Tactile Sensation Recovery after Parotidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: One of the common complications after parotidectomy is a decrease in skin sensation around the parotid gland. This is known to be associated with damage to the great auricular nerve (GAN). The purpose of this study was to investigate the pattern of tactile sensory recovery after parotidectomy and the difference in sensory recovery according to the preservation or sacrifice of the GAN. SUBJECTS AND METHOD: Fifty-two patients who underwent parotidectomy were enrolled in this study. The Touch Test Sensory Evaluator was used to measure the minimum tactile threshold value at 6 sites around the auricle before surgery and at 1 week, 1, 3, 6 and 12 months after surgery. RESULTS: The tactile threshold was the highest at 1 month after parotidectomy in all 6 sites. After 1 month, the threshold value gradually decreased until 12 months after surgery. However, the threshold was not completely recovered to the preoperative threshold level. At least one branch and the main trunk of GAN were preserved in 39 patients; one of GAN branches was preserved but the main trunk of GAN was partially injured in 3 patients, and the main trunk of GAN was completely injured in 10 patients. The tactile sensory recovery showed no significant differences in relation to the GAN status. CONCLUSION: The tactile sensory value kept decreasing up to one month following parotidectomy and then gradually recovered. However, the tactile sensory did not recover completely even one year after surgery. The GAN preservation did not affect tactile sensory recovery.

Preoperative Measurement of Submandibular Gland Stone Size / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The choice of optimal treatment methods among various gland preserving procedures including transoral surgery, sialendoscopy and extracorporeal lithotripsy for submandibular stones is mainly determined by the size of the stone. We tried to assess the accuracy of ultrasonography (USG) and computerized tomography (CT) for the preoperative estimation of submandibular gland stone size. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of 251 patients who were treated for submandibular stones from January 2008 to December 2014. Eighty patients who checked both preoperative USG and CT were included. Preoperative USG and CT measurements of the submandibular stones were compared to postoperative measurements of removed stones. Effects of stone location and presence of acute infection on preoperative measurements were also assessed. RESULTS: The mean submandibular gland stone size was 6.60+/-3.8 mm by USG, 7.23+/-4.0 mm by neck CT and 7.89+/-4.7 mm by the postoperative measurement. USG and CT showed good correlation with the postoperative measurement (correlation coefficient 0.912 and 0.940, respectively). The location of stone and presence of combined infection showed no significant impact on the accuracy of USG and CT measurement. CONCLUSION: USG and neck CT showed high accuracy for predicting submandibular gland stone size. However, it should be taken into consideration that the stone size could be greater than that shown by preoperative measurement.

Correlation Analysis between Anthropometric Measurement and the Results of Seep Questionnaires in Patients with Obstructive Sleep Apnea

BACKGROUND AND OBJECTIVES: Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing and affects quality of life. Several questionnaires have been developed for screening OSA. The aim of this study was to compare the anthropometric measurements of OSA patients using sleep questionnaires as a tool to screen patients with OSA. MATERIALS AND METHOD: This study enrolled 126 adult OSA patients. All subjects underwent overnight polysomnography (PSG) and were measured for body mass index (BMI), neck circumference, waist circumference, and tonsil size. Patients were screened using the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Berlin questionnaire (Berlin Q), and STOP questionnaire (STOP Q). Correlation and multiple regression analyses were conducted to determine the predictive value of the anthropometric measurements of OSA patients. RESULTS: ESS, Berlin Q, and STOP Q results were associated with apnea hypopnea index (AHI), minimal oxygen saturation of PSG and BMI, neck circumference, waist circumference, and hip circumference of OSA patients. However, facial contour did not significantly influence the results of sleep questionnaires. CONCLUSION: Some anthropometric characteristics are associated with sleep questionnaire results. Not only sleep questionnaires, but also anthropometric data can be used as predictive tools of OSA.

