Sialendoscopy for Salivary Duct Stone / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sialendoscopy was introduced with favorable results in the management of salivary duct stones. We recently attempted this new procedure to diagnose and remove sialoliths for the first time in Korea. In this paper, we aimed to find out the clinical efficacy and limitations of sialendoscopy. SUBJECTS AND METHOD: Nine patients, 2 males and 7 females with the average age of 27, who consented to the trial of a new procedure were enrolled in this study beginning in April 2003. Diagnostic sialendoscopy was performed first, and then intervention was attempted after sialoliths were identified. A retrospective analysis was conducted on the characteristics of sialoliths, preoperative work-up, postoperative complications and outcomes. RESULTS: All but one case had sialoliths in the duct of the submandibular gland. In view of diagnostic sialendoscopy, the success rate was 100%, that is, we could detect sialoliths in all cases. In interventional sialendoscopy, however, the success rate was 44% (4 of 9 cases). In 3 cases, the basket broke down or got caught with the stone. Other complications such as salivary duct perforation, bleeding and nerve injury did not occur. CONCLUSION: Sialendocopy is a new, less invasive procedure to visualize the entire salivary ductal system for the diagnosis of salivary duct stone. However, interventional sialendoscopy for the removal of sialolith is a delicate and technically challenging procedure, requiring strict size criteria of the sialolith and much experience of the operator.

Clinical Aspect and Management Strategy of Tuberculous Cervical Lymphadenopathy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tuberculous cervical lymphadenopathy (TCL) is not an uncommon inflammatory disorder. Yet, the management strategy of TCL is controversial and there are no clear answers for when, how and to whom surgical intervention should be applied. This study aimed to analyze the efficacy of antituberculous chemotherapy (AC) and surgical treatment to provide the guidelines of surgical intervention. MATERIALS AND METHODS: A retrospective chart review was carried out for 153 patients with TCL who were treated between Jan. 1998 and Jun. 2001 at Samsung Medical Center, Seoul, Korea. AC was provided for all the patients as an initial treatment. Surgical intervention was combined for the patients who were refractory to the medical management. Treatment results of AC and indications of the surgical intervention were analyzed. RESULTS: AC, as a sole treatment modality, was successful in most (83.7%) of the patients while combined surgical intervention was needed for 16.3%. Overall cure rate (remnant mass size < or =5 mm) was 96.3%. Surgery was provided for the TCL showing progression even after the initiation of AC or not responding to AC within 3 months. The necrotic lymph node less than 4 cm in its size did not need surgical intervention when there was a rapid decrease of size within 2 weeks of AC. For the skin lesions of impending rupture or overt draining sinus, surgical intervention shortened the duration of treatment required for the wound healing. CONCLUSION: Most of TCL can be effectively controlled with AC alone. It would be reasonable to reserve surgical interventions for the TCL with 1) abscess greater than 4 cm in its size, 2) abscess not rapidly responding to AC regardless of its size, 3) draining skin wound, and 4) non-necrotic nodes with poor response to AC over 3 months. Gross total removal of TCL would be preferred for shortening the duration of wound care to drainage procedures including curettage, incision and drainage or simple dressing.

A Case of Oculostapedial Synkinesis Following Bell's Palsy / 대한이비인후과학회지

Oculostapedial synkinesis following Bell's palsy, Ramsay Hunt syndrome and traumatic facial nerve paralysis is a rarely reported phenomenon. Oculostapedial synkinesis accompanying with hemifacial spasm also has been reported. We experienced a 51-year-old woman with persistent loud rumbling noise from her left ear related with voluntary left eye closure compatible with oculostapedial synkinesis after Bell's palsy. We objectively proved this oculostapedial synkinesis with impedance audiometry. The patient was successfully treated by transmeatal tenotomy of the left stapedius muscle tendon under local anesthesia.