A Case of Thyroarytenoid Myoneurectomy Using LASER and Monopolar Electrical Device in Spasmodic Dysphonia

Spasmodic dysphonia is a focal laryngeal dystonia that results in involuntary spasms during speech. The etiology of spasmodic dysphonia is not yet defined, but it is presumed to be a neurological abnormality of central nervous system motor function. The treatment of choice for spasmodic dysphonia is botulinum toxin injection directly at the laryngeal muscles. However botulinum toxin injection requires repeated procedures. Many different kinds of surgical treatments have been introduced but the recurrence rate is still high. So we performed myomectomy with LASER and neurectomy with specially designed electrical surgical knife which can cut recurrent laryngeal nerve branch selectively with its noble curved section. We report a case of a 43-year-old male patient with spasmodic dysphonia treated by thyroarytenoid myoneurectomy.

Salivary Duct Carcinoma with Unusual Clinical Course of Sialolithiasis / 대한이비인후과학회지

Salivary duct carcinoma is a high-grade malignant tumor that is histologically similar to ductal carcinoma of the breast. It accounts for less than 1-3% of salivary gland tumors and 63-100% of cases arise in the parotid gland. Swelling, pain, facial palsy and mass in the salivary gland are clinical features suggestive of salivary duct carcinoma. CT and MR imaging findings are nonspecific. However, a few reports suggest that ill-defined heterogenous mass containing calcification observed on CT scans may be useful for diagnosis. Although salivary duct carcinoma can show calcifications on CT images (33-50%), it can be confused with sialolithiasis. The authors report two cases of salivary duct carcinoma, which was complicated with sialolithiasis in the submandibular gland (in a 25-year-old man with recurrent distal submandibular duct stone, and a 50-year-old man with intraglandular stone). It is suggested that unusual cases of sialolithiasis should be carefully examined to exclude the suspicion of malignancy before surgery.

Osteitis Fibrosa Cystica Mistaken for Malignant Disease

A 65-year-old man with back pain had plain radiographs that showed multiple osteolytic bone lesions of the pelvis, femur and L-spine; an magnetic resonance imaging scan of the L-spine showed extensive bony resorption with a posterior epidural mass involving the L1 spinous process; these findings suggested multiple myeloma or bony metastasis. However, all serology testing was negative. The parathyroid hormone and serum calcium levels were found to be abnormally elevated. A fine needle aspiration biopsy suggested that the L-spine lesion was consistent with the diagnosis of osteitis fibrosa cystica. A pathological fracture of the spine compressed the spinal cord, and surgical intervention was required. The neck computed tomography and Tc-99m sestamibi scan showed a solitary parathyroid mass. A minimally invasive parathyroidectomy using intraoperative parathyroid hormone monitoring was performed and two enlarged parathyroid glands identified. This case illustrates the importance of the consideration of a rare brown tumor associated with primary hyperparathyroidism in patients with the bone lesions suggestive of a malignancy.

Porous Polyurethane Scaffold as a Tracheal Prosthesis Material / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to confirm the usefulness of the porous polyurethane scaffold as a tracheal prosthesis for repair of partial tracheal defect. SUBJECTS AND METHOD: A porous polyurethane (PU) scaffold was manufactured by salt-leaching method. Polyethylene glycol (PEG) was grafted onto the surface of the PU scaffold following surface ozonation treatment. Scanning electro-microscopy (SEM) was then performed to evaluate the morphklogy. For the biocompatibility evaluation, a 5x5 mm sized PU scaffold was implanted into the rabbit's ear. A histological examination was performed with the tissue one month later. Polymerase chain reaction for tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, procollagen, fibromodulin, fibronectin, and actin was also performed. The tensile strength was measured and compared with beagle's trachea to evaluate the mechanical property of the prosthesis. RESULTS: The effect of ozonation and surface grafting with PEG was on the porous scaffold was confirmed by SEM and X-ray photoelectron spectroscopy. The histological examination showed a large amount of fibrous tissue and capillary had grown through the pores of the porous scaffold. The inflammatory reaction was not so severe. TNF-alpha and IL-6 were slightly elevated in the PU scaffold transplanted tissue. However, the concentration levels of the other cytokines were similar between transplanted tissue and normal tissue. The tensile strength was very similar with the beagle's normal trachea. CONCLUSION: The polyethylene grafted polyurethane scaffold is a good candidate prosthesis for tracheal reconstruction.

