Subcutaneous emphysema related to dental procedures

OBJECTIVES: The objective of this study was to analyze 11 cases of subcutaneous emphysema associated with dental procedures from a single hospital and discuss approaches for accurate diagnosis and treatment of the condition. MATERIALS AND METHODS: The medical records of 11 patients who were treated for subcutaneous emphysema related to dental procedures between January 2009 and April 2017 were analyzed retrospectively. Patients with subcutaneous emphysema within the facial area or that spread to the neck and beyond, including the facial region, were assigned to two groups and compared in terms of age, sex, and durations of antibiotic use, hospitalization, and follow-up until improvement. The correlation between location of the origin tooth and range of emphysema spread was analyzed. RESULTS: The average durations of antibiotic use during conservative treatment and follow-up until improvement were 8.55 days (standard deviation [SD], 4.46 days) and 1.82 weeks (SD, 1.19 weeks), respectively. There was no intergroup difference in duration of antibiotic use (P=0.329) or follow-up (P=0.931). Subcutaneous emphysema was more common after dental procedures involving the maxilla or posterior region than after those involving the mandible or anterior region. There was no significant difference in air distribution according to location of the air orifice (maxilla, mandible, or both; P=0.106). CONCLUSION: Upon adequate conservative treatment accompanied by prophylactic antibiotic treatment considering the risk of infection, patients showed signs of improvement within a few days or weeks. There was no significant difference in treatment period between patients with subcutaneous emphysema localized to the facial region and those with subcutaneous emphysema spreading to the neck or beyond. These findings need to be confirmed by analysis of additional cases.

Prenatal ultrasonographic diagnosis of cleft lip with or without cleft palate; pitfalls and considerations / 대한악안면성형재건외과학회지

Ultrasonographic examination is widely used for screening of abnormal findings on prenatal screening. Cleft lip with or without cleft palate of the fetus can also be screened by using ultrasonography. Presence of abnormal findings of the fetal lip or palate can be detected by the imaging professionals. However, such findings may not be familiar to oral and maxillofacial surgeons. Oral and maxillofacial surgeons can use ultrasonographic imaging of fetal cleft lip with or without cleft palate to provide information regarding treatment protocols and outcomes to the parent. Therefore, surgeons should also be able to identify the abnormal details from the images, in order to setup proper treatment planning after the birth of the fetus. We report two cases of cleft lip with or without cleft palate that the official readings of prenatal ultrasonography were inconsistent with the actual facial structure identified after birth. Also, critical and practical points in fetal ultrasonographic diagnosis are to be discussed.

Role of Caffeic Acid on Collagen Production in Nasal Polyp-Derived Fibroblasts

OBJECTIVES: Caffeic acids are known to have anti-oxidant, anti-inflammatory, immunomodulatory, and tissue reparative effects. The purposes of this study were to determine the effect of caffeic acid on transforming growth factor (TGF) beta1-induced myofibroblast differentiation and collagen production, and to determine whether caffeic acid is involved in the antioxidant effect in nasal polyp-derived fibroblasts (NPDFs). METHODS: NPDFs were pretreated with caffeic acid (1-10 microM) for 2 hours and stimulated with TGF-beta1 (5 ng/mL) for 24 hours. The expression of alpha-smooth muscle actin (SMA), collagen types I and III, and Nox4 mRNA was determined by a reverse transcription-polymerase chain reaction, and the expression of alpha-SMA protein was determined by actin ned by immunofluorescence microscopy. The amount of total soluble collagen production was analyzed by the Sircol collagen dye-binding assay. The reactive oxygen species (ROS) generated by NPDFs were determined using 2',7'-dichlorfluorescein-diacetate. siNox4 was used to determine the effect of Nox4. RESULTS: The expression of alpha-SMA and production of collagen were significantly increased following TGF-beta1 treatment. In contrast, the level of expression of alpha-SMA and the level of production of collagen were decreased by pretreatment with caffeic acid. The activation of Nox4 and the subsequent production of ROS were also reduced by pretreatment with caffeic acid. The expression of alpha-SMA was prevented by inhibition of ROS generation with siNox4. CONCLUSION: Caffeic acid may inhibit TGF-beta1-induced differentiation of fibroblasts into myofibroblasts and collagen production by regulating ROS.

