Usefulness of Vacuum-Assisted Closure Therapy in the Treatment of Esophageal Perforation Following Thyroidectomy / 대한이비인후과학회지

Perforation of the cervical esophagus after thyroidectomy is a rare complication. Esophageal perforation is usually treated conservatively with simple surgical drainage and intravenous antibiotic therapy. If complicated by abscess, it needs aggressive surgery including resection and anastomosis. But the aggressive treatments mentioned have low success and high morbidity. Herein, we report a patient with complicated deep neck infection caused by esophageal perforation following thyroidectomy, which was successfully treated with multiple vacuum-assisted closure and intravenous antibiotic therapy after the failure of simple suture and simple drainage as conservative managements.

3D-Printed Nose-to-Larynx Airway Model, Preliminary Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Flexible fiberscopy is essential in the examination of the nose to larynx airway. However, the instrument is sensitive to manipulation and can sometimes be damaged when excessive external force is applied. In addition, patients can be injured during fiberscopic examination. In this regard, a airway model mimicking the human airway passage was developed for the education of fiberscopy to minimize the danger to both patient and fiberscope. MATERIALS AND METHOD: Neck CT data was used to 3D-print the airway model. Using the 3D doctor software, the outlines of the air-filled cavities were extracted. The outline data was modified to make the inside of the outline empty and the outside filled with 3D ink resin. The airway data was used to 3D-print the replica in three pieces, which were then assembled into one. Flexible laryngoscopic examination of nose to larynx was performed using the nose-to-larynx airway model, and for a male patient enrolled in the study. Virtual endoscopy was performed using the same CT data. The examination data were then compared frame by frame with regards to the shapes and positions of nasal inlet, inferior turbinate, torus tubarius, hypopharynx, epiglottis and vocal cord. RESULTS: The airway model was very similar in shape and position of the anatomic landmarks compared with real human airway examined by the fiberscope. CONCLUSION: The results of 3D-printed airway model showed similar shapes as the real human airway, and real time endoscopy could be done using the model. This technique can be extended to make models of tubed organs such as the intestine or the bronchial tree.

A Case of Retropharyngeal Tuberculosis Presenting as a Huge Cystic Lesion / 대한이비인후과학회지

The authors report the clinical features of huge retropharyngeal cyst, which was confirmed as tubercular abscess, in a 24-year-old woman. Retropharyngeal tuberculosis is a rare type of disease and only four cases have been reported in Korea. In this case, the patient experienced foreign body sensation and hoarseness in the throat. On endoscopic examination and computed tomography, a cyst-like lesion which narrowed the oropharynx was shown in the left retropharyngeal space. The patient was successfully treated with surgical drainage and anti-tubercular therapy.

Application of Negative Pressure Wound Therapy for Deep Neck Infection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Negative Pressure Wound Therapy (NPWT) has been used in many surgery to treat complicated wound and impaired wound healing by delivering negative pressure at the wound site through a patented dressing, which helps draw wound edges together, remove infectious materials, and actively promote granulation at the cellular level. Recently application of NPWT has been increased to treat deep neck infection. We aimed to retrieve indications and guidelines to treat deep neck infection from our cases and after reviewing articles. SUBJECTS AND METHOD: From our experience with 9 cases presented as deep neck abscess in which the application of a Vacuum-assisted closure device was used instead of common drainage tubes after surgical evacuation and journal review, indications and guidelines to apply NPWT as one of the tools to treat deep neck infection were retrieved. RESULTS: Indication and Guideline of NPWT. 1) For simple abscess involving single space excepting the mediastinum, intravenous administration of broad-spectrum antibiotics, needle aspiration or simple surgical drainage is recommended. 2) In the case of failure of previous treatments, NPWT will be necessary for immunocompromised hosts such as diabetic patients for whom more than two spaces are involved, the mediastinal involvement, compromised airway or disseminated intravascular coagulation. In severe cases involving the chest, video-assisted thoracoscopic surgery or mediastinoscopy could be used. 3) For patients with improving signs such as decreasing pus, increasing granulation formation, negative culture results from sponge, and normalized C-reactive protein, we can stop NPWT and convert to the regular wound care. CONCLUSION: Indication and Guideline of NPWT could be applied to treat deep neck infection.