Review of Injection Laryngoplasty as Treatment of Voice Disorders / 이화의대지

In the past decade, vocal fold injection (VFI) has re-emerged as a valuable treatment modality for a variety of laryngeal disorders. It offers many advantages for the treatment of glottal insufficiency. It can avoid surgical scar and is easily performed with local anesthesia. In this article, we describe the indication of injection laryngoplasty, variable injection materials and discuss about vocal fold injection approaches.

A Case of Kikuchi's Disease Associated with Hemophagocytic Syndrome / 대한이비인후과학회지

Kikuchi's disease and hemophagocytic syndrome have the clinical similarity in initial presentations, but present different clinical course and prognosis. Kikuchi's disease usually have a self-limiting clinical course, but hemophagocytic syndrome can be fatal. It is important to make differential diagnoses and treat properly. We report a case of 18 year old boy who was admitted to the hospital with two weeks history of fever and progressive cervical lymph node swelling. Cervical lymph node biopsy showed the typical necrotizing lymphadenitis of Kikuchi's disease. There were signs of histiocytosis and hemophagocytic phenomenon in the bone marrow. The etiology, treatment, and prognosis of Kikuchi's disease with hemophagocytic syndrome are discussed.

Usefulness of Intraoperative Parathyroid Hormone Assay in Minimally Invasive Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Intraoperative parathyroid hormone (PTH) assay has been proposed as an effective tool in minimally invasive parathyroidectomy. We evaluated its usefulness during minimally invasive parathyroidectomy. SUBJECTS AND METHOD: Ten patients (female 6, male 4) of primary hyperparathyroidism (8 single diseases, 2 multiple diseases) were analyzed retrospectively. We used computed tomography (CT) and 99mTc-Sestamibi (MIBI) scan for localization of parathyroid lesions preoperatively, and frozen biopsy and PTH assay at 10 (T-10), 20 (T-20) minutes after excision intraoperatively. We also compared the diagnostic sensitivity of CT and MIBI scan and intraoperative PTH. RESULTS: All patients were treated successfully and in single disease group, diagnostic sensitivity of CT, MIBI scan were 75% and 87.5%, and that of T-10 was 75% and T-20 was 100%. In multiple disease group, diagnostic sensitivity of CT, MIBI scan were 75%, 87.5%, and that of PTH was 80%. CONCLUSION: Intraoperative PTH assay improves cure rate in minimally invasive parathyroidectomy. It allowed intraoperative recognition of missed parathyroid lesions by preoperative imaging study.

Development of Guideline for Rating the Physical Impairment of Otolaryngologic Field

We develop a guideline for rating the physical impairment of otolaryngologic fields. Assessment of hearing disturbance and tinnitus required physical examination, pure tone audiometry, speech audiometry, impedance audiometry, brainstem evoked response audiometry, Bekesy audiometry, otoacoustic emission test, and imaging examination. History taking, physical examination, and radiological examination for the vestibular organ and brain, righting reflex test, electronystagmography, and caloric test are taken for evaluation of balance disorder. Olfactory function tests include University of Pennsylvania Smell Identification test, Connecticut Chemosensory Clinical Research Center test, T and T olfactometry and Korean Version of Sniffin's Sticks test. Medical history and physical examination is mandatory to evaluatezseverity of respiration difficulty. Examinations include flexible fiberoptic nasopharyngoscope, bronchoscopy, simple soft-tissue radiography films of upper airway and high resolution computed tomography. Evaluation of mastication and swallowing are history taking, physical examination, examination for upper jaw, lower jaw, and temporomandibular joint, dental examination and radiological studies. Endoscopy and esophagography are also needed. Voice disorder is evaluated based on physical examination, oral pharynx and larynx endoscopy, larynx stroboscopy, hearing assessment, laryngeal electromyography, sound analysis test, aerodynamic test, electroglottography, and radiologic examination. Articulation disorder is assessed by picture consonant articulation test. These are position articulation test, Lee-Kim Korean articulation picture and speech intelligibility assessment.

