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1.
Article in Korean | WPRIM | ID: wpr-920267

ABSTRACT

Background and Objectives@#Interposition using acellular allograft between perforated septal flaps is a popular procedure among surgeons because of its usefulness. However, allograft dermal matrix itself tends to become infected sometimes, and can easily undergo necrosis or be displaced from the implanted site. Here, the authors would like to introduce a newly devised interposition graft made up of allograft and cartilage, which is easy to manipulate and can be fixed in the desired position.Subjects and Method We performed a retrospective chart review from January 2018 to August 2020. A total of 12 patients with septal perforation who received surgical treatment were included in this study. Acellular human dermal allograft (MegaDerm® ; L&C Bio) was used as an interposition allograft piled up by autologous cartilage, and it was positioned between the mucoperichondrial flaps via the endonasal approach. @*Results@#The most common etiology was previous septal surgery (n=8); in one case, the etiology was repeated electrocauterization due to frequent epistaxis; the etiology was not verified for three cases. All 12 cases achieved the result of complete septal perforation closure. All patients on follow-up inquiry reported marked improvements in the visual analogue scale score (mean value, 4.1 to 1) and Nasal Obstruction Symptom Evaluation scale (mean value, 7.3 to 1.8). @*Conclusion@#Composite graft made up of cartilage and allograft dermal matrix achieved successful results without having to fix the graft. It can be an alternative technique to treat septal perforation for inexperienced surgeons and with a limited operation field.

2.
Article in English | WPRIM | ID: wpr-892147

ABSTRACT

Background@#Although long-term dopamine agonist (DA) therapy is recommended as a first-line treatment for prolactinoma, some patients may prefer surgical treatment because of the potential adverse effects of long-term medication, or the desire to become pregnant. This study aimed to determine whether surgical treatment of prolactinomas could be an alternative to DA therapy. @*Methods@#In this retrospective study, 96 consecutive patients (74 female, 22 male) underwent primary pituitary surgery without long-term DA treatment for prolactinomas at a single institution from 1990 to 2010. All patients underwent primary surgical treatment in the microscopic transsphenoidal approach (TSA). @*Results@#The median age and median follow-up period were 31 (16–73) years and 139.1 (12.2–319.6) months, respectively. An initial overall remission was accomplished in 47.9% (46 of 96 patients, 33 macroadenomas, and 13 microadenomas) of patients. DA dose reduction was achieved in all patients after TSA. A better remission rate was independently predicted by lower diagnostic prolactin levels and by a greater extent of surgical resection. Overall remission at the last follow-up was 33.3%, and the overall recurrence rate was 30.4%. The permanent complication rate was 3.1%, and there was no mortality. @*Conclusion@#TSA can be considered a safe and potentially curative treatment for selective microprolactinomas as an alternative to treatment with a long-term DA.

3.
Article in Korean | WPRIM | ID: wpr-901236

ABSTRACT

Background and Objectives@#Functional aphonia refers to in which by presenting whispering voice and almost producing very high-pitched tensed voices are produced. Voice therapy is the most effective treatment, but there is a lack of consensus for application of voice therapy. The purpose of this study was to examine the vocal characteristics of functional aphonia and the effect of voice therapy applied accordingly.Materials and Method From October 2019 to December 2020, 11 patients with functional aphonia were treated using voice therapy which was processing three stages such as vocal hygiene, trial therapy, and behavioral therapy. Of these, 7 patients who completed the voice evaluation before and after voice therapy was enrolled in this study. By retrospective chart review, clinical information such as sex, age, symptoms, duration, social and medical history, process of voice therapy, subjective and objective findings were analyzed. Voice parameters before and after voice therapy were compared. @*Results@#In GRBAS study, grade, rough, and asthenic, and in Consensus Auditory-Perceptual Evaluation of Voice, overall severity, roughness, pitch, and loudness were significantly improved after voice therapy. In Voice handicap index, all of the scores of total and sub-categories were significantly decreased. In objective voice analysis, jitter, cepstral peak prominence, and maximum phonation time were significantly improved. @*Conclusion@#The voice therapy was effective for the treatment of functional aphonia by restoring patient’s vocalization and improving voice quality, pitch and loudness.

