Use of Septal Extension Grafts in Nasal Tip Plasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nasal tip plasty is one of the most important and difficult part of rhinoplasty. Controlling the projection, shape and rotation of nasal tip is a difficult procedure especially in Asians who have a thick skin and weak cartilages. The purpose of our study is to investigate the usefulness of septal extension graft (SEG) in controlling the tip shape. SUBJECTS AND METHOD: We retrospectively studied 20 patients who underwent rhinoplasty including tip surgery with SEG. Five patients were operated by transcolumellar open approach and 15 patients by intranasal approach. Columellar strut was used together with SEG in all patients to control the tip projection. The result of surgery was evaluated by comparing nasal measurements on photographs taken preoperatively and postoperatively. Doctor's and patient's satisfaction were investigated after minimal 6 months later using visual analogue scale. All results were statistically tested. RESULTS: The increment of tip projection was 10% in males and 5% in females and the increment of nasolabial angle were 4.4degrees in males and 8.1degrees in females. Most of the patients showed prominent tip projection and good cosmetic results. However, some patients complained indurations of upper caudal septum. CONCLUSION: SEGs are a reliable method of controlling tip projection and rotation in patients who need prominent tip projection.

Voice and Videostroboscopic Analysis after Neurorrhaphy of Recurrent Laryngeal Nerve Injured during Thyroidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Injury of recurrent laryngeal nerve is one of the major complications of thyroidectomy. One of the treatment options, which has met with some criticism, may be the repair of the injured nerve. This study was designed to investigate the efficiency of the neurorrhaphy of the injured recurrent laryngeal nerve with voice and videostroboscopic analysis. MATERIALS AND METHODS: For the injured recurrent laryngeal nerve, ansa hypoglossi-recurrent laryngeal nerve anastomosis has been performed in 6 patients, and direct end to end anastomosis has been performed in 4 patients. Postoperative parameters of perceptual analysis, acoustic analysis, aerodynamic study, and videostroboscopy after 6 months were compared with those of 11 patients whose recurrent laryngeal nerves were resected and left without neurorrhaphy. RESULTS: Perceptual breathy vocal quality and the aerodynamic parameters were better in anastomosed group, but there were no differences in the acoustic parameters. Medialization of vocal cord and the glottic closure was better in anastomosed group. No patient of the anastomosed group experienced dyspnea due to synkinesis. CONCLUSION: The results of this study indicates that the neurorrhaphy of injured recurrent laryngeal nerve is effective in improving the glottic closure, but unsatisfactory in achieving symmetric glottic tension and mucosa wave during phonation.

The Clinical Application of Voice Analysis in Identifying the Presence of Laryngopharyngeal Reflux in Patients with Pharyngeal Neurosis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pharyngeal neurosis is a common problem in the otolaryngology clinic. Laryngopharyngeal reflux is suggested as one of the etiologic factors in pharyngeal neurosis. The purpose of this study was to find usefulness of voice analysis in diagnosis of pharyngeal neurosis and correlation between voice analysis and 24-hour ambulatory double-probe pH monitoring. MATERIALS AND METHODS: 42 patients with pharyngeal neurosis underwent fiberoptic laryngoscopy, voice analysis, and 24-hour ambulatory double-probe monitoring. The authors used a computerized acoustic analysis pr-ogram (CSL-MDVP) to measure fundamental frequency, jitter, shimmer, and noise to harmonics ratio. RESULTS: There was a significant difference between the positive group and negative group during 24-hour ambulatory pH monitoring regarding jitter and shimmer. Correlation results were good between voice analysis and 24-hour ambulatory double-probe pH monitoring, poor between fiberoptic laryngoscopy and 24-hour ambulatory double-probe pH monitoring. CONCLUSION: This study showed that when abnormal results in voice analysis were found in patients of pharyngeal neurosis, the probability that 24-hour ambulatory double-probe pH monitoring would be abnormal was high.

