Correlation of Bacterial Cultures between the Middle Meatus and the Maxillary Sinus in Chronic Sinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The identification of specific pathogens for chronic sinusitis is important for antibiotic treatment. By comparing endoscope-guided middle meatal cultures to intraoperative maxillary sinus cultures, we tried to determine whether middle meatal cultures can replace maxillary sinus cultures as a noninvasive alternative. MATERIALS AND METHOD: Twenty-two patients with chronic sinusitis, who didn't respond to medical therapy and recieved endoscopic sinus surgery were selected. We collected preoperative middle meatal samples and intraoperative maxillary sinus samples from twenty two patients under end-oscopic visualization using strile cotton swabs. RESULTS: In 18 of the 22 samples (82%), endoscope-guided middle meatal cultures correlated well with the intraoperative maxillary sinus cultures. In both middle meatus and maxillary sinus samples, most frequently encountered microorganism was Staphylococcus aureus. CONCLUSION: Noninvasive middle meatal cultures correlate well with maxillary sinus cultures, and can be confidently used as an alternative.

The Relationship between Unintentional Parathyroidectomy and Postoperative Hypocalcemia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Preservation of parathyroid gland during thyroid surgery is important to prevent postoperative hypocalcemia. We evaluated the incidence of unintentional parathyroidectomy during thyroid surgery and postoperative hypocalcemia, and their clinical relationships. MATERIALS AND METHOD: 136 patients who had undergone thyroid surgery were retrospectively followed. We reviewed the pathology specimens to determine the incidence of unintentional removal of parathyroid tissue and inquired the incidence of postoperative hypocalcemia according to the pathology of tumor, the extent of surgery, and the locations of the parathyroid tissues. RESULTS: 27 patients (19.9%) had pathology reports showing parathyroid tissue contained within the thyroidectomy specimen. Unintentional parathyroidectomy was less correlated with postoperative transient hypocalcemia statistically. The postoperative transient hypocalcemia was more frequent after total thyroidectomy for malignant thyroid tumor than hemithyroidectomy for benign thyroid tumor. Most parathyroid tissues were found in extracapsular locations. CONCLUSION: Unintentional parathyroidectomy was reported in 19.9% of the thyroidectomies in our studies. More meticulous dissection of thyroid capsule may be needed, especially during total thyroidectomy for malignant thyroid tumor.

Delayed Ischemic Optic Neuropathy after Endoscopic Sinus Surgery: A Case Report / 대한이비인후과학회지

The intimate relation between the paranasal sinuses and the orbit places the orbital contents at risk of injury during ESS (endoscopic sinus surgery). This injury may cause severe postoperative orbital complications. These have been widely reported from mild orbital hematoma to devastating visual loss. Despite technological advances with a skillful surgeon, ESS still carries potential risks of direct injury to the orbital contents and optic nerve, which may cause blindness. In our case, the disturbance in visual acuity developed 14 days after ESS without intraoperative orbital complications. And we report a rare case of posterior ischemic optic neuropathy following ESS, which may be presumed to cause the delayed onset blindness postoperatively.

Two Cases of Palatal Island Flap for Reconstruction of Intraoral Defect / 대한이비인후과학회지

After intraoral tumor resection, various reconstructive surgeries have been used to repair the defect. Before the selection of procedure, we should consider the size of defect, the difficulty of operative procedure, operation time and viability of flap, donor site problem in intraoral reconstruction. Palatal island flap within or adjacent to the operative field can frequently provide the necessary tissue, especially, with the lesions of palatine arch, retromolar trigone, tonsillar fossa, and posterior third of the floor of the mouth. We got favorable cosmetic and functional results in two patients who underwent reconstruction with palatal island flaps for intraoral defect. This paper represents the versatility of the palatal island flap for intraoral reconstruction and to introduce our clinical experiences.

The Clinical Significance of Head-shaking Nystagmus in the Patients with Acute Unilateral Peripheral Vestibular Loss

BACKGROUND AND OBJECTIVES: In unilateral peripheral vestibular loss patients, head-shaking induce a bias from remaining asymmetric vestibular sensor and cause the imbalance in velocity-storage mechanisms. Head-shaking nystagmus(HSN) is the transient nystagmus induced by shaking the head in the horizontal plane, and have slow phases directed toward the side of vestibular loss. We evaluated the usefulness of the HSN in acute unilateral peripheral vestibular loss patient with reference to spontaneous nystagmus(SN), bithermal caloric test, and slow harmonic acceleration(SHA) test. MATERIALS AND METHODS: 18 patients of acute unilateral peripheral vestibular loss who had SN and symptoms of acute prolonged vertigo were analyzed retrospectively. The examiner performed passive head rotation in 30 degree anteflexed position with eyes closed and oscillated about 60 degree to each side, 2 Hz for 20 cycles, and the nystagmus was observed with Frenzel glasses immediately after head was stopped. Prevalence and direction of HSN were analyzed with SN, caloric test and SHA test during the follow up period. RESULTS: The prevalence of HSN was 89%(16/18). During follow-up period, direction of nystagmus was changed 28%(13/18) in SN, but in HSN, direction was fixed in all subjects. SN and HSN directed toward the same side in 75%(12/16) but in four cases(25%), direction could not compared because the direction of SN was changed during follow up peroid. In 69%(11/16) of subjects, HSN persisted after the disappearance of SN. In comparison of HSN with bithermal caloric test, direction of CP was highly correlated with direction of HSN(92%) than SN(64%). HSN was more prevalent(92%) than DP(67%) in caloric test and asymmetry(78%) in SHA test. CONCLUSIONS: HSN test, easily performed office maneuvers, is very useful method to identify the laterality of acute unilateral peripheral vestibular loss, especially in chronic stage.