Sialendoscopy: Endoscopic Diagnosis and Treatment of the Salivary Gland Disease / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Obstructive lesion of salivary glands by salivary duct calculi and stenosis is the main inflammatory disease of major salivary glands. Recently, the sialendoscopy has been introduced for the diagnosis and intervention of salivary ductal disease. The purpose of this study is to assess the efficacy of the sialendoscopy for the treatment of inflammatory salivary gland diseases. SUBJECTS AND METHOD: Diagnostic and interventional sialendoscopy were performed in 19 patients (7 parotid glands, 12 submandibular glands), who had salivary duct calculi or recurrent sialadenitis without calculi from 2003 Sep. to 2004 Jun. Diagnostic sialendoscopy was performed for obstructive lesions and evaluation of ductal status. Interventional sialendoscopy was performed for the removal of salivary duct calculi and dilatation of duct stenosis in cases with calculi and stenosis. RESULTS: Diagnostic sialendoscopy was performed in all cases successfully. Sixteen glands had obstructive lesions and 3 glands had sialadenitis with no evidence of obstruction. Only one case with salivary duct calculi was failed. The remaining 10 calculi were removed with microforceps and basket with or without laser fragmentation. The average size of sialoliths was 5.2 mm and multiple stones were found in 2 cases. Five cases with stenosis of parotid and submandibular gland duct were dilated with balloon catheter or endoscopy sheath successfully. In the remaining 3 glands with no obstruction, the finding of ductal inflammation was identified. No major complications were noted. CONCLUSIONS: Diagnostic sialendoscopy is a new and minimal invasive technique for complete exploration of ductal system and evaluating salivary duct disease. Interventional sialendoscopy allows the extraction of salivary duct calculi in most cases and the dilatation of stenotic duct. This technique might be useful in preventing open gland surgery in well indicated cases.

Video-assisted Endoscopic Thyroidectomy with Cervical Approach / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Endoscopic approach to the neck is more widely used since it was first reported by M.Gagner in 1996, because of its low invasiveness and better cosmetic result. In this article, we introduce a surgical technique of video-assisted endoscopic thyroidectomy via cervical approach and assess its efficacy for patients with thyroid nodule. SUBJECTS AND METHOD: Eleven patients hospitalized in our department from May to September 2004, underwent video-assisted thyroidectomy with cervical approach. The subjects were 9 women and 2 men with ages ranging from 23 to 62 year old (mean 40.9 years). Inclusion criteria for the subjects were having benign solitary tumor that is less than 30 mm in longitudinal diameter, low risk micropapillary carcinoma that is less than 1 cm, confined to one lobe, within the thyroid gland, and without lymph node swelling on ultrasonography or computed tomography, and follicular neoplasm that is without evidence of any malignancy or with suspicious and indeterminate cytology among patients with no prior neck surgery or previous radiotherapy. Most patients (82%) had thyroid mass less than 2 cm. Nodular hyperplasia was 7 cases and papillary carcinoma was 4 cases. RESULTS: Hemithyroidectomy with or without isthmusectomy was performed in 10 patients. Video-assisted thyroidectomy was converted into conventional thyroidectomy in only one case because of the uncontrolled intraoperative superior thyroid artery bleeding and large thyroid volume. The operation time was 80+/-12 minutes. Temporary recurrent laryngeal nerve palsy occurred in one case. The average postoperative hospital stay was 5.0+/-1.8 days. Operative scars were small and most patients were satisfied with the cosmetic result. CONCLUSION: We conclude that the video-assisted endoscopic thyroidectomy with cervical approach is feasible, practical, and has safe procedures, and has greater cosmetic benefits than the conventional one. We hope that video-assisted thyroidectomy will become another surgical option for small nodular thyroid diseases.

Endoscopic Repair of Meningoencephalocele: A Case Report

Meningoencephalocele is a rare mass, usually occurring in childhood. This is the herniation of a part of an intracranial component through the skull base defect. Embryologically, the defect result from closure failure of the anterior neuropore. This mass may include meninges (meningocele), meninges and brain (meningoencephalocele), or meninges, brain, and ventricles (meningoencephalocystocele). It is classified as occipital, parietal, basal, and sincipital on the basis of its anatomical location. In past, the treatment of this mass has been by neurosurgeons. The authors experienced a case of basal type intranasal meningoencephalocele in 15 year-old male patient in which the mass protruded into the nasal cavity through the cribriform plate. It was excised successfully by the intranasal approach with nasal endoscopy, and the dural defect was closed by septal cartilage, fascia lata, septal mucosa, and fibrin glue.

