Surgical Technique of Minimal Incision Approach with CO2 Laser for Congenital Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Transcanal antrotomy approach (TCA) enables not only good exposure but also minimal incision approach required for pediatric congenital cholesteatoma (CC). The addition of "CO2 laser enabled ablation and resection (CLEAR)" would facilitate safe and complete removal of CC from stapes. This study evaluates the clinical results of surgically removing CC through TCA with CLEAR (minimal incision approach with CO2 laser, MICL). SUBJECTS AND METHOD: The medical records of patients who underwent endaural extended tympanostomy, MICL, or postauricular approach for CC removal from January 2009 to September 2011 were reviewed in this study. RESULTS: MICL was performed in 37 patients of Potsic I, II CC. It was effective in surgical exposure and reducing the chance of residual CC. MICL could satisfactorily avoid postauricular tympanomastoidectomy, which allowed preservation of healthy mastoid air cells for almost all Potsic III CC, including posterior CC (14 patients). MICL was also useful for 6 cases of Potsic IV CC that extended beyond the incus posterosuperiorly to the auditus ad antrum. Children were not committed to second look operation because the attic was exteriorized with-out the cavity problem and the complete removal of CC from the stapes was facilitated with CLEAR. CONCLUSION: MICL enabled sufficient exposure with less invasive approach as well as complete CC removal, which reduced the postoperative complications and needs for second look operation. This surgical technique could be widely used for Potsic stage I, II, III, and some IV CC.

A Case of Idiopathic Spontaneous Tonsillar Hemorrhage / 대한이비인후과학회지

Spontaneous tonsillar hemorrhage (STH) is an extremely rare event. Usually, the causes of STH are ascribed to vessel wall erosion secondary to bacterial or viral infection of tonsils. Other causes include vascular or tumorous lesions around tonsil, coagulation disorders and idiopathic one. On one hand, the total number of reported STH has slightly increased because STH is defined as all forms of "bleeding tonsils", including even minor bleeding. On the other hand, the portion of the total STH that is life-threatening has become relatively few. Management of STH involves the use of antibiotics, and early tonsillectomy is recommended. We have experienced a case of a 29 year-old female with tonsillar hemorrhage in the absence of any identifiable cause. We report the case with a review of the related literatures.

A Case of Vascular Leiomyoma of the Tongue / 대한이비인후과학회지

Leiomyoma is the most common benign neoplasm of the uterus and gastrointestinal tract, but it is rare in the oral cavity. Also, its occurrence in the tongue is very rare because there is so little smooth muscle tissue present in this region. Clinically, oral leiomyoma usually grows slowly and is generally a non-ulcerated, small (1 to 2 cm), painless, sessile, firm and superficial nodule like lesion, although several authors have reported painful lesions. The diagnosis and treatment of oral leiomyoma is possible with complete surgical excision and histological studies by special stains. Recently, we experienced a 42-year-old woman with 6 month history of protruding tongue mass. She underwent surgical excision and the final pathological result confirmed it to be vascular leiomyoma. We report this case with a review of the related literatures.

A Case of Upper Gastrointestinal Hemorrhage Misdiagnosed as Post-Tonsillectomy Hemorrhage / 대한이비인후과학회지

Tonsillectomy, with or without adenoidectomy, remains the most frequently performed surgical procedure by otolaryngologists. Postoperative hemorrhage, which is classified as primary (24 h) hemorrhage, is recognized as a rare but potentially life-threatening complication. Although most oral bleedings occuring after tonsillectomy are considered as post-tonsillectomy hemorrhages, there could also be other origins such as gastrointestinal hemorrhage. We recently experienced a case of gastrointestinal hemorrhage that was misdiagnosed as secondary post-tonsillectomy hemorrhage. We report this case with a review of the literature.