Diagnostic Validity of Auditory Brainstem Response for the Initial Screening of Vestibular Schwannoma

Background and Objectives@#To investigate the diagnostic validity of auditory brainstem response (ABR) in the screening of vestibular schwannoma (VS). @*Subjects and Methods@#Forty patients diagnosed with VS using magnetic resonance imaging who had undergone ABR before treatment between 2005 and 2015 were included. ABR results were considered positive when findings met at least one of the following criteria: 1) absent evoked response, 2) desynchronization of waves other than wave I, 3) interpeak latency (IPL) between waves I and III >2.5 ms, 4) IPL between waves I and V >4.4 ms, 5) wave V interaural latency difference >0.2 ms, and 6) interaural difference in IPL between waves I and V >0.2 ms. @*Results@#The overall sensitivity of ABR was 85.0%. For tumors measuring 10 mm. The sensitivity of tumors confined to the internal acoustic canal was 73.3% compared with 100.0% for tumors confined to the cerebellopontine angle. In patients with serviceable hearing, the mean tumor size was 7.8±2.9 mm in patients with a normal ABR and 15.1±9.4 mm in patients with an abnormal ABR, indicating a significant difference (p10 mm in patients with serviceable hearing, supporting the need for further active diagnostic and treatment modalities in clinical practice.

Accuracy of digital surgical guides for dental implants / 대한악안면성형재건외과학회지

Background@#Recently developed imaging techniques, such as cone beam computed tomography (CBCT) and CAD/CAM technology, have facilitated reliable implant planning and implant surgical guide production by 3D printing. This study compared the accuracy of implant-guided surgery using the R2GATE® program with CBCT before and after surgery. @*Patients and methods@#The study included patients who visited the Department of Oral and Maxillofacial Surgery at Chonnam National University Hospital from September 2021 to March 2022. Twenty-four implants were placed in eleven patients. Using R2GATE® Windows (Megagen implant, Daegu, Korea) software, implant placement was planned. The difference was measured by the CBCT before and after surgery. The cervical and apical distance and angular deviation of the implants were measured. Statistical analysis was performed using an independent t-test, Pearson correlation, and multiple regression analyses. @*Results@#The three-dimensional linear distance difference between the planned implant and the placed implant was 0.97 ± 0.37 mm at the cervical and 1.13 ± 0.36 mm at the apical. The difference in angle deviation between the planned implant and the placed implant was 3.42 ± 2.12°. Among the variables affecting the accuracy of implant placement, a statistically significant difference was found when using a tissue-supported implant guide, implant diameter and implant length. @*Conclusion@#Based on these results, using the R2GATE® program is useful to use an implant digital surgical guide, and it will be used in various clinic.

A Case of Cochlear Implantation in a Patient With Intracochlear Schwannoma / 대한이비인후과학회지

Intralabyrinthine schwannomas are rare benign tumors, which arise from neural portions within the labyrinth. These are subclassified into seven groups according to the affected inner ear structures. Intracochlear schwannomas (ICS) are tumors confined to the cochlea, and these can cause progressive unilateral sensorineural hearing loss, tinnitus, vertigo and aural fullness. Here, we report a 49-year-old female patient with left sudden sensorineural hearing loss. There was no improvement of hearing despite steroid and hyperbaric oxygen therapy. Space occupying lesion in the basal turn of the left cochlea was identified in MRI with enhancement. She underwent tumor removal through an extended round window approach, and cochlear implantation was performed successfully. This is the first case report of cochlear implantation after tumor removal in a patient with ICS in Korea, and we discuss management options with a review of the literature.

Idiopathic Inflammatory Arthritis in the Auditory Canal in a Patient With Hearing Impairment: A Case Report and Literature Review

Inflammatory arthritis can affect the auditory system during the disease course. Although most cases show asymptomatic hearing impairment, it can result in hearing loss. Here we describe the case of a 70-year-old female with hearing impairment associated with idiopathic inflammatory arthritis in her auditory system. She had suffered from hearing difficulties for decades; however, the causes of her hearing impairment had not been evaluated. Pure tone audiometry showed severe sensorineural hearing loss requiring a cochlear implant. The workup for the cochlear implant revealed erosive changes in the incudomalleolar and incudostapedial joints with soft tissue swelling on temporal bone computed tomography. Bone pathology revealed plasmacytic infiltration and granulomatous inflammation. Laboratory examinations showed elevated levels of inflammatory markers; otherwise, she had negative results for all autoantibodies. In patients with idiopathic hearing loss, inflammatory arthritis of the middle ear without peripheral arthritis can provide a clue regarding the cause of the hearing loss.