Comparative analysis of the amount of postoperative drainage after intraoral vertical ramus osteotomy and sagittal split ramus osteotomy

OBJECTIVES: The purpose of this retrospective study was to compare the amount of postoperative drainage via closed suction drainage system after intraoral vertical ramus osteotomy (IVRO) and sagittal split ramus osteotomy (SSRO). MATERIALS AND METHODS: We planned a retrospective cohort study of 40 patients selected from a larger group who underwent orthognathic surgery from 2007 to 2013. Mean age (range) was 23.95 (16 to 35) years. Patients who underwent bilateral IVRO or SSRO were categorized into group I or group II, respectively, and each group consisted of 20 patients. Closed suction drainage system was inserted in mandibular osteotomy sites to decrease swelling and dead space, and records of drainage amount were collected. The data were compared and analyzed with independent t-test. RESULTS: The closed suction drainage system was removed at 32 hours postoperatively, and the amount of drainage was recorded every 8 hours. In group I, the mean amount of drainage was 79.42 mL in total, with 31.20 mL, 19.90 mL, 13.90 mL, 9.47 mL, and 4.95 mL measured at 0, 8, 16, 24, and 32 hours postoperatively, respectively. In group II, the mean total amount of drainage was 90.11 mL, with 30.25 mL, 25.75 mL, 19.70 mL, 8.50 mL, and 5.91 mL measured at 0, 8, 16, 24, and 32 hours postoperatively, respectively. Total amount of drainage from group I was less than group II, but there was no statistically significant difference between the two groups (P=0.338). There was a significant difference in drainage between group I and group II only at 16 hours postoperatively (P=0.029). CONCLUSION: IVRO and SSRO have different osteotomy design and different extent of medullary exposure; however, our results reveal that there is no remarkable difference in postoperative drainage of blood and exudate.

Full thickness skin grafts from the groin: donor site morbidity and graft survival rate from 50 cases

OBJECTIVES: Full thickness skin grafts (FTSG) offer several advantages; they are esthetically superb, have less postoperative shrinkage, and offer minimal postoperative pain and scar formation at the donor site. As a donor site of FTSG, the groin offers a relatively large area of skin with high elasticity. The aim of this study was to evaluate FTSG from the groin for reconstruction in oral and maxillofacial surgery. MATERIALS AND METHODS: In a retrospective study, 50 patients (27 males, 23 females) who received FTSG from the groin were evaluated for their operation records, clinical photography, and medical records. RESULTS: The width of skin from the groin was distributed from 2-8 cm (mean: 5.1 cm) at the donor site, while the long axis length was distributed from 3-13 cm (mean: 7.4 cm). A high number of patients, 47 patients (94%) out of 50, showed good healing at the donor site. Wound impairment was seen in 3 patients (6%), minor wound dehiscence in 2 patients, and severe wound dehiscence in 1 patient. In the recipient site, delayed healing was observed in 2 patients (4%). CONCLUSION: FTSG from the groin to repair soft tissue defects in reconstruction surgery is a good method due to the relatively big size of the graft, decreasing morbidity at the donor site, and higher graft survival rates.

Full thickness skin grafts from the groin: donor site morbidity and graft survival rate from 50 cases

OBJECTIVES: Full thickness skin grafts (FTSG) offer several advantages; they are esthetically superb, have less postoperative shrinkage, and offer minimal postoperative pain and scar formation at the donor site. As a donor site of FTSG, the groin offers a relatively large area of skin with high elasticity. The aim of this study was to evaluate FTSG from the groin for reconstruction in oral and maxillofacial surgery. MATERIALS AND METHODS: In a retrospective study, 50 patients (27 males, 23 females) who received FTSG from the groin were evaluated for their operation records, clinical photography, and medical records. RESULTS: The width of skin from the groin was distributed from 2-8 cm (mean: 5.1 cm) at the donor site, while the long axis length was distributed from 3-13 cm (mean: 7.4 cm). A high number of patients, 47 patients (94%) out of 50, showed good healing at the donor site. Wound impairment was seen in 3 patients (6%), minor wound dehiscence in 2 patients, and severe wound dehiscence in 1 patient. In the recipient site, delayed healing was observed in 2 patients (4%). CONCLUSION: FTSG from the groin to repair soft tissue defects in reconstruction surgery is a good method due to the relatively big size of the graft, decreasing morbidity at the donor site, and higher graft survival rates.

