Sang Hyun Nam

Prevalence of Diplopia and Extraocular Movement Limitation according to the Location of Isolated Pure Blowout Fractures

Background Isolated pure blowout fractures are clinically important because they are the main cause of serious complications such as diplopia and limitation of extraocular movement. Many reports have described the incidence of blowout fractures associated with diplopia and limitation of extraocular movement; however, no studies have statistically analyzed this relationship. The purpose of this study was to demonstrate the correlation between the location of isolated pure blowout fractures and orbital symptoms such as diplopia and limitation of extraocular movement. Methods We enrolled a total of 354 patients who had been diagnosed with isolated pure blowout fractures, based on computed tomography, from June 2008 to November 2011. Medical records were reviewed, and the prevalence of extraocular movement limitations and diplopia were determined. Results There were 14 patients with extraocular movement limitation and 58 patients complained of diplopia. Extraocular movement limitation was associated with the following findings, in decreasing order of frequency: floor fracture (7.1%), extended fracture (3.6%), and medial wall (1.7%). However, there was no significant difference among the types of fractures (P=0.60). Diplopia was more commonly associated with floor fractures (21.4%) and extended type fractures (23.6%) than medial wall fractures (10.4%). The difference was statistically significant (Bonferroni-corrected chi-squared test P<0.016). Conclusions Data indicate that extended type fractures and orbital floor fractures tend to cause diplopia more commonly than medial wall fractures. However, extraocular movement limitation was not found to be dependent on the location of the orbital wall fracture.

General anesthesia versus monitored anesthetic care with dexmedetomidine for closed reduction of nasal bone fracture

Background Reduction of nasal bone fracture can be performed under general or local anesthesia. The aim of this study was to compare general anesthesia (GA) and monitored anesthetic care (MAC) with dexmedetomidine based on intraoperative vital signs, comfort of patients, surgeons and nurses and the adverse effects after closed reduction of nasal bone fractures. Methods Sixty patients with American Society of Anesthesiologists physical status I or II were divided into a GA group (n = 30) or MAC group (n = 30). Standard monitorings were applied. In the GA group, general anesthesia was carried out with propofol-sevoflurane-N2O. In the MAC group, dexmedetomidine and local anesthetics were administered for sedation and analgesia. Intraoperative vital signs, postoperative pain scores by visual analog scale and postoperative nausea and vomiting (PONV) were compared between the groups. Results Intraoperatively, systolic blood pressures were significantly higher, and heart rates were lower in the MAC group compared to the GA group. There were no differences between the groups in the patient, nurse and surgeons satisfaction, postoperative pain scores and incidence of PONV. Conclusions MAC with dexmedetomidine resulted in comparable satisfaction in the patients, nurses and surgeons compared to general anesthesia. The incidence of postoperative adverse effects and severity of postoperative pain were also similar between the two groups. Therefore, both anesthetic techniques can be used during the reduction of nasal bone fractures based on a patient%s preference and medical condition.

Recurrence of Nevus Lipomatosus Cutaneous Superficialis after CO2 Laser Treatment

