Interposition Technique for Septal Perforation Using a Composite Graft Made Up of Allograft Dermal Matrix and Autologous Cartilage / 대한이비인후과학회지

Background and Objectives@#Interposition using acellular allograft between perforated septal flaps is a popular procedure among surgeons because of its usefulness. However, allograft dermal matrix itself tends to become infected sometimes, and can easily undergo necrosis or be displaced from the implanted site. Here, the authors would like to introduce a newly devised interposition graft made up of allograft and cartilage, which is easy to manipulate and can be fixed in the desired position.Subjects and Method We performed a retrospective chart review from January 2018 to August 2020. A total of 12 patients with septal perforation who received surgical treatment were included in this study. Acellular human dermal allograft (MegaDerm® ; L&C Bio) was used as an interposition allograft piled up by autologous cartilage, and it was positioned between the mucoperichondrial flaps via the endonasal approach. @*Results@#The most common etiology was previous septal surgery (n=8); in one case, the etiology was repeated electrocauterization due to frequent epistaxis; the etiology was not verified for three cases. All 12 cases achieved the result of complete septal perforation closure. All patients on follow-up inquiry reported marked improvements in the visual analogue scale score (mean value, 4.1 to 1) and Nasal Obstruction Symptom Evaluation scale (mean value, 7.3 to 1.8). @*Conclusion@#Composite graft made up of cartilage and allograft dermal matrix achieved successful results without having to fix the graft. It can be an alternative technique to treat septal perforation for inexperienced surgeons and with a limited operation field.

Palatopharyngeal Muscle Suspension Suture Technique for Obstructive Sleep Apnea / 대한이비인후과학회지

Various treatment modalities for obstructive sleep apnea (OSA) patients were introduced including continuous positive airway pressure (CPAP), lifestyle modification, and surgery. Numerous factors such as compliance, treatment failure, and preference should be considered when deciding the treatment. In general, patients for whom CPAP or other conservative treatment modalities failed become candidates for surgical treatments. Uvulopalatopharyngoplasty is one of the most generally performed surgeries, of which success rate is relatively low. Recently, numerous techniques that can correct lateral pharyngeal obstruction for OSA patients were introduced. However, some of them are technically difficult and aggressive. In this article, we introduce a novel surgical method for OSA called palatopharyngeal muscle suspension suture technique.

Two Cases of Cerebral Infarction after Endoscopic Sinus Surgery / 대한이비인후과학회지

Perioperative stroke is one of the most fatal complications for patients as well as for doctors. It is defined as a brain infarction or hemorrhage, occurring during or within 30 days after a surgical procedure. Most of the perioperative strokes have ischemic etiology while only 1% has hemorrhagic etiology, according to one study. The incidence of perioperative stroke is influenced by the complexity and type of the surgery. Generally, its incidence is very low, being about to 0.1-1.9%, with majority of the cases pertaining to cardiac, vascular, neurological surgeries. Based on our research, most cases are perioperative strokes that occur after cardiac and vascular surgeries. Here we report two cases of cerebral infarction after endoscopic sinus surgery, which are very rare.

A Case of Endoscopic Drainage of Pterygoid Fossa Abscess Induced by Fungal Invasion

The infratemporal fossa consists of critical structures affecting patient quality of life. Though abscess formation in the infratemporal fossa is very rare, drainage is highly recommended to avoid severe complications. We recently experienced a rare case of infratemporal fossa abscess. Such an abscess is easy to misdiagnose due to its rarity. Endoscopic drainage of the infratemporal fossa was conducted in this case, and its limited invasiveness was an advantage for a conservative approach. We present this case with a brief review of the approach to abscess of the infratemporal fossa area.