Results of Active Middle Ear Implantation in Patients With Mixed Hearing Loss After Middle Ear Surgery: A Prospective Multicenter Study (the ROMEO Study)

Objectives@#. This study was conducted to evaluate the user satisfaction, efficacy, and safety of round window (RW) vibroplasty using the Vibrant Soundbridge (VSB) in patients with persistent mixed hearing loss after mastoidectomy. @*Methods@#. The study included 27 patients (mean age, 58.7 years; age range, 28–76 years; 11 men and 16 women) with mixed hearing loss after mastoidectomy from 15 tertiary referral centers in Korea. The VSB was implanted at the RW. The Korean translation of the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire and the Korean version of the International Outcome Inventory for Hearing Aids (K-IOI-HA) questionnaire were used to evaluate user satisfaction as the primary outcome. The secondary outcome measures were audiological test results and complication rates. @*Results@#. The mean scores for ease of communication (61.3% to 29.7% to 30.2%), reverberation (62.1% to 43.1% to 37.4%), and background noise (63.3% to 37.7% to 34.3%) subscales of the APHAB questionnaire significantly decreased after VSB surgery. The mean K-IOI-HA scores at 3 and 6 months after surgery were significantly higher than the mean preoperative score (18.6 to 27.2 to 28.1). The postoperative VSB-aided thresholds were significantly lower than the preoperative unaided and hearing aid (HA)-aided thresholds. There was no significant difference between preoperative unaided, preoperative HA-aided, and postoperative VSB-aided maximum phonetically balanced word-recognition scores. None of the 27 patients experienced a change in postoperative bone conduction pure tone average. One patient developed temporary facial palsy and two developed surgical wound infections. @*Conclusion@#. RW vibroplasty resulted in improved satisfaction and audiological test results in patients with mixed hearing loss after mastoidectomy, and the complication rate was tolerable.

Verification of Hearing Aids by Comparing Real Ear Measurements and Word Recognition Scores / 대한이비인후과학회지

Background and Objectives@#In this study, we introduce our method of hearing aid (HA) verification using real ear measurement (REM). We verified HAs that have gone through the fitting program using speech mapping REM; we then compared the outcome with word recognition scores (WRS) to evaluate functional gain. Subjects and Method Fifty-six patients of sensorineural hearing loss (81 ears) were enrolled in the study. In REM, if the gap between the target gain of HA and real ear aided response (REAR) was less than 10 dB SPL, fitting was considered successful. In speech audiometry, unaided maximum discrimination score (PB max), unaided WRS at 65 dB HL and aided WRS at 65 dB HL were measured. By comparing PB max and aided WRS at 65 dB HL, patients were sorted into best (n=15), good (n=57), and poorly (n=9) aided groups and analyzed for the successes of fitting. Fitting was deemed unsuccessful if REAR was ≥10 dB SPL lower than the target value of HA. @*Results@#The mean aided WRS at 65 dB HL of best, good and poorly aided groups were 85.6%, 77.3%, and 54.2%, respectively. There were statistically significant differences between all groups (p=0.019, 0.001, 0.002). The success rates of HA fitting showed significant differences at 0.5, 0.75, 1, 4 kHz of 55 dB SPL (p=0.023, 0.005, 0.003, 0.014), and at 4 kHz of 65 and 75 dB SPL (p=0.004, 0.001). The high WRS group showed sufficient gain at many frequencies. @*Conclusion@#Well fitted HAs can provide sufficient increase in speech intelligibility. Using the speech mapping REM is a great method to verify fitting of HA.

