A Case Of Cavernous Sinus Syndrome and Mutifocal Cerebral Infarction Related To Mucormycosis Of Sphenoid Sinus / 고신대학교의과대학학술지

A 54-year-old man, suffering from severe headache and ophthalmoplegia after undergoing endoscopic sinus surgery was referred to a tertiary hospital. Computed tomography (CT) revealed soft tissue density lesions in the left sphenoid sinus. The internal carotid artery was shown to be occluded in brain magnetic resonance imaging (MRI) scans without any other cerebral lesion. Endoscopic view of left nasal cavity shows whitish hyphae in the ethmoid and the sphenoid sinuses. We diagnosed him with cavernous sinus syndrome caused by mucormycosis and conducted endoscopic sinus surgery to remove remaining lesions and decompress orbit and optic nerves. After the revision surgery the patient's headache and ophthalmoplegia were improved. However, multifocal cerebral infarctions were newly discovered in a postoperative CT scan. We experienced a case of mucormycosis of sphenoid sinus resulting in occlusion of internal carotid artery and multifocal cerebral infarction, and report it with a brief review of these disease entities.

Clinical Value of Blood Neutrophil to Lymphocyte Ratio in Patients with Papillary Thyroid Carcinoma with Neck Lymph Node Metastasis

BACKGROUND AND OBJECTIVES: Blood neutrophil-to-lymphocyte ratio (NLR) has been reported to have poor prognostic impact in variable malignancies. However, studies evaluating the clinical significance of blood NLR in patient with papillary thyroid carcinoma (PTC) has been relatively rare, and the outcomes were inconsistent. In this study, we sought to analyze the clinical value of NLR in patients with PTC who had cervical lymph node metastasis. MATERIALS AND METHODS: Retrospective chart review was conducted with 174 patients with confirmed neck metastasis of PTC after initial thyroidectomy. Blood NLR was estimated by dividing the absolute number of blood neutrophil with that of lymphocyte. Statistical analysis was conducted to evaluate correlation between NLR and clinicopathologic factors, patterns of metastatic lymph nodes, and recurrence. RESULTS: Higher NLR (>1.74) was correlated to younger age of patients ( < 45 years, p=0.045) and smaller size of tumor ( < 1 cm, p=0.017). Blood NLR had no impact on patterns of lymph node metastasis or recurrence. CONCLUSION: Blood NLR may not be considered as a predictive factor for clinical aggressiveness or prognosis in patients with PTC with lymph node metastasis.

Nasal Bone 3 Dimentional Computer Tomography Guided Tailored Osteotomy of the Bony Deviated Nose / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Correction of deviated nose is considered one of the most difficult and serious surgical operations in rhinoplasty. The correction of bony deviation, in particular, requires osteotomy. Although there are individual differences in the shapes or features of bony deviations of each patient, the techniques of osteotomy are limited. Therefore, for proper correction of bony deviation, it is necessary to set up a precise pre-surgical plan. SUBJECTS AND METHOD: We categorized 187 patients with bony deviated nose into 5 types based on the analysis of preoperative nasal bone 3D computer tomography, and studied surgical method for each type. RESULTS: Of 187 patients, 92 (49%) patients are categorized into type I, 62 (36%) patients into type II, 12 (6%) patients into type III, 2 (1%) patients into type IVa, 7 (4%) patients into type IVb and 7 (4%) patients into type V. Only did eight patients (5%) undergo revision surgery due to unsuccessful outcomes. Major complications like infection, abscess, arteriovenous fistula, epiphora, and saddle deformation did not occur at all. CONCLUSION: Preoperative planning under the analysis and categorization using 3D CT is considered helpful for the precise and individualized surgery in corrective rhinoplasty.

An Animal Model of Tracheal Stenosis Induced by an Endotracheal Segmented Tube / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various methods to induce tracheal stenosis in an animal model have been introduced. However, most methods use non-physiologic mechanical or chemical injury to tracheal mucosa or cartilage. In this study, we sought to develop an animal model of tracheal stenosis using a segmented endotracheal tube. MATERIALS AND METHOD: Nine New Zealand White Rabbits were included in this feasibility study. A segmented 1.5 cm LEVIN-Tube (16 French) was inserted into tracheal lumen via tracheotomy site and fixed with a nylon tape circumferentially tied around the trachea. The tube was removed transorally one week later and the tracheal lumen was observed with bronchoscopy every week. Rabbits were sacrificed two weeks after the tube removal and the trachea was evaluated with histologic image. Three rabbits underwent tracheotomy and closure only to evaluate possible impact of tracheotomy procedure to tracheal stenosis (sham surgery). RESULTS: None of the 6 rabbits showed significant complications or death during the study. No significant change of tracheal lumen was identified in 3 sham models. The mean grade of stenosis was 57.2±9.9% (range, 43-70%). Histologic image showed thickening and fibrosis of lamina propria with relatively intact tracheal cartilage framework. CONCLUSION: We developed an animal model of tracheal stenosis using a segmented endotracheal tube fixed with a nylon tape. Since this model has similar pathophysiology to prolonged endotracheal intubation, it may be used in various studies related to tracheal stenosis.