A Case of Fibrolipoma of the Nasal Septum / 대한이비인후과학회지

Lipoma is the most common benign neoplasm in adults. While it is commonly found in the neck, trunk, and extremities, it is extremely rare in the nasal cavity, paranasal sinus, or nasal septum. To our knowledge, there have been only a few cases of septal lipomas reported in the English literature. A 32-year-old woman visited Kosin University Hospital complaining of left nasal congestion and throat discomfort. Upon nasal endoscopy examination and CT, we found a polypoid mass of 2.7×1.5 cm with an elongated neck occupying a region left of the nasopharyngeal to the oropharyngeal cavity. The mass was completely removed via endoscopic endonasal surgery under general anesthesia and was identified as a fibrolipoma in the histopathological examination. We report a case of a successfully treated fibrolipoma originating from the posterior margin of the nasal septum.

Three Wall Orbital Decompression for Compressive Optic Neuropathy in Thyroid Ophthalmopathy / 대한이비인후과학회지

Thyroid ophthalmopathy is an autoimmune disease that affect the orbital and periorbital soft tissue, characterized by bulging eye (exophthalmos) and compressed orbital structures, such as the optic nerves. The indications for surgical treatment for thyroid ophthalmopathy include decreased visual acuity caused by optic neuropathy, conjunctivitis and progressive facial deformity caused by exophthalmos. Orbital wall decompression by nasal endoscopy resulte in good cosmetic effects and visual recovery. Balanced orbital decompression is considered to be a safe and effective surgery that can help avoid postoperative diplopia. We introduce three successful cases of orbital wall decompression for the treatment of thyroid ophthalmopathy.

A Case of White-Eyed Blowout Fracture / 대한이비인후과학회지

The ‘white-eyed’ blowout fracture is an orbital injury in children that is often initially misdiagnosed as a head injury because of predominant autonomic features and lack of soft tissue signs. Delays in treatment can lead to morbidity. It has been recommended that children who present with a ‘white-eyed’ blowout fracture should have surgery performed within 48 hours of diagnosis, otherwise prognosis is poor. We present a 12-year-old boy who was initially misdiagnosed with a head injury due to the minor appearance of his orbital injury and his presenting complaints of nausea and vomiting.

A Case of White-Eyed Blowout Fracture / 대한이비인후과학회지

The ‘white-eyed’ blowout fracture is an orbital injury in children that is often initially misdiagnosed as a head injury because of predominant autonomic features and lack of soft tissue signs. Delays in treatment can lead to morbidity. It has been recommended that children who present with a ‘white-eyed’ blowout fracture should have surgery performed within 48 hours of diagnosis, otherwise prognosis is poor. We present a 12-year-old boy who was initially misdiagnosed with a head injury due to the minor appearance of his orbital injury and his presenting complaints of nausea and vomiting.

Three Wall Orbital Decompression for Compressive Optic Neuropathy in Thyroid Ophthalmopathy / 대한이비인후과학회지

Thyroid ophthalmopathy is an autoimmune disease that affect the orbital and periorbital soft tissue, characterized by bulging eye (exophthalmos) and compressed orbital structures, such as the optic nerves. The indications for surgical treatment for thyroid ophthalmopathy include decreased visual acuity caused by optic neuropathy, conjunctivitis and progressive facial deformity caused by exophthalmos. Orbital wall decompression by nasal endoscopy resulte in good cosmetic effects and visual recovery. Balanced orbital decompression is considered to be a safe and effective surgery that can help avoid postoperative diplopia. We introduce three successful cases of orbital wall decompression for the treatment of thyroid ophthalmopathy.

Rhabdomyoma of Inferior Rectus Muscle Manifesting as Vertical Eye Movement Limitation

No abstract available.

