Radiofrequency Ablation of Microcystic Lymphatic Malformation in the Oral Cavity: 2 Case Studies / 대한이비인후과학회지

Lymphatic malformation is a congenital abnormality of the lymphatic system, which manifests frequently at birth or before 2 years of age. Lymphatic malformations are classified as macrocystic or microcystic. Microcystic lesions typically occur above the level of mylohyoid muscle and need conservative treatment rather than surgical resection because of the high rate of incomplete excision and recurrence. We report our experience with two cases of radiofrequency ablation of lymphatic malformation in the oral cavity recently seen in our practice.

Classification and Clinical Analysis of Zygomatic Fractures / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study investigated the surgical methods and their results according to the subtypes of zygomatic fractures. SUBJECTS AND METHOD: Medical records of 99 zygomatic fractures treated between March 1997 and December 2006 were reviewed regarding fracture type, surgical method and time of operation from the initial trauma. RESULTS: Overall, operations were performed in 70 out of 99 cases. For zygomatic arch fractures, facial asymmetry and trismus in all 14 of 20 cases after surgery by Gillies incision were improved, and one revision procedure was performed. For tetrapod and multifragment fractures, one revision procedure was performed because of displacement of repaired bone fragment following surgery in 60 cases. Considering location and replacement of fractures, surgery was performed through one of incisions below: Gillies, lateral canthal, gingivobuccal, and subcilliary incision. All preoperative symptoms were improved. CONCLUSION: For zygomatic arch fractures, Gillies approach would be an optimal method, while for displaced tetrapod and multifragment fractures, two or more point fixation points would achieve satisfactory results.

Juvenile Paget's Disease with Paranasal Sinus Aplasia

Juvenile Paget's disease (JPD) is a rare skeletal disorder that's characterized by bone demineralization and elevated levels of serum alkaline phosphatase. JPD involves the paranasal sinuses in extremely rare cases. We report here on a 25-month-old Asian male who was diagnosed of JPD associated with aplasia of the paranasal sinuses, but not the ethmoid sinuses. The patient was successfully treated by surgery and we undertook no medical intervention. This appears to be the first reported case of JPD associated with bilateral paranasal sinus aplasia.

Efficacy of the Eustachian Tube Function Test Using by Rigid Videoendoscopy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Since chronic E-tube dysfunction is believed to play an important role in the development of otitis media, it is necessary to evaluate the function of the E-tube clinically. Recently, the endoscopic techniques have been used more frequently to directly inspect the E-tube orifice. In this study, I evaluated the morphologic and dynamic motion of the E-tube orifice with 4 mm 30 degrees videoendoscope and compared with the other existing tests of the E-tube function. SUBJECTS AND METHOD: 101 E-tubes with chronic otitis media were selected. I performed the transnasal 4 mm 30 degrees videoendoscopic examination of the pharyngeal E-tube orifice when patients were swallowing, and classified morphologic and dynamic findings of the E-tube orifice into three categories as follows: Type A, the E-tube is opened widely on swallowing with normal mucosa (normal); Type B, the E-tube is not opened with normal mucosa (functional blockage) and Type C, the E-tube is not opened with pathologic mucosa (mechanical blockage). Throughout the study, the control group was 60 E-tubes that were free of ear pathologies. RESULTS: There were more type As in the control group than in the otitis media group according to videoendoscopic findings of the E-tube orifice. The videoendoscopic analysis of the E-tube orifice had a close correlations with the results of inflation deflation test and with the classification of otitis media, but had no significant relationship with the degree of mastoid pneumatization. CONCLUSION: The morphologic and dynamic examination of the E-tube orifice with videoendoscopic techniques may be an important and useful method to examine the tubal function as well as its dysfunction.

