Endotracheal tube intubation with the aid of a laryngeal mask airway, a fiberoptic bronchoscope, and a tube exchanger in a difficult airway patient: a case report / 대한마취과학회지

A 28-year-old male patient with occipito-atlanto-axial instability underwent a cervical fusion with posterior technique. Post-operatively, the endotracheal tube (ETT) was removed, and the patient was transferred to the intensive care unit. After transfer, an upper airway obstruction developed and reintubations with a laryngoscope were attempted but failed. We inserted a #4 proseal laryngeal mask airway (LMA) and passed a 5.0 mm ETT through the LMA with the aid of a fiberoptic bronchoscope. We passed a tube exchanger through the 5.0 mm ETT and exchanged it with a 7.5 mm ETT. This method may be a useful alternative for difficult tracheal intubations.

Alloplastic total temporomandibular joint replacement using stock prosthesis: a one-year follow-up report of two cases

Alloplastic total replacement of the temporomandibular joint (TMJ) was developed in recent decades. In some conditions, previous studies suggested the rationale behind alloplastic TMJ replacement rather than reconstruction with autogenous grafts. Currently, three prosthetic products are available and approved by the US Food and Drug Administration. Among these products, customized prostheses are manufactured, via computer aided design/computer aided manufacturing (CAD/CAM) system for customized design; stock-type prostheses are provided in various sizes and shapes. In this report, two patients (a 50-year-old female who had undergone condylectomy for the treatment of osteochondroma extending to the cranial base on the left condyle, and a 21-year-old male diagnosed with left temporomandibular ankylosis) were treated using the alloplastic total replacement of TMJ using stock prosthesis. The follow-up results of a favorable one-year, short-term therapeutic outcome were obtained for the alloplastic total TMJ replacement using a stock-type prosthesis.

Relationship between stress levels and treatment in patients with temporomandibular disorders

OBJECTIVES: Stress may have an impact on treatment types that patients receive for temporomandibular disorders (TMDs). This study sought to investigate the relationship between the stress index and type of treatments in patients with TMD. MATERIALS AND METHODS: The psychosocial well-being index-short form (PWI-SF) was used to evaluate stress levels in ninety-two patients with TMD. Treatment types were classified into two groups: one group received counseling, physical therapy or medication, while the second group received splint therapy or surgical intervention. RESULTS: The high-risk group (PWI-SF> or =27, the higher the points, the more severe the stress level) was more frequently treated by splint therapy than the low-risk group (PWI-SF<27). Female TMD patients reported higher PWI-SF scores than male TMD patients. CONCLUSION: This study suggests a relationship between stress levels and treatment types for patients with TMD. Thus, the appropriate evaluation and management of stress could be an important factor in treating TMD.

Anterior open bite with temporomandibular disorders treated with intermaxillary traction using skeletal anchorage system

OBJECTIVES: The anterior open bite with temporomandibular disorders (TMD) is one of the most challenging cases both orthodontically and surgically. We introduce an intermaxillary traction treatment for patients with anterior open bite and TMD using a skeletal anchorage system (SAS). MATERIALS AND METHODS: This study was comprised of 52 patients with anterior open bite and TMD. A total of four mini-screws were inserted, two screws each into the maxilla and mandible, to obtain a class II pattern of elastic application with 120-200 g force. Adjunctive muscle relaxation treatments, such as splint therapy, medication, and botulinum toxin injection were applied during or before intermaxillary traction. At least one treatment among adjunctive muscle relaxation treatment, mentioned above, was applied to 96.2% of patients. We evaluated the clinical characteristics of patients, TMD symptom changes, amount of open bite improved. The degree of open bite improvement was compared between the open bite-reduced group (21 patients) and not-reduced group (5 patients). RESULTS: TMD symptoms (muscle/joint pain, joint sound, mouth opening) remained or improved in most patients, and worsened in about 10% of patients for each items. Anterior open bite was improved by a mean of 1.75 mm (P<0.01) during treatment. The open bite-reduced group exhibited a significant open bite improvement compared to the not-reduced group (P<0.05), with 37% of open bite improvement occurring during the first 3 months of treatment. CONCLUSION: The intermaxillary traction technique using SAS is a valid modality for correction of anterior open bite and improvement of TMD symptoms.

