Association of the Prognosis and the Facial Nerve Enhancement in Gadolinium Enhanced MRI in Patients with Bell's Palsy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aimed to investigate the association of prognosis and facial nerve signal intensity in enhanced magnetic resonance imaging (MRI) in patients with Bell's palsy. SUBJECTS AND METHOD: Patients who visited hospital for Bell's palsy from January of 2015 to June of 2016 were included in this study. A total of 30 patients were gathered and their facial palsy grades were evaluated with the House-Brackmann grade system on the initial visit and at six months after the first visit. In T1-weighted MRI, we measured the signal intensity of the region of interest (ROI), or the most-highly-enhanced portion of the affected facial nerve and the corresponding portion of the contralateral side. We calculated the ratio of ROI of the affected side to the contralateral side, and investigated the correlation between the ratio and the degree of improvement in facial palsy. RESULTS: The most frequent ROI of the affected facial nerve was labyrinthine segment. There was no significant correlation between the ROI ratio and initial H-B grade, or the degree of improvement in facial palsy. CONCLUSION: This study corresponds with the previous studies that indicated that the degree of the gadolinium enhancement of facial nerve in T1-weighted MRI is not related to the prognosis or the severity of the Bell's palsy.

Microcystic Adnexal Carcinoma Misdiagnosed as Desmoplastic Trichoepithelioma on Preoperative Biopsy

Microcystic adnexal carcinoma is a rare type of tumor, with about 300 cases reported globally. Due to its similar histology with other tumors, it is occasionally misdiagnosed as desmoplastic trichoepithelioma, basal cell carcinoma, syringoma, and so on. We present a patient with a mass on the perioral area who was preoperatively diagnosed with trichoepithelioma. Microcystic adnexal carcinoma was diagnosed after excisional biopsy and a wide excision. Defects were reconstructed with a mucosal advancement flap. There was no recurrence and there were no significant complications during the 18-month follow-up period. Because superficial punch biopsy has limitations in width and depth, surgeons should always consider the possibility of malignancy of a mass even if a biopsy shows a benign result.

Multiple Osteomas in the Skull Vault: Case Report

PURPOSE: Osteoma is one of the common benign tumors of the skull vault and facial skeleton. Although most of the osteomas cause no symptoms, forehead osteomas may lead to facial disfigurement. Osteoma usually happens in solitary lesion and multiple osteomas which don't combine with syndrome are very rare. We report an experience of treatment of non-syndromic multiple osteomas in the skull. METHODS: A 54-year-old female patient visited due to the multiple palpable hard masses on her forehead in 2010. In 2002 of her first visit, masses started to appear on her forehead and she was diagnosed as the osteoma by excisional biopsy. She visited again because the mass size and number increased. In preoperative CT scanning, there were above 160 of osteomas, so surgery was planned. Enterogastroduodenoscopy and colonoscopy was conducted to rule out Gardener's syndrome, however there was no abnormality such as multiple polyposis. RESULTS: Under general anesthesia, coronal approach was conducted. There were numerous osteomas in frontal and parietal bone. The multiple osteomas were removed by burring and the patient recovered without any postoperative complications. CONCLUSION: Multiple osteomas in the skull were rarely reported, although it can accompanied with Gardener's syndrome. We report a case of non-syndromic multiple osteomas in skull vault.

Nontuberculous Mycobacterial Infection after Breast Reconstruction with an Implant: A Case Report

PURPOSE: Breast implant surgery is increasing in Korea. NTM (non tuberculous mycobacteria) infection after breast implant surgery is rare, but it has been there reported in several foreign countries. However, no report has been issued on NTM infection after breast reconstruction surgery with an implant in Korea. The purpose of this article is to report a case of NTM infection after breast reconstruction surgery with an implant. METHODS: A female patient who underwent total mastectomy and immediate breast reconstruction with a latissimus dorsi myocutaneous flap and an implant exhibited signs of inflammation after the surgery. Fluid cultures taken at the time of wound exploration were initially negative, but NTM was isolated by culture 10 days later. RESULTS: The implant was removed. M. fortuitum was identified by acid-fast culture and NTM-PCR. The patient was treated with combined antibiotic therapy. CONCLUSION: Although it is difficult to diagnose NTM infection after breast surgery, it is important that surgeons include NTM infection in the differential diagnosis of a post mammoplasty infection after breast implant surgery.