Nevus lipomatosus cutaneous superficialis (NLCS) is a relatively rare benign malformation characterized by ectopic deposition of mature adipose tissue in the collagen bundles of the dermis [1-4]. NLCS is classified into two subtypes: the multiple (classical) type and solitary type [1-3]. The multiple type usually appears within the first two decades of life, most commonly in the pelvic girdle region and consists of flesh-colored or yellow papules or nodules [3,4]. Also, its histopathological features are relatively uniform [3]. In contrast, the solitary type consists of a single nodular lesion without a favored location and it usually occurs in adults [3]. Surgical excision is a simple and adequate treatment for all lesions [2]. Recently, some authors have reported that CO2 laser is useful method of treatment for NLCS, especially in the multiple type [4]. We report here a case of multiple type NLCS on the right lower back, which recurred after CO2 laser treatment and was treated by staged surgical excisions. To the best of our knowledge, there have not been any cases of recurred NLCS after laser treatment in the literature. A 13-year-old girl presented with asymptomatic, yellow-orange papules on the right lower back measuring 14×5 cm and composed of three clusters (Fig. 1). According to her parents, the skin masses had appeared at age 5 and gradually increased in number and size as she grew. However, there was no evidence of any systemic disease and no symptoms due to her back mass. Her family history was unremarkable, with a lack of similar skin lesions. Three years earlier, the patient had been treated with CO2 laser at another clinic to avoid the inconvenience of removing her clothes. At that time, they had thought that the mass was treated well. However, a few months later, remarkably, the skin masses had recurred and increased in numbers and size very rapidly. On physical examination, there were multiple yellow-colored, non-tender, soft nodules coalescing into a plaque on her right lower back. Complete surgical excision was performed divided in three stages and covered with local advancement flaps (Fig. 2). Fig. 1 Clinical photograph of the case. A 14×4 cm nevus lipomatosus cutaneous superficialis lesion on the right flank. Initially, only the central cluster had been presented, but after CO2 laser treatment, Fig. 2 Photograph 6 months postoperatively. The lesion was completely excised and there were only wide scars remaining. Histopathologically, lobules of the mature adipocytes were located between the collagen fibers in the entire dermis. Fat lobules extending to the reticular dermis were located around the capillaries. All of these findings coincide with NLCS (Fig. 3). Fig. 3 Histopathologic findings of the case. Lobules of mature fat are diffusely scattered between collagen fibers in the dermis. Fat lobules extending to reticular dermis are located around the capillaries (H&E, ×200). NLCS is a rare idiopathic benign malformation characterized by ectopic adipose tissue in the dermis [1-3]. Generally, there are no clinical symptoms during its course, although sometimes NLCS can appear with some symptoms [2]. Now NLCS is classified into two subtypes [1-3]. The multiple type usually appears within the first two decades of life, but occasionally it can have a later onset [3]. There is no sex or genetic predilection [3]. Usually the multiple type consists of grouped, flesh-colored or yellow papules or nodules on the pelvic girdle region in a segmental pattern that coalesce to form plaques [1,3,5]. The plaque surfaces are smooth, but sometimes they have a verrucous or cerebriform appearance [4,5]. In our case, the skin lesion appeared from age 5 on the right lower back, and there were no clinical symptoms from the NLCS. It presented typical characteristics of multiple type NLCS. The pathogenesis is still unknown and several theories have been proposed [4]. One theory suggests that multiple type NCLS arises from adipose metaplasia in the course of degenerative changes in the dermal connective tissue [4]. Another theory is that the adipocytes represented a true nevus from the developmental displacement of adipose tissue [4]. A third proposal is that the mature adipocytes grow from mononuclear cells that were differentiating lipoblasts in a perivascular area [1]. The hitopathology of NLCS usually shows clusters of ectopic mature adipose tissues among the collagen bundles in the dermis, and there is no connection to the subcutaneous fat tissue [1,2]. These ectopic adipocytes contain large intracytoplasmic lipid vacuoles, often associated with vascular structures [1,4]. Many authors have reported that treatment is not necessary in most cases, other than for cosmesis [2]. However, clinicians should be aware that sometimes the masses can become a larger tumor if untreated [5]. Simple surgical excision is sufficient for treatment without recurrence in almost cases [2]. However, if surgical excision is not adequate, recurrence is possible. Recently, some authors have reported that CO2 laser treatment is effective for treating large lesions of multiple type NLCS without recurrence [4]. They argue that CO2 laser treatment is somewhat better than surgical excision. Because multiple type NLCS usually involves a large area, sometimes it requires a skin graft. These skin grafts could cause unsatisfying cosmetic results, but the study reported that patients treated with CO2 laser were pleased with the results [4]. The authors treated recurred multiple type NLCS after CO2 laser treatment with staged excisions and covered with local advancement flaps, but the patient was satisfied with the cosmetic results and there was no recurrence. Consequently, physicians should take note that insufficient treatment, including CO2 laser or any surgical excision, can cause recurrence, as in this case. We suggest that staged excision can be another treatment modality for large multiple type NLCS.