Repair of Late Post-traumatic Enophthalmos / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Enophthalmos is a common sequelae of orbital fracture. Moreover, it is difficult to treat secondarily. We assessed the effect of filling up the orbital volume defect with implants on the correction of late posttraumatic enophthalmos. SUBJECTS AND METHOD: Based on patients' clinical data, we retrospectively reviewed 11 patients who had an operation because of late posttraumatic enophthalmos from July 2001 to December 2005. To correct late posttraumatic enophthalmos, porous polyethylene (Medpor(R)), Medpor(R) enophthalmos wedge implant, absorbable mesh, bone graft particulate, rib cartilage, auricle cartilage, and maxilla anterior wall were used. RESULTS: Among 11 patients, 6 patients were men and 5 patients were women. The average age was 33.2 years with the follow-up period of 21.8 months. Five patients had orbital floor fracture, 1 patients had medial orbital wall fracture, 4 patients had a combination of orbital floor and medial orbital wall fractures, and 3 patients had zygoma fracture. Excellent results were obtained in all 5 patients with diplopia. The amount of enophthalmos corrected was between 1 and 5 mm (mean 2.5 mm). There was no case of visual loss, infection, migration, or exposure of implant, but we carried out re-operation on 1 case due to over reduction. CONCLUSION: Filling up the volume defect with proper implants is a relatively simple, safe and efficient technique in correcting late posttraumatic enophthalmos.

Results and Complications of the Orbital Blowout Fractures Repair / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There has been a recent surge in the frequency of blowout fracture operations in the Department of Otorhinolaryngology. Clinical symptoms and signs, operative timing and the results from fracture site and size have been researched in this study. We conducted this study to examine the postoperative complications causing re-operation in orbital blowout fracture repair in the last seven years. SUBJECTS AND METHOD: Based on patients' clinical data, we retrospectively reviewed 160 patients who had operation because of blowout fracture from January 1998 to December 2004. Fifty-two patients had orbital floor, 74 patients had medial orbital wall, 34 patients had a combination of orbital floor and medial orbital wall fractures. We investigated diplopia, limitation of eye movements, and enophthalmos after the surgery, and analyzed the frequency and causes of re-operation. The mean postoperative follow-up was 24 months. RESULTS: We classified complications into immediate complications which occurred within 24 hours, late complications which occurred between 24 hours and 2 weeks, and delayed complications which occurred 2 weeks or more after operation. The symptoms of complications included diplopia, EOM limitation, cheek hypoesthesia, loss of vision, oroantral fistula, implant infection, ectropion, and etc. In case of sequelae which lasted more than six months, the combination of orbital floor and medial orbital wall fractures was higher than other fracture types. We carried out re-operation on 14 cases and the main cause was incomplete reduction. CONCLUSION: Surgeons should perform proper operation according to fracture site and type, and insert the implant after making an adequate dissection in order to reduce the frequency of complication and re-operation.

Expression of glucocorticoid receptor mRNAs in glucocorticoid-resistant nasal polyps

Glucocorticoids (GCs) are the most effective group of medications available to treat inflammation. Although most patients with inflammation respond to GC, a small group of patients exhibit persistent GC-resistance with prolonged inflammation. Previously, it was proposed that the GC-resistance is caused by low amount of human GC receptor (hGR alpha) and/or excessive presence of a GC receptor isoform, hGR beta that was generated from alternative splicing of the hGR message. We have tested this hypothesis by investigating correlation between the expression pattern of hGR mRNAs in patients with inflammatory nasal polyps and the effectiveness of GC treatment.? We have performed reverse transcription PCR analysis of mRNAs coding each hGR alpha and hGR beta in nasal tissues.? hGR alpha mRNA was more expressed in patients with nasal polyps than in normal subjects. However, the elevated hGR alpha mRNA expression was decreased after GC treatment. Compared with hGR alpha mRNA expression, level of hGR beta mRNA expression was very low in all groups. In patients, hGR beta mRNA was expressed at a similar level regardless of GC efficacy, indicating that there is no correlation between the GC sensitivity and the expression level of hGR beta mRNA. Thus, persistent GC-resistance is not associated with low expression of hGRa or over- expression of hGR beta.

