Hypocalcemia and Recurrent Laryngeal Nerve Injury after Thyroid Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The main indication for thyroidectomy are thyroid cancer, multinodular goiter, and Graves' disease. Most important complications of thyroidectomy are recurrent laryngeal nerve injury and hypoparathyroidism. The risk of complication depends on the extent of the operation, and skill and experiences of surgeon. The purpose of this study is to determine the incidence and predictive factors for complication after thyroidectomy. MATERIALS AND METHOD: We examined the records of 233 patients who underwent thyroidectomy at the Department of Otolaryngology, Hanyang University from 1994 to 2001. The postoperative complication including hypocalcemia, recurrent laryngeal nerve palsy and hematoma was identified and analysed. The rate of recurrent laryngeal nerve palsy was calculated on the number of nerve at risk of injury. There were 135 unilateral and 98 bilateral procedures. Nerves at risk is 329. The hypocalcemia was defined as a ionized calcium fell below 1.01 mEq/L. RESULTS: Among 233 patients, 3 patients (1.3%) had permanent hypocalcemia and 57 patients (24.5%) had transient hypocalcemia. According to surgical procedure total thyroidectomy with neck dissection was associated with an increased risk of transient hypocalcemia (63.6%). The incidence of temporary and permanent recurrent laryngeal nerve palsy was 0.9% (3/329) and 0.3% (1/329), respectively. The postoperative hematoma occurred in 7 patients (3%). CONCLUSION: The most frequent complication after thyroidectomy is transient hypocalcemia. Based on our results, thyroidectomy is a relatively safe procedure. Complications can be kept to a minimum by a through knowledge of the anatomy, by understanding thyroid pathology, and by meticulous hemostasis and delicate surgical technique.

The Analysis of Temporal Bone Pneumatization between Children with Otitis Media with Effusion and Cleft Palate / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A number of studies have documented that the incidence of otitis media with effusion (OME) is greater than 90% in children with cleft palates. The purpose of this study was to evaluate the correlation of OME and mastoid pneumatization in children with cleft palate. SUBJECTS AND METHOD: We studied 175 ears in 95 patients. They were categorized into three groups according to otologic finding:normal children (38 ears), children with OME (89 ears), children with cleft palates (38 ears). The mastoid pnuematization was graded into 5 groups. RESULTS: The masoid pneumatization was relatively good in 76.3% of normal children. The mastoid pneumatization was poor in 40.4% of the children with OME. All children with cleft palate had OME in both ears and their mastoid pneumatizations were very poor, with 16.7% of grade IV and 83.3% of grade V. CONCLUSION: The mastoid pneumatization of children with cleft palate was very poor compared to those without cleft palate. We believe that mastoid pneumatization was influenced by the disease of middle ear and mastoid, environmental factors. Special consideration is needed to deal with otologic problems in children with cleft palate.

Expression of Fibronectin Activities in Rat Tongue Mucosal Wound Healing Following CO2 Laser Incision / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The CO2 laser is commonly used in the oral cavity and pharyngolaryngeal lesion, since, unlike the conventional scalpel technique, it provides excellent hemostasis and visualization and thus enables the surgeon to operate in a precise manner. Additional advantages include decreased postoperative pain and less swelling. Despite this advantage, several studies have reported impaired wound healing associated with the use of CO2 laser. Fibronectin is a high molecular weight glycoprotein and serves as a substrate for adhesion and migration of cells which repair cell defects together with fibrin. Fibronectin is involved in the generation of reticulin matrix together with the type III collagen. MATERIALS AND METHODS: The histological changes and the expression of fibronectin activities following incision of tongue mucosa by the CO2 laser and the conventional scalpel technique were compared over a period of 7 days in a rat model. RESULTS: A delay was noted in the healing of the CO2 laser wound. Both CO2 laser and scalpel wound expressed fibronectin, soon after wounding. The expression of fibronectin activities in the CO2 laser rose to the maximal level more slowly than the scalpel wound and its degree was weaker. CONCLUSION: Delayed expression in fibronectin may play a role in the delay of the CO2 laser wound healing.