Role of the "Mini" Caldwell-Luc Operation for Treatment of Chronic Maxillary Sinusitis

BACKGROUND AND OBJECTIVES: The aims of the study were to reintroduce a surgical technique for a "mini" Caldwell-Luc operation and to determine its efficacy. MATERIALS AND METHODS: A prospective study was performed in 23 patients undergoing the "mini" Caldwell-Luc operation. Improvements in clinical symptoms and endoscopic and computed tomographic (CT) findings were evaluated postoperatively over a follow-up period ranging from 6 to 21 months. All patients were surveyed for nasal symptoms (nasal obstruction, rhinorrhea, posterior nasal drip, headache, and anosmia), complications (tooth or gum pain, numbness, persistent facial pain, and facial hypo-paresthesia), and recurrence. Preoperative nasal polyps were classified by the Gaskins method, and preoperative paranasal sinusitis was graded according to the Kennedy CT staging system. RESULTS: Symptom scores were all significantly reduced postoperatively (paired t-test, p<0.05). There were no major complications specific to this technique. Among 29 maxillary sinuses that received the "mini" Caldwell-Luc operation, seven showed recurrence (24%). CONCLUSION: The "mini" Caldwell-Luc operation provides an alternative method of obtaining access to the maxillary antrum and is associated with minimal morbidity.

Comparison of the Effects of Laser-Assisted Conchotomy (LACON)and Coblation-Assisted Partial Turbinoplasty (CAPT) in Allergic Rhinitis

BACKGROUND AND OBJECTIVES: There are many operative methods for allergic rhinitis such as partial or total turbinectomy, submucosal resection. Laser- assisted conchotomy (LACON) and coblation-assisted partial turbinoplasty (CAPT) are recently being commonly performed for minimal invasive surgery. The aim of this study is to compare the subjective and objective results in the groups of patients with allergic rhinitis who underwent LACON or CAPT after long term follow up. MATERIALS AND METHODS: From January 2006 to January 2007, 64 patients with allergic rhinitis refractory to medical therapy who underwent LACON or CAPT were enrolled in this study. 28 patients had LACON therapy and 36 patients underwent CAPT randomly. The symptom of allergy, duration of crust formation, and nasal patency in acoustic rhinometry were analyzed in months 3, 6, 9, 12 after surgery. RESULTS: With the Visual Analogue Scale (VAS), the patients who received LACON all reported significant differences in allergic symptoms. However, patients who received CAPT reported significant differences only in nasal obstruction and rhinorrhea. There were no significant differences in both groups in regard to nasal patency change (nasal volume, cm3) and duration of crust formation. CONCLUSION: As LACON is effective on all symptoms and CAPT is effective only on nasal obstruction and rhinorrhea, the procedures can be performed respectively, depending on the symptoms of patients.

A Case of Intralabyrinthine Schwannoma that Mimicked Meniere's Disease

Intralabyrinthine schwannomas are rare benign tumors that arise from the terminal ends of the eighth cranial nerve. These may involve the cochlea, vestibule, or semicircular canals. These tumors are uncommon, and were diagnosed incidentally either during labyrinthectomy or at autopsy. The increasing use of the MRI in the diagnostic assessment of patients with unilateral sensorineural hearing loss or tinnitus has led to the diagnosis of intralabyrinthine schwannomas. Because the clinical symptoms of intralabyrinthine schwannomas and other otologic disorders, particularly Meniere's disease, are so similar, diagnosis of intralabyrinthine schwannomas is challenging. We report a patient with intralabyrinthine schwannoma, who had been misdiagnosed as having Meniere's disease. With the aid of MRI, intralabyrinthine schwannoma was detected and removed successfully by translabyrinthine approach.

A Case of `Silent' Subdural Abscess Detected Incidentally during the Operation of Chronic Otitis Media with Cholesteatoma / 대한이비인후과학회지

Antibiotic treatment for chronic middle ear infections has reduced the incidence of otogenic intracranial complication. Since CT scan became available for the diagnosis, the mortality rate was reduced to about 10%. Nevertheless, intracranial complications are among the most significant life-threatening complications of chronic middle ear infection. Early diagnosis by careful neurootologic, radiologic examination and aggressive medical and surgical treatment are required for successful management. There have been no reports in the Korean literature on otogenic intracranial complications without any preoperative symptoms or signs of intracranial spreading of infection. We experienced `silent' subdural abscess incidentally during a revision mastoidectomy for chronic otitis media with cholesteatoma. The patient was treated by removing abscess and dural repair following mastoidectomy. We report this case with a review of literatures.

CT Finding of Tuberculous Cervical Lymphadenitis and Management / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are controversies in the management of tuberculous cervical lymphadenitis in spite of high prevalence. This study was performed to investigate clinical findings of the patients indicated for surgery and to analyze clinical efficacies of surgery and antituberculous chemotherapy. Materials and METHODS: Fourty patients who had been pathologically confirmed to have cervical tuberculous lymphadenitis were analyzed retrospectively. We classified them into 4 groups according to CT findings and checked their clinical and laborotary findings, as well as efficacies of treatment used. RESULTS: The Type 4 was the most common. All patients were treated with antituberculous medication. In Type 1 and 2, 11 patients among 13 patients were treated with antituberculous medication alone, whereas in Type 3 and 4, 21 patients among 27 patients were treated with the combined method of surgery and antituberculous medication. Most complicated cases were Type 3 and 4, where two cases had recurrence, but most of the cases had local wound problems. All of these complicated cases had recovered to nearly normal state. Two recurrent cases were treated with the combined methods completely. CONCLUSION: For cases that fall into type 1 and 2 tuberculous cervical lymphadenopathys, Antituberculous medication can serve as the first line of treatment. For cases that fall into type 3 and 4 tuberculous cervical lymphadenopathy, the combined method of surgery and antituberculous medication can be the first choice of treatment. For the initial treatment of type 3, 4, applying antituberculous medication for a period of 1-2 months before surgical intervention would be a more effective treatment.

Intraluminal Invasion of Upper Aerodigestive Tract by Thyroid Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Thyroid carcinoma infrequently invades the upper aerodigestive tract. However, when invasion occurs, it is the source of significant morbidity and mortality. If the tumor extends into the lumen of the upper aerodigestive tract, more critical problems can happen. There have been much debates about surgical therapy of thyroid carcinoma invading the upper aerodigestive tract whether it should be radical or conservative. This study was designed to investigate the intraluminal extension of the upper aerodigestive tract by thyroid carcinoma and review the spectrum of radical resection. MATERIALS AND METHODS: From 1996 to 2000, six patients with thyroid carcinoma invading the upper aerodigestive tract (intraluminal involvement) were radically resected at Inha University Hospital. Clinical records were reviewed retrospectively. RESULTS: The radical resection consisted of a total thyroidectomy and a neck dissection, combined with radical excisions that included three laryngectomies, two laryngopharyngoesophargectomies, and a case of partial pharyngectomy. The histologic types consisted of 5 papillary carcinoma and 1 anaplastic carcinoma. There was one preoperative mortality. Five patients received radioactive iodine therapy postoperatively. One patient died of nodal recurrence at the 13th postoperative month, and 4 patients are still alive with a follow-up period of 19-52 months. CONCLUSION: Based on our results of these six patients who had intraluminal involvement of the upper aerodigestive tract, we suggest that radical resection might be a worthwhile procedure. But it should be considered that radical resection might cause loss of functions in the head and neck organs, and therefore possibilites of conservative resection should be considered throughly during the preoperative examination.