Comparison of the Results between the First Steroid Treatment Group and the Retreatment Group with Idiopathic Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Sudden sensoryneural hearing loss (SSNHL) is an otological emergency disease of a non-specific cause. If there is no improvement or if the degree of hearing loss is severe, patients are often referred to other medical institution. Many papers have reported regarding the treatment results of SSNHL, however, most of them failed to mention the fact that patients were referred from other clinics after steroid treatment. This paper would like to compare the treatment results between patient groups who had been referred following steroid treatment and those who received steroid treatment for the first time.SUBJECTS AND METHOD: We retrospectively analyzed 127 patients from January 2015 to August 2017. Patients who received steroid treatment for the first time were classified as group 1; those who had received steroid treatment at another hospital and those who were re-treated were classified as group 2. The treatment results of each group were evaluated.@*RESULTS@#According to the results of this study, the recovery rates for group 1 and 2 were 66.7% and 31.4%, respectively.@*CONCLUSION@#Most of the previous studies on the treatment results of sudden hearing loss were performed in tertiary medical institutions. It is likely that the treatment results of patients who recovered after treatment in the primary and secondary medical institutions were missed, which means that the results of steroid therapy may be better than those reported previously.

A Case Of Cavernous Sinus Syndrome and Mutifocal Cerebral Infarction Related To Mucormycosis Of Sphenoid Sinus / 고신대학교의과대학학술지

A 54-year-old man, suffering from severe headache and ophthalmoplegia after undergoing endoscopic sinus surgery was referred to a tertiary hospital. Computed tomography (CT) revealed soft tissue density lesions in the left sphenoid sinus. The internal carotid artery was shown to be occluded in brain magnetic resonance imaging (MRI) scans without any other cerebral lesion. Endoscopic view of left nasal cavity shows whitish hyphae in the ethmoid and the sphenoid sinuses. We diagnosed him with cavernous sinus syndrome caused by mucormycosis and conducted endoscopic sinus surgery to remove remaining lesions and decompress orbit and optic nerves. After the revision surgery the patient's headache and ophthalmoplegia were improved. However, multifocal cerebral infarctions were newly discovered in a postoperative CT scan. We experienced a case of mucormycosis of sphenoid sinus resulting in occlusion of internal carotid artery and multifocal cerebral infarction, and report it with a brief review of these disease entities.

Comparison of the Effect of Intratympanic Steroid Injection Medications in Patients with Idiopathic Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study is aimed to investigate the efficacy of dexamethasone and methylprednisolone when used for Intratympanic steroid injection (ITSI) concurrent with systemic steroid as primary therapy. SUBJECTS AND METHOD: We undertook a retrospective study of 106 patients diagnosed with Idiopathic Sudden Sensorineural Hearing Loss at our institution. These patients were divided into the following groups based on their intratympanic steroid medications: Group 1 (which received dexamethasone for ITSI) and Group 2 (which received methylprednisolone for ITSI). The severity of pain after ITSI was also compared using Visual Analogue Scale. RESULTS: The therapeutic results of both groups showed no significant difference. The improvement of pure tone audiometry average threshold were 18.3±19.5 dB for Group 1 and 22.4±25.8 dB for Group 2, with no significant differences (p=0.402). The recovery rate according to Siegel's criteria were 34/70 (48.6%) and 18/36 (50.0%) respectively, with no significant differences (p=0.889). The degree of pain after ITSI were 1.51±1.06 and 3.92±1.63 for Group 1 and 2, respectively, showing significant differences (p<0.001). Again, there were no significant differences even when accompanying symptoms or severity of initial hearing loss were considered. CONCLUSION: There was no significant difference between efficacy of dexamethasone and methylprednisolone when used as primary therapy. Methylprednisolne caused more severe pain after ITSI, suggesting the choice of dexamethasone. Further studies are needed about the concentration of injected steroid.