Comparison of Drug-eluting Coronary Stents, Bare Coronary Stents and Self-expanding Stents in Angioplasty of Middle Cerebral Artery Stenoses

OBJECTIVE: The purpose of this study is to investigate the results of treatment using stent-angioplasty for symptomatic middle cerebral arterial (MCA) stenosis and comparison of in-stent restenosis between drug-eluting stents (DES), bare metal coronary stents (BMS) and self-expanding stents (SES). MATERIALS AND METHODS: From Jan. 2007 to June. 2012, 34 patients (mean age +/- standard deviation: 62.9 +/- 13.6 years) with MCA stenosis were treated. Inclusion criteria were acute infarction or transient ischemic attacks (TIAs) and angiographically proven symptom related severe stenosis. Stents used for treatment were DES (n = 8), BMS (n = 13) and SES (n = 13). National Institutes of Health Stroke Scale (NIHSS) at admission was 2.5 +/- 3.1 and mean stenosis rate was 79.0 +/- 8.2%. Assessment of clinical and angiographic results was performed retrospectively. RESULTS: Among 34 patients, periprocedural complications occurred in four cases (11.8%), however, only two cases (6.0%) were symptomatic. All patients were followed clinically (mean follow-up period; 40.7 +/- 17.7 months) and 31 were followed angiographically (91.2%. 13.4 +/- 8.5 months). There was no occurrence of repeat stroke in all patients; however, mild TIAs related to restenosis occurred in three of 34 patients (8.8%). The mean NIHSS after stent-angioplasty was 1.7 +/- 2.9 and 0.8 +/- 1.1 at discharge. The modified Rankin score (mRS) at discharge was 0.5 +/- 0.9 and 0.3 +/- 0.8 at the last clinical follow-up. In-stent restenosis over 50% occurred in five of 31 angiographically followed cases (16.1%), however, all of these events occurred only in patients who were treated with BMS or SES. Restenosis rate was 0.0% in the DES group and 20.8% in the other group (p = 0.562); it did not differ between BMS and SES (2/11 18.2%, 3/13 23.1%, p = 1.000). CONCLUSION: Stent-angioplasty appears to be effective for symptomatic MCA stenosis. As for restenosis, in our study, DES was presumed to be more effective than BMS and SES; meanwhile, the results did not differ between the BMS and SES groups.

Unilateral Extrapedicular Vertebroplasty and Kyphoplasty in Lumbar Compression Fractures : Technique, Anatomy and Preliminary Results

OBJECTIVE: A single balloon extrapedicular kyphoplasty has been introduced as one of the unilateral approaches for thoracic compression fractures; however, the unilateral extrapedicular technique in the lumbar area needs a further understanding of structures in the lumbar area. The purpose of the present study is to describe methods and pitfalls of this procedure based on the anatomy of the lumbar area and to analyze clinical outcome and complications. METHODS: Anatomical evaluation was performed with 2 human cadavers. A retrospective review of unilateral extrapedicular approaches yielded 74 vertebral levels in 55 patients that were treated with unilateral extrapedicular vertebroplasty and kyphoplasty. Radiographic assessment included the restoration rate of vertebral height and correction of kyphosis. RESULTS: Anatomical evaluation indicates that the safe needle entry zone of bone for the extrapedicular approach was located in the supero-lateral aspect of the junction between the pedicle and vertebral body. The unilateral extrapedicular procedure achieved adequate pain relief with a mean decreases in pain severity of 7.25+/-1.5 and 2.0+/-1.4, respectively. Complications were 1 retroperitoneal hematoma, 6 unilateral fillings and 3 epidural leak of the polymethylmethacrylate. CONCLUSION: The method of a unilateral extrapedicular approach in kyphoplasty and vertebroplasty in the lumbar area might be similar to that in thoracic approach using a route via the extrapedicular space. However, different anatomical characteristics of the lumbar area should be considered.