CT Finding of Tuberculous Cervical Lymphadenitis and Management / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are controversies in the management of tuberculous cervical lymphadenitis in spite of high prevalence. This study was performed to investigate clinical findings of the patients indicated for surgery and to analyze clinical efficacies of surgery and antituberculous chemotherapy. Materials and METHODS: Fourty patients who had been pathologically confirmed to have cervical tuberculous lymphadenitis were analyzed retrospectively. We classified them into 4 groups according to CT findings and checked their clinical and laborotary findings, as well as efficacies of treatment used. RESULTS: The Type 4 was the most common. All patients were treated with antituberculous medication. In Type 1 and 2, 11 patients among 13 patients were treated with antituberculous medication alone, whereas in Type 3 and 4, 21 patients among 27 patients were treated with the combined method of surgery and antituberculous medication. Most complicated cases were Type 3 and 4, where two cases had recurrence, but most of the cases had local wound problems. All of these complicated cases had recovered to nearly normal state. Two recurrent cases were treated with the combined methods completely. CONCLUSION: For cases that fall into type 1 and 2 tuberculous cervical lymphadenopathys, Antituberculous medication can serve as the first line of treatment. For cases that fall into type 3 and 4 tuberculous cervical lymphadenopathy, the combined method of surgery and antituberculous medication can be the first choice of treatment. For the initial treatment of type 3, 4, applying antituberculous medication for a period of 1-2 months before surgical intervention would be a more effective treatment.

A Case of Aspergillus Epidural Abscess in Middle Cranial Fossa / 대한이비인후과학회지

Aspergillosis of the central nerve system is a rare disease, and intracranial fungal epidural abscess has not previously been described. We had been referred a 63-year old man who had 4 months history of hearing difficulty on his left ear and 3 months history of headache. Effusion of left middle ear was identified by otoscopy and tympanocentesis. Temporal bone CT showed soft tissue densities in middle ear, mastoid antrum and air cells with normal bony contours. T1 and T2-weigted MRI showed low signal intensity and peripheral rim enhancement after administration of gadolinium. Drainage of abscess through transmastoid approach was performed. Biopsy specimen showed septated fungal hyphae with Grocott's methanamine silver (GMS) and Periodic acid-schiff (PAS) stains. The authors hereby report a case of aspergillus epidural abscess of the middle cranial fossa.

Expression of Cathelin-Related Antimicrobial Peptide in the Eustachian Tube Epithelium of Mouse / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Antimicrobial peptides and proteins play an important role in innate host defense, and this may be particularly important at mucosal surfaces that form the initial barrier between the host and the external environment. Epithelial cells are the first line of defense mechanism against microorganisms, where antimicrobial peptides are the major participants. Cathelicidins are the precursors of potent antimicrobial peptides that have been identified in several mammalian species. Cathelin-related antimicrobial peptide (CRAMP) is one of the antimicrobial peptides and is the only member of cathelicidin family identified so far in mouse. The present study was undertaken to investigate the expression of CRAMP in the eustachian tube epithelium of mouse. MATERIALS AND METHOD: Tissue samples from the mouse eustachian tube were recovered from its pharyngeal, middle, and distal segments. CRAMP was localized by immunohistochemical staining and mRNA expression was determined by reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: By immunohistochemical study, CRAMP was detected in epithelial cells and submucosal glands of the eustachian tube, but not in the negative control. Using RT-PCR, CRAMP mRNA was detected in the eustachian tube epithelium. CONCLUSION: The expression and localization of CRAMP in the epithelial cells and submucosal glands of the eustachian tube of mouse were defined. We found that CRAMP is one of the antimicrobial peptides found in the eustachian tube epithelium of mouse, and that it participates in the innate immune system of the eustachian tube.

Multiple Nonfunctioning Parathyroid Carcinoma Secondary to Chronic Renal Failure / 대한이비인후과학회지

Parathyroid carcinoma is a rare entity accounting for only 0.5% to 5% of all cases of parathyroid neoplasm. Most of these malignancies present themselves as functional hormone-producing masses with elevated serum levels of parathormone and calcium. These tumors may also be nonfunctional, which is even rarer. Clinical detection of nonfunctioning parathyroid carcinoma prior to operation is primarily based on symptoms of an expanding neck mass and voice change. These condition may allow it to escape clinical attention until it has achieved an advanced state. So, the prognosis is relatively too bad. Most of these tumors often arise from preexisting parathyroid hyperplasia or adenoma. En bloc resection of primary lesion, ipsilateral thyroid lobe and isthmus together with a neck dissection only in case of lymph node involvement is recommended as the standard treatment. In this paper, we will introduce a case report of a bilateral nonfunctioning parathyroid carcinoma secondary to chronic renal failure.

