Auditory Functional MRI Findings in Patients with Unilateral Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Auditory pathway is a unique sensory system in that its ascending pathway has both contralateral and ipsilateral projection to auditory cortex. It has been known that monaural auditory stimulation with auditory functional MRI (fMRI) in normal hearing subject produces bilateral auditory cortical activation, slightly lateralized to opposite side. Our goal was to assess the pattern of auditory cortical activation in patients with unilateral sensory neural hearing loss. SUBJECTS AND METHOD: Auditory fMRI studies using a single-shot gradient-recalled echo-planar imaging (EPI) sequence were performed in eight normal volunteers, thirteen patients with unilateral hearing loss of acute onset (AO, 3 months). A box-car design of 1, 000-Hz sine tone stimuli was given to right or left ear of normal volunteer and to healthy ears of patients. The data were analyzed by BOLD Analysis package. The lateralization index (LI) between contralateral and ipsilateral hemispheric activation were obtained by calculating and comparing the number of activated pixels in each auditory hemisphere. RESULTS: In normal volunteers, the LI was 2.9-5.2 for monaural stimuli suggesting contralateralization of auditory cortex to monaural stimuli. The LI was increased for the AO (8.1-19.2) and decreased for the LD (0.8-1.2). CONCLUSION: The auditory cortical activation in patients with unilateral sensory neural hearing loss showed different pattern according to the duration of hearing loss. The present results might suggest the time course of neuronal plasticity of auditory cortex after deterioration of input function of auditory ascending pathway.

Expression of MUC5AC mRNA in the Goblet Cells of Human Nasal Mucosa / 대한이비인후과학회지

BACKGROUNDS AND OBJECTIVES: Mucus hypersecretion is a common feature in chronic sinusitis with polyps. Since mucus hypersecretion is commonly accompanied by goblet cell hyperplasia, it is important to identify which mucin gene mRNAs are expressed in the goblet cells of the surface epithelium in the human airway. This study aims to investigate the pattern of expression of MUC5AC mRNA in the goblet cells of human nasal mucosa. MATERIALS AND METHODS: Six nasal polyps, five inferior turbinate mucosa specimens, and three normal-appearing mucosa specimens of the posterior ethmoid sinus were obtained. Each of the specimens were cut into 10 micromiter thick serial frozen sections and in situ hybridization of MUC5AC mRNA was performed with an oligonucleotide probe. Alcian blue(pH 2.5)-periodic acid-Schiff staining was performed on the serial sections. RESULTS: In human nasal polyps, MUC5AC mRNA was expressed in the cytoplasm of most of the goblet cells. However, in the inferior turbinate, MUC5AC mRNA was expressed in only some of the goblet cells. On the contrary, in the normal appearing mucosa of the posterior ethmoid sinus, MUC5AC mRNA was barely expressed in the goblet cells. Furthermore, MUC5AC mRNA was mainly expressed in some of the PAS-positive goblet cells. CONCLUSION: Only a portion of the goblet cells in the human nasal mucosa expressed MUC5AC mRNA. This result suggests that surface goblet cells might have other mucin genes in addition to MUC2 and MUC5AC.

True island pectoralis major myocutaneous flap: its advantages / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pectoralis major myocutaneous flap(PMMCF) is a workhorse flap of head and neck reconstruction and it has four types depending on its nature of vascular pedicle. True island type PMMCF has many advantages over conventional muscular type, but reports on this type of flap and its advantages are lacking. Material and METHOD: Fifty two PMMCF(50 patients) used for head and neck reconstruction between 1992 and 1998 were reviewed retrospectively. There were 16 muscular type and 36 true island type PMMCF. We compared the incidence of complication between two groups. RESULT: Six marginal necrosis(less than 20%) and 1 major necrosis(more than 50%) developed in 16 muscular type PMMCF. However in 36 true island type PMMCF, 1 marginal necrosis and 2 major necrosis developed. CONCLUSION: True island type PMMCF has the following advantages over muscular type. 1. True island type has 3-4 cm gain in length. 2. Flap could be harvested at more cephalic portion of the chest. 3. Unwanted tension of the flap could be avoided. 4. Vascular pedicle is not compressed between skin and clavicle. 5. The rotation of vascular pedicle is natural without kinking. 6. Ugly bulge over clavicle is absent postoperatively. 7. This type could be used regardless of types of neck dissection.

