A Case of Second Branchial Cyst in Retropharyngeal Space, Appearing as Dyspnea and Dysphagia / 대한이비인후과학회지

The authors report the clinical features of a huge retropharyngeal second branchial cyst in a 53-year-old woman. The patient showed acute exacerbation of dyspnea and dysphagia. On endoscopic examination and computed tomography (CT), a cyst-like lesion narrowing the oropharynx was observed in the right retropharyngeal space. However, a retropharyngeal abscess was also suspected on some CT images. A cystic mass was found and removed completely via exploration by trans-oral approach. According to the literature review, a branchial cleft anomaly mimicking retropharyngeal abscess is very rare.

Early Endoscopic Electrocoagulation of the Sphenopalatine Artery for Refractory Posterior Epistaxis: Preliminary Study

BACKGROUND AND OBJECTIVES: Intractable epistaxis is a challenging problem associated with clinical morbidity and high costs due to prolonged hospitalization. Early endoscopic electrocoagulation of the sphenopalatine artery can be a good alternative management. SUBJECTS AND METHODS: This study is a retrospective review of 6 patients with uncontrolled epistaxis between January 2013 and January 2014. A decision to surgically intervene was made within 24 hours of hospitalization in all cases. Endoscopic electrocoagulation of the sphenopalatine artery was conducted under general anesthesia. Clinical and hematologic information, preoperative and surgical care, postoperative complications and surgical outcome, and duration of preoperative and postoperative hospital stay were evaluated. RESULTS: Epistaxis was effectively controlled in all cases. Four patients (66.7%) complained of nasal dryness and one of them endured nasal crusting for 9 months after surgery. Recurrent posterior epistaxis occurred after 5 postoperative months in one case, which was successfully controlled without surgery. The average length of postoperative hospital stay was 2.5+/-0.5 days. The average total length of hospital stay was 4.8+/-0.8 days. CONCLUSIONS: Early endoscopic electrocoagulation of the sphenopalatine artery seems effective for controlling intractable epistaxis.

A Case of Acute Bilateral Retrocochlear Hearing Loss as an Initial Symptom of Unilateral Thalamic Hemorrhage

A speech discrimination test is a test using a list of 25 phonetically balanced monosyllables. It is often overlooked but significant enough for pure tone audiometry. Many physicians have performed pure tone audiometry but without a speech discrimination test. A 73-year-old woman visited our clinic complaining of sudden bilateral hearing loss. Pure tone audiometry showed only bilateral high frequency loss. However, speech discrimination had decreased markedly. We decided to follow-up after 1 week of Ginexin-F(R) (ginkgo leaf extract) and Nafril(R) (nafronyl oxalate). She felt a gait disturbance within 2 days. Magnetic resonance imaging revealed a left thalamic hemorrhage. After a 1 month hospitalization, the hematoma subsided, and speech discrimination recovered 3 months later. Acute hearing loss due to thalamic hemorrhage that recovered has never been reported. We report the first case of retrocochlear hearing loss that occurred with a thalamic hemorrhage in a patient who recovered.

Traumatic Lesions in Posterior Cranial Fossa

Author analyzed 117 patients with traumatic lesions in posterior cranial fossa who had been treated at the Department of Neurosurgery in Jeonju Presbyterian Medical Center from January 1982 to December 1985. Results are summarized as follows: 1) The traumatic lesions in posterior cranial fossa were 4.97% of all head injuries. 2) 73 out of 117 patients were male and female were 44 cases. 75.2% of cases were found below age of 40. 3) The most common cause of injuries was traffic accident with motor vehicle(50%). 4) Occipital skull fractures were found in 69 cases(50.4%). Most of them were linear type. There were 15 epidural hematoma(12.8%), 6 cerebellar hematoma, 4 pontine hematoma, 1 subdural hematoma. 5) 67 cases of all patients were on Grady coma scale grade 1 and 2. 48 cases were on Grady coma scale grade 3 and 4. 2 cases were on Grady coma scale grade 4 and 5 on admission. 6) 13 cases with traumatic hematomas in posterior cranial fossa were treated surgically and 13 cases conservatively. 3 of them were expired. 7) There were 61 cases associated injuries(52.1%). Commonly associated injuries were the fracture of rib, clavicle and femur. 8) 50 out of 117 cases showed sequelae:Motor weakness and cranial nerve palsies were main deficits. 9) The total mortality of traumatic posterior fossa lesions was 12.8%(15 cases) and the operative mortality was 15.4%(2 cases).

Traumatic Lesions in Posterior Cranial Fossa

Author analyzed 117 patients with traumatic lesions in posterior cranial fossa who had been treated at the Department of Neurosurgery in Jeonju Presbyterian Medical Center from January 1982 to December 1985. Results are summarized as follows: 1) The traumatic lesions in posterior cranial fossa were 4.97% of all head injuries. 2) 73 out of 117 patients were male and female were 44 cases. 75.2% of cases were found below age of 40. 3) The most common cause of injuries was traffic accident with motor vehicle(50%). 4) Occipital skull fractures were found in 69 cases(50.4%). Most of them were linear type. There were 15 epidural hematoma(12.8%), 6 cerebellar hematoma, 4 pontine hematoma, 1 subdural hematoma. 5) 67 cases of all patients were on Grady coma scale grade 1 and 2. 48 cases were on Grady coma scale grade 3 and 4. 2 cases were on Grady coma scale grade 4 and 5 on admission. 6) 13 cases with traumatic hematomas in posterior cranial fossa were treated surgically and 13 cases conservatively. 3 of them were expired. 7) There were 61 cases associated injuries(52.1%). Commonly associated injuries were the fracture of rib, clavicle and femur. 8) 50 out of 117 cases showed sequelae:Motor weakness and cranial nerve palsies were main deficits. 9) The total mortality of traumatic posterior fossa lesions was 12.8%(15 cases) and the operative mortality was 15.4%(2 cases).