Middle Ear Implant for Sensorineural and Conductive Hearing Loss: Indications and Audiological Results / 대한이비인후과학회지

Background and Objectives@#Middle ear implants (MEI) have been reported to be an effective and safe alternative for the treatment of sensorineural hearing loss (SNHL) and conductive hearing loss (CHL). This study aimed to compare the functional outcomes between SNHL and CHL in terms of audiological gains.Subjects and Method The medical records of 14 consecutive SNHL and CHL patients who underwent MEI surgeries from 2015 to 2019 by a single surgeon were retrospectively reviewed. Audiological changes using hearing aids (HA) and MEI were compared. @*Results@#In SNHL, the mean unaided air-conduction pure tone audiometry (PTA), (57.7 dB HL) decreased significantly using HA and MEI (44.7 and 41.4 dB HL), but with no significant difference from each other. Unaided word recognition score (WRS) at 65 dB HL (45.1%) was significantly improved using HA and MEI (72.6% and 76.6%), with no significant difference. In CHL, the mean unaided air-conduction and bone-conduction PTA were 77.1 (57.5-93.8) and 44.1 (26.3-57.5) dB HL. Three patients could not use conventional HAs due to otorrhea and deformity of the external auditory canal by previous surgeries and 4 patients had used conventional HAs before MEI. Though both HA and vibrant soundbridge (VSB) showed improvement of hearing thresholds (32.0 and 48.8 dB HL) and WRS (80.0% and 94.9%), it was significant only when using VSB. There was no significant difference between HA and VSB. @*Conclusion@#MEI can be an effective treatment option for both SNHL and CHL patients, especially for those who suffered from problems using conventional HA.

Short-Term Experience in Cochlear Implantation with Slim Modiolar Electrode Array (CI532): Comparison to Previous Devices / 대한이비인후과학회지

Background and Objectives@#There have been no reports in Korea regarding cochlear implant surgeries using Cochlear Nucleus Profile Slim Modiolar electrode [CI532 (Cochlear Ltd.)], as it has been recently released in Korea. We aimed to investigate the short-term results of CI532 and compare them with previous devices with perimodiolar or straight electrodes arrays from the same manufacturer.Subjects and Method From August 2018 to July 2019, 52 patients (26 adults; 26 children) who underwent cochlear implantation of CI532 were included. The intraoperative impedance and evoked compound action potential (ECAP) threshold in each electrode were analyzed and compared with the devices with a perimodiolar electrode array [Contour Advance® (Cochlear Ltd.)] and a lateral wall electrode array [CI422 and CI522 (Cochlear Ltd.)]. Postoperative changes of hearing thresholds at each frequency (250, 500, and 1000 Hz) and aided word recognition scores (WRS) were also compared. @*Results@#CI532 showed significantly lower intraoperative impedance in the basal regions compared to the lateral wall electrode array. The ECAP thresholds of CI532 in the apical electrodes were significantly lower than that in the other two groups. After implantation, CI532 showed a significant preservation of hearing thresholds at most frequencies and showed significantly higher preservation rates than the other electrodes. However, there was no difference between the three groups regarding the postoperative short-term aided WRS. @*Conclusion@#CI532 showed lower intraoperative impedances and ECAP thresholds, and better short-term hearing preservation outcomes compared to the other electrodes, suggesting that CI532 electrode might be a better option with less traumatic insertion. However, there was no significant difference in the aided WRS, and further studies with a longer follow-up are necessary to examine the difference of audiologic outcomes.

Changes in Cortical Auditory Evoked Potentials by Ipsilateral, Contralateral and Binaural Speech Stimulation in Normal-Hearing Adults

