis were varied, including such sites as upper eyelid, parotid gland, or thyroid gland. CONCLUSIONS: This preliminary report reveals low incidence of level IIb metastasis in some of clinically proven N0 head and neck cancer. Contralateral level IIb lymph node could be preserved in clinically proven N0 heasd and neck cases. Multiple lymph node metastases increase the probability of metastasis to level IIb. Level IIb resection is necessary in clinically proven N+ cases with multiple nodes or multiple levels of metastases. Also, Level IIb metastasis may tend to increase in some of the primary sites, which drain into the jugular chain via level IIb lymph node.

Mastoid Obliteration with Bone Paste and Fat / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mastoidectomy with canal wall-up technique provides more healthy skin lining conditions of the external ear canal than mastoidectomy with canal wall-down techniques which have several disadvantages. However, in patients who have erosive scutum or posterior wall defects, the canal-wall down procedure is selected for preventing retraction pocket and recurrence of cholesteatoma. We have attempted a new surgical procedure to avoid disadvantages of the canal wall-down procedure in patients with scutum or posterior wall defects. MATERIALS AND METHODS: In 84 patients with chronic otitis media whose scutum or posterior walls have defects, we advocated a new surgical procedure. The posterior wall was kept up, the defected scutum and/or posterior wall was reconstructed with cortical bone paste, and the mastoid cavity was obliterated with abdominal fat. Staged ossiculoplasty was performed for 11 patients. RESULTS: Removal of the bone paste was necessary for only one patient due to infection, but none of the patents had absorption of reconstructed posterior canal wall. In most patients, the wound completely healed within 3 weeks. The mean hearing gain was 21 dB after the staged ossiculoplasty. CONCLUSION: With this procedure, we could avoid disadvantages of the canal wall-down procedure. And in staged ossiculoplasty we found enough middle ear space for ossicle reconstruction.

Design and Fabrication of Inner Konus Crown Using Three Dimensional Computer Graphics / 대한치과보철학회지

A fabrication method of inner and outer crown using CAD/CAM is presented. The information of abutment teeth is transferred to a computer through a 3-dimensional scanner. A Konus inner and outer crown is designed on a computer and a real crown is machined based on this design using CAM. This method can save laboratory time and reduce inaccuracies compare to conventional casting procedure. A stone model with six prepared abutment teeth from a patient was used in this study. Three dimensional information from the model was transferred to a computer using a contact type 3dimensional scanner with a 25micrometer accuracy. All margins were identified on a computer image where there is a change in surface taper of a model. To provide a cement space, the image of a inner surface of a Konus inner crown was duplicated 25micrometer apart from the surface of a prepared abutment teeth image. The cement space was 20micrometer at the cervical margin. All Konus crowns were machined with a 10micrometer accuracy. It was concluded that this method can reduce working-time for the laboratory process and increase accuracy. A further research is required to make a simplified process for a more complex prosthesis.

A Case of Malignant Fibrous Histiocytoma of the Pterygopalatine Fossa / 대한이비인후과학회지

Although there are some reports of malignant fibrous histiocytoma arising from the head and neck region, there has been no reports on the case originating from pterygopalatine fossa. We experienced a case of 29-year old male patient who visited our hospital with complaints of trismus, periorbital swelling and altered sensation on the left zygomatic area. On physical examination, he showed hypertrophic left middle turbinate, retracted ear drum, and swollen posterior wall of the nasopharynx. On computed tomography, he also showed a low density lesion originating from pterygopalatine fossa. Based on these findings, he was diagnosed with malignant fibrous histiocytoma originating from pterygopalatine fossa. and underwent radical maxillectomy, marginal mandibulectomy, radical neck dissection, and tracheotomy.

Pull - out Strength of Different Multiple Suturing Method of the Cruciate Ligament / 대한정형외과학회잡지

The aim of this study was to measure the immediate pull-out strengths by increasing the number of suture loops and to compare the immediate pull-out strengths of three different suturing techniques. In one group, the number of suture loops increased from 2 to 9 and the suturing technique of multiple loops through the proximal ligament stumps was used. The other group, the three different techniques were transverse, vertical, and criss-cross suture. The ultimate strength for the 2 loops was 16.62 (+/-6.7)N, for the 3 loops was 34.45 (+/-12.5)N, for the 4 loops was 54.80 (+/-17.7)N, for the 5 loops was 74.30 (+/-21.4)N, for the 6 loops was 102.49 (+/-13.5)N, for the 7 loops was 105.05 (+/-24.8)N, for the 8 loops was 129.50 (+/-76.1)N, for the 9 loops was 229.50 (+/-48.7)N. The transverse suture had a mean ultimate strength of 47.38 (+/-14.8)N, where-as the vertical suture failed at 76.94 (+/-26.4)N and the criss-cross suture at 101.82 (+/-25.7)N. Consequently, their strength can be improved by increasing the number of loops and we suggest that the criss-cross suture technique is reliable method for clinical use, because of high failure strength and wider apposition area of bone to ligament.

Bilateral Fractured of the Fabella / 대한정형외과학회잡지

The fabella is the seasmoid bone occurring in about 10–30% of individuals and is located in the head of the lateral tendon of the Gastrocnemius muscle. Fracture of the fabella is a very rare condition. Since first reported by Jacob Sagel in 1932, only 5 cases of fabella fracture had been reported. However, there has been no bilateral case. We report a first case of bilateral fracture of the fabella with review of literature. This case was combined with rupture of anterior cruciate ligament and lateral collateral ligament on the right knee.