A Rare Case of Abdominal Porocarcinoma

Eccrine porocarcinoma (EPC) is a cutaneous malignancy that arises from the intraepidermal portion of the eccrine sweat duct (acrosyringium). The eccrine sweat gland is a major sweat gland that is found in virtually all skin. EPC accounts for 0.005% to 0.01% of all cutaneous tumors. It predominantly occurs in elderly people who are more than 60 years old and has a female predominance [1]. As far as we know, only five cases of this medical condition have occurred on the abdomen since Pinkus and Mehregan first described EPS in 1963 [1,2]. Here, we report an unusual case of a 65-year-old female patient with EPC that developed primarily on the abdomen. In 1992, a 65-year-old female patient presented with a palpable and non-tender mass. No ulceration or any discomfort was noted with respect to the lesion. The mass size was 1 cm×1 cm at the beginning, but the size changed periodically, and the lesion had an oozing serous discharge. There were no other problems. Twenty years later, in July 2012, the mass had undergone rapid enlargement, and the lesion had bloody discharge (Fig. 1). Fig. 1 A preoperative photograph shows a brownish maculopapule on the abdomen, and a palpable mass was present. The patient visited the general surgery department of our hospital. For biopsy, curettage was performed, and a grayish-brown soft tissue was obtained from the skin lesion. The tissue was diagnosed as squamous cell carcinoma. Immunohistochemical staining indicated that the tissue was positive for p63. The patient was referred to our department for appropriate therapy. Because of the metastatic potential of squamous cell carcinoma, prior to the operation, we performed a physical examination and positron emission tomography-computed tomography (PET-CT) to search for metastasis. No adjacent palpable lymph node was found in the physical examination. PET-CT indicated a hypermetabolic abnormality on the right lower abdomen (Fig. 2), and there was no evidence of metastasis. The laboratory workup and systemic examination for this patient yielded normal results. Fig. 2 A hypermetabolic abnormality was observed on the right lower abdomen in positron emission tomography-computed tomography (white arrow). Under general anesthesia, wide excision and frozen biopsy were performed. An approximately 6 cm×3 cm tissue mass was excised, applying at least a 10-mm clear margin. A 1.8-cm well-defined nodule was found within the tissue. Broad tumor free margins were confirmed, and the tumor was diagnosed as EPC by a pathologist. Therapeutic lymphadenectomy was not performed because there was no metastasis according to the PET-CT results. We performed primary repair to reconstruct the soft tissue defect. The biopsy histology indicated irregularly proliferating elongated nests composed of small, round basaloid cells and epithelium (Fig. 3), and the tumor nests contained central duct formation (Fig. 4). Immunohistochemical staining was positive for the epithelial membrane antigen (EMA) (Fig. 5), and negative for the carcinoembryonic antigen (CEA); these findings were consistent with a diagnosis of eccrine porocarcinoma [2]. Fig. 3 The right-side epithelium shows irregularly proliferating elongated nests composed of small, round basaloid cells (black arrow heads). The left-side epithelium reveals a complex structure of keratinizing squamous epithelium (black arrows) (H&E, ... Fig. 4 Some tumor nests display central duct formation (H&E, ×100). Fig. 5 An immunoperoxidase stain is positive for epithelial membrane antigen, suggesting eccrine differentiation. The patient was followed up at our department because of the high recurrence of EPC. At 7 months after the operation, there was no evidence of recurrence or metastasis. EPC has a propensity to form on the lower limbs (44%), trunk (24%), head (18%), upper limbs (11%), and neck (3%) [2]. Morphologically, the tumors vary greatly in size, from less than 1 to 10 cm [3]. A long period of clinical features is historically noted (up to 50 years) because some of these tumors can arise from a benign eccrine poroma.Local and regional lymph node metastasis are observed in approximately 20% of patients, and distant metastasis, for example, visceral and bone metastasis, arise in approximately 10% of the patients [3]. Following metastasis, the prognosis is poor, with a reported mortality rate of up to 80% [1]. Because EPC has a high metastatic potential and mortality rate, early definitive diagnosis is necessary, followed by appropriate treatment. The tumor may appear nodular, infiltrative, ulcerated, or polypoid, and these characteristics tend to indicate a malignant tumor. Multinodularity, ulceration, and rapid growth may be associated with either local recurrence or metastasis [3]. Thus, when these characteristics are observed, we need to consider the possibility of a malignant change. Because of the rarity and nonspecific appearance of EPC, a tentative clinical diagnosis will never be accurate and the condition might be misdiagnosed as squamous cell carcinoma, basal cell carcinoma, seborrheic keratosis, or metastatic adenocarcinoma [3]. In particular, as in our case, a small biopsy specimen, such as a needle or punch biopsy, can be easily misdiagnosed. Even defined EPC may present some type of basal or squamous differentiation. The presence of ductal differentiation distinguishes EPC from squamous and sebaceous cell carcinoma. The ducts are usually visible in a microscopic evaluation and can be outlined with CEA and EMA immunohistochemical markers [4]. Further, most metastatic adenocarcinomas are positive for CEA and EMA stains. However, CEA is negative in most EPCs but can be positive in tumors containing well-formed ducts [2]. To achieve a definitive diagnosis, a well-handled specimen and expert pathology and oncology departments are required. Histological findings that predict the worse prognosis are lymphovascular invasion, a mitotic index of more than 14 mitotic cells for every high power field, and a tumoral depth of more than 7 mm [2,4,5]. There is no standard therapeutic protocol for EPC. However, because of its high rate of local recurrence, wide excision with histologically clear margins is the treatment of choice. Appropriate surgical resection achieves curative outcomes in 70% to 80% of the cases, and there is 20% local recurrence and 20% distant metastasis [5]. Because of the high recurrence rate, close follow-up and a search for metastasis should be performed, and sometimes, adjuvant therapy could be performed. However, anecdotal reports show some benefits when utilizing radiation or chemotherapy [3]. EPC is curable if an accurate diagnosis is performed early and appropriate treatment is provided. EPC can be easily misdiagnosed because of a lack of particular characteristics; therefore, a careful approach is necessary. Because of its aggressive potential for metastasis and poor prognosis, a complete early definitive pathologic diagnosis of EPC should be performed along with regional lymph-node involvement assessment, such as a physical examination, and radiological tests. PET-CT can easily indicate whether metastasis is present. Thus, prior to any operation, a PET-CT scan should be performed, as it can assist in determining whether selective adjacent lymph node resection is required.