4.
Article in English | WPRIM | ID: wpr-899851

ABSTRACT

Background@#Although long-term dopamine agonist (DA) therapy is recommended as a first-line treatment for prolactinoma, some patients may prefer surgical treatment because of the potential adverse effects of long-term medication, or the desire to become pregnant. This study aimed to determine whether surgical treatment of prolactinomas could be an alternative to DA therapy. @*Methods@#In this retrospective study, 96 consecutive patients (74 female, 22 male) underwent primary pituitary surgery without long-term DA treatment for prolactinomas at a single institution from 1990 to 2010. All patients underwent primary surgical treatment in the microscopic transsphenoidal approach (TSA). @*Results@#The median age and median follow-up period were 31 (16–73) years and 139.1 (12.2–319.6) months, respectively. An initial overall remission was accomplished in 47.9% (46 of 96 patients, 33 macroadenomas, and 13 microadenomas) of patients. DA dose reduction was achieved in all patients after TSA. A better remission rate was independently predicted by lower diagnostic prolactin levels and by a greater extent of surgical resection. Overall remission at the last follow-up was 33.3%, and the overall recurrence rate was 30.4%. The permanent complication rate was 3.1%, and there was no mortality. @*Conclusion@#TSA can be considered a safe and potentially curative treatment for selective microprolactinomas as an alternative to treatment with a long-term DA.

5.
Article in Korean | WPRIM | ID: wpr-893532

ABSTRACT

Background and Objectives@#Functional aphonia refers to in which by presenting whispering voice and almost producing very high-pitched tensed voices are produced. Voice therapy is the most effective treatment, but there is a lack of consensus for application of voice therapy. The purpose of this study was to examine the vocal characteristics of functional aphonia and the effect of voice therapy applied accordingly.Materials and Method From October 2019 to December 2020, 11 patients with functional aphonia were treated using voice therapy which was processing three stages such as vocal hygiene, trial therapy, and behavioral therapy. Of these, 7 patients who completed the voice evaluation before and after voice therapy was enrolled in this study. By retrospective chart review, clinical information such as sex, age, symptoms, duration, social and medical history, process of voice therapy, subjective and objective findings were analyzed. Voice parameters before and after voice therapy were compared. @*Results@#In GRBAS study, grade, rough, and asthenic, and in Consensus Auditory-Perceptual Evaluation of Voice, overall severity, roughness, pitch, and loudness were significantly improved after voice therapy. In Voice handicap index, all of the scores of total and sub-categories were significantly decreased. In objective voice analysis, jitter, cepstral peak prominence, and maximum phonation time were significantly improved. @*Conclusion@#The voice therapy was effective for the treatment of functional aphonia by restoring patient’s vocalization and improving voice quality, pitch and loudness.

6.
Article in Korean | WPRIM | ID: wpr-920253

ABSTRACT

Background and Objectives@#Ranula is a type of pseudocyst caused by the leakage of saliva from the mouth floor, mainly the sublingual gland, and is classified into a simple ranula and a plunging ranula according to its location clinically. Currently known surgical treatment for ranula includes incision and drainage, marsupialization, ranula excision, and sublingual gland resection. The aim of this study was to help decision making for the treatment of ranula by analyzing the complications including the recurrence rate of each treatment.Subjects and Method We retrospectively reviewed 148 patients with ranula who had been treated from March 2000 to November 2019. All of the patients underwent one of the following treatments: incision and drainage, marsupialization, ranula excision, and sublingual gland resection. Complications including recurrence rate of each treatment were analyzed. @*Results@#Of 144 patients, 92 were simple ranula and 52 were plunging ranula. Four patients underwent incision and drainage, 24 patients with marsupialization, 12 patients with ranula excision, and 104 patients with sublingual gland resection. The recurrence rates according to the treatment of total ranula were 100%, 29.2%, 50.0%, and 8.7%, respectively, in the order of incision and drainage, marsupialization, ranula excision, and sublingual gland resection. There were no complications other than the recurrence of the ranula. @*Conclusion@#In the treatment of ranula, sublingual gland resection is considered to be the most appropriate method with minimal risk of complications and a low recurrence rate.

7.
Article in Korean | WPRIM | ID: wpr-916572

ABSTRACT

Background and Objectives@#Vocal process granulomas (VPGs) are benign lesions of the larynx, typically contact granulomas (CG) and intubation granulomas (IG). The two diseases are known to have different clinical manifestations despite having the same pathological features. The purpose of this study was to analyze the treatment results for CG and IG and to obtain clinical information.Materials and Method We retrospectively reviewed the medical records of patients diagnosed with VPG between January 2015 and December 2018. The patient’s age, sex, medical history, lesion size, lesion type, reflux finding score, response to treatment, duration of treatment, and follow-up period were compared. @*Results@#In total, 32 patients were included in the study, of which 18 were CG and 14 were IG. In the CG group, males were dominant (n=15, 83.3%), whereas in the IG group, females were dominant (n=11, 78.6%) (p=0.0009). The response to medical treatment using proton pump inhibitor and steroid inhaler was better in the IG group (11/14, 78.6%) than in the CG group (7/18, 38.9%) (p=0.036). Of the 14 patients who did not respond to medical treatment, 5 received botulium toxin injections, and all 5 had complete remission. The duration of medical treatment was significantly longer in the IG group (p=0.0029). @*Conclusion@#IG was more common in female, and CG was more dominant in male. IG had better response to medical treatment using proton pump inhibitor and steroid inhaler than CG.