A Case of the EXIT (Ex Utero Intrapartum Treatment) Procedure in Congenital Fetal Cervical Immature Teratoma / 대한이비인후과학회지

The exutero intrapartum treatment (EXIT) is an uncommon procedure indicated for fetal lesions with the potential to cause lifethreatening airway obstruction immediately after child delivery. Maintenance of the maternal-fetal circulation under the general anesthesia can allow time for the fetal airway to be secured before delivery. Cervical teratomas are rare congenital tumors derived from all three germ cell layers. The vast majority are histologically benign, but the significant size can potentiate life-threatening upper airway obstruction. We have recently experienced a case of the large fetal cervical teratoma diagnosed prenatally on ultrasonography and treated surgically using the EXIT procedure.

A Case of Aryepiglottoplasty with Apnea Technique in Laryngomalacia Patient / 대한이비인후과학회지

Laryngomalacia is the most common congenital laryngeal anomaly. Usually, the symptoms of laryngomalacis are mild and the disease does not interfere with the general body growth as it resolves itself spontaneously. Occasionally, however, it causes a failure to grow, apnea or cardiopulmonary diseases. We have recently experienced a case of severe laryngomalacia neonate. Aryepiglottoplasty with apnea technique was carried out under the general anesthesia using CO2 Laser.

The effects of Hydroxyapatite nano-coating implants on healing of surgically created circumferential gap in dogs / 대한치주과학회지

PURPOSE: The aim of this study is to compare the healing response of various Hydroxyapatite(HA) coated dental implants by Ion-Beam Assisted Deposition(IBAD) placed in the surgically created circumferential gap in dogs. MATERIALS AND METHODS: In four mongrel dogs, all mandibular premolars and the first molar were extracted. After an 8weeks healing period, six submerged type implants were placed and the circumferential cylindrical 2mm coronal defects around the implants were made surgically with customized step drills. Groups were divided into six groups : anodized surface, anodized surface with 150nm HA and heat treatment, anodized surface with 300nm HA and heat treatment, anodized surface with 150nm HA and no heat treatment, and anodized surface with 150nm HA, heat treatment and bone graft, anodized surface with bone graft. The dogs were sacrificed following 12 weeks healing period. Specimens were analyzed histologically and histomorphometrically. RESULTS: During the healing period, healing was uneventful and implants were well maintained. Anodized surface with HA coating and 430degrees C heat treatment showed an improved regenerative characteristics. Most of the gaps were filled with newly regenerated bone. The implant surface was covered with bone layer as base for intensive bone formation and remodeling. In case that graft the alloplastic material to the gaps, most of the coronal gaps were filled with newly formed bone and remaining graft particles. The bone-implant contact and bone density parameters showed similar results with the histological findings. The bone graft group presented the best bone-implant contact value which had statistical significance. CONCLUSION: Within the scope of this study, nano-scale HA coated dental implants appeared to have significant effect on the development of new bone formation. And additional bone graft is an effective method in overcoming the gaps around the implants.

