Manometric Characteristics of the Pharynx and upper Esophageal Sphincter in theTotal Laryngectomized Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Total laryngectomy is usually used for patients with advanced laryngeal cancer, and causes injuries to hypopharyngeal mucosa, cricopharyngeal muscle, pharyngeal constrictor muscle. These damages induce postoperative swallowing difficulties, although accurate and objective data have not been reported. The purpose of this study is to evaluate the changes and functional difficulties of swallowing mechanism in patients with total laryngectomy by manometric analysis. MATERIALS AND METHODS: We used station pull-through technique in two groups. The study group consisted of 11 total laryngectomized patients, and the control group consisted of 10 cases. We measured resting pressure, length, pressure after relaxation of UES (upper esophageal sphincter), and pharyngeal pressure. And 5 parameters were analyzed for coordination of hypopharynx and UES during swallowing. RESULTS: In the study group, the resting pressure, the maximal pressure after relaxation, and the length of UES was 36.3+/-10.5 mmHg, 149.8+/-14.6 mmHg, and 3.4+/-0.8 cm respectively. In the control group, the results was 34.9+/-9.6 mmHg, 85.5+/-12.3 mmHg, 2.2+/-0.6 cm respectively. The pharyngeal pressure was 81.8+/-10.1 mmHg in the study group, and 67.1+/-12.3 mmHg in the control group. The interval of pharyngeal constriction was 3.0+/-0.23 sec in the study group and 0.49+/-0.04 sec in the control group. The interval of UES relaxation was 2.43+/-0.14 sec in the study group and 0.99+/-0.03 sec in the control group. CONCLUSION: Manometric analysis showed higher pressure of the pharynx and UES in the total laryngectomized patients than in the normal adults. And there was a failure in the coordination between pharyngeal constriction and UES relaxation.

Immunohistochemical Study for Differentiation of Human Middle Ear Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Human epidermis is a continuously dividing tissue, in which keratinocytes gradually differentiate and mature while moving from basal cells to suprabasal cell layers. Epidermal homeostasis is maintained by a delicate balance between proliferation and terminal differentiation. Cholesteatoma is characterized by the presence of a squamous epithelium invading the middle ear, which is believed to have hyperproliferative properties. The aim of this study is to determine whether the hyperproliferative character of cholesteatoma is associated with differentiation of basal cell or suprabasal cell layers. MATERIALS AND METHODS: Using immunohistochemical techniques, we investigated the reaction pattern of monoclonal antibody to involucrin and filaggrin as differentiation markers in the cholesteatoma matrices which were harvested during surgery. For the control, the same immunohistochemical study was also done in deep meatal skin and retroauricular skin during the same surgery. RESULTS: The immunostaining intensity of filaggrin at suprabasal cell layers was higher in cholesteatoma than in retroauricular skin and deep meatal skin. The immunostaining intensity of involucrin at suprabasal cell layers was higher in cholesteatoma and deep meatal skin than in retroauricular skin. CONCLUSION: This result represents that the epidermal cells in cholesteatoma at suprabasal layers actively differentiate more than the epidermal cells in retroauricular skin. So this study suggests that hyperkeratinization in cholesteatoma might be due to altered differentiation of suprabasal keratinocytes. Furthermore, this study reveals that the deep meatal skin has unusual hyperproliferative behavior in contrast to the retroauricular skin.

Rectus Abdominis Free Flap Reconstruction for Orbital-Maxillary Defect in Advanced Maxillary Sinus Cancer / 대한이비인후과학회지

In the management of advanced maxillary sinus cancer, sometimes it requires an extensive ablation and orbital exenteration that results in large and full defects of the cheek and orbital regions. Reconstruction of large orbital-maxillary defects can be accomplished in one stage by microsurgical free transfer of rectus abdominis myocutaneous flap. The muscle component is suitable to fill the orbital and maxillary cavities, and the skin components are used for cheek, palate and lateral nasal cavity wall reconstruction as a three-dimentional folded free flap. Major problems with this flap are the bulkiness, the possibility of abdominal hernia and muscle weakness following the removal of the rectus abdominis muscle. Free deep inferior epigastric artery skin flap without rectus abdominis muscle is available in the reconstruction of large orbital-maxillary defect without the problems of the rectus abdominis myocutaneous free flap. We experienced one case of rectus abdominis myocutaneous free flap, and one other case of inferior rectus abdominis free flap for the reconstruction of huge surgical defects due to radical maxillectomy with orbital excenteration. Both of the patients were satisfied and there have been no severe complication associated with these technique.

Clinical Values of HRCT for Diagnosis of Incus Dislocations / 대한이비인후과학회지

BACKGROUND: The quick and accurate radiologic evaluation is essential to minimize the sequelae of temporal bone trauma. High resolution computed tomography(HRCT) is regarded as a method of choice in the evaluation of the head trauma including temporal bone fractures. Although the diagnosis of ossicular dislocation with HRCT has been described, we could find only one report on the usefulness of coronal sections in the diagnosis of lateral displacement of the incus. OBJECTIVES: The purpose of this study is to evaluate the usefulness of a recently reported radiologic sign, named the "Y" sign, for the diagnosis of lateral dislocation of the incus on the coronal HRCT sections of the temporal bones. MATERIALS AND METHODS: We retrospectively reviewed the axial and coronal HRCT sections of 13 cases who the laterally dislocated incus was confirmed operatively. RESULTS: In the axial HRCT sections, abnormal ice cream cone was shown in only 3 cases, but normal ice cream cone was shown in 10 cases. In the coronal HRCT sections, the Y-sign was shown in 11 cases-open Y-sign: 3 cases, closed Y-sign: 8 cases, in contrast, only 2 cases did not shown Y-sign. CONCLUSION: The Y-sign in the coronal sections is more correlated with the dislocated incus than with abnormal ice cream cone configuration in the axial sections. So, the Y-sign seems to be very useful in the diagnosis of the dislocated incus.