Measuring the Behavioral Parameters of Mouse Following Unilateral Labyrinthectomy in Round Free Field Using an Infrared Lamp and a Simple Webcam Camera / 대한평형의학회지

BACKGROUND AND OBJECTIVES: In this research, movements of mouse after labyrinthectomy were analyzed to determine the degree of vestibular dysfunction and compensation. MATERIALS AND METHODS: By using an infrared lamp, mouse movements were recorded for 100 seconds in a dark room. The experimental area was manufactured as a circular space with a diameter of 60 cm. The movements of five mice labyrinthectomized on right side were observed and recorded at 3 hours, 9 hours and 120 hours after the operation, and also the ten mice of control group. RESULTS: The differences between the total moving distances and the rotating angle from the origin that set the center of round field between groups were analyzed with pictures of 1 frame per second. It is concluded that all 4 groups show significant differences between its mean rotation angle and total moving distances statistically. At 9 hours after right labyrinthectomy, mice tended to turn clockwise; but at 120 hours, there was no significant difference between clockwise and counter-clockwise rotation. CONCLUSION: Measuring the movement of mouse in round free field can be the proper method to determine the degree of vestibular dysfunction and vestibular compensation. This test was time-saving and cost-effective method.

Comparative Analysis of the Reference Lines on McNamara's and Delaires Analyses for the Anterior and Posterior Facial Relationship of Maxillofacial Deformity

2 Cases of Auriculoplasty Using Modified Pocket Method / 대한이비인후과학회지

Laceration and amputation of the auricle due to external injuries are common because of its location. Several choices of reconstructive surgical procedure have been introduced for amputated auricle until now. Modified pocket method is known as the one of techniques useful for a patient whose auricle was amputated with severe contamination. We report two cases of auricular reconstruction using modified pocket method in traumatic auricular amputation with a review of literatures.

Analysis of Relationship between the Dehydration Test and the Diuretics Treatment in Definite Meniere's Disease / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Diuretics and dehydration tests are used for the main treatment of Meniere's disease as well as the predictor of the disease activity. We analyzed the relationship between the results of dehydration test and the effect of diuretics in patients with definite Meniere's disease. SUBJECTS AND METHOD: Seventy patients with definite Meniere's disease were selected from January 1999 to June 2007 by reviewing the medical records, retrospectively. Fifty six patients underwent a glycerol test and thirty patients with the furosemide test before treatment. Hydrochlorothiazide was prescribed over twelve months. RESULTS: The positive rates of glycerol and furosemide tests were 46.7% and 51.8%, respectively. The number of patients who kept the medication over twelve months were 62 (88.6%); those who showed complete remission (CR) were 10 (16.1%), partial remission (PR) 26 (41.9%) and no response (NR) 26 (41.9%). The positive rate of furosemide test was 60% in the patients with CR, 44.4% in patients with PR and 42.9% in patients with NR. The positive rate of glycerol test was 80% in the patients with CR, 68% with PR and 25% with NR. There is statistically significant relationship between the positive rate of glycerol test and the treatment response (p=0.001), but there was no correlation between the positive rate of furosemide test and the treatment response (p=1.000). CONCLUSION: The significant relationship was found between diuretics treatment and glycerol test. The glycerol test can be used as an indicator for expecting a good treatment response to diuretic therapy.

A Case of Multiple Perilymph Fistula Induced by Tympanostomy Tube Insertion / 대한평형의학회지

This controversial diagnosis centers around the phenomenon of perilymph leaking from the inner ear into the middle ear cleft through the oval window, round window or other fissures in the bony labyrinth that may be abnormally patent. A perilymph fistula may develop after stapedectomy surgery, penetrating middle ear trauma, head trauma, barotrauma, or possibly spontaneously. Uncertainty regarding the clinical criteria for the diagnosis and the inability to document the presence of a microfistula at surgery contribute to the problematic nature of this diagnosis. However, this condition should be seriously considered in the patient with vertigo after head trauma, barotrauma injury, or previous middle ear surgery. It is particularly likely in patients with penetrating middle ear trauma with vertigo. Most authors agree that perilymph fistulas generally heal spontaneously, therefore a few days of bed rest is appropriate in acute cases. Cases suspected after penetrating trauma should be explored early if symptoms persist. Here, authors report a case of multiple perilymph fistula possibly caused by tympanostomy tube insertion in a 48-year-old man with a review of the literature.