Usefulness of Fibrin Glue in Transantral Orbital Floor Fracture Repair Using Bioresorbable Panel / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the advantages and limitations of using fibrin glue for securing bioresorbable panels to reconstruct the fractured orbital floor by transantral approach. SUBJECTS AND METHOD: A retrospective study was conducted from July 2009 to July 2015 in 35 patients with pure orbital floor fractures. Nineteen patients underwent reduction surgery for inserting the bioresorbable panel and 16 patients underwent reduction surgery using fibrin glue for securing the bioresorbable panel via a transantral approach. In both groups, a chart review of preoperative and postoperative ocular symptoms, operation records, and complications was conducted. RESULTS: There was no significant difference between two groups in the demographic data of patients. Comparing the surgical outcomes between two groups, diplopia and mean discrepancy between fractured bone chip and intact orbital floor based on computed tomography scans showed much better results in the group that used bioresorbable panel secured by fibrin glue than in the bioresorbable only group. Furthermore, we carried out revision operations in six cases in the bioresorbable panel only group, where we found that the main cause of fracture to be the dislocation of bioresorbable panel. On the other hand, in the bioresorbable panel secured by the fibrin glue group, there were no reoperation and postsurgical complications. CONCLUSION: During the course of the study, we sensed orbital floor fracture repair using bioresorbable panel secured by fibrin glue via a transantral approach as an easy and effective technique with good postoperative results, and minimal implant related complications. This novel procedure is recommended as a surgical option for the reduction of orbital floor fractures, especially in large and posterior fractures.

Comparison of the Short-Term Effect of Steroid Dosage Regimens in Patients with Idiopathic Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: For idiopathic sudden sensorineural hearing loss (ISSHL) patients, steroids are one of the most important therapies which are used to reduce inflammation in the inner ear. However, dosage regimens of oral steroid therapy have not been well established. This study aims to investigate the progression in recovery from ISSHL, and the optimal dosage regimen with steroids. SUBJECTS AND METHOD: We undertook a retrospective study of 149 patients diagnosed with ISSHL at our institution. We compared various clinical parameters such as age, gender, vertigo, tinnitus, the interval between disease onset and initial treatment, and severity of hearing loss. The 149 patients were divided based on their steroid regimens into two groups: group 1 (which received 40 mg of prednisolone in the morning and 20 mg at night) and group 2 (which received 20 mg of prednisolone three times daily). We then compared the results of group 1 with that of group 2. RESULTS: Recovery rates in group 1 (58/90, 64.4%) were significantly higher in ISSHL than those in group 2 (27/59, 45.8%). In particular, the complete recovery rates of Siegel's criteria in group 1 (35/90, 38.9%) were higher than those in group 2 (12/59, 20.3%). Therapeutic results were affected by the presence of tinnitus. Of the patients with tinnitus, 64.3% in group 1, and 43.9% in group 2 recovered. CONCLUSION: In the group treated with twice-daily regimens, greater hearing improvements were observed compared with the group treated with three times-daily regimens. These findings suggest that higher dose for a single administration may be an important prognostic factor.

Correction of Post-Traumatic Enophthalmos and Temporal Depression Using Rib Cartilage and Fat / 대한이비인후과학회지

Posttraumatic enophthalmos is one of the common complications of facial bone fracture, leading to serious functional and esthetic sequele. However, the correction of this complication is a challenging procedure. A 62-year old patient was injured in a traffic accident, resulting in enophthalmos of the right orbit, which had been uncorrected by a previous correction surgery. The patient showed prominent enophthalmos, ptosis of right orbit, and temporal area depression without complaining diplopia. Under general anesthesia, the correction of enophthalmos of right orbit was done using diced coastal cartilage and an absorbable mesh plate. The depressed right temporal and the frontal area were reinforced using harvested abdominal fat. Three months after the surgery, additional fat injection was introduced to supplement under local anesthesia. Currently, 12 months after the surgery, the patient is in stable state without any complications.

A Immediate Orbital Floor Reconstruction after Suprastructure Maxillectomy

Orbital wall Reconstruction After Maxillectomy For Maxillary Malignancies Is Very Challenging For Surgeons. Preservation Of The Orbit Is A Current Trend In This Procedure In Order To Increase The Quality Of Life Of Patients. If The Patients Have Not Achieved A Proper And Adequate Rigid Frame Of The Orbital Floor After Maxillectomy, They Can Suffer From Enophthalmos, Diplopia, And/Or Decreased Vision. The Authors Report One Case Of Immediate Orbital Floor Reconstruction Using A Bioreabsorbable Panel And Titanium Mesh After Successful Suprastructure Maxillectomy. The Functional And Plastic Outcomes Of The Orbit Were Excellent 4 Years After Surgery, Without Complications or recurrence.

