The Usefulness of Cone Beam Computed Tomography in Endoscopic Sinus Surgery

BACKGROUND AND OBJECTIVES: Cone beam CT is a relatively new radiologic technique for head and neck imaging, and is widely used in dentistry to plan implant procedures. Compared to conventional CT, it has greater spatial resolution, a lower radiation dose (about 10% that of conventional CT), and lower cost. The objective of this study was to evaluate the utility of cone beam CT for endoscopic sinus surgery. SUBJECTS AND METHODS: A total of 50 patients were involved. Endoscopic sinus surgery was performed unilaterally under local anesthesia, so we used the half Lund-Mackay score to quantify preoperative CT findings. The intraoperative severity score was also determined, and the relationship between the preoperative Lund-Mackay score and intraoperative severity was assessed. The subjective level of operator satisfaction was scored on a ten-point visual analogue scale in terms of four items: overall satisfaction, disease extent of each sinus, identification of anatomic landmarks, and distinction of soft tissue characteristics. RESULTS: The preoperative half Lund-Mackay score was 5.26 and the intraoperative severity score was 5.02; these two scores were significantly correlated (p < 0.01). The level of overall operator satisfaction was relatively high (9.04/10). CONCLUSION: Cone beam CT is a useful imaging method for preoperative evaluation of endoscopic sinus surgery.

Early Development of the Nose in Human Embryo: A Stereomicroscopic and Histologic Analysis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We aimed to analyze the morphologic features of the nose in the human embryo from 4th to 8th developmental weeks according to the Carnegie stage. MATERIALS AND METHOD: A total of 27 cases of embryos, ranging from Carnegie stage of 13 to 23, were analyzed. The external morphology was observed with a stereomicroscope, photographed and analyzed. The histologic features were observed with a light microscope in the horizontally-transected specimens stained with hematoxylin-eosin staining. RESULTS: The nasal placode was observed at the stage 13, and it became flat or even concave at the stage 14. At the stage 15, the nasal pit was formed. At the stage 16, the nasal sac and nasal fin were observed. At the stage 17, the oronasal membrane was formed by thinning of the nasal fin. At the stage 18, the primitive choana was established by rupture of the oronasal membrane. At the stage 19, the lateral palatine process projected vertically below the level of the tongue. The cartilaginous nasal capsule was formed at the stage 20. At the stage 21, the olfactory area was localized to the upper portion of the lateral nasal wall and the nasal septum. At the stage 22, the lateral palatine process developed in a somewhat horizontal orientation. At the stage 23, the premaxilla and primitive choana were formed. CONCLUSION: The development of the nose is most active from the Carnegie stage of 13 to 19, which corresponds to the end of the 4th embryonic week to the end of the 7th week. Thus, this period is considered to be the most important period in human nasal embryonic development.

Clinical Characteristics and Voice Analysis of Mutational Dysphonia: Diplophonia and Clinical Use of Electroglottographic Measures / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mutational dysphonia, also referred to as mutational falsetto, is defined as the dysphonia that continuously have high pitch after adolescence. The aims of this study were to investigate the acoustic and electroglottographic characteristics of mutational dysphonia before and after voice therapy and to identify the factors that may be of help in its treatment. SUBJECTS AND METHOD: The clinical records of 15 patients with mutational dysphonia were reviewed, and analyses of their voice records were carried out with the help of Lx Speech Studio studio (Laryngograph Ltd, London, UK) program. RESULTS: After voice therapy was combined with manual compression method, the voices of the subjects were lowered in pitch and also improved in voice quality. Furthermore, we were able to classify the mutational dysphonia into 4 categories according to diplophonia and closed quotients. The most common type among the categories was bimodal distribution of fundamental frequency, or so-called diplophonic, accompanied with low closed quotient-falsetto voice-at high frequency area. However, the results also showed that all cases of mutational dysphonia can not be generalized simply as falsetto voice. The effect of the therapy for each type was different, and we could assume that in the cases with diplophonia accompanied with non-trained falsetto voice, it is expected that it can be treated readily. CONCLUSION: The diplophonia and closed quotient, which were easily analyzed by using Lx Speech Studio program, are important factors which help to classify the mutational dysphonia, choose the treatment options, monitor the efficacy of therapy, and estimate the prognosis of diseases.

Effect of Patient-Controlled Analgesia after Tonsillectomy with Laser Resection of Palatopharynx (LRPP)

BACKGROUND AND OBJECTIVES: Pain control is one of the most important factors for the patients that underwent the snoring surgery. This study was performed to investigate the effectiveness of intravenous patient-controlled analgesia (PCA) for postoperative pain control after tonsillectomy with laser resection of palatopharynx. MATERIALS AND METHODS: In this double-blind randomized study, 44 patient were randomly allocated to 2 groups. In the PCA group comprising 32 patients, fentanyl citrate, ketorolac tromethamine and zofran in normal saline solution were administered by PCA equipment. In the control group comprising 12 patients, normal saline solution was given without analgesic drug by PCA equipment. Visual analogue pain score (VAS) was recorded right after surgery and 2, 4, 6, 12, 18, and 24 hours after surgery and satisfaction score was recorded just before discharge from the hospital. RESULTS: VAS was significantly higher in the control group of all time points. Overall satisfaction score was also higher in PCA group than control group. CONCLUSION: The results of this study suggest that intravenous PCA is an effective method for postoperative pain control after tonsillectomy with laser resection of palatopharynx.

A Clinical Review on 173 Cases of Unilateral Vocal Cord Paralysis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Unilateral vocal cord paralysis is a common finding in the practice of otolaryngology. Having an idiopathic cause, requiring surgeries on neck and chest, presenting tumors, trauma and neurological diseases are considered to be its major etiology. We reviewed and compared both domestic and international papers and analyzed the trend of clinical characteristics and causes of unilateral vocal cord palsy in Korean patients. MATERIALS AND METHOD: We reviewed 173 patients who visited the Severance Hospital and the Yong dong Severance Hospital from April, 1995 to December, 2001. They were diagnosed with unilateral vocal cord palsy by reviewing systems, physical examination, radiographic studies, and endoscopy. They were analyzed according to sex, age, cause of vocal cord palsy, condition of the paralyzed vocal cord and treatment methods by a preestablished protocol. RESULTS: The male to female ratio was 1.6: 1. Patients in their fifties consisted of 24.3% of the total number of cases, and patients over 60 formed 30.6%, showing that the frequency of unilateral vocal cord palsy increased with age. The paralyzed vocal cord was fixed at paramedian position in 79.8% of the cases. The left vocal cord was paralyzed about twice as much as the right vocal cord. Among the causes of vocal cord palsy, 32.4% of the cases were due to postoperative paralysis, and most of those were developed after thyroid surgery. About 67% of the cases were not related to surgery, of which the causes were most commonly idiopathic, with tumor being the next frequent. In 38.4% of the patients, atrophy of the membranous portion of the paralyzed vocal cord was noted. Rotation of the arytenoid cartilage was seen in 25.3%. CONCLUSION: Vocal cord paralysis is not only a disease entity in itself, but can be seen as a sign of an underlying disease. Thus, determining the cause of vocal cord paralysis is extremely important. Although the number of cases of vocal cord paralysis due to surgery is now decreasing, those due to trauma or idiopathic causes are rising and paralysis due to tumor is increasing. Consequently, it is necessary to perform a complete and thorough search for the underlying cause of vocal cord paralysis.