Histological and Morphological Change of Implanted Reinforcement Gore-Tex(R) in Nasal Dorsum of Rabbit / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: For nasal augmentation surgery, several materials have been used. Porous material, expanded polytetrafluoroethylene (Gore-Tex(R)) contains numerous pores which allow stability of the implant, but this advantage has been tempered by unpredictable outcomes. The purpose of this study is to evaluate morphological and histological changes of reinforced Gore-Tex(R) in the rabbit model. MATERIALS AND METHOD: Twenty New Zealand white rabbits were used. The reinforced Gore-Tex(R) block was implanted in the nasal dorsum. According to the duration of implantation, rabbits were divided into four groups such as 1, 3, 6 and 12 months. The animals were grossly examined with respect to the status of the Gore-Tex(R). We evaluated the three-dimensional size of the implants over time and used light and electron microscopy to investigate the histological changes associated with the whole tissue blocks. RESULTS: Grossly, none of the implants was lost or extruded and there was no evidence of wound infection. Diminution rates of thickness, width and height in the implants were respectively 16.7%, 7.5%, and 3.5%. Histologically, the growth of connective tissue was observed in all specimens and internodal space was decreased by connective tissue ingrowth as time goes on. Neovascularization was observed in the groups for which duration was longer than 6 months, and degenerative changes were also observed in the groups over 6 month of implanted duration. CONCLUSION: The reinforced e-PTFE should be carefully trimmed because of the possibility of decreasing size over time. And additional studies are needed to further investigate the stability of Gore-Tex(R).

A Case of Self-Induced Pneumoparotitis / 대한이비인후과학회지

Self-induced pneumoparotitis is a rare cause of swelling of the parotid gland. It has been reported to be a result of psychosomatic disorder, unintentional habit, and it is sometimes self-induced by patients to achieve secondary gain. We report a case of a 18-year-old man who had a self-induced pneumoparotitis complicated by recurrent parotitis, subcutaneous emphysema and pneumomediastinum. With repeated behavior of insufflation, parotid acini may rupture and air may extend into the retropharyngeal space, causing pneumomediastinum or pneumothorax. In self-induced cases, treatment should necessitate psychologic therapy for behavior modification.

A Case of Angioleiomyoma of the Oropharyngeal Wall / 대한이비인후과학회지

We report a recently encountered case of angioleiomyoma in oropharynx. The patient was a 26-year-old woman. The main symptoms were feeling of narrowing down of the pharynx and difficulty in breathing in the left supine position. Laryngoscopy revealed a 3.5cm-sized, spherical mass with a smooth surface, originating in the right oropharyngeal wall. The tumor was successfully removed using suspension microlaryngoscopy under general anesthesia. Histopathologically, it was well circumscribed and composed of proliferating smooth muscle fibers and dilated blood vessels. The tumor is a benign nature and recurrence is rare. Complete removal is the treatment of choice with care taken to avoid profuse bleeding.

Clinical Analysis of the Canal Paresis in Patients with Benign Paroxysmal Positional Vertigo

BACKGROUND AND OBJECTIVES: Canal paresis in patients with BPPV has been variously reported to present in 13% to 57%. Should disorders affecting the peripheral vestibular system, such as vestibular neuronitis, head trauma precede or coexist the onset of BPPV, then particle repositioning maneuver (PRM) may be less effective or ineffective and need further vestibular rehabilitation after the particle repositioning maneuver. The purpose of this study is to investigate the clinical feature and importance of vestibular rehabilitation in patients with BPPV associated with canal paresis. MATERIALS AND METHODS: A retrospective review was made of 212 patients who visited and diagnosed as BPPV at Hallym university medical center from March 2004 to September 2006. We evaluated the coexistence of canal paresis, methods of treatment and outcome of 128 patients who performed bithermal caloric test. RESULTS: The vestibular assessment by bithermal caloric test showed the canal paresis in 28 patients. In 21 patients, the canal paresis was ipsilateral, in 2 patients, it was contralateral to the BPPV, and in 5 patients, canal paresis was bilateral. Among 28 patients with canal paresis, 12 patients demonstrated as primary BPPV, 16 patients as secondary BPPV. 28 patients with canal paresis were performed PRM. Vestibular rehabilitation was performed in 18 patients who had ongoing symptoms such as nonspecific continuous dizziness after PRM. Among 18 patients, 14 patients were improved, 4 patients were treatment resistant. CONCLUSION: This study shows the importance of detailed vestibular testing such as bithermal caloric test in BPPV patients. Patients with evidence of concomitant vestibular pathology would be expected to require further vestibular rehabilitation.