Objectives@#. Cortical auditory evoked potentials (CAEPs) have been used to examine auditory cortical development or changes in patients with hearing loss. However, there have been no studies analyzing CAEP responses to the different sound stimulation by different stimulation sides. We characterized changes in normal CAEP responses by stimulation sides in normal-hearing adults. @*Methods@#. CAEPs from the right auditory cortex were recorded in 16 adults following unilateral (ipsilateral and contralateral) and bilateral sound stimulation using three speech sounds (/m/, /g/, and /t/). Amplitudes and latencies of the CAEP peaks in three conditions were compared. @*Results@#. Contralateral stimulation elicited larger P2-N1 amplitudes (sum of P2 and N1 amplitudes) than ipsilateral stimulation regardless of the stimulation sounds, mostly due to the larger P2 amplitudes obtained, but elicited comparable P2-N1 amplitudes to bilateral stimulation. Although the P2-N1 amplitudes obtained with the three speech sounds were comparable following contralateral stimulation, the /m/ sound elicited the largest P2-N1 amplitude in ipsilateral stimulation condition due to the largest N1 amplitude obtained, whereas /t/ elicited larger a P2-N1 amplitude than/g/ in bilateral stimulation condition due to a larger P2 amplitude. @*Conclusion@#. Spectrally different speech sounds and input sides are encoded differently at the cortical level in normal-hearing adults. Standardized speech stimuli, as well as specific input sides of speech, are needed to examine normal development or rehabilitation-related changes of the auditory cortex in the future.

Relationship between Video Head Impulse Gain and Severity of Dizziness in Patients with Vestibular Neuritis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#We evaluated the correlation between video head impulse test (vHIT) and dizziness handicap inventory (DHI), which is commonly used to quantify severity of dizziness in vestibular neuritis (VN).SUBJECTS AND METHOD: Twenty VN patients undergoing vHIT either at the acute or follow-up stages of treatment were assessed by DHI questionnaire. Gain and gain asymmetry (GA) were correlated with DHI scores and abnormal vHIT rates were compared according to the severity of dizziness (mild ≤30; moderate-to-severe ≥32).@*RESULTS@#vHIT gains significantly increased from the acute to follow-up stages (from 0.45±0.18 to 0.70±0.25), whereas GA and DHI scores decreased (GA, from 0.36±0.15 to 0.22±0.18; DHI scores, from 35±26 to 23±23). Although vHIT gains or GA showed no correlation with DHI scores at the acute stage, vHIT gains showed significant correlation with DHI scores at the follow-up (R-sq=0.32, p=0.01) stage. vHIT gains and GA did not differ according to the severity of dizziness during the acute stage; however, vHIT gains (0.78±0.25) of patients with mild dizziness were significantly higher than those (0.51±0.14) with moderate-to-severe dizziness at the follow-up stage. During the follow-up, all patients with moderate-to-severe dizziness showed abnormal vHIT gain, but 43% of patients with mild dizziness showed abnormal vHIT gain, showing a significant difference (p<0.05).@*CONCLUSION@#Reduced vHIT gain was significantly correlated with high degrees of dizziness at the follow-up, but not at the acute stage, suggesting that high-frequency canal dysfunction is contributed in part by the subjective dizziness at the follow-up. Our findings suggest that vHIT might give an indirect evidence for implementing vestibular rehabilitation for enhancing impaired vestibular function and relieving subjective dizziness.

Comparison of Aided and Unaided Thresholds and Selection Processes of Contralateral Routing of Signal Hearing Aids and Implantable Bone Conduction Devices in Patients with Asymmetric Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#We reviewed the selection processes of contralateral routing of signal (CROS) hearing aids (HAs) and bone-conduction (BC) Has, and compared aided and unaided hearing thresholds.SUBJECTS AND METHOD: Twenty-four patients with asymmetrical hearing loss who used BC HAs (n=12) and CROS HAs (n=12) were enrolled. The choice of two different HAs were compared with respect to the degree of hearing loss, the unaided hearing thresholds and functional gains.@*RESULTS@#When the hearing thresholds of the better hearing ears were >30 dB HL, most (92%, 11 of 12) chose CROS rather than BC HAs, with significant difference (p=0.001). Both CROS and BC HAs groups showed significantly improved functional gains (46.6 dB and 53.4 dB, respectively). Aided air-conduction (AC) thresholds (40.2 dB HL) in the CROS group were similar to the AC thresholds (43.1 dB HL) of better hearing ears. However, the hearing threshold of Aided AC thresholds (35.8 dB HL) in BC HAs group were less than the BC thresholds (17.3 dB HL) of better hearing ears by 19 dB (p30 dB HL. The CROS group showed aided thresholds similar to the thresholds of better hearing ears, but the BC HAs group showed poorer aided thresholds than the thresholds of better hearing ears. For patients with asymmetric hearing loss, HAs should be selected based on the degree and types of hearing loss and the maximum output level of the selected device.

