Analysis of Clinical Feature and Management of Laryngeal Fracture: Recent 22 Case Review

PURPOSE: Laryngeal fracture is rare, but complications are frequent and severe. Controversy still exists in regards to its proper management. The aim of this study was to present the clinical findings and management of laryngeal fracture in Korea. MATERIALS AND METHODS: We analyzed the medical records of 22 patients with laryngeal fracture at a tertiary care trauma center from 2000 to 2010 retrospectively. RESULTS: In total, 22 patients (19 men and 3 woman) presented with laryngeal fractures caused by blunt (n=13) or penetrating (n=9) injury. Pain (68.1%), odynophagia (68.1%), hoarseness (18.1%), hemoptysis (13.6%), and subcutaneous emphysema (9%) were the common presenting symptoms and noncomminuted fracture was common. High velocity blunt trauma (mostly traffic accidents) patients had more extensive injury and poor voice outcomes. Penetrating trauma patients due to physical assault or suicide attempt demonstrated more frequently injuries on the left side. CONCLUSION: In driver-caused traffic accidents, where injuries in a wide area within the larynx occurred, poor voice results were seen, and these injuries required aggressive treatment. When endotracheal intubation was performed at experienced emergency centers with fiberoptic laryngoscopes, airway management was safely achieved. In addition, if the fractured laryngeal framework was corrected at appropriate times, voice results were good.

Clinical Results of Endoscopic Endonasal Transsphenoidal Hypophysectomy during an Acceleration Phase of Learning Curve / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to compare endoscopic endonasal transsphenoidal hypophysectomy (EETSA) with microscopic transseptal transsphenoidal hypophysectomy (MTTSA) in terms of clinical results during an acceleration of learning curve. SUBJECTS AND METHOD: A retrospective chart review was performed of the first 14 cases of EETSA and previous 14 cases of MTTSA. Resection results, endocrinologic outcomes, complication rates, operating time, and duration of hospital stay were investigated. A non-parametric analysis was performed to determine the significance of differences between groups. RESULTS: EETSA was performed, achieving gross total removal, based on postoperative MRI, for 12 of the 14 patients (86%) and hormonal remission for 4 of the 5 patients (80%); on the other hand, MTTSA was performed, achieving gross total removal for 9 of the 14 patients (64%) and hormonal remission for 1 of the 5 patients (20%). We found better resection results in patients who underwent EETSA than in those who did MTTSA with respect to tumors extending into suprasellar area (p<0.05). Visual improvement was achieved in all the cases with visual defect (n=5) after EETSA, whereas 4 of 6 cases (66%) were improved after MTTSA. Significant differences in complication rates, operating time and hospital stay could not be determined. All cases with CSF leakage in EETSA were successfully managed by using the nasoseptal flap. CONCLUSION: EETSA provided better resection results than MTTSA did, especially in cases extending into the suprasellar area, showing good hormonal cure and visual improvement rates. Two approaches were comparable with respect to complications during the learning curve.

A Case of Transoral Approach of Multiple Sialolithiasis in Parotid Duct / 대한이비인후과학회지

Sialolithiasis is a condition characterized by the obstruction of a salivary gland or its duct due to the formation of calcareous material or sialoliths resulting in salivary ectasia and even provoking the subsequent dilation of the salivary gland or salivary duct. The most difficult cases involve sialoliths in the posterior part of the Stensen's duct, the presence of multiple stones with stenosis of the distal part of the duct. We report on a case of Stensen's duct abscess with multiple sialolithiasis in a 46-year-old man. The patient's cheek was swollen, and showed no evidence of any other lesions. The patient was treated with surgical removal of stones by the intraoral approach, sialodochoplasty and antibiotics therapy. There has been no recurrence nor duct problem during the 12 months period of follow up.