8.
Article | WPRIM | ID: wpr-836427

ABSTRACT

Granular cell tumor is rare tumor origination from Schwann cell. It occurs extremely rarely in pediatric age. Treatment is complete resection, but this may not always be possible because of the risk of airway stenosis or vocal cord paralysis. Six year-old male patient visited otolaryngology clinic due to dyspnea and stridor. Posterior glottis mass was indentified and was partially resected to confirm histology and resolve airway obstruction. One year after operation, the patient was living well without re-growing of tumor. We report a case of granular cell tumor in pediatric larynx with a review of literature.

9.
Journal of Rhinology ; : 145-149, 2020.
Article in Korean | WPRIM | ID: wpr-836284

ABSTRACT

The infratemporal fossa consists of critical structures affecting patient quality of life. Though abscess formation in the infratemporal fossa is very rare, drainage is highly recommended to avoid severe complications. We recently experienced a rare case of infratemporal fossa abscess. Such an abscess is easy to misdiagnose due to its rarity. Endoscopic drainage of the infratemporal fossa was conducted in this case, and its limited invasiveness was an advantage for a conservative approach. We present this case with a brief review of the approach to abscess of the infratemporal fossa area.

10.
Article in English | WPRIM | ID: wpr-831344

ABSTRACT

Objectives@#. This study aimed to elucidate the patterns of upper airway collapse in obstructive sleep apnea (OSA) patients with a low body mass index (BMI). @*Methods@#. We designed and conducted a retrospective cohort study. Consecutive patients diagnosed with OSA who underwent drug-induced sleep endoscopy (DISE) were included. Patients were classified into four groups according to their BMI. Age, sex, and polysomnography data were investigated. The patterns of upper airway collapse were characterized by the structures involved (soft palate, tongue base, lateral pharyngeal wall, and epiglottis). We compared the patterns of upper airway collapse in the supine and lateral decubitus position among the four BMI groups using the chi-square test and multivariate binary logistic regression analysis. @*Results@#. A total of 627 patients (male, 517; mean age, 47.6±12.8 years) were included, consisting of 45, 79, 151, and 352 patients who were underweight or lower normal-weight (defined as the low BMI group), upper normal-weight, overweight, and obese, respectively. Severity indicators of OSA, such as the overall apnea-hypopnea index and duration of SaO2 below 90%, were significantly lower in patients with a low BMI than in obese patients, while their average oxygen saturation was significantly higher. The most common obstruction site in the supine position was the tongue base in patients with a low BMI (100%), whereas this obstruction site was significantly less common in obese patients (54.8%). Tongue base obstruction was mostly relieved in the lateral position, with no discernible obstruction in 86.7% of the low BMI patients. @*Conclusion@#. Airway obstruction in OSA patients with a low BMI is mostly due to tongue base obstruction, which improves in the lateral position. These characteristics should be kept in mind when considering treatment options for this subgroup of OSA patients.

11.
Article in English | WPRIM | ID: wpr-811266

ABSTRACT

Osteogenesis imperfecta is a heterogeneous group of connective tissue diseases that is predominantly characterized by bone fragility and skeletal deformity. Two siblings with undiagnosed type I osteogenesis imperfecta underwent orthognathic surgery for the treatment of facial asymmetry and mandibular prognathism. The authors report two cases of combined orthodontics and orthognathic surgery in patients with type I osteogenesis imperfecta, mandibular prognathism, and facial asymmetry.


Subject(s)
Congenital Abnormalities , Connective Tissue Diseases , Facial Asymmetry , Humans , Orthodontics , Orthognathic Surgery , Osteogenesis Imperfecta , Osteogenesis , Prognathism , Siblings
12.
Article in English | WPRIM | ID: wpr-900721

ABSTRACT

Osteogenesis imperfecta is a heterogeneous group of connective tissue diseases that is predominantly characterized by bone fragility and skeletal deformity. Two siblings with undiagnosed type I osteogenesis imperfecta underwent orthognathic surgery for the treatment of facial asymmetry and mandibular prognathism. The authors report two cases of combined orthodontics and orthognathic surgery in patients with type I osteogenesis imperfecta, mandibular prognathism, and facial asymmetry.