Anthropometric Growth Study of the Auricle in Korean / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Knowledge of the postnatal growth of ear is decisive in determining the optimal time for ear reconstruction and planning the morphology of an artificial ear. However, basic population studies have not been carried out in Korea and the dynamics of ear growth and the age of maturation have not been clearly determined and established. The aim of this study was to establish the age of ear maturation and to help determine the optimal time of ear reconstruction for Koreans. SUBJECTS AND METHOD: From June 2000 through February 2001, we measured facial length and the 3 lengths of the auricle, i.e., length, width, the distance between the two insertion points of the auricle and facial length in 950 Korean subjects between the ages of 0 to 18. RESULTS: The auricle length reached 90% of its mature size at 14 years and width at 15 years. The distance between the two insertion points of the auricle was not significantly different in this study. CONCLUSION: The length and width of auricle reached 90% of the adult size at the age of 14 and 15, respectively. Therefore, when performing auriculoplasty, consideration should be given for auricle growth up to the age of 15 years.

Dual Ectopic Thyroid: A Case Report / 대한이비인후과학회지

Ectopic thyroid is an uncommon embryological aberration characterized by the presence of thyroid tissue in a site other than in its usual pretracheal region. It occurs along the path of descent of the developing thyroid primodium from the foramen cecum. It most commonly presents as a lingual thyroid, and is the only thyroid in 70% of all cases. It is extremely rare for two ectopic foci of thyroid tissue to present simultaneously. The authors report a recent case of dual ectopic thyroid present in the lingual and infrahyoid area with no thyroid tissue in the pretracheal area in a 15 year-old girl. The presence of dual ectopic thyroid tissue was confirmed by CT and scintigram with 99 mTc. The patient had originally been scheduled for surgery under the impression of a thyroglossal duct cyst, but the pre-operative neck CT and thyroid scans revealed the presence of a dual ectopic thyroid, thus preventing unnecessary surgery. Therefore, ultrasound scans or a neck CT's and thyroid scans should be performed routinely to confirm the presence of thyroid in the normal position and avoid unnecessary surgeries.

Dentigerous Cyst Involving the Maxillary Sinus

BACKGROUND AND OBJECTIVES: Dentigerous cysts arise from the reduced enamel epithelium and expand into the surrounding bone. They grow unnoticed to such extensive sizes as to occupy a considerable portion of the maxillary sinus. This study was designed to clarify the clinical, radiological and histopathological features of ten cases of the dentigerous cyst involving the maxillary sinus. MATERIALS AND METHODS: Medical records of ten patients, who were diagnosed with dentigerous cyst, were analyzed from June 1990 to May 2000 retrospectively. RESULTS: The greatest incidence of dentigerous cyst occurred between the ages of 10 and 30 years old (average age 29.6 years). Facial swelling and pain were the most common com-plaints, followed by oro-antral fistula, headache and facial numbness. CT scan of paranasal sinuses showed a slightly nonhomogeneous soft tissue density surrounded by an incomplete bony wall which occupied partially antral space. In the middle of the cyst, the isolated high density of unerupted tooth was seen. In the lining epithelium, the stratified squamous epitheliums were the most frequent. Six patients underwent cyst removal via Caldwell-Luc approach and four patients underwent cyst removal via intraoral approach. The postoperative course has been gone well without recurrence. CONCLUSIONS: The differential diagnosis and early detection of the dentigerous cyst in involving maxillary sinus are important. Rhinologist should be aware of this disease entity when encountered with patients presented with unilateral painful swelling of cheek.

