Botox Therapy for Deep Nasolabial Fold and Bitterness Furrow after Facial Nerve Paralysis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Facial sequelae after facial paralysis cause serious functional and aesthetical problems including facial asymmetry, symkinesis and facial crease. The most common aesthetical problem is facial furrow and crease induced by facial hyperkinestic movement due to incomplete facial recovery. The aim of this study is to investigate the efficacy of botulinum toxin A injection in patients with deep nasolabial fold and bitterness furrow after facial paralysis. SUBJECTS AND METHOD: Thirty-five patients who recovered partially from facial paralysis, had deep nasolabial fold and bitterness furrow with or without facial asymmetry. Botulinum toxin A intramuscular injection on perioral area for mouth corner deviation, subcutaneous injection on deepen nasolabial fold, and intramuscular injection on bitterness furrows had improved lower facial symmetry and cosmetic configuration without Pseudo Bell's palsy. RESULTS: Of 26 patients who had facial palsy side nasolabial fold before the injection, 21 patients improved. Of the 21 patients who had facial palsy side bitterness furrow, 16 patients improved after the injection. Of 11 patients who had contralateral nasolabial fold, 4 patients improved after the injection. Of 13 patients who had contralateral bitterness furrow, 7 patients improved after the injection. CONCLUSION: After botulinum toxin A injection, the patients showed marked improvement of nasolabial fold, bitterness furrow and lower facial asymmetry.

Facial Nerve Paralysis due to Chronic Otitis Media: Prognosis in Restoration of Facial Function after Surgical Intervention

PURPOSE: Facial paralysis is an uncommon but significant complication of chronic otitis media (COM). Surgical eradication of the disease is the most viable way to overcome facial paralysis therefrom. In an effort to guide treatment of this rare complication, we analyzed the prognosis of facial function after surgical treatment. MATERIALS AND METHODS: A total of 3435 patients with COM, who underwent various otologic surgeries throughout a period of 20 years, were analyzed retrospectively. Forty six patients (1.33%) had facial nerve paralysis caused by COM. We analyzed prognostic factors including delay of surgery, the extent of disease, presence or absence of cholesteatoma and the type of surgery affecting surgical outcomes. RESULTS: Surgical intervention had a good effect on the restoration of facial function in cases of shorter duration of onset of facial paralysis to surgery and cases of sudden onset, without cholesteatoma. No previous ear surgery and healthy bony labyrinth indicated a good postoperative prognosis. CONCLUSION: COM causing facial paralysis is most frequently due to cholesteatoma and the presence of cholesteatoma decreased the effectiveness of surgical treatment and indicated a poor prognosis after surgery. In our experience, early surgical intervention can be crucial to recovery of facial function. To prevent recurrent cholesteatoma, which leads to local destruction of the facial nerve, complete eradication of the disease in one procedure cannot be overemphasized for the treatment of patients with COM.

What Causes Incomplete Facial Function Recovery in Patients with Immediate Facial Paralysis Following Vestibular Schwannoma Surgery?

BACKGROUND AND OBJECTIVES: Preservation of facial nerve function in vestibular schwannoma (VS) surgery is still a significant operative challenge. Several prognostic factors correlate with postoperative facial nerve function. Most partial facial nerve damage can recover completely without functional defect. However, recovery of the facial nerve in some patients is either incomplete or non-existent. To evaluate the cause of incomplete facial function recovery at long term follow-up (> or =1 year), we analyzed the factors that influenced facial function recovery in a consecutive series of patients that had immediate post-operative, partial paralysis after VS surgery with preservation of neural integrity. MATERIALS AND METHODS: We conducted a retrospective review of 143 cases of VS surgery that occurred between January 1994 and December 2008. Twenty-seven patients that had immediate, postoperative partial facial paralysis and normal preoperative facial function with intact nerve after tumor excision were analyzed with regards to age, sex, tumor size, tumor location, internal auditory canal (IAC) widening, duration of surgical procedure, postoperative complication, and facial function after a postoperative follow-up period of > or =1 year by the House-Brackmann (HB) grading system. RESULTS: Of the 143 patients that underwent VS surgery, 27 (18.8%) patients had immediate, postoperative partial facial paralysis. At long-term follow-up, there were 11 (7.6%) patients with incomplete facial recovery. Facial function recovery after facial nerve injury did not show a significant difference in tumor size, surgical approach, or tumor location. However, preoperative IAC widening and the duration of the procedure were related to facial restoration after surgery. CONCLUSIONS: The injured facial nerve during VS surgery showed incomplete recovery in many cases. Chronic compression of the facial nerve, together with IAC widening preoperatively, led to incomplete restoration of injured facial nerves.

