Does Nasal Polyps Influence on the Location of Nasal Fontanelle? / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aimed to evaluate the relationship between the location of the nasal fontanelle and either the chronic rhiosinusitis with nasal polyp in middle meatus (NP) or the chronic maxillary sinusitis (CMS). SUBJECTS AND METHOD: We classified the subjects without any nasal septal deviation (<5degrees) into three groups: the normal control group, the CMS group (CMS without NP) and the NP group (CRS with NP). Both angles of nasal septum and fontanelle were measured by CT imaging and nasal cavities were counted as an individual side. We compared 96 CT scans of normal controls with 79 of CMS groups and 54 of NP groups. In case of discrepancy in the locations of both fontanelles on their CT scans, we reconstructed all the images to identify the fontanelle location. The lateral side on which the fontanelle was actually located was assigned the positive angle and the medial side the negative angle to determine the presence of fontanelle deviation. The normal range of the fontanelle deviation was established by the mean angle obtained from the normal group, which included 50% of each medial and lateral side. RESULTS: The mean angles of the control group, the CMS group and the NP group were 1.34degrees, 3.47degrees, and 6.99degrees, respectively. A statistically significant relationship was noted between the control and NP group (p=0.001), but not between the control and CMS group, CMS and NP group (p=0.237 and 0.051, respectively). CONCLUSION: The nasal polyp in middle meatus influenced on the location of nasal fontanelle to lateral side compared to the normal controls.

Changes of VEMP Responses by the Strength of SCM Muscles Contraction and Stimulation Intensities / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the effect of the strength of SCM muscle contraction and the intensity of the sound stimulation on the VEMP parameters (amplitude, latency and threshold). SUBJECTS AND METHOD: Twenty normal subjects were included. Subjects pushed with their jaw against the hand-held inflated cuff to generate cuff pressures of 20, 40 and 60 mmHg and sequential stimulation intensities were applied. Variances of each parameter were analyzed. RESULTS: There was no significant difference in terms of threshold according to the side and strength of SCM contraction. P1-N1 amplitude demonstrated no significant differences according to the side ; however, the amplitude increased significantly as the cuff pressure and stimulation intensity increased. Interaural amplitude difference ratios showed an increased difference at 20 mmHg when compared to those at 60 mmHg. There was neither a cuff pressure effect, nor stimulation intensity effect when considering the P1 latencies. As for the N1 values, there was no stimulation intensity effect but there was a delayed latency at 20 mmHg when compared to those at 40 or 60 mmHg. Interaural latency difference of N1 latencies did not differ significantly according to the cuff pressure ; however, there was an increased difference at 20 mmHg when compared to those at 40 or 60 mmHg. CONCLUSION: This study shows that VEMP response is influenced by the cuff pressure and stimulation intensity, and we recommend to get each VEMP parameter using this feedback method in the clinical setting.

Soft Palate Reconstruction with a Superior-Constrictor Advancement-Rotation Flap(SCARF) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Reconstruction of the soft palate after tumor resection is a difficult surgical procedure because of the requirements of the dynamic functional velopharynx. The ideal technique should be simple, reliable, sensate, dynamic and fast, and should be performed transorally or transcervically. Many methods such as obturators, loco-regional flaps, and free flaps have been devised to reconstruct the soft palate but none meets all this criteria. Superior-constrictor advancement-rotation flap (SCARF) is a dynamic local myomucosal flap to achieve circumferential closure of the velopharynx and reestablish its valvular sphincteric function and this satisfies all the criteria mentioned above. We evaluated the validity of SCARF for reconstruction of the soft palate after tumor resection. MATERIALS AND METHODS: From 1998 to 1999, three patients underwent a SCARF reconstruction of the velopharynx after 30% to 70% of the soft palate had been resected. All patients were evaluated after wound healing with regard to subjective satisfaction and objective parameters such as speech-language evaluation and videofluoroscopic study. RESULTS: All patients reestablished velopharyngeal competence without significant phonatory or deglutitive disability. There was no donor site complication. CONCLUSION: We could functionally reconstruct the defect of soft palate (maximum 70%) after tumor resection with SCARF. The SCARF reconstruction of the soft palate was simple, fast, reliable and performed transorally without any significant donor site morbidity.