Jae Hwan Kwon

A quantitative analysis of gait patterns in vestibular neuritis patients using gyroscope sensor and a continuous walking protocol

BackgroundLocomotion involves an integration of vision, proprioception, and vestibular information. The parieto-insular vestibular cortex is known to affect the supra-spinal rhythm generators, and the vestibular system regulates anti- gravity muscle tone of the lower leg in the same side to maintain an upright posture through the extra-pyramidal track. To demonstrate the relationship between locomotion and vestibular function, we evaluated the differences in gait patterns between vestibular neuritis (VN) patients and normal subjects using a gyroscope sensor and long-way walking protocol.MethodsGyroscope sensors were attached to both shanks of healthy controls (n=10) and age-matched VN patients (n = 10). We then asked the participants to walk 88.8 m along a corridor. Through the summation of gait cycle data, we measured gait frequency (Hz), normalized angular velocity (NAV) of each axis for legs, maximum and minimum NAV, up-slope and down-slope of NAV in swing phase, stride-swing-stance time (s), and stance to stride ratio (%).ResultsThe most dominant walking frequency in the VN group was not different compared to normal control. The NAVs of z-axis (pitch motion) were significantly larger than the others (x-, y-axis) and the values in VN patients tended to decrease in both legs and the difference of NAV between both group was significant in the ipsi- lesion side in the VN group only (p=0.03). Additionally, the gait velocity of these individuals was decreased relatively to controls (1.11 ± 0.120 and 0.84 ± 0.061 m/s in control and VN group respectively, p<0.01), which seems to be related to the significantly increased stance and stride time of the ipsi- lesion side. Moreover, in the VN group, the maximum NAV of the lesion side was less, and the minimum one was higher than control group. Furthermore, the down-slope and up-slope of NAV decreased on the impaired side.ConclusionThe walking pattern of VN patients was highly phase-dependent, and NAV of pitch motion was significantly decreased in the ipsi- lesion side. The change of gait rhythm, stance and stride time, and maximum/minimum NAV of the ipsi- lesion side were characteristics of individuals with VN.

Isolated trapdoor-type medial blowout fracture in an adult presenting horizontal diplopia treated by endoscopic endonasal approach

Orbital blowout fracture frequently occurs along the floor or medial aspect of the orbital wall, which are the two thinnest areas of the bony orbit. True trapdoor injury of the orbit is less common and is rare as an isolated medial wall injury, because the medial orbital wall has several bony septa within the ethmoid sinus that provide support and decrease the risk of a trapdoor fracture. Additionally, the incidence of trapdoor-type blowout fracture in adults is lower than in children. In a trapdoor-type blowout fracture with restricted ocular movement, prompt diagnosis and early intervention are associated with better clinical outcomes. We encountered a case of trap door-type medial blowout fracture with horizontal eye ball movement limitation in an adult. She underwent endonasal endoscopic reduction surgery for the medial blowout fractures. Here we report this case, and suggest early diagnosis and prompt surgical exploration.

An Isolated Nasolacrimal Duct Osteoma

Osteomas of the nose and paranasal sinus are common benign tumors that can extend to surrounding structures and result in orbital or intracranial involvement. Presenting symptoms include facial pain, headache, cerebral symptoms, ocular symptoms, and so on, depending on the location and size of the tumor. They commonly occur within the frontal, ethmoid, maxillary, and sphenoid sinuses; however, there are rare cases of reported osteomas in the nasal cavity, turbinate, or orbit. Our case report describes a patient with nasolacrimal duct osteoma who presented with ipsilateral ocular pain, epiphora, and medial canthal swelling. We performed intranasal dacryocystorhinostomy using a nasal endoscope and removed the lacrimal duct osteoma. This report describes symptoms and management of an isolated nasolacrimal duct stone with a review of the literature.

The Application of an Ultrasonic Bone Aspirator for Septoturbinoplasty

Objective:The objectives of this study were to introduce the use of an ultrasonic bone aspirator (UBA; SONOPET [Mutoh Co, Ltd, Tokyo, Japan]) for septoturbinoplasty and to evaluate the efficacy and usefulness of this surgical procedure. Design:This was a retrospective chart review. Setting:This study was performed at a university medical center. Methods:Of the 53 patients who underwent septoturbinoplasty from July to October 2013, 30 were operated on using a UBA and were enrolled in this study. Patients were followed for more than 6 months after surgery. Patterns of septal deviation and surgical results and complications were investigated by paranasal sinus computed tomography scans, nasal endoscopy, and acoustic rhinometry. Improvement of symptoms was measured using the Nasal Obstruction Symptom Evaluation scale. Results:Patterns of bony septal deviation were classified as follows: localized septal bony spur or crest (n = 7), basal bony septal deviation (n = 9), posterior bony septal deviation (n = 8), bony spur with basal part deviation (n = 5), and basal and posterior bony septal deviation (n = 1).Twenty-six patients underwent septoplasty with bilateral inferior turbinate reduction surgery using either a microdebrider (n = 10) or a microdebrider with UBA (n = 16). Four patients underwent septoplasty with unilateral turbinate reduction surgery using a microdebrider and UBA. Based on nasal endoscopic findings after surgery, 24 patients had a straight septum, whereas 6 exhibited minimal remaining curvature. Subjective symptoms of nasal obstruction evaluated using the visual analog scale and the Nasal Obstruction Symptom Evaluation scale were improved in all patients. Surgery using a UBA increased minimal cross-sectional area and nasal volume change in patients. There were no significant complications related to UBA use such as saddle nose, bleeding, or septal perforation. Conclusions:Application of a UBA for septo-turbinate surgery is an easy, safe, and effective method that reduces the occurrence of common complications, such as septal perforation, delayed healing, infection, and bleeding. In addition, the UBA produces minimal thermal and mechanical injury to surrounding tissue and enables precise and incremental bone removal with continuous irrigation and suction. This tool allows for easy sculpting and reduction of bony architecture of the nasal cavity.