Correlation of Glucose Transporter-1 Expression With Uptake of 18F-Fluorodeoxyglucose Positron Emission Tomography in Thyroid Papillary Carcinoma / 대한이비인후과학회지

Backgroud and Objectives: 18F-FDG Positron emission tomography (18F-FDG PET) is a noninvasive diagnostic tool for many kinds of human cancer, where glucose transporter-1 (Glut-1) acts as a main transporter in the uptake of 18F-FDG in cancer cells. The object of this study is to assess the expression of Glut-1 in human papillary carcinoma and the relationship between the expression and the uptake of 18F-FDG PET. SUBJECTS AND METHOD: We evaluated 30 patients diagnosed as papillary carcinoma. Tumor sizes were measured and Glut-1 expression rate (ER), expression intensity (EI) and total expression score (ES) were analyzed. 18F-FDG PET was performed in 19 patients and standardized uptake value (SUV) was measured in each case. The correlations between ER and SUV, ES and SUV, tumor sizes and SUV, ER and tumor sizes were analyzed statistically. RESULTS: 96.7% (29/30) of tumors were Glut-1 positive, the mean ER was 67.42+/-22.89% and the mean ES 131.8+/-71. Tumor cells showed higher expression of Glut-1 than normal thyroid tissue. 18F-FDG uptake was positive in 81% (17/21) of solitary thyroid papillary carcinoma and negative in 19% (4/21). The average SUV of the PET positive group was 6.75+/-4.8, ER 71.25 +/-20.6% and ES 134.68+/-51.4. The average size of PET positive tumors was 3.37+/-2.94 cm2 and that of negative tumors was 0.43+/-0.45 cm2. Both ER and ES of Glut-1 were correlated with SUV significantly. The size and SUV were also correlated significantly. But the size and ER were not correlated significantly. CONCLUSION: Thyroid papillary carcinoma has high ER of Glut-1 and there is a positive correlation between Glut-1 expression and the uptake of 18F-FDG PET. The size of tumor can also affect the 18F-FDG uptake. But there is no correlation between the size and Glut-1 expression and further studies are needed to find the mechanisms and to decide the cut-off value.

Steatocystoma Simplex of the Anterior Neck / 대한이비인후과학회지

As a benign adnexal tumor, steatocystoma usually occurs as an autosomal dominant condition known as steatocystoma multiplex. Steatocystoma simplex, the noninherited solitary counterpart of steatocystoma multiplex,was first described by Brownstein in 1982, and is exceedingly rare. We report a case of steatocystoma simplex in a 27-years-old female, who presented with an asymptomatic soft, oval shaped mass on the lower anterior neck. The lesion was completely excised and confirmed as steatocystoma simplex on histopathological examination.

Bone formation following dental implant placement with augmentation materials at dehiscence defects in dogs : pilot study / 대한치주과학회지

PURPOSE: Guided bone regeneration(GBR) has emerged as a treatment in the management of osseous defects associated with dental implants. But several studies have reported different degrees of success of guided bone regeneration, depending upon the type of barrier selected, presence or absence of an underlying graft material, types of graft material, feasibility of technique, and clinician's preference. The aim of the present study was to evaluate bone formation following dental implant placement with augmentation materials at dehiscence defects in dogs. MATERIAL AND METHODS: Standardized buccal dehiscence defects(3x5 mm) were surgically 2 Mongrel dog's mandibles, each 8 SLA surface, 8 anodizing surface implants. Each buccal dehiscence defect received flap surgery only(no treatment, control), Cytoflex(R) membrane only, Resolut XT(R) membrane only, Resolut XT(R)+Osteon(TM). Animals were sacrificed at 8 weeks postsurgery and block sections were harvested for histologic analysis. RESULTS: All experimental group resulted in higher bone formation than control. Resolut XT(R)+Osteon(TM) group resulted appeared highest defect resolution. There was no difference between SLA and anodizing surface, nonresorbable and resorbable membrane. CONCLUSION: GBR results in rapid and clinically relevant bone closure on dehiscence defects of the dental implants.