A Case of Reduction of Frontal Sinus Anterior Wall Fracture Using Bioabsorbable Plate / 대한이비인후과학회지

Frontal sinus fractures are relatively uncommon maxillofacial injuries, making up only 5% to 12% of all facial fractures. Management of the fracture depends on the type and severity of the fracture and the presence of associated injuries. The use of a metalic plate as a reduction material for facial bone fracture has vastly grown; however, in infants, metal implants induce growth restriction of facial bone and the plate needs to be removed after approximately 3-6 months. Due to these weakness, the use of it as a bioabsorbable plate has thus taken over the large proportion of all its uses. A 15-year-old man was admitted to our hospital with a depression fracture of the frontal sinus anterior wall after trauma to the frontal area. Seven days after the trauma, the patient got open reduction. After exposing the fracture site with a butterfly incision, and placing the fractured bony fragments back in original place, the bioabsorbable plates were fixed on them. Postoperatively, depressed frontal area was restored normally. There is no evidence of complication after 28 months from the operation. We report a successful reduction of the frontal sinus anterior wall fracture using bioabsorbable plates.

Endoscopic Endonasal Reconstruction of Blowout Fracture of the Medial Orbital Wall Using a n-shape 1 mm Thick Silastic Sheet and Filling up with Compressed Merocel(R) / 대한이비인후과학회지

In the reduction procedure of blowout fracture of the medial orbital wall, endoscopic endonasal reduction has become common ever since its introduction, due to its various advantages. However, it is difficult to carry out in patients with a narrow middle meatus due to nasal septal deformity and a paradoxically bent middle turbinate. Furthermore, it has difficulty when correcting up to the upper-medial wall adjacent to the cribriform plate. As endoscopic endonasal reduction was performed for the medial blowout fracture patients, we remedied the weak point of the existing surgical method known up to now, and carried out the reduction more simply by modifying it by inserting n-shape 1 mm thick silastic sheet and filling it up with compressed Merocel?. Thus, we would like to introduce this technique.

Retrospective Study on 527 Patients with Maxillofacial Trauma: A 5-year Experience / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In modern society, maxillofacial trauma is correlated with an increase in population and traffic accident due to industrialization and urbanization. Many studies have examined maxillofacial trauma, although these studies have shown various results due to investigator's viewpoint and regional and cultural differences. Hence, we conducted this study to examine the current status of patients with maxillofacial trauma. SUBJECTS AND METHOD: Based on patients' clinical data, we retrospectively reviewed clinical characteristics, demographic information and radiographic findings of 527 patients (633 cases based on the fracture sites) with maxillofacial trauma who had visited our hospital between January 1998 and December 2002. We analyzed patients' sex, cause of trauma, and fracture sites. Furthermore, we analyzed the type of treatment for each fracture site. RESULTS: Patients with maxillofacial fracture showed a male predominance of 2.9: 1, and were prevalent in the 20's, 10's and 30's in the order of frequency. These patients showed an increasing tendency in their numbers on a yearly basis, and were the most prevalent in 2002 and on November according to year and month, respectively. The most common etiology was `violence (36.6%)'. Predilection sites were `nasal bone (52.1%)' and `orbit (21.5% [blowout fracture of the orbital wall])'. CONCLUSION: Patients with maxillofacial trauma showed an increasing tendency in their numbers on a yearly basis and frequently exhibited nasal bone fracture and blowout fracture of the medial orbital wall. Accordingly, these patients frequently consult otolaryngologits in comparison with the past. otolaryngologists will pay more attention to these patients.

