Surgical Treatment of a Plunging Ranula using the Intraoral and Submandibular Approach

PURPOSE: A plunging ranula is relatively uncommon and represents a mucus escape reaction occurring from a disruption of the sublingual salivary gland. It is a common condition found in young adults, even though the reported age range is 2 - 61 years. We report our experience of a complete excision of a plunging ranula via the intraoral and submandibular approach. METHODS: A 23-year-old man had a large protruding mass in the right submandibular area. Initially, the protruding mass appeared bilaterally but the left side disappeared spontaneously. The MRI findings revealed a homogenous fluid attenuation mass in the submandibular space, suggesting a ranula. The sublingual gland was extirpated through the intraoral approach and the ranula excised totally via the submandibular approach. RESULTS: The patient had an uneventful postoperative course without infection, paralysis and tongue sensory changes, etc. The pathology findings were characteristic of a pseudocyst without a lining epithelium or endothelium but with a vascular fibro-conective tissue wall filled with mucinous fluid. No recurrence was observed on the submandibular area during the 8 month follow-up period. CONCLUSION: The combined intraoral approach and submandibular approach is an effective and highly recommended method for sublingual gland extirpation and complete excision of a plunging ranula.

Oribicularis Oris Muscle Defects in Philtral Deformities in the Repaired Cleft Lip

PURPOSE: The purpose of this study is to estimate muscle defect by ultrasonography in the patients with secondary deformities of the lip. We investigated the association between the muscle defect in the repaired cleft lip and the philtral appearance not only at resting state but also maximal puckering. METHODS: From December 2006 to November 2007, 52 children were evaluated after primary or secondary cheiloplasty. Digital photographs were taken both from the front and both three quarter views in repose and at maximal pucker. Video clips were also taken in repose and at maximal pucker. A panel of four, scored the philtral ridge and dimple seen on these photographs and videos by using two visual analog scales. Eminence of the philtral ridge was scored by a 5 point grading scale, from "conspicuous groove" to "normal philtral ridge" and the philtral dimple was scored by 3 point grading scale, from "no dimple" to "prominent dimple". Ultrasound images of the upper lip were made using a linear array transducer at the resting position of the lip and evaluated by a single radiologist. RESULTS: The philtral ridge eminence scored 2.79+/-0.54 and 1.40+/-0.53 at resting and maximal pucker, correlating with "flat" and "conspicous groove". The philtral dimpling scored 1.44+/-0.53 and 2.27+/-0.66 at resting and maximal pucker, correlating with "no dimple" and "slight dimple". Ultrasound imaging showed the average muscle dehiscence to be 3.78+/-2.14mm at resting position. Correlation between the muscle defect in ultrasound imaging and philtral ridge eminence at rest was statistically significant (p<0.050), but was not significant(p=0.756) at maximal pucker using Spearman's rank correlation. Correlation between the muscle defect in ultrasound imaging and philtral dimpling was not statistically significant both at rest (p=0.920) and at maximal pucker(p=0.815) using Spearman's rank correlation. CONCLUSION: Quantitative assessment of the muscle defect using ultrasonography correlates with the static philtral appearance, but does not correlate with the dynamic appearance. Also, the size of the muscle defect does not show any correlation with the philtral dimpling. Our findings reveal that ultrasound imaging partially reflect static appearance of philtrum but cannot reflect dynamic appearance and suggest the need for further research to evaluate dynamic appearance.

Expression of Nonsteroidal Anti-Inflammatory Drug-Activated Gene-1(NAG-1) in Human Nasal Mucosa and Cultured Nasal Epithelial Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nonsteroidal anti-inflammatory drug-activated gene-1 (NAG-1) is a recently discovered TGF-beta superfamily cytokine. But localization and functions of NAG-1 have not been thoroughly studied. So, we wanted to investigate its expression and localization in human nasal mucosa and also wanted to investigate the change of NAG-1 expression as a function of mucociliary and squamous differentiation. MATERIALS AND METHODS: Anterior and middle portion of human inferior turbinate were used and immunohistochemistry with NAG-1 antibody was done. Passage-2 normal human nasal epithelial cell culture using air-liquid interface method was performed for 14 days and the cells were divided as retinoic acid (RA)-sufficient and RA-deficient group. Hematoxylin and eosin staining was done on each group to study the degree of differentiation. Western blot analysis for NAG-1 expression was performed on each group on 0, 7, and 14 days. RESULTS: NAG-1 expression of muco-ciliated epithelium was noted in ciliated cells and serous acini, but was not found in goblet cells and mucous acini. In the squamous epithelium, its expression was weaker than in the mucociliated epithelium. In the RA-sufficient culture, NHNE cells were differentiated into ciliated epithelium, but in the RA-deficient culture, keratinizing squamous epithelium was noted. In the Western blot analysis, NAG-1 expression was significantly higher in the RA-sufficient culture than in the RA-deficient culture and this expression was time-dependent. CONCLUSION: NAG-1 may be related to differentiation and apoptotic process of nasal epithelial cells. However, it is still unclear whether NAG-1 is an inducer or a byproduct of differentiation or apoptosis. The role of NAG-1 protein remains to be solved.

Preliminary Results of Mitomycin-C Application in the Treatment of Laryngeal Stenosis and Granuloma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mitomycin-C is an antibiotic, antineoplastic agent that inhibits DNA and protein synthesis, and fibroblast proliferation. It has been successfully used in adjunction to glaucoma surgery, dacryocystorhinostomy, pterygium surgery, and middle meatal antrostomy. The purpose of this study is to evaluate the efficacy and safety of intraoperative Mitomycin-C application as an adjunct therapy in the endoscopic treatment of laryngeal stenosis and granulation. MATERIALS AND METHOD: A total 13 subjects, of whom 2 had anterior glottic web, 4 posterior laryngeal stenosis, and 7 laryngeal granuloma were included. All underwent stroboscopy and were treated with endoscopic laryngomicrosurgery with CO2 laser. Then, 1 cc of 0.4 mg/mL Mitomycin-C was directly applied for 4 minutes on the surgical site. The patients' symptoms were assessed, and the size of the airway was graded on a scale of I (< or =50%) to IV (total occlusion) after a mean follow-up period of 5 months. The recurrence of the laryngeal granuloma was checked. RESULTS: There was a significant improvement in postoperative symptoms in the group of posterior laryngeal stenosis. Two with tracheotomy underwent decannulation. The postoperative size of airway was markedly increased and restenosis was not noted. There was only one case of recurrence in the granuloma group. CONCLUSION: According to these preliminary results, it is suggested that application of Mitomycin-C can be used as a beneficial adjunct therapy in the endoscopic COc laser excision for laryngeal stenosis and granuloma.