Effect of Bone Marrow Cell Collection Techniques and Donor Site Locations on In-Vitro Growth of Bone Forming Cells

PURPOSE: This study evaluated the influence of bone marrow cell collection techniques and donor site locations on the in-vitro growth of bone-forming cells. METHODS: Sixty six samples of bone marrow cell collections (BMCC) or bone marrow aspirates (BMA) from 15 patients were obtained. Thirty eight samples for culture were composed of 23 BMA from 7 tibial condyles and 16 ilia, with the other 15 BMCC from the contralateral ilia. The other 28 samples were used for the analysis of alkaline phosphatase activities. After counting total cell number, mesenchymal stem cells (MSC) obtained from samples were incubated for 14 days. Alkaline phosphatase staining was used to count the number of stained colonies to show osteogenic differentiation. RESULTS: The average MSC counts of BMA from tibial condyles and ilia were 1.42x10(6) and 7.35x10(6) respectively, with 4.80x10(6) from ilial BMCC (p=0.010). MSC cultures could not be produced from tibial condyles in all 7 samples. However, 9 of 15 BMCC samples and 9 of 16 ilial BMA samples were successfully cultured (p=0.018). The average of cell counts in the successful cultures was 7.92x10(6), whereas that in the failed cultures was 2.85x10(6) (p=0.000). Multiple regression analysis showed that colony count was associated with the patient's age and total cell numbers, but not with collection methods such as BMCC or BMA (p=0.000, R=0.648, beta; age=-0.405, cell number=0.356). The discriminating formula indicated that more than 5.25x10(6) cells were needed for successful culture. CONCLUSIONS: For successful cultures in vitro and for grafts, the total number of collected bone forming cells is more important than donor sites or collection methods. For young patients, grafting of bone-marrow-derived osteoprogenitor cells is promising.

Morphologic Feasibility of Pedicle Screw Insertion in Korean / 대한정형외과학회잡지

PURPOSE: This study examined the morphological characteristics of the thoracic and lumbar vertebrae of normal Koreans and the factors causing breakage of the pedicular wall by measuring the thoracolumbar vertebrae relative to the pedicle screw insertion. MATERIALS AND METHODS: The effect of the pedicle screw shape on the pedicle wall integrity of 56 normal Koreans was examined by performing a computer simulation of the inserting pedicle screws into the pedicle wall by superimposing the graphical images of the screws onto the CT scan images. RESULTS: Because the inner pedicle diameters of the most thoracic vertebrae from T4 to T10 were <5 mm, most pedicles of the thoracic vertebrae were expected to be broken after inserting the 5 mm-diameter cylindrical screws. The pedicles of the thoracic and lumbar vertebrae were classified into 6 groups by performing the cluster analysis using morphometric parameters. Group 1 was labeled "relatively narrow". Group 2 "moderate". Group 3 "wide and angular". Group 4 "severly narrow and short", Group 5 "long", and group 6 "relatively wide and angular". The simulation showed the pedicles of groups 1 and 4 to be too narrow for the 5 mm-diameter cylindrical screws to preserve the pedicular wall integrity. CONCLUSION: The pedicles of the vertebra of Koreans are similar in size to those of Caucasians. Personal morphological characteristics of the pedicles as well as their sizes and levels of the vertebrae are believed to be the significant factors that can cause the breakage of the pedicular wall.

Interlocking Intramedullary Nail in Distal Tibia Fracture

PURPOSE: To evaluate the effectivity of interlocking intramedullary nailing for distal tibia fracture and prognostic factor to bone healing. MATERIALS AND METHODS: From April 2000 to June 2005, 21 cases who had distal tibia fracture were treated by interlocking intramedullary nail were analyzed. The duration of follow-up was more than 1 year. We evaluated clinical results by IOWA ANKLE rating system and union time by simple X-ray. Furthermore, we estimated prognostic factor to union time. RESULTS: The bone union was achieved at average 18.5 weeks. At the last follow-up, there was no non-union and infection. Average IOWA ANKLE rating score was 91.3 point. The union time was delayed in open and segmental fracture at initial fracture. And severe soft tissue injury in open fracture revealed bad result. CONCLUSION: We concluded that interlocking intramedullary nail is effective method for treatment of the distal tibial fractures. And, adequate soft tissue management is important to bone healing and clinical outcome.