Dentigerous Cyst Involving the Maxillary Sinus

BACKGROUND AND OBJECTIVES: Dentigerous cysts arise from the reduced enamel epithelium and expand into the surrounding bone. They grow unnoticed to such extensive sizes as to occupy a considerable portion of the maxillary sinus. This study was designed to clarify the clinical, radiological and histopathological features of ten cases of the dentigerous cyst involving the maxillary sinus. MATERIALS AND METHODS: Medical records of ten patients, who were diagnosed with dentigerous cyst, were analyzed from June 1990 to May 2000 retrospectively. RESULTS: The greatest incidence of dentigerous cyst occurred between the ages of 10 and 30 years old (average age 29.6 years). Facial swelling and pain were the most common com-plaints, followed by oro-antral fistula, headache and facial numbness. CT scan of paranasal sinuses showed a slightly nonhomogeneous soft tissue density surrounded by an incomplete bony wall which occupied partially antral space. In the middle of the cyst, the isolated high density of unerupted tooth was seen. In the lining epithelium, the stratified squamous epitheliums were the most frequent. Six patients underwent cyst removal via Caldwell-Luc approach and four patients underwent cyst removal via intraoral approach. The postoperative course has been gone well without recurrence. CONCLUSIONS: The differential diagnosis and early detection of the dentigerous cyst in involving maxillary sinus are important. Rhinologist should be aware of this disease entity when encountered with patients presented with unilateral painful swelling of cheek.

Nasal Septal Perforation due to Button Battery

A button battery in the nose of children is an unusual foreign body, which can cause liquefaction necrosis with subsequent severe local tissue destruction. All button batteries as foreign bodies in the nasal cavity should be removed immediately to prevent severe local tissue damage, resulting in late sequelae, such as septal perforation or stenosis of the nasal meatus. We present two cases of nasal septal perforation followed by button battery foreign body and discuss the special aspects of this foreign body.

Nasal Septal Perforation due to Button Battery

A button battery in the nose of children is an unusual foreign body, which can cause liquefaction necrosis with subsequent severe local tissue destruction. All button batteries as foreign bodies in the nasal cavity should be removed immediately to prevent severe local tissue damage, resulting in late sequelae, such as septal perforation or stenosis of the nasal meatus. We present two cases of nasal septal perforation followed by button battery foreign body and discuss the special aspects of this foreign body.

Clinical Experience of Chronic Recurrent Parotitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic recurrent parotitis has been considered as an ascending infection from the oral cavity, but its causes remain unknown. Although conservative mechanical and medical measures are usually effective in controlling the acute exacerbations of this disease, surgical treatment may become necessary when the infection become too frequent or severe for episodic treatment. This study was designed to evaluate the etiology and pathology, and to analyse the outcome of surgery. MATERIALS AND METHODS: A retrospective study was conducted on nine patients who were managed by surgery(seven patients: superficial parotidectomy, two patients: total parotidectomy) after failure with all conservative measures. The age distribution was from 25 to 72 years, with the mean of 44 years. RESULTS: Of nine patients, the numbers of recurrence were 1-5 times (with the average of three times). Duration of illness ranged from one to 42 years, with a mean of 12 years. Conservative treatments preceding surgery included parotid gland massage, sialogogues, repeated use of antibiotics, and Stensens duct probing in all patients. The disease persisted in all the patients despite these measures, but following parotidectomy (superficial: 7 patients, total: 2 patients), all had complete resolution of the disease. Two patients developed transient facial weakness (House-Brackmann grade II) postoperatively without permanent sequelae. Other complications included seroma in two patients, facial deformity in two patients, Freys' syndrome in one patient, and salivary fistula in one patient. CONCLUSION: Chronic recurrent parotitis, when deeply severe, causes significant. When all the conservative medical management fail, parotidectomy can be offered as the last resolution.

Expression of Human b-Defensin-1 mRNA in Human Nasal Mucosa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES:Antimicrobial peptides are cationic proteins that are found in a wide range of organisms. Recent reports suggest that human beta-defensin-1 (hBD-1), a prominent group of antimicrobial peptides, is an important component of the innate immune response, particularly at mucosal surfaces that are vulnerable to colonization by potential pathogens. Therefore, hBD-1 may participate in providing intrinsic nasal mucosal defense against microbial infections. The present study aimed to look for hBD-1 mRNA in apparently normal human nasal mucosa. MATERIALS AND METHODS: The expression of hBD-1 mRNA was investigated in the inferior turbinate tissues using reverse transcription-polymerase chain reaction (RT-PCR) and in situ hybridization. RESULTS: The expression of hBD-1 mRNA was detected in these tissues. By in situ hybridization, hBD-1 mRNA was predominantly localized in superficial epithelial cells and submucosal glandular epithelium. CONCLUSION: These data suggest that nasal epithelia and submucosal glands may secrete hBD-1 and thus contribute to the mucosal defense of the nose.