A Case of Acute Unilateral Maxillary Sinusitis Developed after Dental Implant / 대한이비인후과학회지

Recently, alloy dental implant is frequently performed in dentistry. The complications of a dental implant include maxillary sinusitis, oroantral fistula, displacement of implants and others. Maxillary sinusitis among these complications is one of the severe complications, which is being reported to occur rarely. The complications of dental implant are often accompanied by gingival swelling, pain, fistula and other symptoms, for which immediate therapeutic measures may be implemented. Nevertheless, as the authors encountered, overlooking secondary nasal symptoms of a dental implant may lead patients to rely merely on drug treatment without realizing the particular causes for such symptoms. The authors experienced a case with acute unilateral maxillary sinusitis developed after dental implant performed at the dental clinic, which was alleviated by performing endoscopic sinus surgery. Such complication has been rarely reported overseas, nor domestically. By reporting this case, we aimed to call attention to the complication of sinusitis and to take into consideration of implant displacement in suspicious cases of acute maxillary sinusitis.

Reduction of the Blowout Fracture of the Inferior Orbital Wall Using Elasticity of Silicon Tube / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: For the cases of the blowout fracture of the inferior orbital wall, reduction was performed frequently through transantral approach supporting herniated orbital tissue with silastic block, gauze or ureteral ballon catheter. But transantral approach has significant drawbacks such as instability, displacement of materials, and incomplete reduction. To overcome these shortcomings, we used an elastic silicon tube through transantral approach. In this paper, we compare the operative results between the group in which silastic blocks were used and the group in which silicon tubes were used. MATERIALS AND METHOD: We examined 19 patients whose maxillary sinuses were packed with silastic blocks or silicon tubes through only transantral approach. Among them, silastic blocks were used in nine cases ("block group") and silicon tubes in ten ("tube group"). Differences in preoperative and postoperative ocular symptoms, the percentage of revision operation, and occurrence of the infection of maxillary sinuses were compared between the two groups. RESULTS: In the block group, revision operations were carried out in three cases. Among those, one case was due to the undercorrection of fracture and two were due to the displacement of supporting material. In the tube group, one revision operation was necessary due to the overcorrection of fracture. Postoperative diplopia was observed in two cases among the block group and in one case among the tube group. One case with limitation in extraocular muscle movement was postoperatively detected among the block group. One case of infection of maxillary sinus was observed among the tube group. CONCLUSION: Reduction technique using silicone tube was easy and fast to perform by surgeons. We consider this reduction technique is a good surgical procedure instead of using silastic blocks.

The Analysis of Loudness Discomfort Level and Hyperacusis in Tinnitus Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hyperacusis is an abnormally strong reaction which occurs within auditory pathways resulting from exposure to moderate sound. More patients are inflicted with it than with tinnitus, accounting for a relatively high proportion of the total tinnitus patients. However, no single test could pass as an objective diagnostic test of hyperacusis. Among various psychoacoustic evaluations, loudness discomfort level (LDL) is frequently used in the evaluation of hyperacusis. Thus, this study aimed to demonstrate a proportion of hyperacusis in tinnitus patients and characterize LDL in hyperacusis and tinnitus patients as a diagnostic test. MATERIALS AND METHOD: Using 186 patients with tinnitus as experiment group and 35 acoustically normal persons as control group, pure tone audiometry (PTA), LDL, and dynamic range (DR) were checked. RESULTS: Amongst the total number of tinnitus patients, there were 10 hyperacusis patients (5.38%). Those hyperacusis patients had much lower LDL (73.50 dB) and DR (41.50 dB) than tinnitus patients without hyperacusis (LDL: 100.90 dB, DR: 67.20 dB) as well as the control group (LDL: 104.86 dB, DR: 93.98 dB). CONCLUSION: Hyperacusis patients consist 5.38% (10/186) and have much lower LDL than tinnitus patients without hyperacusis and the control group. There is a positive correlation between hyperacusis and LDL. Therefore, in a diagnosis of hyperacusis, it is essential to check LDL and take a careful look into the history from patients.

