Joo Hyun Woo

Comparison of 1-point fixation with 2-point fixation in treating tripod fractures of the zygoma.

PURPOSE Zygomatic tripod fracture is relatively common and generally requires open reduction-internal fixation through several incisions. However, lateral eyebrow incisions have sometimes left unsightly scars, and thus we have used 1-point fixation through a buccogingival incision so as not to leave scars in selected cases. The aim of this study was to compare 1-point fixation in the zygomaticomaxillary (ZM) area with 2-point fixation in the ZM and frontozygomatic (FZ) areas in tripod fractures. MATERIALS AND METHODS This study is retrospective and was approved by the institutional review board of our hospital. From November 2005 to March 2010, 30 patients were enrolled in this study. We investigated 14 patients with 1-point fixation in the ZM area (group 1), 1 of whom had bilateral tripod fractures, and 16 patients with 2-point fixation in the ZM and FZ area (group 2). We postoperatively checked for 1) unfavorable scars; 2) bony movement, pain, and palpability in the FZ area; 3) satisfaction with surgical outcomes; 4) presence or absence of surgeries for plate removal; and 5) anxiety about no fixation of the FZ area. RESULTS Of 16 patients in group 2, 10 (63%) complained of unsightly scars in the lateral eyebrow incision site, whereas none of the patients in group 1 complained of external scarring. None of the patients complained of bony movement and pain in the FZ area in either group. In group 2, 4 of 16 patients (25%) complained of palpability in the FZ area, whereas none in group 1 complained of palpability. The satisfaction score for surgery was 9.4 ± 1.6 in group 1 and 7.7 ± 2.6 in group 2 (P < .05). Two patients underwent surgery for plate removal in group 2. None of the patients in group 1 complained of any cosmetic problems, with no fixation in the FZ area. CONCLUSIONS One-point fixation in the ZM area in zygomatic tripod fractures can avoid unsightly scars and give high satisfaction with surgical outcomes in selected patients with tripod fractures.

Comparison of tonsillar biofilms between patients with recurrent tonsillitis and a control group

Abstract Conclusion: The results of the study suggest that biofilms play a causative role in recurrent tonsillitis. Objective: To analyze the association between tonsillar biofilms and recurrent tonsillitis. Methods: The recurrent tonsillitis group comprised patients with a history of at least five episodes of tonsillitis per year over the previous 2 years. The control group comprised volunteers scheduled for laryngeal microsurgery with no history of tonsillitis over the previous 2 years. Between October 2009 and August 2010, specimens were obtained from 20 patients with recurrent tonsillitis and 20 volunteers (controls). Scanning electron microscopy (SEM) was used to confirm the presence of biofilms. Biofilms were graded at a magnification of ×500 by SEM and classified into five grades. The percentages of subjects affected and biofilm grades were compared between the recurrent tonsillitis and control groups. Results: The two groups were matched for age and sex. SEM revealed that biofilms were significantly more prevalent in the recurrent tonsillitis group than in the control group. Furthermore, the biofilms in the recurrent tonsillitis group were of significantly higher grade than those in the control group.

The effect of maxillary sinus irrigation on early prognostic factors after endoscopic sinus surgery: a preliminary study.

Background Sinus irrigation has been used to treat chronic rhinosinusitis refractory to medical and surgical treatments. The aim of this study was to evaluate the effect of maxillary sinus saline irrigation on the prevention of purulent rhinorrhea, extensive granulation formation, and polyp recurrence after endoscopic sinus surgery (ESS). Methods This prospective, controlled study was approved by the Institutional Review Board of Gachon University Gil Medical Center. Between August 1, 2011, and May 31, 2012, we recruited a total of 30 patients who underwent bilateral ESS. Group A was composed of 15 patients that were treated with bilateral maxillary sinus saline irrigation for 2 months after ESS. Group B was composed of 15 patients who were followed up during the same period after ESS. We checked for persistent purulent discharge, extensive granulation, and recurrent polyps in both groups to evaluate the effects of maxillary sinus irrigation on their prevention. Results Age, gender, and preoperative Lund-Mackay scores were not significantly different between the two groups (p > 0.05). In group A, one patient showed polyp recurrence. In group B, one patient showed extensive granulation tissue, two patients showed uncontrolled purulent discharge, three patients showed extensive granulation tissues and uncontrolled purulent discharge, and one patient showed recurrent polyps (p = 0.03). In addition, total endoscopic scores in the 3rd month were significantly different between groups A and B (p = 0.01). Conclusion Maxillary sinus saline irrigation may be effective in the prevention of poor prognostic factors, such as persistent purulent discharge, at the early stages after ESS.