Endoscopic Dacryocystorhinostomy Using Ultrasonic Bone Aspirator

PURPOSE: To report the results of 15 endoscopic dacryocystorhinostomy (eDCR) cases using ultrasonic bone aspirator (UBA) and evaluate the UBA efficiency in these surgeries. METHODS: Fifteen eyes of 12 patients presenting with nasolacrimal duct obstruction were evaluated in the present study. eDCR and osteotomy were performed using UBA (Cusa excel, Integra, New Jersey, NJ, USA) from January 2014 to June 2014. RESULTS: All the patients showed complete resolution of the epiphora. There were no complications or recurrences for a minimum of 10 months postoperatively. CONCLUSIONS: This is the first report on eDCR using UBA. The surgeries were successful and no complications were observed. eDCR using UBA is an easy, safe and effective technique with minimal heat production, minimal damage to the surrounding soft tissue and quick and precise bone removal.

Transantral Orbital Floor Fracture Repair Using a Folded Silastic Tube

OBJECTIVES: The purpose of this study was to evaluate the advantages and limitations of using a silicon tube to support the fractured orbital floor by a transantral approach. METHODS: A retrospective study was conducted from January 2000 to December. 2011 in 51 patients with pure orbital floor fractures. The patients underwent reduction surgery via a transantral approach for inserting a folded silastic tube to support the fractured orbital floor in the maxillary sinus. A chart review of preoperative and postoperative ocular symptoms, operation records, and complications was maintained. RESULTS: In 18 out of 25 patients with diplopia, postoperative improvement was seen. In 13 out of 15 patients with extraocular muscle limitation, postoperative improvement was seen. Enophthalmos resolved postoperatively in four of five patients. Postsurgical complications occurred in three patients: an overcorrection, an infection in the maxillary sinus, and an implant extrusion, all of which were resolved by revision surgeries. CONCLUSION: During the course of the study, we sensed reduction using a folded silastic tube via a transantral approach as an easy and effective technique with good postoperative results, and minimal implant related complications. This novel procedure is recommended as a surgical option for the reduction of orbital floor fractures.

Risk Factors of Saddle Nose Deformity after Septoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Surgeons operate carefully to prevent nasal deformity during septoplasty, however, rarely unfavorable esthetic outcomes such as saddle nose deformity may occur. This study was designed to investigate patient factors associated with post-septoplasty saddle deformity. SUBJECTS AND METHOD: Of 588 patients who underwent endonasal conservative septoplasty from Jan. 2011 to Dec. 2014, a total of 183 patients were enrolled in this study group after exclusion. Patients were divided into two groups: 12 patients who developed saddle deformity of nasal dorsum after septoplasty belonged to the 'deformity group', and the remaining 171 patients were enrolled in the 'non-deformity group'. We investigated preoperative external nose status, patterns of septal deformity, dorsal septal thickness, the angle of axial and coronal deviation of caudal sepum on CT scan. RESULTS: The postoperative saddle deformity was not found to correlate with the location of the most deviated septum and the thickness of dorsal septum (p>0.05). 50% of patients in the deformity group had saddle nose preoperatively, showing statistical differences between the two groups (p=0.000). 75% of patients in the deformity group had severe deviation at the most deviated site, also showing a significant difference compared with the non-deformity group (p=0.011). The axial and coronal deviation angle of caudal septum in the deformity group were significantly increased compared with the non-deformity group (p<0.01). CONCLUSION: The preoperative saddle nose, severity of deviation, and angle of axial and coronal deviation of caudal septum are all possible risk factors of postoperative saddle deformity. We recommend that the surgeon should check these factors before septoplasty to prevent postoperative saddle nose deformity.