What Causes Incomplete Facial Function Recovery in Patients with Immediate Facial Paralysis Following Vestibular Schwannoma Surgery?

BACKGROUND AND OBJECTIVES: Preservation of facial nerve function in vestibular schwannoma (VS) surgery is still a significant operative challenge. Several prognostic factors correlate with postoperative facial nerve function. Most partial facial nerve damage can recover completely without functional defect. However, recovery of the facial nerve in some patients is either incomplete or non-existent. To evaluate the cause of incomplete facial function recovery at long term follow-up (> or =1 year), we analyzed the factors that influenced facial function recovery in a consecutive series of patients that had immediate post-operative, partial paralysis after VS surgery with preservation of neural integrity. MATERIALS AND METHODS: We conducted a retrospective review of 143 cases of VS surgery that occurred between January 1994 and December 2008. Twenty-seven patients that had immediate, postoperative partial facial paralysis and normal preoperative facial function with intact nerve after tumor excision were analyzed with regards to age, sex, tumor size, tumor location, internal auditory canal (IAC) widening, duration of surgical procedure, postoperative complication, and facial function after a postoperative follow-up period of > or =1 year by the House-Brackmann (HB) grading system. RESULTS: Of the 143 patients that underwent VS surgery, 27 (18.8%) patients had immediate, postoperative partial facial paralysis. At long-term follow-up, there were 11 (7.6%) patients with incomplete facial recovery. Facial function recovery after facial nerve injury did not show a significant difference in tumor size, surgical approach, or tumor location. However, preoperative IAC widening and the duration of the procedure were related to facial restoration after surgery. CONCLUSIONS: The injured facial nerve during VS surgery showed incomplete recovery in many cases. Chronic compression of the facial nerve, together with IAC widening preoperatively, led to incomplete restoration of injured facial nerves.

An Unusual Case of Luetic Lymphadenitis as a Solitary Submandibular Mass / 대한이비인후과학회지

Syphilis, a chronic systemic infection caused by Treponema pallidum, is usually sexually transmitted and characterized by episodes of active disease interrupted by a latent period. After an incubation period of averaging 2-6 weeks, a primary syphilis with a firm, non-tender chancre appears, often associated with regional lymphadenopathy. Secondary syphilis shows localized or diffuse mucocutaneous lesions and generalized non-tender lymphadenopathy. In about onethird of untreated cases, the tertiary stage appears, characterized by progressive destructive mucocutaneous, musculoskeletal or parenchymal lesions, aortitis or symptomatic central nervous system diseases. Without serological testing, the precise diagnosis is very difficult. In fact, it has often been called the great imitator because it was often confused with other disease. We report a very unusual case of luetic lymphadenitis presented as a solitary submandibular mass.

A Case Report of Brain Herniation into the Middle Ear Mimicking as Secondary Cholesteatoma Following Temporal Bone Fracture / 대한이비인후과학회지

Brain herniation into the middle ear cavity is a rare entity that occurs mostly as a complication of otologic surgery. Other causes include a congenital skull base defect, infection, trauma, neoplasm and irradiation. It gives rise to cerebrospinal fluid otorrhea, progressive hearing loss, tinnitus, meningitis and other neurologic symptoms. Such patients tend to be misdiagnosed as having chronic otitis media and are often treated for long periods with inadequate conservative therapy. We report a case of brain herniation into the middle ear following traumatic temporal bone fracture, which was treated surgically via a transmastoid approach.

