Motor Innervation of the Trapezius Muscle: The Intraoperative Motor Conduction Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In radical neck dissection, sacrifice of the spinal accessory nerve creates a definite deficit of the shoulder function. To demonstrate the presence of motor input from the spinal accessory and the cervical plexus to the trapezius muscle, intra-operative motor nerve conduction study was performed. SUBJECTS AND METHOD: Twenty-four patients were studied on completion of the operation. In each patient, the entire length of the spinal accessory nerve, the upper cervical plexus and some cervical plexus branches running to the trapezius were preserved independently. Compound muscle action potentials were measured for each part of the trapezius muscle on stimulation of the spinal accessory, C2, C3 and C4 nerves. RESULTS: By stimulating the spinal nerve, evoked responses were obtained from all 24 patients in the upper, middle and lower trapezius. C2 contributions were seen in 2 out of 24 patients, supplying all three parts of the muscle in 0. C3 contributions were seen in 11 out of 24 patients, supplying all three parts of the muscle in 8. C4 contributions were seen in 20 out of 24 patients, supplying all three parts of the muscle in 16. CONCLUSION: The spinal accessory nerve provides the most important and consistent motor input and C2, C3 and C4 also provide motor input to the trapezius muscle. But they were not consistently present and did not innervate all three parts of the trapezius muscle. Compared with other studies, it is interesting to note that C4 gives more consistent motor input to the trapezius muscle than other cervical branches.

A Case of Keratoacanthoma-Like Squamous Cell Carcinoma of the Auricle / 대한이비인후과학회지

Keratoacanthoma (KA) is regarded as a benign skin tumor, but sometimes it is very difficult to distinguish it from well-differentiated squamous cell carcinoma (SCC), especially when SCC has KA-like characteristics. Classical KA has a well-defined craterlike architecture without single cell invasion. We experienced a case of KA-like SCC of the auricle: the patient was 75-year old male with solitary elevated skin lesion on his left auricle. Initial impression was KA and local excision was performed. Histopathological examination revealed central crateriform depression and keratin debris with many atypical and mitotic cells. Recurrence was developed 6 weeks after the operation and secondary excisional surgery was performed. The patient remains in good status with no evidence of recurrence 10months following the operation.

Clinical Efficacy of Intranasal Azelastine Hydrohloride Spray in Korean Vasomotor Rhinitis Patients

Background & Objectives: Vasomotor rhinitis (VMR) is a chronic non-allergic rhinitis without the increased Ig E level and eosinophilia. Azelastine hydrochloride is a second generation anti-histamine medication with anti-inflammatory properties that inhibits the synthesis of inflammatory materials. There are reports that azelastine hydrochloride can be effective in the treatment of VMR. Therefore, this study examined the clinical efficacy of intranasal azelastine hydrochloride spray in comparison with placebo for the treatment of VMR. MATERIALS AND METHOD: This study was a prospective double blind randomized test. The subjects consisted of 84 VMR patients. Among them, 54 patients were treated with intranasal azelastine hydrochloride for 4 weeks and 30 patients with intranasal normal saline. Following the treatment, an analysis of the symptom score was performed in order to compare the treatment effects between the study group and the control group. RESULTS: In the study group, the symptom score was significantly improved in the areas of sneezing (1.38 to 0.72), rhinorrhea (1.57 to 0.76), nasal obstruction (1.76 to 1.01) and postnasal drip (1.43 to 0.65). In the control group, however, the symptom score was significantly improved in a single area of rhinorrhea (1.73 to 0.65). Patients in the study group, thus, displayed greater improvements in the areas of sneezing, rhinorrhea, nasal obasturction and postnasal drip comparative to the control group. Consequently, the study group patients were more satisfied with their quality of life than those of the control group. CONCLUSION: Azelastine chloride is a useful medicine for the treatment of VMR, especially in controlling sneezing, rhinorrhea, nasal obstruction and postnasal drip.

A Case of Sporadic Nasopharyngeal Burkitt's Lymphoma / 대한이비인후과학회지

Burkitt's lymphoma is a high grade non-Hodgkin's lymphoma of B-cell origin. There are three clinical subtypes, namely, endemic African, sporadic American and human immunodeficiency-associated subtype. It usually occurs in children or younger person. Sporadic American Burkitt lymphoma involves mainly the abdomen and rarely head and neck. Complex chemotherapy is the choice of treatment. We present one case of sporadic American Burkitt lymphoma that involves the nasopharynx manifested with frequent epistaxis and nasal obstruction. Clinical and histological features are reviewed.

A Case of Blindness after Transsphenoid Approach for Pituitary Adenoma Removal: Revision Treatment Experience under Local Anesthesia

Pituitary adenoma accounts for 10% to 20% of intracranial tumors. Surgical approach to pituitary adenoma had been performed via craniotomy until the early 20th century, but transsphenoidal approach has been accepted as a primary procedure since 1910. However, there are frequent complications in the nose including nasal mucosal laceration, nasal septal perforation, and external nose deformities. Furthermore, cerebrospinal fluid leakage, visual field loss or blindness rarely occur. When blindness occurs by postoperative hematoma compression, revision operation is usually required for bleeding control and hematoma removal under general anesthesia. However, optic nerve decompression with postoperative hematoma removal via transsphenoidal approach can be adequately performed by endoscopic technique under local anesthesia, because there is no sensory nerve innervation in the pia mater and arachnoid membrane. We report a case of successful hematoma removal with bleeding control by endoscopic technique under local anesthesia in a patient who became blind due to postoperative hematoma after transphenoid approach for pituitary adenoma removal.