A New Anterior Approach for Fluoroscopy-guided Suprascapular Nerve Block: A Preliminary Report

BACKGROUND: The aim of the study was to investigate the feasibility of fluoroscopy-guided anterior approach for suprascapular nerve block (SSNB). METHODS: Twenty patients with chronic shoulder pain were included in the study. All of the nerve blocks were performed with patients in a supine position. Fluoroscopy was tilted medially to obtain the best view of the scapular notch (medial angle) and caudally to put the base of coracoid process and scapular spine on same line (caudal angle). SSNB was performed by introducing a 100-mm, 21-gauge needle to the scapular notch with tunnel view technique. Following negative aspiration, 1.0 ml of contrast was injected to confirm the scapular notch, and 1 % mepivacaine 2 ml was slowly injected. The success of SSNB was assessed by numerical rating scale (NRS) before and after the block. RESULTS: The average NRS was decreased from 4.8 +/- 0.6 to 0.6 +/- 0.5 after the procedure (P < 0.05). The best view of the scapular notch was obtained in a medial angle of 15.1 +/- 2.2 (11-19degrees) and a caudal angle of 15.4 +/- 1.7degrees (12-18degrees). The average distance from the skin to the scapular notch was 5.8 +/- 0.6 cm. None of the complications such as pneumothorax, intravascular injection, and hematoma formation was found except one case of partial brachial plexus block. CONCLUSIONS: SSNB by fluoroscopy-guided anterior approach is a feasible technique. The advantage of using a fluoroscopy resulted in an effective block with a small dose of local anesthetics by an accurate placement of a tip of needle in the scapular notch while avoiding pneumothorax.

Posterior Short-Segment Instrumentation of Thoracic and Lumbar Bursting Fractures: Retrospective study related with Load-Sharing classification / 대한척추외과학회지

STUDY DESIGN: The authors designed the retrospective study with the Load-Sharing Classification in 47cases of the bursting thoracic-lumbar fractures, which were operated using the pedicle screws. OBJECTIVE: To judge the effectiveness of posterior short segment instrumented fusion in thoracic-lumbar fractures according to the Load-Sharing classification. MATERIAL AND METHOD: From 1995 through 1998, 47 patients who had been operated with short segment transpedicular instrumentation including fractured vertebra were selected and they were divided two groups, one below 6 point of Load-Sharing score, the other above 7 point. In follow up of average 39 months, the guide of reduction loss, which include the change of anterior vertebral body height and sagittal index were analysed statistically with the Student T-test at the postoperative time and the last follow-up time. RESULTS: In group below 6 point, the average of anterior vertebral body height was 56.2% before the operation and reduced 77.6% after the operation and measured 76.4% at final follow-up. The reduction loss was 1.2%. The sagittal index of preoperative 19.4degree became 10.6degree after the operation and measured 11.8degree at the last follow-up. The loss of correction angle was 1.2degree . In the other group above 7 point, anterior vertebral body height was average 51.7% before the operation and reduced 75% after the operation and measured 71.2% in last follow up, so reduction loss was 3.8%. Sagittal index was average 21.6degree before the operation and corrected 12.6 after the operation and measured 14.6degree in last follow up. All of 19 patients with neurologic deficits improved by over the one Frankel grade except grade A. CONCLUSION: Although the additional study is needed, there were no significant difference of statistical analysis about indexes between two groups.

Reconstruction of Nasal Defects with Local Flap: Analysis of 7 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Reconstruction of the nasal defect caused by resection of nose neoplasm or trauma represents a particular challenge to reconstructive surgeons. Each tissue defect has to be evaluated individually in terms of the best possible substitution or alteration from both aesthetic and functional points of view. The method of reconstruction varies according to the location, size, and depth of the defect. Of various methods, local Rap is frequently used because the nasal contours are variable with convex and concave surfaces in close proximity, and there is little lax skin from which to borrow tissue for closure, and the skin of the nose has a texture and color not easily matched by skin elsewhere. Of various local flaps, transposition flap and forehead flap are most frequently used for reconstruction of the nasal defect. The authors carried out retrospectively a clinical study on seven cases of nasal reconstruction that used local flaps after resection of malignant tumors of the nose with a brief review of the literature. MATERIALS AND METHODS: A single surgeon's results in seven consecutive patients were clinically analyzed retrospectively. RESULTS: There were no significant complications. Good aesthetic and functional outcomes were observed with nasal defects reconstructed with the local flaps. CONCLUSION: Local flaps were the most useful choice for reconstructive rhinoplasty. Transposition flaps and forehead flaps, in particular, were particularly useful for each cosmetic unit of the nose.

Management of Frontal Sinus Fracture according to the Type and Severity of the Fracture : Analysis of 23 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Frontal sinus fracture can have serious consequences due to proximity of the sinus to the intracranial cavity and the potential for serious combined injuries. Management of the Fractures depends on the type and severity of the fracture and the presence of associated injuries. In this article, we present an overview of fracture treatment options, and offer a simple algorithm for management based on the type and severity of the facture. PATIENTS AND METHODS: Twenty-three patients with frontal sinus fractures were analysed. All patients were male, with the mean age of 31. The average follow-up length was 13 months. Of 23 patients, 8 patients had anterior wall fractures and 15 patients had anterior and posterior wall fractures. Their types of fracture, combined injuries, surgical methods, surgical results, and complications were analysed. RESULTS: Six patients had conservative management and 17 patients had surgery. Of 17 patients who had surgery, 6 patients had only repair of the fracture, 3 patients had repair of the fracture with sinus obliteration, and 8 patients had repair of the fracture with cranialization of the frontal sinus. The most common associated injury was fractures of other facial bones (83%), especially the orbit. Traumatic optic neuropathy was the most common complication associated with the frontal sinus fracture or its accompanying injuries. CONCLUSION: Frontal sinus fractures were safely managed with repair of the fracture, sinus obliteration, or with sinus cranialization which was used irrespective of type and severity of fractures.

Histochemical Staining of PetaNADPH Diaphorase in Mongolian Gerbil and CJU/A Mouse Cochleae / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nitric oxide (NO) is an inorganic, gaseous free radical that carries a variety of messages between cells. The histochemical demonstration of neuronal betaNADPH-d is the demonstration of the presence of NOS. The purpose of this study was to identify the existence of NOS and the difference of the expression of betaNADPH-d in mouse and gerbil cochleae. MATERIALS AND METHODS: Each of the eight cochleae of Mongolian gerbil (Meriones unguiculatus) and mice (CJU/A) were fixed by cardiac perfusion with 4% paraformaldehyde in 0.1M phosphate buffer solution. The en-bloc cochleae were incubated after decalcification, and stained with betaNADPH-d and counterstained with acid fuchsin. The relative intensity of staining was decided in the same location of cochlea. RESULTS: Most supporting cells were strongly stained except Claudius cells and Boettcher's cells in gerbil. However, Boettcher's cells were strongly stained in mice. Outer hair cells, inner hair cells, basial membrane and lining cells of spiral limbus were strongly stained. Interdental cells of spiral limbus, inner border cells and intermediate cells of stria vascularis were moderately stained. Tectorial membrane and amorphous layer of basial membrane were not stained. CONCLUSION: Using betaNADPH-d staining, this study documents the presence of nitric oxide synthase in mice and gerbil cochleae and the difference of staining between two species.