Clinical Analysis on the Cystic Lesions in the Maxilla

BACKGROUND AND OBJECTIVES: Jaw cysts are frequently diagnosed by dentists, however they are also presented with symptoms specific to otolaryngology which are different from common symptoms found in dentistry. Thus, those diagnosed by otolaryngologists are likely to show different clinical manifestations. The purpose of this study was to investigate the clinical characteristics of jaw cysts found in otolaryngology. MATERIALS AND METHODS: A retrospective study was carried out. Frequency, sex, age, symptoms, site of occurrence, histopathology, treatment and results of 30 jaw cysts, were analyzed. These were diagnosed and surgically treated between May, 1990 and August, 1998 at our otolaryngology department. RESULTS: Among 30 jaw cysts, there were 15 cases (50%) of nasolabial cysts, 8 cases (27%) of dentigerous cysts, 5 cases (17%) of nasopalatine cysts and 2 cases (6%) of radicular cysts. Nasolabial cysts (NLC) were the most common among middle-aged females, and they showed a common complaint of cheek swelling. They were all removed surgically by gingivobuccal incision. One case of cellulitis was reported postoperatively and it was treated with antibiotics. Dentigerous cysts (DC) were mostly found among young males. The most common chief complaint was cheek swelling. 4 cases (50%) of DC were associated with chronic paranasal sinusitis. In 5 cases (63%) the cysts were surgically removed after opening the maxillary sinus by gingivobuccal incision. 3 cases (37%) were removed by the Caldwell-Luc approach. Nasopalatine cysts (NPC) were prevalent during the third and fourth decade. Common symptoms were palatal swelling, pain and tenderness. All were treated with surgery by the transpalatal approach. One case of postoperative palatal fistula was reported and was successfully repaired. There were 2 cases of radicular cyst (RC). 1 case was removed by sublabial incision, and the other case was removed by the Caldwell-Luc approach. CONCLUSION: The most common jaw cysts in the maxilla were nasolabial cyst. Most jaw cysts were treated by surgery without recurrence.

Clinical Analysis on the Cystic Lesions in the Maxilla

BACKGROUND AND OBJECTIVES: Jaw cysts are frequently diagnosed by dentists, however they are also presented with symptoms specific to otolaryngology which are different from common symptoms found in dentistry. Thus, those diagnosed by otolaryngologists are likely to show different clinical manifestations. The purpose of this study was to investigate the clinical characteristics of jaw cysts found in otolaryngology. MATERIALS AND METHODS: A retrospective study was carried out. Frequency, sex, age, symptoms, site of occurrence, histopathology, treatment and results of 30 jaw cysts, were analyzed. These were diagnosed and surgically treated between May, 1990 and August, 1998 at our otolaryngology department. RESULTS: Among 30 jaw cysts, there were 15 cases (50%) of nasolabial cysts, 8 cases (27%) of dentigerous cysts, 5 cases (17%) of nasopalatine cysts and 2 cases (6%) of radicular cysts. Nasolabial cysts (NLC) were the most common among middle-aged females, and they showed a common complaint of cheek swelling. They were all removed surgically by gingivobuccal incision. One case of cellulitis was reported postoperatively and it was treated with antibiotics. Dentigerous cysts (DC) were mostly found among young males. The most common chief complaint was cheek swelling. 4 cases (50%) of DC were associated with chronic paranasal sinusitis. In 5 cases (63%) the cysts were surgically removed after opening the maxillary sinus by gingivobuccal incision. 3 cases (37%) were removed by the Caldwell-Luc approach. Nasopalatine cysts (NPC) were prevalent during the third and fourth decade. Common symptoms were palatal swelling, pain and tenderness. All were treated with surgery by the transpalatal approach. One case of postoperative palatal fistula was reported and was successfully repaired. There were 2 cases of radicular cyst (RC). 1 case was removed by sublabial incision, and the other case was removed by the Caldwell-Luc approach. CONCLUSION: The most common jaw cysts in the maxilla were nasolabial cyst. Most jaw cysts were treated by surgery without recurrence.

Three Cases of Actinomycosis of the Head and Neck / 대한이비인후과학회지

Actinomycosis is a rare form of disease that is caused by Actinomyces such as A. israelii and A. bovis, which may take the form of an acute or a subacute disease progression. 55% of this disease arises in the head and neck area, and the remaining 45% of the disease occurs in the chest and the gastrointestinal tract, Our cases show the rare routes of invasion of actinomycosis. The first case was a 40-year-old man complaining of headache for 5-6 months and of a recently developed trismus. Soft brownish bulging mass was observed in his posterior nasopharyngeal wall. CT showed the skull base involvement, and biopsy confirmed actinomycosis. The patient was successfully cured with penicillin. The second case was a 49-year-old female presenting a firm and fragile mass in her left nasal cavity. She was treated with endoscopic removal of the mass including the adjacent mucosa followed by ampicillin administration for 8 months. The last case was a 78-year-old female having a painful mass on the right cheek, Diagnosis was confirmed with the fine needle aspiration biopsy. She was successfully treated with surgical excision and antibiotic treatment. We present, with the appropriate review, 3 cases of actinomycosis that developed in three different areas of the head.