Analysis of treatment patterns of temporomandibular disorders

INTRODUCTION: This study examined the treatment patterns of temporomandibular disorders (TMD) including conservative and surgical procedures. MATERIALS AND METHODS: Patients with TMD who visited Gangnam Severance Hospital from June 2007 to May 2008 were enrolled in this study. All patients were examined from the orthopantomogram, temporomandibular joint (TMJ) tomography, and a clinical examination. The patients who required a further evaluation were examined by magnetic resonance imaging and/or computed tomography. The treatment patterns were divided into counseling, medication, splint therapy, botulinum toxin injection (BTI) and surgical treatment. RESULTS: Among the 2,464 patients, the average age was 31.8 years (ranging from 6 to 93); 764 (31.0%) were male and 1,700 (69.0%) were female. 2,355 (95.6%) patients were treated with conservative therapy; 1,460 (62.0%) patients were treated with medication, 931 (39.5%) patients were treated with splint, and 46 (2.0%) were treated with BTI. There were 109 (4.4%) patients treated surgically. Eight (0.3%) patients were treated with total temporomandibular joint replacement surgery. CONCLUSION: Almost all patients with TMD were treated using conservative methods. Those patients who received surgical treatment because of an ineffective response to conservative treatment had definite problems with the internal derangement and/or osteoarthritis or had severe clinical symptoms.

Clinical and Radiological Findings of Discogenic Low Back Pain Confirmed by Automated Pressure-Controlled Discography

OBJECTIVE: Few studies on the clinical spectrum of automated pressure-controlled discography (APCD)-defined positive discs have been reported to date. Thus, the present study was undertaken to analyze clinical parameters critical for diagnosis of discogenic pain and to correlate imaging findings with intradiscal pressures and pain responses in patients with APCD-positive discs. METHODS: Twenty-three patients who showed APCD-positive discs were selected for analysis. CT discogram findings and the degrees of nuclear degeneration seen on MRI were analyzed in comparison to changes of intradiscal pressure that provoked pain responses; and clinical pain patterns and dynamic factors were evaluated in relation to pain provocation. RESULTS: Low back pain (LBP), usually centralized, with diffuse leg pain was the most frequently reported pattern of pain in these patients. Overall, LBP was most commonly induced by sitting posture, however, standing was highly correlated with L5/S1 disc lesions (p < 0.01). MRI abnormalities were statistically correlated with grading of CT discogram results (p < 0.05); with most pain response observed in CT discogram Grades 3 and 4. Pain-provoking pressure was not statistically correlated with MRI grading. However, it was higher in Grade 3 than Grade 4. CONCLUSION: APCD-positive discs were demonstrated in patients reporting centralized low back pain with diffuse leg pain, aggravated by sitting and standing. MRI was helpful to assess the degree of nuclear degeneration, yet it could not guarantee exact localization of the painful discs. APCD was considered to be more useful than conventional discography for diagnosis of discogenic pain.

Expression of Estrogen Receptors in Retrodiscal Tissue of the Temporomandibular Joint Disorder Patients

Those composing temporomandibular joint (TMJ) complex such as the temporal bone, the disc and the mandibular condyle perform their own functions with organic relation. The retrodiscal tissue is the main area of pain induction and contributes to compositional change of synovial fluid. If displacement of the disc lasts long time, not only adaptive changes, but also destructive or degenerative changes may happen. It was reported that these changes and symptoms appear mostly to female rather than male and especially, in the case of patients suffering from TMJ disorder, a large quantity of female sex hormone is found in the joint synovium. And that may play a role in bone resorption and inflammation. Also, the frequency and the intensity of pain perception for female is reported to be much more than for male. In this study, we investigated the expression extents of estrogen receptors (ER) and progesteron receptors (PR) in retrodiscal tissue with immunohistochemistry among the patients received TMJ surgery and compared with MRI findings and surgical findings. We report the relations between the expression of ER in retrodiscal tissue and the pathological change in TMJ, such as inflammation, internal derangement and osteoarthritis.