An Unusual Case of Kinking Common Carotid Artery / 대한이비인후과학회지

An abnormal course of carotid artery may surprise surgeons during surgery and result in an transient ischemic attack or other ischemic symptoms. We report an unusual case of kinking in the common carotid artery located below the right thyroid lobe, which was found during a total thyroidectomy in a 74-years old patient. We emphasize in this case how important it is to palpate the neck before surgeries such as tracheostomy, thyroid surgery and so on.

Fibrovascular Polyp of the Hypopharynx: A Case Report

We report here on a case of fibrovascular polyp arising in the hypopharynx of a 62-year-old man. Laryngomicroscopic surgery with laser ablation was performed to excise the mass. Histopathologically, the surface of the polyp was covered with mature squamous epithelium. The polyp showed a characteristic lobular proliferation of mature adipose tissue that was separated by myxoid or collagenous connective tissue. Some scattered skeletal muscle bundles were seen in the central portions of the polyp and these bundles were surrounded by a concentric proliferation of the spindle cells; this was reminiscent of Pacinian corpuscles. Regarding their location and the intermingled pattern of proliferating tissues, it is more plausible that the skeletal muscle is a hamartomatous component rather than entrapped, preexisting tissue.

Two Cases of Sudden Hearing Loss With Vertigo as an Isolated Symptom of Anterior Inferior Cerebellar Artery Infarction

Isolated sudden hearing loss with vertigo is usually peripheral origin. We report two cases with anterior inferior cerebellar artery infarction (AICA) manifesting sudden hearing loss with vertigo as an isolated symptom. Patient 1 was a 64-year-old man presented with right sided sudden hearing loss and vertigo accompanying horizontal beating nystagmus to the left. He had no other neurologic symptoms. MRI showed right AICA infarction involving lateral pons and middle cerebellar peduncle. Patient 2 was a hypertensive 56-year-old man. Left sided sudden hearing loss with vertigo was as an initial manifestation. Two days later, left sided facial palsy developed and MRI showed acute infarction in left lateral pons, middle cerebellar peduncle, and cerebellum. AICA infarction can be presented the hearing loss and vertigo as an isolated symptom and mimic the syndrome of peripheral origin.

A Case of Trichofolliculoma in the Nasal Vestibule / 대한이비인후과학회지

Trichofolliculoma is a rare skin lesion. It is an adnexal tumor of hair follicles, which was first described by Miescher. Trichofolliculoma is a hamartomatous lesion of hair follicle origin, intermediate in differentiation between a hair follicle nevus and trichoepithelioma as classified by Kligman and Pinkus. It usually manifests clinically as a small, slowly growing, well-demarcated, flesh-colored papule on head and neck. The diagnosis is difficult clinically and is based mainly on histopatholigic appearance. It is commonly misdiagnosed as sebaceous cyst, nevus, and basal cell carcinoma. Treatment is by simple excision and recurrence is rare. We report a case of trichofolliculoma of nasal vestibule with a review of literature.

Analysis of Electrophysiological Change in the Rat LC Nucleus after Salicylic Acid Treatment / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The precise mechanism of salicylic acid induced tinnitus has not been clearly identified as yet in spite of wide range of studies undertaken. We looked for the electrophysiologic evidence that salicylic acid has effect on the Locus Coeruleus (LC) neurons in vitro. MATERIALS AND METHOD: In LC, we measured the neuronal firing rate and cell membrane property according to the concentration of salicylic acid with extracellular single unit recording and whole cell current clamp recording. RESULTS: The basal firing activity was increased in 15 of the 20 LC nuclei, which were treated with 0.3 mM salicylic acid. Both 1mM and 2 mM salicylic acid increased the basal firing rate of all except for one LC neuron (n=20). These neurons also showed recovery after washing. However, 5 mM salicylic acid induced cell death after the bursting response in all of the LC neurons (n=10)(Fig. 2). There were no specific changes in the whole cell current-clamp recording of the LC neurons during the period of drug treatment (Fig. 3). CONCLUSION: The dose dependent response pattern observed in the extracellular single unit recording and the fact that there were no specific changes in the whole-cell current-clamp recording following the salicylic acid treatment suggest that the salicylic acid induced intracellular change in the LC neuron is caused not by the direct ligand-receptor reaction but by the indirect 2nd messenger system.