Expression of Matrix Metalloproteinase-2/-9 in Nasal Polyp and Antrochoanal Polyp / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nasal polyp (NP) and antrochoanal polyp (ACP) are soft tissue masses, featuring chronic inflammation and tissue remodeling. To elucidate the mechanism of tissue remodeling, we investigated the expressions of matrix metalloproteinase-2 (MMP-2) and MMP-9 in ACP and NP and compared them with normal inferior turbinate mucosa. SUBJECTS AND METHOD: Nasal samples, obtained from controls (n=10), from ACP (n=10) and from NP (n=13), were analysed by immunohistochemistry. MMP-2/-9 expression was identified in epithelial, endothelial, gland, inflammatory cells. We assessed MMP-2/-9 immunoreactivity of ACP and NP in comparison with the normal inferior turbinate. The number of immunostained inflammatory cells were determined. RESULTS: In ACP, compared with controls, the MMP-2 expression was increased in vessel endothelium, while the MMP-9 expression was increased in vessel endothelium and inflammatory cells. In NP, compared with controls, increased expression of MMP-9 was observed in gland and inflammatory cells. CONCLUSION: ACP showed increased expression of MMP-2/-9, while NP showed increased expression of MMP-9. It is concluded that MMP-2/-9 in ACP and MMP-9 in NP may play a role in tissue remodeling.

The Clinical and Radiological Evaluation of Results about Closed Reduction for Children with Nasal Bone Fractures / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It has generally been accepted that closed reduction is the management of nasal fracture in children. But proper management is still confusing and clinical and radiological evaluation about long term results have yet to be determined. The purpose of this study is to determine which closed reduction method for nasal bone fractures in children is effective when considering clinical and radiological aspects. MATERIALS AND METHOD: We analysed the medical records of 35 children with nasal bone fractures up to the age of 15, who were operated by closed reduction between 2000 and 2002. We evaluated postoperative satisfaction of doctors and patients and postoperative CT scan score (Motomura et al 2001) of 14 children over more than at least 2 postoperative years. RESULTS: A peak incidence ages ranged from 13 to 15 years. The most frequent cause was sports injuries. The degree of postoperative satisfaction and postoperative CT scan score was favorable. CONCLUSION: In management of nasal fracture in children, closed reduction is effective and satisfactory when clinical and radiological aspects are considered.

Histological Evaluation of Gore-Tex(R) used in Nasal Augmentation of Human / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although Gore-Tex is popularly used in nasal augmentation in human, studies about the histological changes have been carried out only in animal models. The purpose of this study is to investigate histological changes of Gore-Tex used in nasal augmentation in human. SUBJECTS AND METHODS: Gore-Tex of 24 patients who underwent nasal augmentation using Gore-Tex (non-reinforced sheets) 2-36 months ago and had re-operated for the sole cosmetic problems was obtained. Histologic examination was performed from specimens including Gore-Tex and the surrounding soft tissue with light microscope and electromicroscope. RESULTS: Histologically, connective tissue ingrowth was observed in all specimen. But the degree of foreign body reaction and collagen deposit varied from specimen to specimen and had no relationship with the duration. Neovascularization was observed from specimen whose duration was longer than 12 months and degenerative calcification was observed from 36 month old specimen. CONCLUSION: Unlike the findings of previous reports, individual differences and partial degenerative lesions in Gore-Tex were observed. Additional studies are required to confirm the stability of Gore-Tex as an implant to be used in human.

Clinical Analysis of Traumatized Auricular Laceration / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Contusions and lacerations of the auricle are common, but reconstructive procedures are difficult because the auricle has an intricate cartilage framework covered with delicate skin. The purpose of this study was to present therapeutic principles of traumatized auricular laceration. SUBJECTS AND METHOD: The study was performed retrospectively and included 35 traumatized auricular laceration patients. Their wound state, degree of laceration, whether or not had exposure of cartilage, methods of reconstruction used and postoperative complications were analyzed. RESULTS: Multiple laceration was found in 11 patients. Eight of 19 patients who had cartilage exposed had been performed cartilage suture method for alignment. Primary reconstruction was performed for two avulsed subtotal injury patients. Pocket principle technique was used for one patient whose auricle was contaminated and amputated. Postoperative complications were noted as paresthesia, color change, delayed healing, deformity and partial loss of auricle. CONCLUSION: Rapid and active management of traumatized auricular lacerations is important to prevent infection and postoperative complications.

Expression of Maspin in Squamous Cell Carcinoma of the Head and Neck / 대한이비인후과학회지

Squamous cell carcinomas (SCCs) of the head and neck are malignant tumors with their ability to invade and metastasis, which can affect the prognosis. The molecular pathogenesis of SCC of the head and neck is still not clear. Further understanding of the molecular alteration in SCC of the head and neck will be enable to provide more accurate and useful prognostic markers and more effective treatments. Maspin, a member of the serpin family of protease inhibitors, is known to have tumor-suppressor functions. However, association between its expression level and survival has not been demonstrated in Head and Neck cancer. Using the immunohistochemical technique to examine the expression levels of maspin in 30 cases of SCC in head and neck, the results showed that 73.3% of the cases expressed low to intermediate levels of maspin and 26.6% of the cases expressed high levels of maspin. The clinicopathological features of the SCC cases were also compared with the maspin expression level, and the results were that high maspin expression was significantly associated with the absence of lymph node metastasis. More importantly, higher maspin expression was significantly associated with better results of disease free survival time period, so it is suggested that high maspin expression may be a favorable prognostic marker for SCC of the head and neck.