Villonodular Synovitis of the Temporomandibular Joint: A Case Report

Villonodular synovitis, also called pigmented villonodular synovitis, is the benign lesion with the characteristic of locally aggressive proliferation of mononuclear histiocyte and giant cell. Typically it involves single joint, especially about 80% of disease occurs in the knee joint. Villonodular synovitis of the temporomandibular joint is very rare disease. Differential diagnosis includes synovial chondromatosis and tumors of the temporomandibular joint. Optimal treatment consists of complete excision of the mass and removal of the synovium including adjacent affected bony structures. This is a case report of villonodular synovitis developed in the temporomandibular joint.

Inflammatory synovial cyst of the temporomandibular joint: A case report

A Case of Removal of Esophageal Foreign Body Causing Esophageal Submucosal Hematoma / 대한이비인후과학회지

Foreign bodies in upper digestive tract are one of frequently encountered accidental cases in otolaryngologic fields. Esophageal hematoma have been reported in association with impaired hemostasis, emetogenic, food-related injury, and spontaneous disorder. Submucosal hematoma of the esophagus caused by food-related traumatic injury is a rare entity. A study has reported that various foods, such as fish bones, hot noodles, steak, spice, and hard confections cause esophageal injury, resulting in esophageal submucosal hematoma. Hematoma occurs within the submucosal plane of the esophagus, causing dissection of mucosa from its underlying muscle, resulting in extramucosal narrowing of the esophageal lumen. Its prognosis is good, and improvement is achieved by conservative treatment. We experienced an uncommon esophageal submucosal hematoma caused by an esophageal fish bone. Therefore, we report this case with a review of literature.

A radiographic study of changes of upper respiratory airway space after orthognathic surgery of both jaws in patients with skeletal class III malocclusion

The Study of Distribution and Expression of Water Channel Proteins(Aquaporins) in the Rat Eustachian Tube / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The mucosal epithelium of middle ear and eustachian tube needs hydration to maintain proper amount of moisture. Recent discoveries of various types of water channel proteins (aquaporins ; AQPs) in mucous epithelium suggest that they play critical roles in the regional regulation of water balance. The purpose of this study is to assess the distribution and expression of different subtypes of AQPs in the rat eustachian tube. SUBJECTS AND METHOD: We analyzed the distribution and expression of AQP1, 2, 4, 5, and 7 using RT-PCR, Western blot, and immunohistochemistry study in the rat middle ear and eustachian tube samples. RESULTS: The expression of the mRNA of AQP1, 4, and 5 were observed in the rat eustachian tube and middle ear. The bands of AQP1, 4, and 5 were detected at 28 kDa, 31 kDa, and 26 kDa proteins in the Western blot analysis, respectively. The immunohistochemical analysis demonstrated that AQP1 was expressed in fibroblasts at subepithelial portions of the rat eustachian tube and that AQP4 was observed at the basolateral membrane of the ciliated epithelial cells. The distribution of AQP5 in rat eustachian tube was limited to the apical surface of serous gland cells, but all of the epithelial goblet cells were labeled negative. CONCLUSION: We demonstrated that there are various subtypes of AQP in rat eustachian tube and that they existed at specific cells and sites. This study may be a preliminary study to determine the possibility of relationship between AQP expression and AQP-related disease in the middle ear and eustachian tube.

