Are Cross-hatching Incisions Mandatory for Correction of Cartilaginous Septal Deviation?

OBJECTIVES: Cross-hatching incisions have been considered mandatory for correcting cartilaginous septal deviation. We evaluated the clinical outcome of septoplasty without cross-hatching incisions to determine the necessity for making septal cartilage incisions. METHODS: The reconstructed septal components during septoplasty were categorized into four anatomical areas: vomer, maxillary crest, perpendicular plate of ethmoid (PPE) and septal cartilage (the area for cross-hatching incisions). During septoplasty, we attempted to complete the surgery only by removing or fracturing the bony part of the septum without cross-hatching incisions on the cartilage. Only in the cases that the deviation was not immediately corrected, the cross-hatching incisions were made onto the cartilage at the end of the procedure. We analyzed the frequency of manipulating the septal components. The changes of symptoms were evaluated using a modified nasal obstruction symptom evaluation (NOSE) scale and a visual analog scale (VAS) preoperatively, 1 and 3 months after the surgery. RESULTS: Seventy five percents of the deviated septums were immediately corrected only by removing or fracturing of the bony septal components. In decreasing order of frequency, the sepal components for correcting septal deviation were the vomer (59%), maxillary crest (49%), septal cartilage (cross-hatching only: 25%) and PPE (15%). The modified NOSE scale and the VAS demonstrated significant improvement of the nasal symptoms postoperatively (P<0.05). CONCLUSION: Most of septal deviations could be corrected by manipulating only the bony septum. The results of this procedure were not different from conventional septoplasty with cross-hatching incisions. Our data suggest cross-hatching incisions during septoplasty might have been overemphasized and that the main cause for cartilaginous deviation may be the extrinsic forces that are generated by the neighboring bony structures.

Are Cross-hatching Incisions Mandatory for Correction of Cartilaginous Septal Deviation?

OBJECTIVES: Cross-hatching incisions have been considered mandatory for correcting cartilaginous septal deviation. We evaluated the clinical outcome of septoplasty without cross-hatching incisions to determine the necessity for making septal cartilage incisions. METHODS: The reconstructed septal components during septoplasty were categorized into four anatomical areas: vomer, maxillary crest, perpendicular plate of ethmoid (PPE) and septal cartilage (the area for cross-hatching incisions). During septoplasty, we attempted to complete the surgery only by removing or fracturing the bony part of the septum without cross-hatching incisions on the cartilage. Only in the cases that the deviation was not immediately corrected, the cross-hatching incisions were made onto the cartilage at the end of the procedure. We analyzed the frequency of manipulating the septal components. The changes of symptoms were evaluated using a modified nasal obstruction symptom evaluation (NOSE) scale and a visual analog scale (VAS) preoperatively, 1 and 3 months after the surgery. RESULTS: Seventy five percents of the deviated septums were immediately corrected only by removing or fracturing of the bony septal components. In decreasing order of frequency, the sepal components for correcting septal deviation were the vomer (59%), maxillary crest (49%), septal cartilage (cross-hatching only: 25%) and PPE (15%). The modified NOSE scale and the VAS demonstrated significant improvement of the nasal symptoms postoperatively (P<0.05). CONCLUSION: Most of septal deviations could be corrected by manipulating only the bony septum. The results of this procedure were not different from conventional septoplasty with cross-hatching incisions. Our data suggest cross-hatching incisions during septoplasty might have been overemphasized and that the main cause for cartilaginous deviation may be the extrinsic forces that are generated by the neighboring bony structures.

A Case of Repair of Retroauricular Skin Defect and Mastoid Cavity with Posterior Wall Reconstruction Using Tutoplast(R)(Allograft Cancellous Bone Chip) and Bone Dust after Canal Wall Down Mastoidectomy / 대한이비인후과학회지

Canal wall down mastoidectomy is often selected for the complete eradication of lesion and prevention of recurrence in patients with cholesteatoma. However, potential complications include a chronically draining cavity, retention of debris that requires frequent cleaning, difficulty with fitting a hearing aid. Aimed at solving these problems, surgeons have attempted reconstruction with a variety of techniques and materials: the reconstruction of an anatomically correct canal wall and complete obliteration of the mastoid cavity. We recently experienced a case of a retroauricular skin defect and cavity after canal wall down mastoidectomy of a 58-year-old male patient. The skin defect and cavity were repaired using a local skin flap, mastoid obliteration and posterior wall reconstruction methods using Tutoplast(R)(Allograft cancellous bone chip). We report this along with a review of literature.

Clinical Study on the Reliable Temporal Bone Fracture Classification Scheme / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Until now, the temporal bone fracture patient has been classified mostly according to the classic definition of transverse or longitudinal one, but it is often obscure and has problems of discrepancy in correlation with otologic symptoms. So we investigated the practicality of other noticeable reporting schemes for reasonable adoption. SUBJECTS AND METHOD: We thoroughly reviewed the medical records of the temporal bone fracture patients in past two years. And high resolution CT images were also re-evaluated by the senior radiologist using traditional and newer (otic capsule sparing vs. otic capsule violating, petrous vs. nonpetrous) classification schemes. RESULTS: A total of 61 cases were identified as temporal bone fracture. Among various symptoms, only sensorineural hearing loss was significantly higher in the transverse type of traditional scheme and in otic capsule violating fracture. Symptoms such as subjective and verified hearing loss including conductive hearing loss and ear fullness were higher in nonpetrous fracture (p<0.05). CONCLUSION: Traditional and otic capsule scheme correlated poorly with clinical presentation, whereas the petrous classification was better matched with main symptoms. Therefore, the petrous scheme was suggested as the more discriminative classification plan of temporal bone fracture to predict its sequela.

An Implant for Bone Formation using Autologous Mesenchymal Stem Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of the current study was to examine ectopic bone formation with autologous mesenchymal stem cells (MSC) on a porous 3-D Poly (DL-lactic-co-glycolic acid, PLGA) in canine model. MATERIALS AND METHOD: Bone marrow derived autologous mesenchymal stem cells (MSCs) were isolated and purified from dogs. The porous PLGA scaffold loaded MSCs was treated with osteo-inductive medium containing dexamethasone, beta glycerophosphate and ascorbic acid. Osteogenic differentiation and mineralization were examined with RT-PCR for osteocalcin mRNA and Von Kossa staining of the cell-polymer complex. For in vivo bone formation, polymers containing osteogenic differentiated cells were implanted into the subperiosteal space of the canine maxillary sinus and evaluated at 1st and 2nd month RESULTS: In vitro osteogenic differentiation was evident from 2 weeks after osteogenic induction. The mineralization was increased in a time dependent manner. Ectopic bone was generated in the subperiosteal space of canine maxillary sinus at 1 month and matured at 2 months. CONCLUSION: From these results, we conclude that ectopic tissue engineered bone formation in the facial area is possible and that it may be useful for facial reconstruction or regeneration of bone defect.