A Case of Osteoma of the Tongue / 대한이비인후과학회지

Lingual osseous lesion can be classified as one of three types: osteoma, chondroma and osteochondroma. Osteoma is a benign neoplasms consisting of mature normal osseous tissue. Osseous growths within the oral cavity, but it is especially rare to find it in the tongue. The majority of the lesions occur in the posterior third of the tongue at or in close proximity to the foramen cecum and the circumvallate papillae. Clinically, tongue osteomas are benign, slow- growing tumors made up of densely sclerotic, well-formed bone. Symptoms include foreign body sensation, dysphagia, nausea, and choking. However, most patients tend to be asymptomatic, and histologic studies can confirm the diagnosis. Treatment of the oral osteoma is by surgical excision, preferably by a transoral approach. This should give complete resolution and there were rare recurrences with good prognosis. Recently, we experienced a 25 year old woman with asymptomatic hard mass on the base of the tongue. A surgical resection was performed and pathologic analysis confirmed tongue osteoma for the patient. Now we report this case with a review of literature.

A Case Report of Leiomyoma of the Hard Palate / 대한이비인후과학회지

Leiomyoma is a benign smooth muscle tumor that can be classified into three types: solid, vascular and ephithelioid leiomyoma. This disease occurs most frequently in the uterus, gastrointestinal tract and skin. The oral cavity is an unusual site for a leiomyoma and occurrence in the hard palate is very rare because there is so little smooth muscle tissue present in this region. Clinically, oral leiomyomas usually grow slowly and are asymptomatic firm superficial nodule like lesions, although occasional tumors can be painful. The diagnosis and treatment of oral leiomyoma is possible with complete surgical excision and histological studies by special specific stains. Recently, we experienced a 60-year-old man with 6 month history of soft mass on the hard palate. He underwent surgical resection. Pathological analysis confirmed vascular leiomyoma. Here, we report this case with review of literature.

A Case of Tympanogenic Labyrinthitis Complicated by Acute Otitis Media

Widespread use of antimicrobial drugs in the management of otitis media has significantly reduced the incidence of labyrinthitis nowadays. Cases of tympanogenic labyrinthitis following acute otitis media have rarely been reported in recent literature on otolaryngology. We report an unusual case of tympanogenic labyrinthitis that presented with sudden sensorineural hearing loss (SNHL) following acute otitis media in an adult who had no previous otological complaints. An audiogram revealed SNHL with pure tone threshold of 43.7 dB in the left ear. MRI was helpful to identify the inflammatory change of the membranous labyrinth. The patient's hearing returned to normal after treatment. The definite diagnosis of serous labyrinthitis was established retrospectively.

A Case Report of Castleman's Disease(Giant Lymph Node Hyperplasia) Presenting as a Isolated Neck Mass / 대한이비인후과학회지

Castleman's disease, a benign lymphoproliferative disease of unknown etiology, rarely occures as a neck mass. Only 6% of the cases reported in the literature was detected primarily in the neck. This disease consists of unicentric or multicentric (or systemic) forms by clinical manifestation and hyaline vascular type or plasma cell type, histologically. The more common hyaline vascular type usually presents as an asymptomatic lymphoid mass. On the other hand, in plasma cell type, systemic manifestations are frequently observed. Definite diagnosis and treatment is possible with complete surgical resection following histologic evaluation. Recently, we experienced a 22 year old woman patient with 5 year history of right neck mass. She underwent surgical mass resection. Pathologic analysis confirmed hyaline vascular variant of Castleman's disease. Now, we report this case with a review of previously reported literature.

Laryngeal Chondrosarcoma Arising from the Cricoid Cartilage / 대한이비인후과학회지

Laryngeal chondrosarcoma is an uncommon cartilaginous tumor very rarely encountered in the head and neck but most commonly in the sarcoma of the larynx. They occur most often in middle aged and older men. The prognosis of this tumor is potentially poor and surgical resection is generally recommended for the treatment. No benefit of chemotherapy or radiotherapy in chondrosarcoma has been documented in the literature. A 57 year-old male visited our clinic with history of dyspnea and hoarseness. Direct laryngoscopy showed a submucoid, intraluminal mass in subglottic space arising from posterolateral part of the cricoid cartilage. Neck computed tomography revealed a large calcified mass in the larynx. The perioperative frozen section showed it to be grade I chondrosarcoma of the cricoid cartilage. Conservative surgery with complete excision of tumor was performed through laryngofissure approach after tracheostomy. Follow up assesment was performed under close check up at 12 months after the surgery, but we found neither recurrence nor metastasis.

