Surgical Treatment of Parathyroid Adenoma 4 Cases / 대한이비인후과학회지

Parathyroid adenoma is an uncommon disease in Korea. However, the frequency of this disease has slowly increased with routine measurement of serum calcium and increasing awareness by the public of hyperparathyroidism in recent years. We have experienced 4 cases of parathyroid adenoma during recent months and analyzed the cases to evaluate clinical characteristics and outcome of surgical treatment retrospectively. Four cases were diagnosed by persistent elevation of serum calcium and parathyroid hormone. They presented asymptomic clinical symptoms, osteoporosis/ osteodeficiency, or renal stone, gastrointestinal disturbance or neck mass. Parathyroid lesions were detected preoperatively by ultrasonography, thyroid scanning or neck computerized tomographic imaging in three of them. The tumor locations were left lower in two cases and right lower in two cases. All patients received proper surgical management and their histopathologic findings disclosed adenoma in all cases. These results would be a useful guideline for better diagnostic strategies, proper surgical management and follow-up study for recurrence in the primary hyperparathyroidism.

Surgical Morbidity of Intraoral Removal of the Submandibular Gland / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: For surgery of chronically inflamed submandibular gland, most head and neck surgeons carry out skin incision on the neck, but several clinical problems after surgery has been mentioned. An intraoral approach as an alternative to the standard transcervical approach has been reported. To evaluate a postoperative morbidity in the intraoral approach for excision of submandibular gland. SUBJECTS AND METHODS: A total of 62 surgery cases for chronic submandibular sialoadenitis with or without stone, including those resulting from benign tumor of submandibular gland, were carried out via intraoral approach during a 3-year period. RESULTS: Most patients (85.5%) had sialoadenitis with or without stone. Early postoperative complications developed in 87.1% of the temporary lingual sensory paresis, followed by temporary limitation of tongue movement in 67.7% and 2 cases of postoperative bleeding and 1 case of abscess formation. The tongue paresis resolved spontaneously in all patients in a mean period of 3-4 weeks, whereas late complications developed in 3 cases of residual salivary gland and abnormal sense of mouth floor and one case of gustatory sweating syndrome. No residual inflammation in Wharton's duct was noted. Neurological complications of hypoglossal and marginal mandibular nerves were not observed at all. CONCLUSION: The major advantages of this approach are no external scar, no injury to the marginal mandibular nerve or to the hypoglossal nerve, and no residual Whartons duct inflammation. The disadvantage is a more difficult dissection to transcervical approach before proper expert due to narrow surgical field, especially in the severe adhesion of salivary gland to surrounding tissue. However, with experience, the intraoral dissection of submandibular gland should be easier.

A Case of High Jugular Bulb Associated with Conductive Hearing Loss / 대한이비인후과학회지

A high jugular bulb is often discovered as an incidental finding that is asymptomatic. The incidence of high jugular bulb protruding into the level of oval window is rare. Conductive hearing loss in association with this anomaly may occur, but has been reported infrequently in the literature. We report one case of high jugular bulb and the associated conductive hearing loss. Mechanisms to explain the conductive hearing loss include contact of the jugular bulb with tympanic membrane, interference with the ossicular chain, and obstruction of the round and oval window niche. The operative findings, radiographic and audiometric data that support these mechanisms of couductive hearing loss are presented.