Direction-Changing and Direction-Fixed Positional Nystagmus in Patients With Vestibular Neuritis and Meniere Disease

OBJECTIVES: Direction-changing positional nystagmus (PN) was considered to indicate the presence of benign paroxysmal positional vertigo involving lateral semicircular canal in most cases. We investigated the incidence of PN on the supine head-roll test and compared the characteristics of nystagmus in patients with vestibular neuritis (VN) and Meniere disease (MD). METHODS: A retrospective review of patients, who were diagnosed with unilateral VN or unilateral definite MD between September 2005 and November 2011, was conducted. Sixty-five VN patients and 65 MD patients were enrolled. Eye movements were recorded for 30–60 seconds at the positions of sitting, head roll to the right, and head roll to the left, and maximum slow-phase eye velocity was calculated. PN was classified as direction-fixed (paretic or recovery) and direction-changing (geotropic or apogeotropic). RESULTS: Spontaneous nystagmus was observed in 57 patients (87%, the slow-phase eye velocity of 7°/sec±5°/sec) with acute VN, 39 (60%, 2°/sec±1°/sec) with follow-up VN, and 32 (49%, 2°/sec±2°/sec) with MD. Direction-fixed PN was the most common type. Direction-fixed paretic type was most common in acute VN (80%) and follow-up VN (42%), and direction-fixed recovery type was most common in MD (31%). Paretic type was significantly more common in acute VN (80%) than in follow-up VN (42%) and MD (26%), and the recovery type was significantly more common in MD (31%) than in acute VN (3%) and follow-up VN (14%). Direction-changing PN was more common in MD (22%), followed by follow-up VN (14%) and acute VN (9%). CONCLUSION: Though direction-fixed paretic PN was most common in VN and MD patients, direction-changing PN could be observed in a few patients (9%–20%) with peripheral vestibular disorders regardless of the duration from the onset of dizziness, suggesting the presence of otolith-related dizziness.

Relationship between Video Head Impulse Gain and Severity of Dizziness in Patients with Vestibular Neuritis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We evaluated the correlation between video head impulse test (vHIT) and dizziness handicap inventory (DHI), which is commonly used to quantify severity of dizziness in vestibular neuritis (VN). SUBJECTS AND METHOD: Twenty VN patients undergoing vHIT either at the acute or follow-up stages of treatment were assessed by DHI questionnaire. Gain and gain asymmetry (GA) were correlated with DHI scores and abnormal vHIT rates were compared according to the severity of dizziness (mild ≤30; moderate-to-severe ≥32). RESULTS: vHIT gains significantly increased from the acute to follow-up stages (from 0.45±0.18 to 0.70±0.25), whereas GA and DHI scores decreased (GA, from 0.36±0.15 to 0.22±0.18; DHI scores, from 35±26 to 23±23). Although vHIT gains or GA showed no correlation with DHI scores at the acute stage, vHIT gains showed significant correlation with DHI scores at the follow-up (R-sq=0.32, p=0.01) stage. vHIT gains and GA did not differ according to the severity of dizziness during the acute stage; however, vHIT gains (0.78±0.25) of patients with mild dizziness were significantly higher than those (0.51±0.14) with moderate-to-severe dizziness at the follow-up stage. During the follow-up, all patients with moderate-to-severe dizziness showed abnormal vHIT gain, but 43% of patients with mild dizziness showed abnormal vHIT gain, showing a significant difference (p<0.05). CONCLUSION: Reduced vHIT gain was significantly correlated with high degrees of dizziness at the follow-up, but not at the acute stage, suggesting that high-frequency canal dysfunction is contributed in part by the subjective dizziness at the follow-up. Our findings suggest that vHIT might give an indirect evidence for implementing vestibular rehabilitation for enhancing impaired vestibular function and relieving subjective dizziness.