Clinical Analysis of 42 Patients with Bilateral Vestibulopathy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To find out the causative factors and clinical features of bilateral vestibulopathy in the Korean population. SUBJECTS AND METHOD: The data of 42 patients (mean age: 55.04+/-18.87 years) with bilateral vestibulopathy were reviewed retrospectively between 1997 and 2009. We carried out a full neurotological examination, electronystagmography, a bithermal caloric test, a rotatory chair test, cranial imaging and laboratory studies. RESULTS: Nineteen patients (45.24%) were diagnosed as having secondary bilateral vestibulopathy with causative factors. The most common cause was ototoxic drug (14.29%). Other etiologic causes were labyrinthitis, temporal bone fracture, Meniere's disease, peripheral neuropathy and meningitis/encephalitis. Forty-five percent of all patients had symptoms that lasted less than 1 month, and about 43% of the patients presented with chronic progressive symptoms of over 1 year. CONCLUSION: In about 54% of all patients, we couldn't find any causative factors leading to bilateral vestibulopathy. Because a large subgroup of patients had a history of dizziness over one year, an adequate number of studies on vestibular and cerebellar function are recommended for patients of chronic dizziness to exclude bilateral vestibulopathy.

Multicanal Benign Paroxysmal Positional Vertigo: Concurrent Bilateral Posterior Canalolithiasis and Unilateral Lateral Cupulolithiasis / 대한평형의학회지

Multicanal BPPV (benign paroxysmal positional vertigo), especially BPPV affecting both labyrinths, is uncommon. A review of the literature revealed that the majority of reported cases of multiple BPPV either involved a combination of two different canals limited to one labyrinth or two different canals in both labyrinths, although one case of multicanal BPPV was reported to involve three canals bilaterally. Here, the authors report a case of bilateral posterior canalolithiasis and unilateral horizontal canal cupulolithiasis in a 54-year-old man, and include a review of the literature.

The Comparison of the Magnetic Resonance Images in the Patient With Definite Meniere's Disease Before and After Endolymphatic Sac Decompression / 대한평형의학회지

Endolymphatic hydrops is believed to be underlying pathophysiology of Meniere's disease. The degree of endolymphatic hydrops observed by MRI (magnetic resonance imaging) in patients with Meniere's disease offers a new method to study the progression of Meniere's disease. There have been multiple attempts to diagnose Meniere's disease with the help of radiologic tests including MRI in Korea. We describe a case report of a patient with Meniere's who showed changes of endolymphatic sac in MRI after endolymphatic sac decompression.

Normal eruption guidance of unerupted permanent teeth associated with dentigerous cyst by decompression: 5 cases report

The purpose of this report is to describe a treatment method of dentigerous cyst associated with unerupted permanent teeth in mixed dentition patients. In our cases, extraction of infected primary teeth was followed by decompression of the cyst. At the same time, parts of the cystic walls were sent for histopathological examination. Decompression was performed by inserting a rubber tube into the cystic cavity through the extraction socket. The cystic cavity was kept open by means of vigorous use of a syringe by patient. Postoperative panoramic radiograph was taken bimonthly. After 5~12 months, the impacted permanent teeth were erupted on the desired position. All cases presented favorable result. By extracting the infected primary teeth, and opening the cyst for continuous drainage, it was possible to achieve spontaneous eruption of the involved permanent teeth into the proper position. In all our cases, there was no sign or symptom of recurrence of the cyst up to postoperative 18 months.

Selective Deep Lobe Parotidectomy for Preservation of Parotid Function: A Case Report

Tumors of the deep lobe of parotid gland are rare. These benign tumors have usually been treated by total parotidectomy, which has functional and esthetic side effects. Recently, there has been a trend for operations of parotid gland benign tumors to be less radical and selective deep lobe parotidectomy has been introduced. This technique preserves the superficial lobe and facial nerve when tumor is located in the deep lobe. Selective deep lobe parotidectomy preserves parotid salivary function, minimizes the incidence of facial nerve damage and gustatory sweating (Frey's syndrome) and improves cosmetic outcome. We report a case of pleomorphic adenoma of the deep lobe that was successfully treated by selective deep lobe parotidectomy with satisfactory result.