A Case of Retropharyngeal Abscess Treated by Vacuum-Assisted Closure Application / 대한이비인후과학회지

The incidence of retropharyngeal abscess has been decreased with the use of antibiotics, but it can cause critical complications such as airway obstruction, aspiration pneumonia, disseminated intravascular coagulation, mediastinitis, or sepsis. A vacuum-assisted closure (VAC) device is a surgical drain that can help prevent reaccumulation of purulent collections. We present one case of retropharyngeal abscess treated by VAC and highlight the utility of VAC in the management of retropharyngeal abscess.

A Case of Inhalation Burn-Induced Extensive Tracheal Inflammatory Crust Removed by Ventilating Bronchoscopy under Tracheostomy and Extracorporeal Membrane Oxygenation / 대한이비인후과학회지

Foreign body impaction in airway is life-threatening as it can cause total airway obstruction. Such foreign bodies are removed under bronchoscopy in most patients. In some patients, however, the cardiopulmonary condition becomes unstable to undergo ventilating bronchoscopy under general anesthesia to remove the foreign body. In these conditions, extracorporeal membrane oxygenation (ECMO) can be adopted for cardiopulmonary support to stabilize the patient while removing the foreign body. ECMO supports tissue oxygenation and has been shown to improve survival of patients with adult respiratory distress syndrome. ECMO allows lungs to reserve their functions and decreases further lung injuries. The authors report one case of extensive tracheal inflammatory crust removed by ventilating bronchoscopy under tracheostomy and ECMO.

Clinical Application of 3 Dimensional Reconstruction of CT from Fish Bone Foreign Body Model / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aimed to gather three-dimensional data to detect fish bones as an esophageal foreign body model and to assess the possibility that this method could be applied for cases of real fish bone foreign body (FBFB). MATERIALS AND METHOD: Fish bones from two species were collected and sizes were measured. Pork meat loaf was placed flat into a plastic box containing plaster cast and bones were laid over the meat layer. Another layer of meat was placed on the bones, then another layer of plaster cast, and the final layer of meat were placed. The meat-bone sandwich was regarded as a fish bone foreign body model of esophagus. The model was imaged using computed tomography (CT) scan and the CT data were reconstructed three-dimensionally making multi-planar reconstruction, maximal intensity projection, and volume rendering images. We tried to find tools to detect the shape and lying position of the FBFB model. The above tools were applied to 3 FBFB cases to verify effectiveness of the tools. RESULTS: Multi-planar reconstruction, maximal intensity projection, and volume rendering images were reconstructed easily. After single or more processing, all of the bones could be detected. The shape and lying positions could be detected using tools made from FBFB models. CONCLUSION: Reconstructed images of CT data readily enabled the detection of fish bone in the esophageal model and real cases.

Stone of Stensen's Duct Removal by Modified Blair Incision / 대한이비인후과학회지

Parotid sialolithiasis accounts for 10 to 20% of all cases of sialolithiasis that involves the head and neck and presents management challenges for a variety of reasons. In this report, we present a rare case of removing a double stone in Stensen's duct by anexternal approach (open parotid sialolithotomy).

A Case of Arteriovenous Malformation Presenting as Wallenberg Syndrome / 대한이비인후과학회지

Lateral medullary syndrome, also known as Wallenberg syndrome, is characterized by sensory deficits affecting the trunk and extremities on the opposite side of the lesion, and the face and cranial nerves on the same side of the lesion. Other clinical symptoms and findings are dysphagia, slurred speech, ataxia, facial pain, vertigo with nystagmus, Horner's syndrome, diplopia, and possibly palatal myoclonus. The cause of this syndrome is usually occlusion of the posterior inferior cerebellar artery or vertebrobasillar artery. We observed a case of Wallenberg syndrome occuring secondary to the cavernous malformation and initially presenting as unilateral vocal cord palsy. The centrally-medicated vocal cord palsy is a rare cause of hoarseness, but should be considered in cases where no other local cause can be found.

