Comparison of Midazolam with and without Nalbuphine for Intravenous Sedation in Nasal Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Effective and safe premedication in nasal surgery is very important in nasal surgery under local anesthesia. We investigated the effects of preoperative administration of midazolam only and midazolam combined with nalbuphine HCl for nasal surgery under local anesthesia. SUBJECTS AND METHOD: A total of 30 patients presenting for nasal surgery under local anesthesia were randomly assigned. Patients in the midazolam group (n=15) received single administration of midazolam and subjects in the nalbuphine group (n=15) were injected nalbuphine in addition to midazolam. Cardiovascular and respiratory status were monitored continuously. Questionnaires were given to the operator and the patients, and the scores were compared statistically. RESULTS: Operator's assessment indicated better pain control gain in the nalbuphine group. The other parameters in the operator's assessment and the patient's assessments were not statistically significant between the two groups. No adverse cardiovascular and respiratory side effects were noted, but pruritus was observed more frequently in the nalbuphine group. CONCLUSION: Better pain control gain was indicated only by the surgeon for the nalbuphine group, but there was no additional advantage in other parameters of combining nalbuphine with midazolam. We concluded that a single preoperative administration of midazolam would be effective enough and serve as a safe method for simple nasal surgery.

Magnetic Resonance Imaging in Facial Nerve Palsy: Comparison between Bell's Palsy and Herpes Zoster Oticus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Magnetic resonance imaging (MRI) is a valuable and important tool for use in diagnosing and investigating diseases affecting the facial nerve. However, there are few reports investigating the difference in the MRI findings of Bell's palsy and Ramsay Hunt syndrome. in order to evaluate the difference in the clinical values regarding these two groups of facial nerve palsy syndrome. In this study, we observed the MRI findings to investigate the value of MRI and its clinical significance in those two different groups of facial nerve palsy. SUBJECTS AND METHOD: Fourty-eight patients of Bell's palsy or herpes zoster oticus, who were admitted to Kangnam St. Mary's Hospital from January 1998 to December 2003, were selected to assess the results of gadolinium enhanced MRI. The frequency and the site of the facial nerve enhancement and its correlation with electroneuronography (ENoG), the time interval of the palsy to MRI, and initial ESR levels were observed in both groups of facial nerve palsy. RESULTS: On gadolinium enhanced MRI, 16 of 24 patients with Bell's palsy and 22 of 24 patients with herpes zoster oticus had contrast enhancement in the meatal, labyrinthine segments and geniculate ganglion. The number of enhanced segments was significantly larger in the patients with herpes zoster oticus than in the patients with Bell's palsy (p<0.05). There has been significant correlation between the number of enhanced segment of the facial nerve and the result of ENoG in the patients with herpes zoster oticus (p<0.05). CONCLUSION: Gadolinium enhanced MRI (Gd-MRI) studies may predict the extent of lesion within the course of the facial nerve and its clinical value as a prognostic factor could be suggested in patients with herpes zoster oticus

Prognostic Value of Electroneurography in Bell's Palsy and Ramsay-Hunt's Syndrome / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study evaluated the usefullness of electroneurography (ENoG) as a prognostic indicator in Bell's palsy and Ramsay-Hunt's syndrome. SUBJECTS AND METHOD: Retrospective case-series review in a university-based hospital. The treatment consisted uniformly of high-dose prednisolone, dextran, vasodilators, carbogen therapy, and stellate ganglion block. Acyclovir was administered in the case of Ramsay-Hunt's syndrome. ENoG was performed 7 to 10 days in Bell's palsy and 10 to 14 days in Ramsay-Hunt's syndrome. The recovery of the facial nerve function was documented using the House-Brackmann grading system. All patients were followed up until they recovered or at least for 3 months. RESULTS: The recovery rates to House-Brackmann grade II or better were 96.3% in Bell's palsy and 84.6% in herpes zoster oticus. There was no significant difference of ENoG value between recovery and non-recovery groups in Bell's pasly and in herpes zoster oticus. The logistic regression model between ENoG values and the chance of recovery was not found in Bell's palsy and in herpes zoster oticus. CONCLUSION: Although ENoG accurately predicts the percentage of remaining motor axons of the facial nerve, it cannot give a precise information on the prognosis or recovery rate of facial paralysis.

Treatment of Chordoma by Transsphenoidal Approach: 2 Cases

Chordomas are benign tumors that are thought to originate from remnants of notochord. They develop in the sacrococcygeal region but rarely form in the sellar region. Clival chordomas are benign tumors but because of their critical location, local invasion, recurrence, and occasional metastatic spread and their prognosis is similar to that of malignant tumors. The conventional transcranial approach is a treatment with high surgical morbidity. But transsphenoidal approach is a less invasive method with reduced surgical morbidity and complications. We report two cases of chordoma arising from the clivus treated by a transsphenoidal approach.

Effect of Muscle Relaxant on Post-Tonsillectomy Pain / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pain is one of the most troublesome discomfort accompanying tonsillectomy. Pharyngeal muscle spasm is one of the causes of post-tonsillectomy pain. We investigated the effect of an oral central muscle relaxant agent (chlorophenesin carbamate: CPC) on post-tonsillectomy pain. MATERIALS AND METHOD: Thirty adult patients undergoing tonsillectomy were included in this study. Basic pain control per oral administration consisted of 3.0 g/day (t.i.d.) salicylsalicylic acid and intramuscular injection of 5 mg diclofenac sodium (DCF) on demand. The patient population was divided into CPC group (n=15) and control group (n=15) randomly. CPC Group (n=15) received additional oral ingestion of 375 mg (t.i.d.) CPC for 7 days after operation. Pain assesment was peformed using visual analogue scale (VAS) at rest and while swallowing at the first (POD1) and seventh (POD7) day of the operation. Pain relief score (PRS) is the difference between VAS at POD1 and POD7. The number of injection of DCF was compared also. RESULTS: VAS of CPC group and the control at POD1 were 1.9+/-1.7/4.8+/-2.3 (rest/swallowing) and 2.8+/-1.6/5.2+/-1.9, respectively. VAS of CPC group and the control at POD7 were 1.5+/-1.8/3.4+/-1.9 and 1.8+/-1.3/3.5+/-1.5, respectively. The VAS scores of the two groups at POD1 and POD7 are not significantly different. The PRS of CPC group and the control group were 1.7+/-0.7/1.4+/-1.4 (rest/swallowing) and 1.0+/-1.0/1.6+/-1.2 (rest/swallowing), respectively. No significant difference in PRS was observed between the two study groups. The number of injection of DCF between the two groups is not significantly different. CONCLUSION: No significant benefit is found for the use of oral muscle relaxant agent after tonsillectomy.