13.
Article in English | WPRIM | ID: wpr-893017

ABSTRACT

Osteogenesis imperfecta is a heterogeneous group of connective tissue diseases that is predominantly characterized by bone fragility and skeletal deformity. Two siblings with undiagnosed type I osteogenesis imperfecta underwent orthognathic surgery for the treatment of facial asymmetry and mandibular prognathism. The authors report two cases of combined orthodontics and orthognathic surgery in patients with type I osteogenesis imperfecta, mandibular prognathism, and facial asymmetry.

14.
Article in Korean | WPRIM | ID: wpr-920124

ABSTRACT

Lipoma is the most common benign neoplasm in adults. While it is commonly found in the neck, trunk, and extremities, it is extremely rare in the nasal cavity, paranasal sinus, or nasal septum. To our knowledge, there have been only a few cases of septal lipomas reported in the English literature. A 32-year-old woman visited Kosin University Hospital complaining of left nasal congestion and throat discomfort. Upon nasal endoscopy examination and CT, we found a polypoid mass of 2.7×1.5 cm with an elongated neck occupying a region left of the nasopharyngeal to the oropharyngeal cavity. The mass was completely removed via endoscopic endonasal surgery under general anesthesia and was identified as a fibrolipoma in the histopathological examination. We report a case of a successfully treated fibrolipoma originating from the posterior margin of the nasal septum.

15.
Article in English | WPRIM | ID: wpr-763313

ABSTRACT

OBJECTIVES: There is a great deal of interest in the possibility that environmental factors may influence the risk of developing allergic rhinitis (AR) in early life. We investigated the simultaneous effects of mode of delivery and duration of breastfeeding on the development of AR in children. METHODS: Data from 1,374 children participating in the Allergic Rhinitis Cohort Study for kids (ARCO-kids study) was analyzed. All subjects were divided into AR or non-allergic rhinitis (NAR) groups. Data on environmental factors, mode of delivery and duration of breastfeeding were collected using a questionnaire. RESULTS: Compared with short-term breastfeeding (<6 months), long-term breastfeeding (≥12 months) was significantly associated with a lower prevalence of AR (adjusted odds ratio [aOR], 0.54; 95% confidence interval [CI], 0.34 to 0.88). Children in the AR group also had a higher cesarean delivery rate than those in the NAR group (39.1% vs. 32.8%, P=0.05). Regarding the combined effects of mode of delivery and duration of breastfeeding, long-term breastfeeding with a vaginal delivery strongly suppressed the development of AR, compared to short-term breastfeeding with a cesarean delivery (aOR, 0.47; 95% CI, 0.30 to 0.73). CONCLUSION: Long-term breastfeeding (≥12 months) and a vaginal delivery are associated with a lower risk of developing childhood AR.


Subject(s)
Breast Feeding , Cesarean Section , Child , Cohort Studies , Delivery, Obstetric , Female , Humans , Odds Ratio , Pregnancy , Prevalence , Rhinitis , Rhinitis, Allergic
16.
Article in Korean | WPRIM | ID: wpr-719324

ABSTRACT

BACKGROUND AND OBJECTIVES: In recent years, surgical imaging has become important for legal and educational purposes. Significant improvements can be made from the surgeon's point of view in recording surgical procedures, particularly with respect to the action camera with high-definition video recordings. For otolaryngologic surgery, the surgical view is narrow, and there is a limit to proper imaging using the existing lens of the action camera. Therefore, we aimed to find out if we could obtain surgical images through simple modification of action camera. MATERIALS AND METHOD: The action camera was modified to match the surgical field. We selected a suitable lens for otolaryngology surgery using a calculation formula. The action camera was simply modified according to the design. The modified action camera can be mounted on the surgeon's head or the surgical light. We compared the images taken with the modified action camera and the images taken with the existing camcorder. The modified action camera was able to capture a narrow surgical field for otolaryngologic surgery. RESULTS: Unlike the existing method, we were able to obtain high-quality images using a modified action camera at the first person's viewpoint without auxiliary manpower. The action camera was considerably cost effective compared to other methods of recording surgery. CONCLUSION: The modified action camera allows for high-definition, cost-effective, and firstperson viewpoint for otolaryngologic surgery. The modified action camera allows for detailed videography that can enhance surgical teaching, presentation and patient education materials.


