Results and Complications of the Orbital Blowout Fractures Repair / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There has been a recent surge in the frequency of blowout fracture operations in the Department of Otorhinolaryngology. Clinical symptoms and signs, operative timing and the results from fracture site and size have been researched in this study. We conducted this study to examine the postoperative complications causing re-operation in orbital blowout fracture repair in the last seven years. SUBJECTS AND METHOD: Based on patients' clinical data, we retrospectively reviewed 160 patients who had operation because of blowout fracture from January 1998 to December 2004. Fifty-two patients had orbital floor, 74 patients had medial orbital wall, 34 patients had a combination of orbital floor and medial orbital wall fractures. We investigated diplopia, limitation of eye movements, and enophthalmos after the surgery, and analyzed the frequency and causes of re-operation. The mean postoperative follow-up was 24 months. RESULTS: We classified complications into immediate complications which occurred within 24 hours, late complications which occurred between 24 hours and 2 weeks, and delayed complications which occurred 2 weeks or more after operation. The symptoms of complications included diplopia, EOM limitation, cheek hypoesthesia, loss of vision, oroantral fistula, implant infection, ectropion, and etc. In case of sequelae which lasted more than six months, the combination of orbital floor and medial orbital wall fractures was higher than other fracture types. We carried out re-operation on 14 cases and the main cause was incomplete reduction. CONCLUSION: Surgeons should perform proper operation according to fracture site and type, and insert the implant after making an adequate dissection in order to reduce the frequency of complication and re-operation.

A Case of Reduction of Frontal Sinus Anterior Wall Fracture Using Bioabsorbable Plate / 대한이비인후과학회지

Frontal sinus fractures are relatively uncommon maxillofacial injuries, making up only 5% to 12% of all facial fractures. Management of the fracture depends on the type and severity of the fracture and the presence of associated injuries. The use of a metalic plate as a reduction material for facial bone fracture has vastly grown; however, in infants, metal implants induce growth restriction of facial bone and the plate needs to be removed after approximately 3-6 months. Due to these weakness, the use of it as a bioabsorbable plate has thus taken over the large proportion of all its uses. A 15-year-old man was admitted to our hospital with a depression fracture of the frontal sinus anterior wall after trauma to the frontal area. Seven days after the trauma, the patient got open reduction. After exposing the fracture site with a butterfly incision, and placing the fractured bony fragments back in original place, the bioabsorbable plates were fixed on them. Postoperatively, depressed frontal area was restored normally. There is no evidence of complication after 28 months from the operation. We report a successful reduction of the frontal sinus anterior wall fracture using bioabsorbable plates.

The Effects of Stiffness in Transverse Ligament and Wire Diameter on Atlanto-Axial Posterior Fixations / 대한정형외과연구학회지

PURPOSE: To analysis the effects of reduction of stiffness in transverse ligament and wire diameter on atlanto-axial posterior fusion and fixations using finite element model. MATERIALS AND METHODS: The finite element model of occipito-atlanto-axis was made based on cadaver with a normal occiput and cervical spine. In order to investigate the effects of the wire diameter on the posterior fusion and fixations, an unstable atlanto-axial finite element model was made to reduce stiffness of the transverse ligament orderly (50%, 75%, 100%). And the wire was tied according to Brooks and Jenkins'method after modeling the grafted bone to fit in the space between the atlas and axis. The wire diameter was 18G, 20G and 22G. Anterior atlanto-dens interval (AADI) was measured after placing 1.5 Nm pure flexion movement on the occiput. RESULTS: The AADI was increased as the stiffness of transverse ligament was reduced. In the case of 50%, 75% and 100% decrement, the AADI were 3.37 mm, 3.87 mm and 4.94 mm. In the case of 50% and 75% decrement, the sufficient fixations were obtained although we used thin wire. However, in the 100% decrement, the AADI was exceeded the 3 mm when we used thin wire (20G, 22G) and sufficient fixations were obtained with only 18G. CONCLUSION: The sufficient fixations were obtained regardless of wire diameter in the partial tear of transverse ligament. In the complete tear, the minimal 18G wire diameter was useful to acquire sufficient fixations. However, the results were derived from the finite element model analysis. Thus further verification should be necessary to confirm the results using cadaver experiments.