Virtual Endoscopy of Impacted Foreign Bodies in Tracheal and Esophageal Model / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was conducted to gather basic information of virtual endoscopy (VE) in detecting and gaining information of tracheoesophageal foreign body (FB) models. SUBJECTS AND METHOD: The chest model was made using a PVC bottle, a plastic tube, a vinyl tube and a plaster. Fish bones, shells and plastic toys were used to simulate foreign bodies of tracheoesophageal model. CT of the chest model was reconstructed three-dimensionally by using the Rapidia software for virtual endoscopy of foreign body models. The virtual endoscopic images were compared with real foreign body materials as to shape, size, location and orientation. RESULTS: Tracheoesophageal FB models were easily made. CT data gave good 3D images and virtual endoscopic images showed realistic foreign body materials. CONCLUSION: The results indicate the usefulness of converting CT data into virtual endoscopic images so as to help in the diagnosis of foreign bodies.

Can Three-Dimensional Reconstructed Image Replace Medical Photograph? / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In recent years, medical recording by digital photography has become a useful tool in every field. Developments in digital techonology have enabled digital X-ray techniques as well as three-dimensional imaging tools such as CT and MRI. Digital data are processed to form three-dimensional images of the patient body and to provide virtual endoscopy. This study aims to widen the application of 3D images for medical recording. SUBJECTS AND METHOD: CT data from five patients with neck mass were used to make gross 3D images showing the lesion site with the aid of 3D-doctor 4.0 and RAPIDIA 3D ver. 2.8 (INFINITT healthcare , Seoul, Korea). Surface rendered images and volume rendered images were compared with the medical photos regarding identification, visibility of lesion, measuring, multidirectional view and reproducibility. RESULTS: 3D images could show real surface contour of the patients, including lesion sites. Shapes shown by the 3D images are exactly the same as the medical photographs, thus it was possible to measure the length and angles and view the image in any directions by rotating. CONCLUSION: Surface rendered and volume rendered images can be used as pre-operative recording tools.

Contralateral Suppression of Transient Evoked Otoacoustic Emission in Vestibular Neuritis / 대한평형의학회지

BACKGROUND AND OBJECTIVES: The etiology of vestibular neuritis is unknown. Many investigators have suggested that this condition spares the inferior vestibular nerve system. However, others have reported that the lesion sometimes affects the inferior vestibular nerve system based on vestibular evoked myogenic potential. The function of the inferior vestibular nerve was studied in acute vestibular neuritis by monitoring medial olivocochlear bundle (MOCB) function. Under normal conditions, contralateral acoustic stimulation has inhibitory effects on ipsilateral otoacoustic emissions through the MOCB. MATERIALS AND METHODS: Twenty patients that presented with dizziness and spontaneous nystagmus, and were confirmed to have acute vestibular neuritis by rotatory chair and caloric testing were enrolled in this study. We evaluated the evoked otoacoustic emissions with and without contralateral acoustic stimulation in both ears in all patients. The percent loss of normal inhibitory action on otoacoustic emissions was determined in the normal and affected ears. RESULTS: All patients showed inhibitory effects in response to contralateral acoustic stimulation on evoked otoacoustic emissions in normal ears. Fifteen patients (75%) had an absence of contralateral suppression of otoacoustic emissions on the affected side. CONCLUSION: The findings of this study suggest the presence of dysfunction of the MOCB in patients with acute vestibular neuritis.

Application of Three-dimensional Reconstruction in Esophageal Foreign Bodies

This study was conducted to investigate the clinical application of three-dimensional (3D) reconstructed computed tomography (CT) images in detecting and gaining information on esophageal foreign bodies (FBs). Two patients with esophageal FBs were enrolled for analysis. In both cases, 3D reconstructed images were compared with the FB that was removed according to the object shape, size, location, and orientation in the esophagus. The results indicate the usefulness of conversion of CT data to 3D images to help in diagnosis and treatment. Use of 3D images prior to treatment allows for rapid prototyping and surgery simulation.