The Allergenicity of the Storage Mites(Tyrophagus Putrescentiae and Acarus Siro) in Patients with Allergic Rhinitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Storage mites, Tyrophagus putrescentiae (TP) and Acarus siro (AS), known as the major causative allergens to people who deal with stored foods and grains, may occur more frequently in house dust than expected. During the recent 6 months, positive reactions to TP and AS were observed as frequently as those to Dermatophagoides pteronyssinus (DP) in patients with allergic rhinitis in Pusan. The purpose of this study was to identify allergenic components within TP and AS, and evaluate the cross reactivity with DP. MATERIALS AND METHODS: Using extracts of DP, TP and AS, prepared after dialysis and lyophilization, allergenic components were identified using SDS-PAGE and western blotting. Cross reactivity among them were evaluated by inhibition tests using pharmacia CAP system. RESULTS: The protein components of DP, TP and AS, showed different patterns in SDS-PAGE. Molecular weight of major IgE binding components of TP were 17 kD, 25 kD and 67 kD, and those of AS were 18 kD, 19 kD, 25 kD and 27 kD. TP- or AS-specific IgE was partially inhibited by DP extract; however, DP-specific IgE was not significantly inhibited either by TP or AS extract. Significant inhibition were noted between TP and AS. CONCLUSION: TP and AS may share common allergens with DP. However, sensitization to TP or AS was also suspected in some cases. The percentage of Acaridae family in Pusan was 12% of total mites. Therefore, storage mites should be considered as causative allergens and included in allergy test battery.

Clinical Study on Blowout Fractures of the Inferior and Medial Orbital Walls / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A blowout fracture is the outward fracture of orbital wall that occurs at the inferior wall or medial wall as intraocular pressure, caused by the impact of trauma, increases rapidly. The importance of diagnosis and treatment for blowout fractures have increased as heavy industrialization, high speed transportation and violent accidents have increased recently. We caaried out a retrospective study of blowout fracture according to different incidences, treatment methods and their results. MATERIALS AND METHOD: A retrospective review was performed on 154 cases of blowout fracture. They were diagnosed with 5mm facial CT, and treated in our department from March, 1989 to March, 1998. RESULTS: Severnty-four patients (48%) had medial fractures, 49 patients (32%) had inferior fractures and 31 patients (20%) had medial and inferior fractures. The cases of inferior fractures were treated with the reduction of fractured area with autologous bone harvested from the anterior wall of maxillary sinus, titanium mesh, and silastic sheet. Medial fractures were treated with endoscopic intranasal reduction with silastic sheet. CONCLUSION: In this study, medial fractures comprised 68%, demonstrating more incidence than inferior fractures. Anterior wall of maxillary sinus was very useful in reduction of inferior wall fracture. We operated on 92 patients of the 154 cases of inferior and medial blowout fractures, and had successful results.

Clinical Study of Frontal Sinus Fractures: A Review of 14 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The incidence of frontal sinus fractures has increased as traffic and industrial accidents have increased. However, they are still uncommon compared to other facial traumas because of the arch configuration and the thickness of the anterior wall of the frontal sinus. Accurate evaluation is highly recommended in cases of frontal sinus fractures because they are likely to result in serious complications, including frontal sinusitis, meningitis, and mucocele. In this paper, we reviewed 14 cases of frontal sinus fractures and investigated the clinical characteristics and treatment results. MATERIALS AND METHODS: A retrospective review was performed on 14 patients with frontal sinus fractures who had been treated in our department from June, 1995 to August, 1997. RESULTS: Eleven patients were treated with surgery, including osteoplastic frontal sinus surgery with fat obliteration (5 patients), open reduction and internal fixation of the anterior wall (4 patients), and cranialization (2 patients). Three patients were treated with conservative methods. There were no complications such as infection, meningitis, and mucocele formation in the patients who underwent surgery for an average follow-up period of 19 months. CONCLUSION: Our results show that an aggressive approach is justified for treatment of frontal sinus fractures.

Auditory sensitivity of 40 Hz event related potential in the hearing impaired subjects / 대한이비인후과학회지

No abstract available.