A Case of Infratemporal Fossa Abscess Caused by Acute Sinusitis / 대한이비인후과학회지

Infratemporal fossa abscess caused by acute sinusitis, without other predisposing factors, is very rarely reported. We present such a case in a 78-year-old woman who was treated successfully with surgical drainage and antibiotics. She presented with a 10-day history of swelling and pain on the right side of her face. Physical examination revealed swelling on the right mandible area up to the zygomatic arch and the presence of mucopurulent rhinorrhea in the right nasal cavity without abnormal dental findings. Computed tomography revealed a right infratemporal fossa abscess and ipsilateral maxillary sinusitis connected through a defect on the posterior wall of the maxillary sinus. Drainage procedure was performed by navigation-guided endoscopic sinus surgery and intravenous antibiotics were administered. During a four months follow-up period, there was no sign of recurrence. Infratemporal fossa abscess can develop from acute sinusitis without predisposing factors, including dental infection. Surgical drainage along with intravenous antibiotics can lead to successful treatment in such cases.

Persistent Dysphonia after Laryngomicrosurgery for Benign Vocal Fold Disease

OBJECTIVES: Laryngomicrosurgery (LMS) is used to manage most vocal fold lesions. However, the functional voice outcome of the LMS might be diverse due to the influence of various factors. We intend to evaluate the incidence and etiologic factors of persistent dysphonia after LMS for benign vocal fold disease (BVFD). METHODS: We performed a retrospective review of 755 patients who underwent LMS for BVFD. We analyzed the clinical characteristics, preoperative and postoperative two onths voice studies. Postsurgical dysphonia was defined as grade 1 or above in GRBAS (grade, roughness, breathiness, asthenia, and strain) scale. Thirty nine patients (5.2%; 25 males and 14 females; average, 42.9 years; range, 21 to 70 years) were diagnosed with postsurgical dysphonia. RESULTS: There was no correlation between the diagnosis, coexistence with laryngopharyngeal reflux disease, habit of smoking, or occupational voice abuse and voice outcome. The patients with a worse preoperative acoustic parameter had aworse voice outcome. Stroboscopic findings showed excessive scarring or bowing in 21 cases, presence of lesion remnant in eight cases, prolonged laryngeal edema in five and no abnormal findings in three. CONCLUSION: Great care should be taken in patients with worse preoperative jitter. With a few exceptions, postoperative dysphonia can be avoided by the use of an ppropriate surgical technique.

Clinical Significance of beta-Tricalcium Phosphate and Polyphosphate for Mastoid Cavity Obliteration during Middle Ear Surgery: Human and Animal Study

OBJECTIVES: Mastoid obliteration is used to obliterate the mastoid cavity following a mastoidectomy or to prevent the formation of a retraction pocket. This study evaluated the effectiveness of beta-tricalcium phosphate and polyphosphate (beta-TPP) for mastoid obliteration in middle ear surgeries in prospective human and animal studies. METHODS: Twenty patients with chronic otitis media underwent mastoid obliteration using beta-TPP after a intact canal wall mastoidectomy or simple mastoidectomy. The clinical data were prospectively evaluated including: the diagnosis, temporal bone computed tomography (TBCT), otoscopic findings, pure tone audiogram, and complications. In the animal experiment, beta-TPP was applied into the right bulla in five rats, and the opposite bulla was used as the control in the non-obliterated state. The skulls of five other rats were drilled out and the holes were obliterated with beta-TPP. TBCT were obtained at 3, 6, and 9 months after the obliteration and histologic analysis was done at 3 and 9 months after surgery. RESULTS: In the human study, fourteen TBCTs were obtained at 12 months after the surgery. All demonstrated no bone resorption in the obliterated mastoids. Among the 15 cases displaying retracted tympanic membranes preoperatively, 11 showed no retraction, 2 showed retraction postoperatively, 1 was lost to follow-up and 1 was a case of postoperative wound infection. Among 20 cases, one case developed a postoperative infection that necessitated a second operation. Sixteen underwent ossiculoplasty; hearing improvements were obtained in 15 cases and 1 case showed decreased hearing. In the animal study, new bone formation without significant bone resorption in the radiologic and histologic findings were noted in both the skull and bulla groups. CONCLUSION: Although beta-TPP is a foreign material having the possibility of infection, mastoid obliteration with it can be a treatment option in middle ear surgeries to prevent retraction pockets or the recurrence of diseases.