MERS versus Standard Surgical Approaches for Porcine Vocal Fold Scarring with Adipose Stem Cell Constructs

Objective Cells, scaffold, and surgical approaches are important for regeneration of the lamina propria of the scarred vocal fold (VF). Microendoscopy of Reinke’s space (MERS) is a surgical approach used to access the lamina propria. The present study evaluated MERS in the treatment of VF scarring as compared with standardized approaches for the treatment of VF scarring with adipose stem cell constructs. Study Design Animal study. Setting Academic center. Subjects and Methods VF injury was performed bilaterally to induce scarring in 20 pigs. Eight weeks after injury, pigs were classified into no treatment, minithyrotomy, VF injection, VF incision/dissection, and MERS. All groups (except control) were implanted with adipose stem cell and hyaluronan. Four weeks after treatment, histology for collagen, hyaluronan, and fibronectin; mRNA expression for α-smooth muscle actin, tumor growth factor β1, collagen 1α1, collagen 3α1, matrix metalloproteinase 2, basic fibroblast growth factor, and hepatocyte growth factor; and tissue rheology were evaluated. Results Differences were measured among surgical approaches for protein levels of collagen, hyaluronan, and fibronectin (P = .0133, P < .0001, and P = .0025, respectively). Fibroblast growth factor, collagen 1α1, and matrix metalloproteinase 2 transcript levels were different among treatment groups (P = .003, P = .0086, and P = .014, respectively), while no differences were measured for α-smooth muscle actin, tumor growth factor β1, hepatocyte growth factor, and collagen 3α1. Rheologically, significant differences were not measured between groups. Conclusion MERS is a promising surgical approach for the treatment of VF scarring, optimizing the placement of implanted biomaterials.

The effect of expandable polyvinyl acetate packing for preventing stenosis of the frontal sinus ostium.

Background The aim of this study was to evaluate the effect of repeated expandable polyvinyl acetate (EPA) packing for preventing stenosis of the frontal sinus ostium after patients undergo functional endoscopic sinus surgery (FESS). Methods A nonrandomized, prospective study of 20 patients with chronic frontal sinusitis was conducted based on the Lund-Mackay scoring system. EPA was packed, for 3 days/week, in total, three times for 3 weeks, into the left frontal sinus ostium right after FESS. For the control, the right side frontal sinus ostium was left unpacked. After 6 months, the patency of the frontal sinus ostium was measured with a ruler under endoscopic guidance and the patency was classified as obstructed, stenotic, or patent according to the size. Results Obstruction developed in the right side in four patients and in the left side in two patients. Stenosis was found in the right side in eight patients and in the left side in one patient. The ostium of the frontal sinus was patent in the right side in 8 patients and patent in the left side in 17 patients. The sizes of the ostia were significantly different between the frontal sinuses on both sides 6 months after FESS (p < 0.05). Conclusion The outcome of repeated EPA packing was favorable in patients undergoing FESS.

Macrophage Response to Allogeneic Adipose Tissue-Derived Stromal Cells in Hyaluronan-Based Hydrogel in a Porcine Vocal Fold Injury Model:

Objective: Adipose tissue-derived stromal cells (ASC) embedded in hyaluronan scaffold is a beneficial prophylactic treatment for vocal fold (VF) surgical scar. Here, we investigated the macrophage inflammatory response to allogeneic ASC-constructs and identified changes in lamina propria extracellular matrix. Method: Pig ASC were characterized and transfected with GFP+ lentivirus. Thirty-three pigs underwent VF biopsies, and after 3 days, gel alone, gel+pASC, placebo, or pASC alone was injected into wound bed. Animals were sacrificed 3, 7, or 26 days post-injection. Flow cytometry; qPCR for NF-α, TGFβ, IL-10, IL-4, IFNγ, IL-12, FGF2, Col1A1, and HGF; and immunohistochemistry for collagen, elastin, HA, and fibronectin were performed to characterize macrophage phenotype, quantify cytokine transcription, analyze extracellular matrix remodeling, and track GFP+ cells. Results: No significant differences were found in SWC3+/SWC9+ phenotype or mRNA expression between cells+gel, gel, or placebo. The ASC alone exhibited significantly greater collagen, gel alone resulted in significantly less hyaluronan, and gel+pASC significantly more fibronectin (all P < .05). The pASC-GFP+ were detected 26 days post-injection. Conclusions: The ASC-constructs were biocompatible; they did not influence the macrophage inflammatory response or provoke increases in collagen expression. Long-term engraftment was confirmed.

