The Clinical Effectiveness of Open Septorhinoplasty for Primary Treatment of Nasal bone Fracture

BACKGROUND AND OBJECTIVES: Closed reduction has been a primary treatment procedure for nasal bone fracture, but the post-operative results have not always been satisfactory. We compared the satisfaction rate of closed reduction with that of open septorhinoplasty for the treatment of nasal bone fracture and evaluated the effectiveness of open septorhinoplasty for the primary treatment of nasal bone fracture. MATERIALS AND METHOD: We performed a retrospective review of patients who underwent a closed reduction treatment for nasal bone fracture from March 2004 to February 2006 and conducted telephone surveys to monitor their post-operative cosmetic and functional problems. We estimated the factors that were involved in the low satisfaction rate and determined the indications of open septorhinoplasty. Prospectively, the patients who underwent open septorhinoplasty from September 2006 to August 2007 were interviewed for their cosmetic and functional satisfaction rate. RESULTS: Forty percent of the patients who underwent closed reduction had cosmetic concerns and twenty percent had functional concerns. The factors involved in the low satisfaction rate were septal fracture, associated fractures, and multiple fragmentation. Eight percent of the patients who underwent open septorhinoplasty had cosmetic concerns and other eight percent had functional concerns. CONCLUSION: A careful pre-operative evaluation of the type of fracture is important for the treatment of nasal bone fracture. Also, when nasal bone fracture is combined with septal fracture, associated fracture or unilateral fragmentation, open septorhinoplasty has to be considered to reduce secondary deformities and to improve the satisfaction rate of the patients.

A Case of Sarcomatoid Carcinoma of Larynx / 대한이비인후과학회지

Sarcomatoid carcinoma is a rare type of head and neck cancer that presents both epithelial squamous cell carcinoma and sarcomatous features. There is much debate on pathogenesis, clinical behavior, therapeutic options and prognostic factors for this tumor. Treatment is similar for squamous cell carcinoma with respect to the state, location and size of the tumor. We report a case of sarcomatoid carcinoma on larynx, which was treated by surgical excision and postoperative radiotherapy. The relevant literature is briefly reviewed.

A Case of Schwannoma Arising in Pterygopalatine Fossa / 대한이비인후과학회지

Schwannoma, also referred to as neurilemmoma, is an encapsulated benign soft tissue tumor arising from the schwann cells of the nerve sheath. Although 25 to 45% of schwannomas arise in the head and neck region, pterygopalatine fossa is the rarest sites of involvement with only 23 cases reported in the medical literature. It is usually seen in the second and fifth decades, but sex or racial predilection has not been noted. Clinical features of this tumor are dependent on the involved anatomical site, nerve of origin, and compression of adjacent structures. The differential diagnosis of masses in pterygopalatine fossa includes angiofibroma, fibrous histiocytoma, malignant melanoma, lymphoma, and low-grade rhabdomyosarcoma. The treatment of choice is that the tumor is completely removed with careful preservation of its nerve. Recently, the authors experienced a case of schwannoma arising in pterygopalatine fossa, which was removed with transantral approach. Hence, we report a rare case with a review of literature.

The Clinical Application of Endoscopic Sphenoidotomy and Anatomical Role of the Superior Turbinate

BACKGROUND AND OBJECTIVES: Recently, endoscopic sinus surgery (ESS) is commonly performed to treat the sphenoid sinus disease. Identification of the natural ostium of sphenoid sinus (SS) according to surgeon's operating view play an important role in endoscopic sphenoid approach. This study is undertaken to investigate the role of superior turbinate (ST) as an anatomic landmark of natural ostium of SS in endoscopic sphenoidotomy. MATERIALS AND METHODS: Medical records and computed tomography (CT) images of 77 patients from March 2006 to December 2007 who underwent ESS were analyzed. We tried to investigate the location and distance of the natural ostium on the superior turbinate, skull base and nasal septum. We also measured the anterior wall thickness of the SS by using CT images. RESULTS: The natural ostium of the SS was located on the medial side of the ST in all patients who underwent endoscopic sphenoidotomy (45 cases). The level of posteroinferior end of the ST corresponded to the inferior portion of anterior wall of the SS. The lateral portion thickness of the anterior wall of the SS was thinner than the medial portion (77 cases). CONCLUSION: During an endoscopic sphenoidotomy, the superior turbinate is an important anatomic landmark for identifying the natural ostium of the SS. When widening the anterior wall of SS is performed, we sug-gest that the procedure should be directed to the lateral 1/3 portion, considering the thickness of anterior wall of SS.

The Effect of the Amniotic Membrane on Treatment of Tympanic Membrane Perforation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tympanic membrane perforations are usually caused by trauma, infection, surgical procedures such as tympanoplasty or myringoplasty. Because perforations interfere with the transmission and perception of sound, whatever the cause of the perforation, repair of the membrane is desirable. The purpose of this study is to investigate the clinical application and usefulness of allograft amniotic membrane, instead of autograft materials, in the management of tympanic membrane perforation. SUBJECTS AND METHOD: A retrospective study was performed on 14 patients who underwent myringoplasty with allograft amniotic membrane for tympanic membrane perforation from October 2006 to September 2007. Information was collected on sex, age, the cause of perforation, the perforation size, postoperative hearing result, the success rate. RESULTS: Of 14 patients, 13 patients were successfully treated by myringoplasty with allograft amniotic membrane and one patient failed due to infection. So the overall success rate was 93%. The mean air-bone gap was improved from 13.3 dB to 7.1 dB. CONCLUSION: The myringoplasty with allograft amniotic membrane is a successful procedure for the healing of tympanic membrane perforations.

Ultrasonography-Guided Fine Needle Aspiration of Incidentally Detected Nonpalpable Thyroid Nodule / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: With the availability of more sensitive ultrasonography, a larger number of nonpalpable thyroid nodule can be detected. But it is controversial that USG-FNA should be routinely used to incidentally detect nonpalpable thyroid nodule. The purpose of this study is to investigate the clinical significance of thyroid incidentaloma and the usefulness of the USG-FNA in the management of thyroid incidentaloma. SUBJECTS AND METHOD: A retrospective study was performed on 208 patients who underwent USG-FNA for thyroid incidentaloma smaller than 1.5 cm from 2001 to 2005. The cytologic findings were compared with the ultrasonographic findings and the surgical pathology. RESULTS: Suspicious malignant sonographic findings were detected in 48 cases. And in 10 cases, more than two malignant findings were detected. Of the 208 cases, 159 cases were cytologically diagnosed as benign lesion (76.4%), 7 cases as follicular neoplasm (3.3%), 33 cases as malignancy (15.8%), and 9 cases as inadequate specimen (4.4%). Of the 40 cases with follicular neoplasm and malignant cytology, 37 cases underwent surgery and 30 cases were confirmed to malignancy on the postoperative pathologic diagnosis. In the cases diagnosed to malignancy on pathology, extracapsular extension was present in 9 cases (30%), and nodal metastasis in 8 cases (26.7%). The sensitivity, specificity, and accuracy of the USG-FNA for malignancy were 93.3%, 71.4%, and 89.1%, respectively. CONCLUSION: USG-FNA is a useful diagnostic tool in the management of thyroid incidentaloma especially when more than two suspicious malignant sonographic findings need to be detected. The clinical characteristics is not significantly different between palpable and nonpalpable nodules.