The cephalometric analysis of the soft tissue changes at the middle face in the skeletal class III patients with the orthognathic 2-jaw surgery

A Case of Angiofibroma Arising from the Middle Turbinate of an Adult Woman / 대한이비인후과학회지

Juvenile nasopharyngeal angiofibroma accounts for less than 0.5% of head and neck tumors. It primarily affects male adolescents, and originates in the posterolateral wall of the nasopharynx. Although angiofibromas extend beyond the nasopharynx commonly, they rarely originate outside the nasopharynx. Primary extranasopharyngeal angiofibromas have been sporadically reported in the literature. We report an unusual case of an angiofibroma arising from the middle turbinate. The tumor was completely removed through endonasal, endoscopic technique after pre-operative embolization.

Treatment of Allergic Rhinitis Using Bipolar Radiofrequency-Assisted Partial Turbinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The ideal treatment for allergic rhinitis that is refractory to medical therapy is still lacking. Recently, radiofrequency-assisted partial turbinoplasty (RFAPT) has been introduced as a new treatment modality for reduction of inferior turbinate volume. The aim of the study is to evaluate the efficacy of RFAPT for the treatment of allergic rhinitis that is unresponsive to medical therapy and compare the postoperative outcome of RFAPT with that of Laser-assisted partial turbinoplasty (LAPT). SUBJECTS AND METHOD: Forty-eight patients with nasal obstruction due to allergic rhinitis which is refractory to medical therapy were prospectively evaluated with a follow-up period of 3 months. Twenty patients (40 sides) were treated with RFAPT, and 28 patients (56 sides) with LAPT. The the degree of postoperative changes in nasal obstruction, rhinorrhea, itchy nose, sneezing, operation time, operation-associated pain, intraoperative bleeding, duration of crust formation was compared between the two surgical methods. RESULT: There were no significant differences in the improvement of allergic symptoms and intraoperative bleeding between the two groups. Operative time was less in the RFAPT group and crust was formed for a shorter postoperative period. Operation-associated pain was less in the LAPT group. CONCLUSION: The study demonstrates that RFAPT appears to be effective for treating allergic rhinitis whihc demonstrates poor response to medical therapy.

A giant sialolith in a wharton's duct: A case report

Osteochondroma of the mandibular condyle: a case report

Relationship between digital infrared thermographic imaging findings and status of the joint on magnetic resonance imaging in temporomandibular disorders

A case report: Osteomyelitis of the maxilla in a patient with osteopetrosis

Microencapsulated Bovine Adrenal Medullary Chromaffin Cells Transplanted into Rat Spinal Cord Alleviated Cold Allodynia / 대한마취과학회지

BACKGROUND: The intrathecal grafting of adrenal chromaffin cells as a potential analgesic source, to delivery analgesic substances such as catecholamines and opioid peptides, is known to be effective at treating acute and chronic pain in several animal pain models. We tested whether the intrathecal implantation of encapsulated bovine chromaffin cells reduces cold allodynia in a rat model of neuropathic pain induced by chronic constriction injury of the sciatic nerve. METHODS: Bovine adrenal medullary chromaffin cells microencapsulated in sodium alginate-poly-l-lysin-alginate (APA) were implanted into the subarachnoid space of rats (n = 10) and foot cold sensitivity was investigated using an acetone test. At the end of the study, histology and capsule catecholamine production were evaluated. RESULTS: A significant reduction in cold allodynia was observed in animals implanted with chromaffin cells. In addition, the suppression of cold allodynia was reversed by naloxone. Abundant clusters of viable chromaffin cells stained with neutral red, were observed in the retrieved implants and after nicotine stimulation, and catecholamine was quantified. An ultrastructural study showed no fibrotic reaction against capsules, or disorganised capsules. CONCLUSIONS: These results suggest that intrathecal encapsulated chromaffin cells act as "mini pumps", which continuously deliver analgesic substances and produce analgesia in this chronic pain model of nerve injury-without immunosuppressant.