A new rat model for investigation of subglottic stenosis

Abstract Conclusion: This study attempted to develop a new rat model of subglottic stenosis (SGS), resulting from subglottic mucosal injury administered by electrocauterization. Despite failure of the posterior SGS model, the anterior SGS model was considered feasible. Objective: To investigate the feasibility of using rats as an animal model for SGS. Methods: Thirty-seven female Sprague-Dawley rats were assigned to the control group or to the anterior or posterior subglottic injury group. Electrical cauterization was performed on the anterior or posterior 180° of the subglottic mucosa. Animals were euthanized at 4 weeks after injury. Histologic features of the subglottis were evaluated as regards changes in the subglottic lumen, lamina propria, cartilage, and epithelium after hematoxylin and eosin and Masson trichrome staining. Results: Survival in the anterior injury group was 80% (13/15) until 4 weeks, and results of histologic evaluation showed an increase in thickness of lamina propria with fibrosis and cartilage damage, resulting in luminal narrowing. A high rate of mortality was observed in the posterior injury group.

The Effect of Human Adipose Tissue–Derived Mesenchymal Stem Cells in Rat’s Subglottic Stenosis Model:

Objective: Subglottic stenosis remains a clinical challenge. The aim of this study was to evaluate the effect of human adipose tissue–derived mesenchymal stem cells (hAMSCs) in rat model of subglottic stenosis. Subjects and Methods: Ninety-six 13-week-old male rats were enrolled in this study. They were divided into 3 groups as normal control (NC) group, a subglottic injury and media injection (SM) group, and a subglottic injury and media-stem cell injection (SMSC) group. The hAMSCs were immediately injected into subglottis after injury. Histologic characteristics of subglottis; the mRNA expressions of interleukin-1β, cyclooxygenase-2, tumor growth factor-β and basic fibroblast growth factor; and hAMSCs’ survival were evaluated. Results: The hAMSCs survived in the subglottis of the rat until 10 days after implantation. The NC and SMSC groups had a significantly wider subglottic lumen and thinner lamina propria than the SM group at 56 days after injury. Collagen intensity of subglottis was significantly higher in the SM group than in the NC and SMSC groups at 28 days after injury. Gene expression didn’t show significant difference between the SM group and the SMSC group. Conclusions: The hAMSCs injection was found to be helpful for preventing subglottic stenosis in a rat model.

A case of pediatric ectopic thyroid in lateral lymph nodes

Abstract On average, ectopic thyroids are positioned in the embryotic decent path that emerges as a lingual thyroid or a thyroglossal duct cyst. It is uncommon for ectopic thyroids to be located in the lateral neck, which only represents 1%–3% of all cases. Any ectopic thyroids that emerge in the posterior lateral neck in pediatric patients should be regarded as an extremely unique case. We report a 13-year-old boy with ectopic thyroid tissue in the cervical lymph nodes with orthotopic euthyroid thyroid. The masses were located on the left posterior triangle area, which were confirmed as histologic benign thyroid tissue without any malignancy in the head and neck. Authors suggest that this case supports the benign lymphatic transport theory of lateral ectopic thyroid.

P099: Analysis of the Prognostic Factors in Sudden Hearing Loss

crease in osteoclast formation when exposed to PA LPS. This osteoclastogenic effect was even more pronounced in MyD88-/BMMs exposed to PA LPS. CONCLUSIONS: These results demonstrated that PA LPS is able to activate both MyD88-dependent as well as MyD88independent pathways. However, the effect of PA LPS stimulation on osteoclast precursors (BMMs) is based on the integrity of the TLR signaling pathway.