Comparison of Wound Healing Effect of Different Forms of Chitosan

This study is to compare the effect of wound healing using three different types of chitin, which include the shapes of sponge, velvet, thick non-woven fabrics, and thin non-woven fabrics. The sponge type had more capacity to absorb the first discharge of a wound than the velvet type and the two non-woven fabrics types. Instead of absorbing the discharge effectively, the velvet type showed a difficulty to take off the dressing stuff from a wound since it was solidly stuck to the wound. The sponge type showed less infiltration of inflammatory cells, producing angiogenesis and fibroblast faster than any other types. Next, the thick non-woven fabrics type was a little more effective than the thin non-woven fabrics type: However, there was no difference between two types. The velvet type sustained the infiltration of inflammatory cells for the longest duration, producing slower angiogenesis and fibroblast. In wound contraction and wound healing, the sponge type was most effective with statistical significance than any other types(p0.05). In conclusion, the sponge type showed the best effectiveness to absorb the early discharge, facilitating the progress of inflammatory phase to increase the healing rate. It induced an early healing of wound caused by wound contraction rather than by wound epithelization.

Retrospective Study on 527 Patients with Maxillofacial Trauma: A 5-year Experience / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In modern society, maxillofacial trauma is correlated with an increase in population and traffic accident due to industrialization and urbanization. Many studies have examined maxillofacial trauma, although these studies have shown various results due to investigator's viewpoint and regional and cultural differences. Hence, we conducted this study to examine the current status of patients with maxillofacial trauma. SUBJECTS AND METHOD: Based on patients' clinical data, we retrospectively reviewed clinical characteristics, demographic information and radiographic findings of 527 patients (633 cases based on the fracture sites) with maxillofacial trauma who had visited our hospital between January 1998 and December 2002. We analyzed patients' sex, cause of trauma, and fracture sites. Furthermore, we analyzed the type of treatment for each fracture site. RESULTS: Patients with maxillofacial fracture showed a male predominance of 2.9: 1, and were prevalent in the 20's, 10's and 30's in the order of frequency. These patients showed an increasing tendency in their numbers on a yearly basis, and were the most prevalent in 2002 and on November according to year and month, respectively. The most common etiology was `violence (36.6%)'. Predilection sites were `nasal bone (52.1%)' and `orbit (21.5% [blowout fracture of the orbital wall])'. CONCLUSION: Patients with maxillofacial trauma showed an increasing tendency in their numbers on a yearly basis and frequently exhibited nasal bone fracture and blowout fracture of the medial orbital wall. Accordingly, these patients frequently consult otolaryngologits in comparison with the past. otolaryngologists will pay more attention to these patients.

Reduction of the Blowout Fracture of the Inferior Orbital Wall Using Elasticity of Silicon Tube / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: For the cases of the blowout fracture of the inferior orbital wall, reduction was performed frequently through transantral approach supporting herniated orbital tissue with silastic block, gauze or ureteral ballon catheter. But transantral approach has significant drawbacks such as instability, displacement of materials, and incomplete reduction. To overcome these shortcomings, we used an elastic silicon tube through transantral approach. In this paper, we compare the operative results between the group in which silastic blocks were used and the group in which silicon tubes were used. MATERIALS AND METHOD: We examined 19 patients whose maxillary sinuses were packed with silastic blocks or silicon tubes through only transantral approach. Among them, silastic blocks were used in nine cases ("block group") and silicon tubes in ten ("tube group"). Differences in preoperative and postoperative ocular symptoms, the percentage of revision operation, and occurrence of the infection of maxillary sinuses were compared between the two groups. RESULTS: In the block group, revision operations were carried out in three cases. Among those, one case was due to the undercorrection of fracture and two were due to the displacement of supporting material. In the tube group, one revision operation was necessary due to the overcorrection of fracture. Postoperative diplopia was observed in two cases among the block group and in one case among the tube group. One case with limitation in extraocular muscle movement was postoperatively detected among the block group. One case of infection of maxillary sinus was observed among the tube group. CONCLUSION: Reduction technique using silicone tube was easy and fast to perform by surgeons. We consider this reduction technique is a good surgical procedure instead of using silastic blocks.

A Case of Acute Unilateral Maxillary Sinusitis Developed after Dental Implant / 대한이비인후과학회지

Recently, alloy dental implant is frequently performed in dentistry. The complications of a dental implant include maxillary sinusitis, oroantral fistula, displacement of implants and others. Maxillary sinusitis among these complications is one of the severe complications, which is being reported to occur rarely. The complications of dental implant are often accompanied by gingival swelling, pain, fistula and other symptoms, for which immediate therapeutic measures may be implemented. Nevertheless, as the authors encountered, overlooking secondary nasal symptoms of a dental implant may lead patients to rely merely on drug treatment without realizing the particular causes for such symptoms. The authors experienced a case with acute unilateral maxillary sinusitis developed after dental implant performed at the dental clinic, which was alleviated by performing endoscopic sinus surgery. Such complication has been rarely reported overseas, nor domestically. By reporting this case, we aimed to call attention to the complication of sinusitis and to take into consideration of implant displacement in suspicious cases of acute maxillary sinusitis.