Comparison of Aided and Unaided Thresholds and Selection Processes of Contralateral Routing of Signal Hearing Aids and Implantable Bone Conduction Devices in Patients with Asymmetric Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We reviewed the selection processes of contralateral routing of signal (CROS) hearing aids (HAs) and bone-conduction (BC) Has, and compared aided and unaided hearing thresholds. SUBJECTS AND METHOD: Twenty-four patients with asymmetrical hearing loss who used BC HAs (n=12) and CROS HAs (n=12) were enrolled. The choice of two different HAs were compared with respect to the degree of hearing loss, the unaided hearing thresholds and functional gains. RESULTS: When the hearing thresholds of the better hearing ears were >30 dB HL, most (92%, 11 of 12) chose CROS rather than BC HAs, with significant difference (p=0.001). Both CROS and BC HAs groups showed significantly improved functional gains (46.6 dB and 53.4 dB, respectively). Aided air-conduction (AC) thresholds (40.2 dB HL) in the CROS group were similar to the AC thresholds (43.1 dB HL) of better hearing ears. However, the hearing threshold of Aided AC thresholds (35.8 dB HL) in BC HAs group were less than the BC thresholds (17.3 dB HL) of better hearing ears by 19 dB (p30 dB HL. The CROS group showed aided thresholds similar to the thresholds of better hearing ears, but the BC HAs group showed poorer aided thresholds than the thresholds of better hearing ears. For patients with asymmetric hearing loss, HAs should be selected based on the degree and types of hearing loss and the maximum output level of the selected device.

The Presence of Neural Stem Cells and Changes in Stem Cell-Like Activity With Age in Mouse Spiral Ganglion Cells In Vivo and In Vitro

OBJECTIVES: Spiral ganglion neurons (SGNs) include potential endogenous progenitor populations for the regeneration of the peripheral auditory system. However, whether these populations are present in adult mice is largely unknown. We examined the presence and characteristics of SGN-neural stem cells (NSCs) in mice as a function of age. METHODS: The expression of Nestin and Ki67 was examined in sequentially dissected cochlear modiolar tissues from mice of different ages (from postnatal day to 24 weeks) and the sphere-forming populations from the SGNs were isolated and differentiated into different cell types. RESULTS: There were significant decreases in Nestin and Ki67 double-positive mitotic progenitor cells in vivo with increasing mouse age. The SGNs formed spheres exhibiting self-renewing activity and multipotent capacity, which were seen in NSCs and were capable of differentiating into neuron and glial cell types. The SGN spheres derived from mice at an early age (postnatal day or 2 weeks) contained more mitotic stem cells than those from mice at a late age. CONCLUSION: Our findings showed the presence of self-renewing and proliferative subtypes of SGN-NSCs which might serve as a promising source for the regeneration of auditory neurons even in adult mice.

Microbiological Results From Middle Ear Effusion in Pediatric Patients Receiving Ventilation Tube Insertion: Multicenter Registry Study on the Effectiveness of Ventilation Tube Insertion in Pediatric Patients With Chronic Otitis Media With Effusion: Part

OBJECTIVES: The aim of this multicenter registry study was to investigate the effectiveness of ventilation tube insertion and the microbiology of otitis media with effusion (OME) in children. This part I study was conducted to evaluate the microbiological profile of children with OME who needed ventilation tube insertion. METHODS: Patients < 15 years old who were diagnosed as having OME and received ventilation tube insertion were prospectively enrolled in 16 tertiary hospitals from June 2014 to December 2016. After excluding patients with missing data, the data of 397 patients were analyzed among a total of 433 enrolled patients. The clinical symptoms, findings of the tympanic membrane, hearing level, and microbiological findings were collected. RESULTS: In 103 patients (25.9%), antibiotics were used within 3 weeks before surgery. Ventilation tube insertion was performed in a total of 710 ears (626 in both ears in 313 patients, 55 in the left ear only, and 29 in the right ear only). Culture of middle ear effusion was done in at least one ear in 221 patients (55.7%), and in a total of 346 ears. Only 46 ears (13.3%) showed positive results in middle ear effusion culture. Haemophilus influenzae (17.3%, followed by coagulase-negative Staphylococcus and Staphylococcus auricularis) was the most common bacteria detected. CONCLUSION: H. influenzae was the most commonly found bacteria in middle ear effusion. Relatively low rates of culture positivity were noted in middle ear effusion of patients with OME in Korea.