Ganglion Cyst of the Posterior Longitudinal Ligament Causing Lumbar Radiculopathy

Degenerated conditions such as herniated disc or spinal stenosis are common etiologies of lumbar radiculopathy. Less common etiologies include spinal extradural cyst such as synovial cysts and ganglion cysts. Ganglion cyst of the posterior longitudinal ligament (PLL) of the spine is a rare entity that can result in classical sciatica. Posterior longitudinal ligament cyst has no continuity with the facet joint and has no epithelial lining. Two young male patients presented with unilateral sciatica and were found to have intraspinal cystic lesions causing lumbar radiculopathy. Magnetic resonance imaging demonstrated rounded, cystic lesions (i.e., hypointense on T1- but hyperintense on T2-weighted images) adjacent to minimally dehydrated, nonherniated disc spaces in both cases. These patients underwent posterior decompression and cysts were excised, and their sciatic symptoms were completely resolved. Histological examination showed typical features of ganglion cysts in these cases.

Computerized Tomographic Measurements of Morphometric Parameters of the C2 for the Feasibility of Laminar Screw Fixation in Korean Population

OBJECTIVE: C2 laminar screw fixation is considered as an excellent alternative to Magerl's transfacetal approach or Harms construct for the atlantoaxial stabilization. However, to our knowledge, there is no report on the feasibility of the new approach to Korean population. We investigated morphometric parameters of the dorsal arch of the C2 to provide the quantitative data for the feasibility of laminar screw fixation. METHODS: One-hundred-and-two patients' cervical computed tomography had been reconstructed and investigated on the anatomical parameters related with C2 laminar screw placement. Sixty patients were male and forty-two patients were female. Measurements included the laminar thickness and slope, spino-laminar angle, and maximal screw length. RESULTS: Ages ranged from 20 to 81 and the mean age was 48.4. Mean laminar thickness was 5.7 mm (+/-1.0) (5.8 mm in male and 5.4 mm in female). Fifty-one patients (50%) had a laminar thickness smaller than 5.5 mm at least unilaterally, therefore the patients were considered as inappropriate candidates for the laminar screw fixation in the smaller side of the laminae. Mean value of maximal length of screw was 33.3 mm (34.3 mm in male and 31.9 mm in female). Mean spino-laminar angle was 43.2degrees and mean slope angle was 32.9degrees. CONCLUSION: Half of patients had inappropriate laminar profiles to accommodate a 3.5 mm screw in at least one side of the axis. The three-dimensional computed tomography reconstruction is mandatory for the preoperative assessment for the feasibility of the C2 lamina.

Troublesome Occipital Neuralgia Developed by C1-C2 Harms Construct

Recently, Harms and Melcher modified Goel's approach, the C1 lateral mass and C2 pedicle screw fixation, and the new technique is currently in favor among neurosurgeons. Comparing to the advantages of Harms construct, the disadvantages were not extensively investigated. We experienced a patient with severe occipital pain developed after the C1 lateral mass screw placement for the traumatic atlantoaxial instability. We reviewed literatures about Harms construct with focus on the occipital neuralgia as a postoperative complication and suggest here technical tips to avoid the troublesome pain.

Modified Trajectory of C2 Laminar Screw - Double Bicortical Purchase of the Inferiorly Crossing Screw

The crossing laminar screw fixation might be the most recently developed approach among various fixation techniques for C2. The new construct has stability comparable to transarticular or transpedicular screw fixation without risk of vertebral artery injury. Quantitative anatomical studies about C2 vertebra suggest significant variation in the thickness of C2 lamina as well as cross sectional area of junction of lamina and spinous process. We present an elderly patient who underwent an occipito-cervical stabilization incorporating crossed C2 laminar screw fixation. We preoperatively recognized that she had low profiles of C2 lamina, and thus made a modification of trajectory for the inferiorly crossing screw. We introduce a simple modification of crossing C2 laminar screw technique to improve stability in patients with low laminar profiles.

Bilateral Vertebral Artery Dissecting Aneurysms: A Long Term Follow-up Results of Microsurgical Trapping and Proximal Occlusion

Regarding the bilateral vertebral artery (VA) dissecting aneurysms, treatment strategy remains controversial because there have not been enough cases to reach a conclusion on the best treatment. We present a patient underwent staged microsurgical trapping and endovascular coiling for each dissecting aneurysm of bilateral VA presenting subarachnoid hemorrhage (SAH). The ruptured side was managed by VA trapping procedure without any neurological deficit. Postoperative cerebral angiography revealed patent right PICA without filling of previous right dissecting aneurysm and spontaneous occlusion of the left dissecting aneurysm one month after trapping procedure. However, follow-up angiography revealed recanalization and growing of the left VA dissecting aneurysm one year after the operation. The patient underwent endovascular embolization using GDC for the proximal occlusion of the left VA and postoperative course was uneventful.