Microbiology of Chronic Maxillary Sinusitis in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Problems with antibiotic susceptibility have recently been raised in the treatment of paranasal sinusitis. Therefore, well-established antimicrobial policy is needed. Samples collected in children who have sinusitis can be useful to monitor the evolution of resistance. However, relatively a little is known about the maxillary sinus flora in children with chronic sinusitis. This study aims to get a better insight into the maxillary sinus flora and its resistance. SUBJECTS AND METHOD: Maxillary sinus samples were obtained through inferior meatal puncture from 120 children with history of chronic sinusitis, who have undergone adenoidectomy or adenotonsillectomy. Samples were sent to the laboratory for bacterial cultures and antibiotics sensitivity tests. RESULTS: Organisms were isolated from 142 sinuses (59.0%) of 240 sinus culture, and 98 sinuses (41.0%) were sterile. Among the 142 sinuses, 97 sinuses have single strain, and 45 sinuses have mixed strains. Most recovered organisms were gram (+) aerobes. Among the gram (+) aerobes, Staphylococcus aureus strains in 41 strains (17.1%), -hemolytic Streptococcus in 42 strains (17.5%), coagulase negative Staphylococcusin 15 strains (6.3%) were the commonly encountered organism. In an antibiotic sensitivity test for gram (+) bacteria, Vancomycin and Teicoplanin showed sensitivity over 95%. CONCLUSION: Most isolated organisms were Staphylococcus aureus and -hemolytic Streptococcus. These organisms showed increased resistance to previously used antibiotics, as compared with the result of similar study carried 18 years ago.

Up-regulation of Cathelicidin in Chronic Sialadenitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Salivary secretions and the secreted IgA in the secretions play a critical role in maintaining oral health via innate host defense mechanism. Cathelicidins are a family of peptides thought to provide an innate defensive barrier against a variety of potential microbial pathogens. LL-37, an antimicrobial peptide, is the only Cathelicidin protein so far identified in humans. The purpose of this study was to examine the expression of Cathelicidin in human salivary glands and to investigate upregulation of Cathelicidin in inflammatory conditions. MATERIALS AND METHOD: Reverse transcriptase-polymerase chain reaction (RT-PCR) and immunohistochemical staining were performed on 20 salivary gland tissues, of which 10 were normal and 10 were chronic sialadenitis. RESULTS: Cathelicidin mRNA transcripts were detected in the normal salivary glands and chronic sialadenitis. The level of Cathelicidin mRNA in chronic sialadenitis was significantly increased compared with that in the normal salivary gland. Cathelicidin protein was expressed in the glandular epithelium of the normal salivary gland and chronic sialadenitis. CONCLUSION: The results indicate that Cathelicidin might play an important role in the innate host defense of human salivary glands.

Acoustic Pharyngometry in Normal Adults / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Assessment of the upper airway for possible site of obstruction is one of the keys to a successful management of patients of sleep apnea syndrome. Acoustic pharyngometry has a potential for localizing obstructive sites, so normal standard data was prerequisite for using this equipment. The aim of this study was to measure normal standard data in normal adults with acoustic pharyngometry on sitting, supine, left and right decubitus positions. SUBJECTS AND METHOD: A total number of 120 normal adults were examined by acoustic pharyngometry. RESULTS: Oropharyngeal junctional area was located within 8-11 cm, and glottic area was within 15-18 cm. There was no statistically significant difference in pharyngeal crosssectional area and pharyngeal volumes measured on sitting, supine, left and right decubitus positions (p>0.05). CONCLUSION: Acoustic pharyngometry is easy, rapid and cost-effective and has been shown to be successfully repeatable.

Synchronous Ipsilateral Double Primary Carcinomas of the Parotid Gland: A Case Report / 대한이비인후과학회지

Synchronous parotid neoplasms are rare cases. In particular, a synchronous neoplasm of two histologically different types is extremely unusual. A review of other references show that most cases of synchronous neoplasms are compounds of two distinct benign neoplasms or that of one benign neoplasm and other malignant tumor. To date, there are no reports about synchronous unilateral double primary carcinomas of the parotid gland. Here, we report a 39-year-old woman who developed the basal cell adenocarcinoma and the mucoepidermoid carcinoma simultaneously in the left parotid gland.