Double Glomus Tumors Originating in the Submandibular and Parotid Regions

Glomus tumors are rare neoplasms that originate from the glomus bodies, an arteriovenous anastomosis with a specialized vascular structure. The most common site for these tumors is the subungal region of the fingers. Occasionally, glomus tumors are found in the middle ear, trachea, nasal cavities, stomach, and lungs. The occurrence in the parotid regions is very rare. While multiple glomus tumors in the whole body are thought to represent only 10% of all cases, instances of multiple tumors in the neck have not yet been reported in the literature. We report a case of double glomus tumors in the submandibular and parotid regions.

Double Glomus Tumors Originating in the Submandibular and Parotid Regions

Glomus tumors are rare neoplasms that originate from the glomus bodies, an arteriovenous anastomosis with a specialized vascular structure. The most common site for these tumors is the subungal region of the fingers. Occasionally, glomus tumors are found in the middle ear, trachea, nasal cavities, stomach, and lungs. The occurrence in the parotid regions is very rare. While multiple glomus tumors in the whole body are thought to represent only 10% of all cases, instances of multiple tumors in the neck have not yet been reported in the literature. We report a case of double glomus tumors in the submandibular and parotid regions.

Chondrocutaneous Advancement Flap for Helical Rim Defect / 대한이비인후과학회지

Helical rim defects of the auricle are usually the result of injury or tumor excision. Acquired helical rim defects are eye-catching and cosmetically unacceptable. We experienced a case of squamous cell carcinoma at the helical rim. The lesion was resected with clear margin and the defect was successfully reconstructed with a helical rim chondrocutaneous advancement flap.

A Case of Non-Communicating Dumbbell Shaped Fourth Branchial Cleft Cyst / 대한이비인후과학회지

The fourth branchial cleft cyst is rare and frequently unknown to clinicians. Misdiagnosis is common and definitive surgery is often made difficult by previous episodes of infection and incision. We have experienced a case of non-communicating dumbbell shaped fourth branchial cleft cyst. We performed complete excision of the entire epithelial tract after disarticulating the cricothyroid joint. There was no recurrence.

A Case of Metachronous Carcinosarcoma and Squamous Cell Carcinoma of the Both Parotid Glands / 대한이비인후과학회지

Carcinosarcoma of the parotid gland is rare. Furthermore, metachronous bilateral double primary carcinoma of the parotid gland is very rare. We report a case of metachronous bilateral double primary Carcinosarcoma and Squamous cell carcinoma of both parotid glands in the same patient. He received operation and postoperative radiotherapy for a left parotid gland cancer. Four years later, the right parotid gland cancer developed, which was treated by excision followed by radiotherapy. At follow-up, he remained free of disease.

Grommet Cholesteatoma / 대한이비인후과학회지

There are occasional complications after tympanostomy tube insertion due either to the operative procedure itself or to the anato-mical or physiological effects of the tubes. Hearing loss, persisting perforation, tympanosclerosis, atrophy, atelectasis, and the development of cholesteatoma have all been attributed to the tympanostomy tubes. The development of a secondary cholesteatoma at the site of the tube placement Grommet cholesteatoma- is a very uncommon complication. We report one case of cholesteatoma associated with tympanostomy tube insertion.

Three Cases of Lymphoepithelial Carcinoma / 대한이비인후과학회지

Lymphoepithelial carcinoma was first reported in 1962. Since then, about 130 cases have been reported in the English-language literature. Lymphoepithelial carcinoma is a rare tumor of the major salivary gland. Most reported cases have occurred in Asians and Eskimos. We report two cases of lymphoepithelial carcinoma of the major salivary glands and one case of lymphoepithelial carcinoma of unknown origin. They received operation and postoperative radiotherapy. At follow-up, they remained free of disease.