Management of Osteoradionecrosis of the Mandible in Patients with Oral and Oropharyngeal Cancers / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Osteoradionecrosis (ORN) of the mandible is one of the most serious complications following radiotherapy for oral and oropharyngeal cancer. However, the predisposing factors and clinical course of ORN are variable and its proper management is currently undetermined. The objective of this study is to review our ORN cases and evaluate the treatment methods. PATIENTS AND METHODS: We retrospectively reviewed 57 cases of oral and oropharyngeal cancers, where patients received combined surgery and radiotherapy from 1990 to 1998. Osteoradionecrosis occurred in 5 cases, and we evaluated the predisposing factors, clinical course and results of treatments. Four patients were treated with radical sequestrectomy and open reduction of mandible. Of these four patients, three received the combined treatment with hyperbaric oxygen (HBO) therapy, and one received the conservative treatment. RESULTS: Four ORN cases occurred at the lateral mandibulotomy site and one case arose at the opposite mandibular body unrelated to osteotomy. The interval between ORN and radiotherapy was so variable as 3 to 140 months. Four patients were successfully treated with the combined surgical and HBO therapies (3 cases) or with the conservative treatment (1 case). The remaining case could not be controlled by surgical treatment without HBO. CONCLUSION: Osteoradionecrosis usually occurred at lateral mandibulotomy sites, especially combined with sagittal partial mandibulectomies. We recommend that lateral mandibulotomies should, whenever possible, be avoided if the radiotherapy is planned postoperatively. And the patients who received radiotherapy at the mandible should be observed for osteoradionecrosis for long time. Our treatment results suggest that a combined surgery with HBO therapy can be a primary treatment modality for ORN.

Clinical Characteristics of Primary Paranasal Sinus Mucoceles and Their Surgical Treatment Outcome / 대한이비인후과학회지

BACKGROUND AND OBJECTIVE: Paranasal sinus mucocele is a slowly expanding benign lesion which can occur as a result of trauma, spontaneous obstruction of sinus ostium or ostial tract. Since it may destruct the adjacent bony structures by pressure, early diagnosis and proper treatment are necessary. This study aims to analyze the clinical characteristics of primary paranasal sinus mucoceles, and to compare the treatment results of external and transnasal approaches based on the rates of complications and recurrences. MATERIALS AND METHODS: Thirty one cases of primary paranasal sinus mucocele diagnosed at Severance Hospital from January 1988 to September 1997 were retrospectively reviewed. RESULTS: Twenty one cases were approached transnasally, 7 cases by external approach and 3 cases by sublabial approach. The most common site of origin was ethmoid sinus and proptosis was the most common presenting feature. Among the mucoceles of frontal and frontoethmoid sinuses, there was no difference in the rates of recurrences or complications between the two different approach methods. CONCLUSION: Primary paranasal sinus mucocele occurs most commonly in the ethmoid sinus, and the endonasal approach is considered to be effective for the initial treatment of primary paranasal sinus mucoceles.

Effects of Preoperative Midazolam and Ketorolac Tromethamin Treatment in Septoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was to investigate the effect of preoperative administration of midazolam and ketorolac for postoperative pain and antegrade amnesia in septoplasty under local anesthesia. MATERIALS AND METHODS: We studied 40 patients who underwent septoplasty under local anesthesia. The patients were divided into four groups, each consisting 10 patients (N=40). The groups received different treatment, with the first group receiving ketorolac, the second group ketorolac and diazepam, and the third group ketorolac and midazolam. The fourth group received midazolam only. Postoperative pain was evaluated according to Verbal Rating Pain Scores (VRP), and Visual Analogue Pain Scores (VAS) at 2, 4, 6, 12, 24 and 48 hours after operation. Antegrade amnesia was evaluated also. RESULTS: Postoperative pain was decreased at 6, 12, 24 hours in the third and fourth group. Antegrade amnesia was noted in the third and fourth group. The third group showed strong antegrade amnesia. CONCLUSION: Preoperative administration of ketorolac and midazolam were effective for postoperative pain and antegrade amnesia in septoplasty.