Flow Cytometric Analysis of Cultured Adult Neural Stem Cells from Guinea Pig Spiral Ganglion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To make stem cell therapy successful as one of treatment options for sensorineural hearing loss, it is essential to culture and obtain sufficient amounts of adult neural stem cells, as well as separating them from adult auditory organs. This study was designed to investigate the proportion of cultured adult neural stem cells and its differentiated cells from guinea pig spiral ganglion. MATERIALS AND METHOD: The spiral ganglions from guinea pigs of 3-6 month age were obtained. The tissues were digested with 0.25 % trypsin and 10 mg/mL of DNase I, cells were then cultured with neurobasal medium (DMEM/F12 containing B27 supplement, L-glutamin, gentamycin) and added with 20 ng/mL of epidermal growth factor and 10 ng/mL of fibroblast growth factor. After 3 passages of culture, neural stem cells and differentiated cells were analyzed with the flow cytometric method. RESULTS: We concluded that neural stem cells were successfully cultured from spiral ganglions and these cells were in process of differentiation into neurons and Schwann cells. The results of flow cytometric analysis of cells in culture medium showed that 1.7% of cells (cell count of 24,300) expressed nestin, 3.45% polysialylated neural cell adhesion molecule, 7.19% (cell count of 66,300) neural cell adhesion molecule, and 3.57% beta III tubulin. CONCLUSION: Though obtaining adult neural stem cells from adult spiral ganglion was successful, the cell count was small. Further studies on the subject of making proper culture medium are needed to obtain adequate amounts of adult neural stem cells.

Effect of Growth Factors on Hearing Restoration in Deafened Animal Model / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sensorineural hearing loss is caused by ototoxic drugs, radiation therapy, noise exposure and trauma, etc. They make irreversible changes in cochlear hair cells and degeneration of spiral ganglion neurons. It is known that neurotrophins and other growth factors have an important role in protectingcochlear hair cells and spiral ganglion neurons. We designed this study to analyze the effect of neurotrophins and growth factors delivered to the inner ear of deafened guinea pig. MATERIALS AND METHOD: Healthy 15 guinea pigs with normal Preyer's reflex were chosen, and were made deaf by infusion of kanamycin and ethacrynic acid. Myringotomy was done to both ears, normal saline injected into the left ear, and BDNF (brainderived neurotrophic factor), GDNF (glial cell derived neurotrophic factor), NT-3 (neurotrophin-3), IGF (insulin-like growth factor), EGF (epidermal growth factor), FGF (fibroblast growth factor) were injected in the right ear. RESULTS: Statistically significant hearing gain was obtained up to 35.00+/-13.78 dB in the group 1 (BDNF, GDNF, NT-3 treated group), and up to 34.0+/-5.47 dB in the group 2 (IGF treated group). However, no statistically significant hearing gain was observed in the group 3 (EGF, FGF treated group). CONCLUSION: We observed statistically important improvement of hearing threshold in the BDNF, GDNF, NT-3 treated group and IGF treated group.

Expression of Neural Cell Adhesion Molecule and Polysialic Acid in Cultured Spiral Ganglion Neurons / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Neural cell adhesion molecule (NCAM) and polysialic acid (PSA) function basically in cell adhesion and migration. In neural development, they are closely associated with axon pathfinding, synaptogenesis, neural cell migration, differentiation and myelination. The purpose of this study is to assess expression of NCAM and PSA expression in spiral ganglion neurons and Schwann cells and to postulate their functions. MATERIALS AND METHOD: Guinea pig spiral ganglion cells were harvested and cultured in vitro. The cells were grown and differentiated in culture medium together with brain derived neurotrophic factor (BDNF), neurotrophin 3 (NT-3) and glial cell derived neurotrophic factor (GDNF). After 1 week of culturing, the cells were fixed and immunocytochemical staining with beta-III tubulin, S-100, polysialic acid (PSA) and neural cell adhesion molecule (NCAM) were performed. We then checked axon growth rate with Axon Analyzer System(R). RESULTS: In the spiral ganglion culture, cultured neurons showed positive staining for beta-III tubulin, NCAM, and different expressions of PSA. S-100 positive glial cells (Schwann cells) showed different expressions of NCAM and no expression of PSA. Some NCAM positive neurons and Schwann cells were in contact each other. The growth rate of neuron was about 10-30 micrometer/h using Axon Analyzer System(R). CONCLUSION: We postulated that NCAM may play an important role in neural cell adhesion, myelination, fasciculation and ganglion formation. But PSA did not express the adhesive function of NCAM ; its absence may have been due to developmental reason. The differential expression of NCAM in the Schwann cells may indicate its different immunocytochemical characteristics and functions as shown in the CNS glial cells, astrocytes and oligodendrocytes.