Lumbo-sacro-pelvic Fixation Using Iliac Screws for the Complex Lumbo-sacral Fractures

Fractures of lumbo-sacral junction involving bilateral sacral wings are rare. Posterior lumbo-sacral fixation does not always provide with sufficient stability in such cases. Various augmentation techniques including divergent sacral ala screws, S2 pedicle screws and Galveston rods have been reported to improve lumbo-sacral stabilization. Galveston technique using iliac bones would be the best surgical approach especially in patients with bilateral comminuted sacral fractures. However, original Galveston surgery is technically demanding and bending rods into the appropriate alignment is time consuming. We present a patient with unstable lumbo-sacral junction fractures and comminuted U-shaped sacral fractures treated by lumbo-sacro-pelvic fixation using iliac screws and discuss about the advantages of the iliac screws over the rod system of Galveston technique.

The Incidence of Aneurysmal Subarachnoid Hemorrhage in Youngdong District, Korea

OBJECTIVE: The purpose of this study is to investigate the incidence of aneurysmal subarachnoid hemorrhage (SAH) in Youngdong district for 10 years. METHODS: From Jan. 1997 to Dec. 2006, 732 patients (327 males, 405 females, mean age: 54.8+/-13.1 years) with spontaneous SAH were admitted to our hospital. We reviewed the medical records and radiological findings regarding to the ictus of SAH, location and size of the ruptured aneurysms, Hunt-Hess grade and Fisher grade on admission, personal details such as address, age, and sex, and previous history of medical diseases. RESULTS: In these 732 patients, 672 cases were confirmed as aneurysmal SAH. Among them, 611 patients (262 males, 349 females, mean age: 54.9+/-13.2 years) came from Youngdong district. The average crude annual incidence of aneurysmal SAH for men, women, and both sexes combined in Youngdong district was 7.8+/-1.7, 10.5+/-2.7, and 9.1+/-2.1 per 100,000 population, respectively. Because of the problems related to the observation period and geographical confinement, it was suspected that the representative incidence of aneurysmal SAH in Youngdong district should be made during the later eight years in six coastal regions. Therefore, the average age-adjusted annual incidence for men, women, and both sexes combined was 8.8+/-1.4, 11.2+/-1.3 and 10.0+/-1.0, respectively in the coastal regions of Youngdong district from 1999 to 2006. CONCLUSION: In overall, our results on the incidence of aneurysmal SAH was not very different from previous observations from other studies.

The Dissecting Aneurysm of the Posterior Inferior Cerebellar Artery with Unusual Clinical Course

The dissecting aneurysms of the posterior cerebral circulation arise most commonly from the vertebral artery and occasionally extend to the posterior inferior cerebellar artery(PICA). The dissecting aneurysm localized in the PICA without involving the vertebral artery is rare. We present a PICA dissecting aneurysm that had kaleidoscopic clinical course of bleeding, occlusion, and recanalization before the surgery. The patient had serial follow-up angiograms based on significant changes of clinical status. The patient successfully underwent microsurgical trapping with clips for the dissecting aneurysm and showed neurological improvement.