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.

Endoscopic cryotherapy for the treatment of epistaxis due to hereditary hemorrhagic telangiectasia.

Hereditary hemorrhagic telangiectasia (HHT), an autosomal dominant vascular disease, involves mainly skin, mucocutaneous membranes, and viscera. Epistaxis is one of the most common symptoms of HHT, and chronic, frequently relapsing epistaxis can cause symptoms such as iron deficiency anemia, severe crusting, and nasal obstruction that can cause lower quality of life. Treatments for HHT range from medication and conservative management to more aggressive surgeries. None of the treatment options, however, have had satisfactory outcomes until now. We introduced cryotherapy for a patient with HHT and at least a 10-year history of frequent, severe epistaxis. This treatment strategy resulted in successful management of symptoms and no associated complications. We present herein a literature review and the clinical course and symptoms of an HHT patient who underwent cryotherapy.

Myoepithelioma of the Nasal Septum

Myoepithelioma is defined as myoepithelial cells composed of tumor with solid, myxoid, and reticular growth pattern by the World Health Organization. It is a rare neoplasm that arises in the major salivary gland or minor salivary gland comprising approximately 1% of all salivary gland tumor. This neoplasm occurs in the parotid gland and soft palate mostly, which can be found in other organs. However, up to now, myoepithelioma of nasal septum has not been reported in English medical literature. Histologically, it is grouped as spindle, epitheliod, reticular, and clear cell types. Spindle cell type is the most common. In this case, a 40-year-old woman presented with complaining of nasal stuffiness and accidentally found right nasal cavity mass. Endoscopic surgery for excision of the mass was performed under local anesthesia, which was confirmed as myoepithelioma. After surgery, the patients symptom was disappeared and there has not been sign of recurrence for 6 months. We present a rare patient of myoepithelioma of the nasal septum with review of relevant literature.

Use of a Balloon Catheter With Intraoperative C-Arm Fluoroscan for Reduction of Zygomatic Arch Fractures

Background and Objectives: The purpose of this study was to evaluate the usefulness of C-arm fluoroscan with a balloon catheter in patients undergoing closed reduction of zygomatic arch fractures. Subjects and Methods: All patients who had zygomatic arch reduction surgery between 2006 and 2015 were identified and classified into 2 groups. Group A included those patients who underwent closed reduction of zygomatic arch fractures. Group B included those who underwent zygomatic arch reduction surgery with a C-arm fluoroscan and supporting balloon. A balloon catheter was used to stabilize the zygomatic bone after reduction. Results were scored from 1 (poor) to 3 (good) to assess surgical outcomes based on 3 criteria: alignment of the zygomatic arch on a postoperative computed tomography scan, facial asymmetry in photography, and the patients subjective satisfaction. Results: The authors enrolled 32 patients with zygomatic arch fractures. 18 patients underwent closed reduction for zygomatic arch fractures (group A), while 14 patients underwent closed reduction with C-arm fluoroscan and balloon support (group B). The average score for group A was 2.00 for alignment, 2.56 for facial asymmetry, and 2.67 for subjective satisfaction compared with 2.64 for alignment, 2.86 for facial asymmetry, and 2.79 for subjective satisfaction in group B. There were statistically significant differences in the alignment and facial asymmetry scores between the 2 groups. Conclusion: The authors suggest that C-arm fluoroscan with balloon support is a useful modality for reduction of zygomatic arch fractures that provides better surgical outcomes than conventional closed reduction surgery.

Pneumocephalus due to middle ear inflation.

Middle ear inflation procedures are widely used for diagnosis and treatment of middle ear disease. Although its values are controversial, it is used in testing eustachian tube function or treating middle ear diseases, such as effusions or atelectasis. Physicians rarely experience complications with this procedure; thus, complications following middle ear inflation are rare. Known adverse effects of middle ear inflation procedures include pneumocele, brain hematoma, and air embolization. Pneumocephalus is one of the rare complications of middle ear inflation. It is a potentially fatal condition, and although middle ear inflation is used around the world, it is rarely encountered by general physicians and even otolaryngologists. We report a case of pneumocephalus that occurred immediately following a middle ear inflation procedure using a pneumatic otoscope with myringotomy (paracentesis).