A Case of Minimally Invasive Parathyroidectomy Using Intraoperative iPTH Monitoring to Ensure Operative Success / 대한이비인후과학회지

The frequency of hyperparathyroidism has slowly increased recently with routine measurement of serum calcium and increasing awareness by the public of the disease. The success of parathyroid surgery depends on the identification and removal of all hyperactive parathyroid tissue. Advances in preoperative imaging, such as high resolution ultrasonography and Tc-99m sestamibi, plays a major role in the targeted operative approach that does not disturb the normal parathyroid glands. Tc 99m sestamibi scanning is generally viewed as the gold standard for preoperative parathyroid localization with high sensitivity and specificity, while the intraoperative measurement of intact parathyroid hormone (iPTH )provides the surgeon with a quantitative test that predicts the postoperative serum calcium level and can justify early closure or further exploration for hyperfunctioning parathyroid gland. Therefore, the combination of Tc-99m sestamibi and rapid intraoperative iPTH measurement enable minimally invasive techniques for multiple parathyroid lesions. The combination of Tc-99m sestamibi and intraoperative iPTH monitoring, indispensable for securing operative success, represents an accurate and effective diagnostic tools. The authors experienced a case that proved the combination of Tc-99m sestamibi and rapid intraoperative PTH monitoring useful and made a report with a review of literature.

The Use of Second Metacarpal Vascular Pedicle Graft and Temporary Scaphotrapeziotrapezoid Fixation for the Treatment of Kienbock's Disease / 대한정형외과학회잡지

PURPOSE: Revascularization is a useful method for treating Kienbock's disease. The aim of this study was to evaluate the use of the second dorsal metacarpal vascular pedicle to treat Kienbock's disease. MATERIALS AND METHODS: A retrospective study was carried out on 9 patients who had undergone vascular pedicle graft for Kienbock's disease between 1999 and 2003. The mean follow up period was 35 months. At the time of surgery, 2 patients were graded as stage II, 6 as IIIa and 1 as IIIb. The ulnar variance was neutral in all cases. A vascular pedicle graft using second dorsal metacarpal vessel were performed and temporary scaphotrapeziotrapezoid (STT) fixation were applied for 6 months. RESULTS: Wrist motion except for the radial deviation and grip strength had improved significantly. The patients returned to work after an average of 22 weeks. Resorption of the sclerosis was observed in 7 cases, but lunate collapse was observed in the simple radiograph in 6 cases. According to Lichtman's criteria, 7 cases were satisfactory but 2 cases with a relative old age were unsatisfactory. According to Nakamura's classification, 5 cases were good, 3 cases were fair and 1 case was poor. CONCLUSION: In Kienbock's disease with neutral ulnar variance, a revascularization procedure of vascular pedicle graft with temporary STT fixation is a good treatment method but the patient's age should be considered when determining the revascularization procedure. A prospective study will be needed to determine the optimal duration of temporary STT fixation.

The analysis of short term success rate and healing patterns of Implantium(R) Implant / 대한치주과학회지

This study is an analysis of distribution of patients who installed Implantium(R) implant in Yonsei University Dental Hospital and types of implant site for about 1 years recall check and success rate. 164 implants were installed to 52 patients in this study. It shows the conclusion below. 1. Patients at the age of 40s and 50s were 65% of all implant cases and average number of implant was 4 (man), and 2.7 (woman). 75 implants were operated on maxilla and 89 were mandible. 19 implants on anterior region and 145 implants on posterior region. 2. Most distribution of bone qaulity for implant site was type III(37.2%) and bone quantity was type C(61.7%) 3. The majority of implants were those of 10, 12mm in length (85%) and regular diameter in width (48.8%). 4. 30 implants were installed with the advanced technique-GBR, window opening, osteotome technique. 5. Two implants were removed before prosthodontic treatment due to the osseointegraton failure. The success rate was 98.8% in 15.2 months follow up period and the marginal bone loss was 0.28mm. The results provided us with basic data on patient type, implant distribution, bone condition, and survival rate. Within the limit of present study, It was concluded that Implantium(R) implant could be used satisfactorily in various clinical situations.