Anterior Fusion with Caspar Plating in Traumatic Cervical Spine Instability

OBJECTIVE: In these retrospective studies, the authors report an evaluation of clinical and radiological outcome in patients with cervical spine injury who underwent anterior cervical fusion with Caspar Plating system. METHODS: The authors studied 45 patients with unstable cervical spine after trauma between July 1996 and December 2001. Our series consist of 39 male and 6 female. The cervical spine injury was most common in men in fourth decade. Motor vehicle accidents were a frequent cause of cervical spine injury. Thirty-three patients had fractures with instablity, ten a ligamental injury without fracture, one traumatic hernated disc. Lateral cervical spine X-rays were reviewed for evaluation of fusion and instrumentation failure. RESULTS: In most cases, operation for stabilization was done around one weeks after trauma. In all patients excellent immediate postoperative stability of the spine was obtained, although posterior fusion was necessary at same time in one patient. Solid fusion was achieved in all except two patients who died during the first 2 months after the operation. Three patients developed instrumentation related failure(6.7%): Two patients had screw loosening, one infection. Two of these patients underwent reoperation. The most dreaded complication of dural or cord penetration by drilling or screw placement was not observed. There was no postoperative neurological disturbances. Four patients died of causes unrelated to operation: Two patients died of upper gasterointestinal bleeding, and the other two died of pneumonia and sepsis respectively. CONCLUSION: The Caspar plating system affords an effective means of improving the fusion rate with acceptable instrumentaton-related morbidity in cervical spine injury.

Economical Analysis of Cervical Disc Disease by Anterior Inter-body Fusion Methods - Comparing of Bone Graft vs Plating -

OBJECTIVES: The purpose of this study was to assess the complications, duration of admission, cost effectiveness, radiologic stabilization of the anterior cervical bone fusion in the treatment of cervical disc disease with and without plating. MATERIALS AND METHODS: Fifty-two surgically treated patients for cervical disc disease were reviewed. Group I consisted of consecutive treated patients with iliac auto-bone graft without instrumentation after anterior cervical discectomy. Group II consisted of consecutive treated patients with iliac autologous-bone graft with CASPER cervical plate fixations. Radiologic fusion was decided when loss of end plate boundary between graft bone and vertebral body and immobile, maintenance of the disc space were evident on simple dynamic plain films. The patients were discharged after the stabilization of cervical motion by films was of tained. These groups were analysed multiple variably with Mann-Whitney U-test. RESULTS: Group I consisted of 18 patients, group II consisted of 34 patients. Mean age was 49.0+/-8.1 years, mean duration of admission was 17.27+/-10.51 days, mean costs for treatment was 1,970,000+/-475,000 won. In group I, mean age was 47.7(34-60) years, 16 patients had undergo on one-level operation, 2-patients had undergo on two-level operation, mean duration of admission was 28.7+/-10.4 days, mean costs for treatment was 2,194,473+/-561,639 won. The periods of stabilization was 6.6+/-3.36 weeks on radiologic study. Mean periods of out patient follow up was 16.8(6-64) weeks after discharge. Mean period of radiologic follow up was 17.3(4-6) weeks after surgical operation. In group II, mean age was 49.7(37-62) years and 18 patients one-level operation, 14-patients had undergo on two-level operation and 2-patients three-level operation. Mean duration of admission was 11.24+/-3.29 days, mean costs for treatment was 1,850,823+/-389,372 won. The periods of stabilization was 5.88+/-7.07 weeks on radiologic study. Mean period of out patients follow up was 16.7(4-60) weeks after discharge. Mean period of radiologic follow up was 12.4(3-52) weeks after surgical operation. The duration of admission showed statistical significance in Group II but other items showed no significant difference between two groups. CONCLUSIONS: The more economic, early life return and effective method of cervical disc disease in our series were evident in patients who had undergone, iliac bone graft and plate fixations after anterior discectomy.

Ectopic Pituitary Adenoma within the Sphenoid Sinus

A 69-year-old woman presented with right abducent nerve paresis caused by an ectopic pituitary adenoma invading the posterior wall of the sphenoid sinus. The tumor was removed via transsphenoidal approach. The histological diagnosis was invasive pituitary adenoma with bony destruction. The symptom was improved without complication. The authors present a rare case of ectopic pituitary adenoma with a literature review.

Chondrosarcoma of the Temporal Bone: A Case Report

Chondrosarcoma of the temporal bone is a rare lesion. Clinically it has been confused with chordoma, glomus jugulare tumor and meningioma, among other conditions, and due to its anatomic location, cranial nerve palsy is frequently observed. We report a case involving a 50-year-old woman with chondrosarcoma of the temporal bone.