Subject(s)
Education , Head , Methods , Otolaryngology , Patient Education as Topic , Video Recording
17.
Article in Korean | WPRIM | ID: wpr-760111

ABSTRACT

Malakoplakia is usually found in the genitourinary tract; however, it occurs uncommonly as a chronic inflammatory disease and rarely in the head and neck area, having been reported in the literature only few times. Here, we report, with a review of the related literature, a case of malakoplakia on the posterior neck. A 76-year-old male patient visited our institution presenting a rapidly growing neck mass that had invaded the overlying skin for several weeks. The results of imaging studies strongly indicated a malignant tumor, but an accurate diagnosis was not made until after a fine needle aspiration biopsy was undertaken twice. The lesion was completely excised with an extended radical neck dissection including the overlying skin and scalene muscle upon consent of the patient. The pathological diagnosis was made with various immunohistochemical staining methods including Von Kossa, Periodic acid-Schiff-diastase, CD-68 and CD163. During the 24 months follow-up after the surgery, there was no sign of recurrence.


Subject(s)
Aged , Biopsy , Biopsy, Fine-Needle , Diagnosis , Follow-Up Studies , Head , Humans , Lymphatic Diseases , Malacoplakia , Male , Neck Dissection , Neck , Recurrence , Skin
18.
Article in Korean | WPRIM | ID: wpr-758523

ABSTRACT

BACKGROUND AND OBJECTIVES: Laryngeal electromyography (LEMG) is valuable to evaluate the innervation status of the laryngeal muscles and the prognosis of vocal fold paralysis (VFP). However, there is a lack of agreement on quantitative interpretation of LEMG. The aim of this study is to measure the motor unit action potentials (MUAP) quantitatively in order to find cut-off values of amplitude, duration, phase for unilateral vocal fold paralysis patients. MATERIALS AND METHOD: Retrospective chart review was performed for the unilateral VFP patients who underwent LEMG from March 2016 to May 2018. Patient's demography, cause of VFP, vocal cord mobility, and LEMG finding were analyzed. The difference between normal and paralyzed vocal folds and cut-off values of duration, amplitude, and phase in MUAP were evaluated. RESULTS: Thirty-six patients were enrolled in this study. Paralyzed vocal fold had significantly longer duration (p=0.021), lower amplitude (p=0.000), and smaller phase (p=0.012) than the normal. The cut-off values of duration, amplitude, and phase in MUAP for unilateral VFP were 5.15 ms, 68.35 µV, and 1.85 respectively. CONCLUSION: An analysis of MUAP successfully provided quantitative differences between normal and paralyzed vocal folds. But, additional research is needed to get more available cut-off value which is helpful to evaluate the status of laryngeal innervations.


Subject(s)
Action Potentials , Demography , Electromyography , Humans , Laryngeal Muscles , Methods , Paralysis , Prognosis , Retrospective Studies , Vocal Cord Paralysis , Vocal Cords
20.
Article in English | WPRIM | ID: wpr-762712

ABSTRACT

PURPOSE: An enhanced recovery after surgery (ERAS) protocol incorporates up-to-date perioperative care principles; the primary aim in using an ERAS protocol is to reduce issues that delay the recovery and cause the complications. The aim of this study was to compare outcomes associated with head and neck cancer surgery with free-flap reconstruction before and after implementation of an ERAS protocol. METHODS: Outcomes were analyzed by dividing patients into 2 groups: 29 patients in the non-ERAS group and 60 patients in the ERAS group. The ERAS group performed a prospective observational cohort study of patients who underwent a head and neck cancer surgery with free-flap reconstruction in Ajou University Hospital from August 2015 to December 2017. The non-ERAS group retrospectively reviewed the medical records of patients who had undergone the same surgery from August 2012 to July 2015. RESULTS: Demographics, comorbidities, hospital length of stay (LOS), postoperative complications, starting time of rehabilitation, and postoperative periods before radiotherapy for the non-ERAS and ERAS groups were compared. Hospital LOS was significantly lower for patients whose care followed the ERAS protocol than for patients in the non-ERAS group (30.87 ± 20.72 days vs. 59.66 ± 40.43 days, P < 0.0001). CONCLUSION: In this study, hospital LOS was reduced through fast recovery after the implementation of the ERAS protocol. Therefore, the ERAS protocol appeared feasible and safe in head and neck cancer surgery with free-flap reconstruction.


Subject(s)
Cohort Studies , Comorbidity , Demography , Free Tissue Flaps , Head and Neck Neoplasms , Head , Humans , Length of Stay , Medical Records , Perioperative Care , Postoperative Care , Postoperative Complications , Postoperative Period , Prospective Studies , Radiotherapy , Radiotherapy, Adjuvant , Rehabilitation , Retrospective Studies
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