Reconstruction of the orbital wall using superior orbital rim osteotomy in a patient with a superior orbital wall fracture / 대한악안면성형재건외과학회지

BACKGROUND: Fractures of the orbital wall are mainly caused by traffic accidents, assaults, and falls and generally occur in men aged between 20 and 40 years. Complications that may occur after an orbital fracture include diplopia and decreased visual acuity due to changes in orbital volume, ocular depression due to changes in orbital floor height, and exophthalmos. If surgery is delayed too long, tissue adhesion will occur, making it difficult to improve ophthalmologic symptoms. Thus, early diagnosis and treatment are important. Fractures of the superior orbital wall are often accompanied by skull fractures. Most of these patients are unable to perform an early ocular evaluation due to neurosurgery and treatment. These patients are more likely to show tissue adhesion, making it difficult to properly dissect the tissue for wall reconstruction during surgery. CASE PRESENTATION: This report details a case of superior orbital wall reconstruction using superior orbital rim osteotomy in a patient with a superior orbital wall fracture involving severe tissue adhesion. Three months after reconstruction, there were no significant complications. CONCLUSION: In a patient with a superior orbital wall fracture, our procedure is helpful in securing the visual field and in delamination of the surrounding tissue.

A retrospective clinical investigation for the effectiveness of closed reduction on nasal bone fracture / 대한악안면성형재건외과학회지

BACKGROUND@#The nasal bone is the most protruding bony structure of the facial bones. Nasal bone fracture is the most common facial bone fracture. The high rate of incidence of nasal bone fracture emphasizes the need for systematical investigation of epidemiology, surgical techniques, and complications after surgery. The objective of this study is to investigate the current trends in the treatment of nasal bone fractures and the effectiveness of closed reduction depending on the severity of the nasal bone fracture.@*PATIENTS AND METHODS@#A total of 179 patients with a nasal bone fracture from 2009 to 2017 were enrolled. Their clinical examination, patient's records, and radiographic images of nasal bone fractures were evaluated.@*RESULTS@#Patients ranged from children to elderly. There were 156 (87.2%) males and 23 (12.8%) females. Traffic accident (36.9%) was the most common cause of nasal fracture. Orbit fracture (44 patients, 24.6%) was the most common fracture associated with a nasal bone fracture.Complications after surgery included postoperative deformity in 20 (11.2%) patients, nasal obstruction in 11 (6.1%) patients, and olfactory disturbances in 2 (1.1%) patients and patients with more severe nasal bone fractures had higher rates of these complications.@*CONCLUSION@#Closed reduction could be performed successfully within 2 weeks after injury.

Orbicularis oris muscle reconstruction and cheiloplasty with Z-plasty in a patient with a transverse facial cleft / 대한악안면성형재건외과학회지

BACKGROUND@#Transverse facial clefts are Tessier's number 7 facial cleft among numbers 1–15 in Tessier's classification of craniofacial malformations, which varies from a simple widening oral commissure to a complete fissure extending towards the external ear.CASE PRESENTATION: In a patient with a transverse facial cleft, to functionally arrange the orbicularis oris muscle and form the oral commissure naturally, we performed a surgical procedure including orbicularis oris muscle reconstruction and cheiloplasty with Z-plasty.@*CONCLUSION@#We achieved good results functionally and esthetically by orbicularis oris muscle reconstruction and cheiloplasty with Z-plasty. The surgical modality of our anatomical repair and 3 months follow-up results are presented.

Surgical excision of osteochondroma on mandibular condyle via preauricular approach with zygomatic arch osteotomy / 대한악안면성형재건외과학회지

BACKGROUND: Osteochondroma is a benign tumor that tends to develop in mandibular condyle and coronoid process in the craniofacial region. If tumor mass has grown from condyle into the infratemporal space with zygomatic arch obstructing the access, there are risks associated with surgical exposure and local resection of these masses. CASE PRESENTATION: This study reports on a case of osteochondroma on mandibular condylar head where we treated with surgical excision via preauricular approach with 3D analysis. After the local resection, there were no surgical and post-operative complications until 8-month follow-up period. CONCLUSIONS: In local excision of osteochondroma, our method is a minimally invasive method. It is a good example of osteochondroma treatment.