Evaluation of the Embolic Effect of Polyvinyl Alcohol Foam particles According to Particle Size on the Cerebral Artery of a Cat, Focusing on T2 Weighted MR Images and Pathologic Study After 24 Hours

PURPOSE: This study was designed to determine the embolic effect of PVA particles of various sizes on the cerebral artery of a cat and to determine the appropriate particle size for embolization. MATERIALS AND METHODS: A total of 21 cats were divided into three groups according to the PVA particle size injected: group I(n=7), embolized with 45-150 micrometer PVA; group II(n=7), with 150-250 micrometer PVA; and group III(n=7), with 350-500 micrometer PVA. PVA particles were slowly injected into the left common carotid artery of each cat, and T2-weighted coronal MR images were obtained 24 hours after injection. During histologic examination of brain sections we analyzed the size, number of occluded vessels, and the ischemic changes caused by the particles. RESULTS: On T2 weighted images, areas of high signal intensity (infarction) were observed in four of the seven cats (57%) in group Iand in two of the seven (29%) in group II. High signal intensity was not found in group III. The mean percentage of areas of high signal intensity was 11.86 +/-1 . 37 % in group Iand 5.18 +/-1 . 77% in group II( P <0.05). During histologic examination, occlusion of the distal branches of the anterior cerebral (ACA) and/or the middle cerebral arteries(MCA) by PVA particles was observed in all seven cats (100%) in group I, and in four of the seven cats (57%) in group II. No group IIIcat showed occlusion of the distal branches of the ACA and/or MCA. The mean caliber of occluded vessels was 175 micrometer in Group Iand 258 micrometer in Group II. The mean number of occluded vessels seen on all slide sections was 14 in Group I and 5 in Group II. CONCLUSION: Small PVA particles had a greater cerebral embolic effect than did those which were medium or large. For the induction of embolic infarction in cat brain, PVA particles 45-150 micrometer in size are appropriate.

Evaluation of the Embolic Effect of Polyvinyl Alcohol Foam particles According to Particle Size on the Cerebral Artery of a Cat, Focusing on T2 Weighted MR Images and Pathologic Study After 24 Hours

PURPOSE: This study was designed to determine the embolic effect of PVA particles of various sizes on the cerebral artery of a cat and to determine the appropriate particle size for embolization. MATERIALS AND METHODS: A total of 21 cats were divided into three groups according to the PVA particle size injected: group I(n=7), embolized with 45-150 micrometer PVA; group II(n=7), with 150-250 micrometer PVA; and group III(n=7), with 350-500 micrometer PVA. PVA particles were slowly injected into the left common carotid artery of each cat, and T2-weighted coronal MR images were obtained 24 hours after injection. During histologic examination of brain sections we analyzed the size, number of occluded vessels, and the ischemic changes caused by the particles. RESULTS: On T2 weighted images, areas of high signal intensity (infarction) were observed in four of the seven cats (57%) in group Iand in two of the seven (29%) in group II. High signal intensity was not found in group III. The mean percentage of areas of high signal intensity was 11.86 +/-1 . 37 % in group Iand 5.18 +/-1 . 77% in group II( P <0.05). During histologic examination, occlusion of the distal branches of the anterior cerebral (ACA) and/or the middle cerebral arteries(MCA) by PVA particles was observed in all seven cats (100%) in group I, and in four of the seven cats (57%) in group II. No group IIIcat showed occlusion of the distal branches of the ACA and/or MCA. The mean caliber of occluded vessels was 175 micrometer in Group Iand 258 micrometer in Group II. The mean number of occluded vessels seen on all slide sections was 14 in Group I and 5 in Group II. CONCLUSION: Small PVA particles had a greater cerebral embolic effect than did those which were medium or large. For the induction of embolic infarction in cat brain, PVA particles 45-150 micrometer in size are appropriate.

Fracture of Distal Catheter after Ventriculoperitoneal Shunt: Case Report

No abstract available.