The Efficacy of Palatine Tonsillectomy Under Local Anesthesia: Comparative Analysis with Tonsillectomy Under General Anesthesia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tonsillectomy is one of the most common surgical procedures in otolaryngologic field and it can be carried out under general anesthesia or local anesthesia. The author compared tonsillectomy under local anesthesia to general anesthesia with respect to operation, anesthesia and recovery time as well as satisfaction of the patients. SUBJECTS AND METHOD: Fifty patients who underwent tonsillectomy were divided into a local anesthesia group (25 patients) and a general anesthesia group (25 patients). Parameters such as time spent for anesthesia, operation, recovery time, episodes of cautery, initiation of normal daily life including normal diet, pain, and complication were compared between the two groups. Paired student t-tests were used for statistical analysis. RESULTS: Among other parameters, local tonsillectomy was superior in terms of saving time during anesthesia, operation, recovery as well as hospital course compared to tonsillectomy under general anesthesia. However, ease on the initiation of normal daily life including normal diet, pain, and complication did not differ between the two groups. CONCLUSION: The author feels that local tonsillectomy should be advocated not only for time saving during operation, anesthesia and recovery but also for the satisfaction or compliance of the patients. In these respects, it is suggested that more active training should be provided to surgeons during their residency on tonsillectomy under local anesthesia.

Enterococcal Otogenic Brain Abscess / 대한이비인후과학회지

Despite advances in imaging and antibiotic treatment, brain abscess is still encountered occasionally and is one of the most significant life-threatening complications of otologic disease. Nowadays, mortality rates of up to 10 percent have been reported. Brain abscesses are developed up to 0.5 percent of cases of acute otitis media and 3 percent of cases of chronic suppurative otitis media. In this case, underlying middle ear pathology showed chronic otitis media with cholesteatoma. Successful management of otogenic brain abscess still includes medical and surgical treatment. Initial surgical treatment of abscess is very controversial today. Some authors prefer the surgical excision of brain abscess prior to the management of temporal bone, yet other authors prefer the surgery of temporal bone prior to the management of brain abscess. Although an enterococcus is a significant cause of human infections outside of the central nervous system but, enterococcal infections involving the central nervous system are uncommon clinical entities. Because of the relatively small number of individuals who develop brain abscess or meningitis due to an enterococcus, an appropriate therapy has not been well defined. We report a case of enterococcal otogenic brain abscess which was treated successfully using antibiotics, immediate radical mastoidectomy and later stereotactic abscess drainage with a review of literatures.

Two Cases of Neurilemmoma of the Cervical Vagus Nerve Including IntracapsularEnucleation of Nerve Preservation / 대한이비인후과학회지

Neurilemmomas is benign tumor originating from all kinds of cranial nerve except optic nerve and olfactory nerve, spinal nerve root and peripheral nerve. It superficially resembles neoplasm of fibroblastic origin, but has distinctive histological pattern and arise from the neuroectodermal sheath of schwann. Approximately 25% to 40% of all neurilemmomas are found in the neural structure of the head and neck. The tumor mostly develops in the acoustic nerve and there are several reports of neurilemmonas originating form tongue, pharynx, lip, larynx and palate etc. However, reports of Neurilemmoma originating from cervical vagus nerve have been extremely rare. We experienced two cases neurilemmoma of cervical vagus nerve that were treated with different surgical methods. In the first case, the tumor was extirpated by sacrificing the nerve trunk and in second case, it was enucleated by preserving the neural pathway using the microsurgical technique.

A Case of Extracranial Primitive Neuroectodermal Tumor that occured in the temporal fossa / 대한이비인후과학회지

No abstract available.