A Case of Intracranial and Extradural Cholesterol Granuloma / 대한이비인후과학회지

Cholesterol granuloma is a histological term used for the description of a tissue response to a foreign body such as cholesterol crystals. The pathogenesis of cholesterol granuloma is controversial. But three factors are thought to have an important role in its development: obstruction of ventilation, impaired drainage, and hemorrhage. It may arise from any portion of the pneumatized temporal bone. But huge cholesterol granuloma with intracranial and extradural extension has been rarely reported. Recently, we experienced a case of huge cholesterol granuloma with intracranial and extradural extension. The patient has never experienced chronic otitis media before. The cholesterol granuloma was successfully removed by transmastoid approach. So we report this case along with a literature review.

Pathophysiologic Consideration of Benign Paroxysmal Positional Vertigo due to the Horizontal Semicircular Canal Cupulolithiasis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular disorders. There have been some reports suggesting that directional changing positional nystagmus occurs due to canalolithiasis and cupulolithiasis of the horizontal semicircular canal (HC). The canalolithiasis theory of HC-BPPV is presented with a transient geotropic direction changing horizontal nystagmus as the pathophysiologic mechanism of BPPV. The HC-BPPV cupulolithiasis is characterized by a positional nystagmus that does not fatigue, but persists as long as the position is held, and changes direction in different head positions. There is still a controversy relating to differentiating the lesion side and the otolith adherent sites on the cupula differentiation. The purpose of this study was to differentiate the lesion side and the otolith adherent site on the cupula, and propose a treatment through analyses of clinical features, electronystagmographic (ENG) results, treatment maneuvers and its effectiveness. SUBJECTS AND METHOD: Fifteen patients who showed ageotropic direction changing horizontal nystagmus were included in this study. Supine head turning test was performed to induce positional nystagmus. Various findings of the nystagmus were recorded with ENG. Other ENG tests (visual tracking tests and bithermal caloric test) and magnetic resonance imaging were checked to exclude the possibility of any central lesion. Cupulolith repositioning maneuver (CuRM) was applied on the all patients and these patients were instructed to keep the healthy side at the lateral decubitus position while sleeping. RESULTS: All patients showed significant differences between the intensity of each side nystagmus, and all of them showed stronger ageotropic direction changing horizontal nystagmus when the head was rotated to the unaffected side in a supine head turning test. The nystagmus had a short latency, no fatigability, and persistency in character. Typical nystagmus and spinning sensation in the supine head turning test had completely subsided after physical therapy. CONCLUSION: In the cupulolithiasis of horizontal semicircular canal, ageotropic nystagmus was stronger when the pathological ear was at the uppermost position, and this excitatory nystagmus beats to the lesion side. The proposed CuRM and post-treatment lateral decubitus position kept during the night (while sleeping on the day of treatment) were effective in differentiating the otolith adherent site on the cupula and treating the cupulolithiasis of the horizontal semicircular canal.

Surgical Morbidity of Intraoral Removal of the Submandibular Gland / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: For surgery of chronically inflamed submandibular gland, most head and neck surgeons carry out skin incision on the neck, but several clinical problems after surgery has been mentioned. An intraoral approach as an alternative to the standard transcervical approach has been reported. To evaluate a postoperative morbidity in the intraoral approach for excision of submandibular gland. SUBJECTS AND METHODS: A total of 62 surgery cases for chronic submandibular sialoadenitis with or without stone, including those resulting from benign tumor of submandibular gland, were carried out via intraoral approach during a 3-year period. RESULTS: Most patients (85.5%) had sialoadenitis with or without stone. Early postoperative complications developed in 87.1% of the temporary lingual sensory paresis, followed by temporary limitation of tongue movement in 67.7% and 2 cases of postoperative bleeding and 1 case of abscess formation. The tongue paresis resolved spontaneously in all patients in a mean period of 3-4 weeks, whereas late complications developed in 3 cases of residual salivary gland and abnormal sense of mouth floor and one case of gustatory sweating syndrome. No residual inflammation in Wharton's duct was noted. Neurological complications of hypoglossal and marginal mandibular nerves were not observed at all. CONCLUSION: The major advantages of this approach are no external scar, no injury to the marginal mandibular nerve or to the hypoglossal nerve, and no residual Whartons duct inflammation. The disadvantage is a more difficult dissection to transcervical approach before proper expert due to narrow surgical field, especially in the severe adhesion of salivary gland to surrounding tissue. However, with experience, the intraoral dissection of submandibular gland should be easier.

Ancient Schwannoma in the Tracheoesophageal Groove / 대한이비인후과학회지

The schwannoma is an encapsulated nerve sheath tumor. We experienced a case of ancient schwannoma arising in the tracheoesophageal groove, probably originating from the recurrent laryngeal nerve. It was presented on the right lower lateral neck, anterior to the sternocleidomastoid muscle. The CT scan and esophagography suggested a tumor in the thyroid gland and the esophagus, but the fine needle aspiration cytology suggested a neurogenic tumor. The mass was completely removed with careful preservation of its nerve. The mass was interpreted as an ancient schwannoma by a pathologist. The patient had a favorable postoperative course, except for a temporary vocal fold paralysis.