Comparison study of the use of absorbable and nonabsorbable materials as internal splints after closed reduction for nasal bone fracture.

Background The authors sought to compare the use of the nonabsorbable polyvinyl alcohol sponge (PVA, Merocel) and absorbable synthetic polyurethane foam (SPF, Nasopore Forte plus) as intranasal splints after closed reduction of fractured nasal bones during the hospitalization period. Methods The medical records of 111 patients who underwent closed reduction for nasal bone fracture at Sanggye Paik Hospital, Inje University College of Medicine, from 2012 to 2013 were reviewed retrospectively. PVA (group A) or SPF (group B) was packed as an internal splint after closed reduction. The efficacy of the materials was compared and statistically analyzed. Results PVA was used in 82 patients, and SPF was used in 29 patients. The patients in group B complained significantly more of nasal pain on the first day after operation than the patients in group A. Headaches on the operation day were significantly more painful in group B than in group A. Bleeding on the fourth postoperative day was significantly reduced in group B as compared to group A. The patients in group B exhibited significantly more intensive nasal obstruction on the operation day and the following day than the patients in group A. However, on the third and fourth postoperative days, the nasal obstruction in group B was less than that in group A. The pain and bleeding related to the packing material was significantly reduced in group B as compared to group A. Conclusions The use of SPF as an absorbable packing material is a reasonable substitute for the traditional nonabsorbable material.

Fracture of the anterior nasal spine.

AbstractA 24-year-old man was assaulted and complained of vague discomfort with tenderness on the nose. Physical examination manifested pain over the nasolabial angle region aggravated by upper lip closure. Computed tomography with three-dimensional reconstruction of the facial bone revealed a fracture of the anterior nasal spine accompanying the overt displacement. The patient underwent open reduction and internal fixation. Clinical symptoms were completely resolved after the surgery. Regular diet was recommenced in 2 weeks without any complications. The purpose of this study was to emphasize the awareness of the clinical feature and the modality of treatment in case of anterior nasal spine fracture with displacement.

Ocular Complications in Assault-Related Blowout Fracture

Background Blowout fracture is one of the most common facial fractures, and patients usually present with accompanying ocular complications. Many studies have looked into the frequency of persistent ocular symptoms, but there is no study on assault patients and related ocular symptoms. We evaluated the incidence of residual ocular symptoms in blow-out fractures between assaulted and non-assaulted patients, and sought to identify any connection among the degree of enophthalmos, defect size, and assault-related injury. Methods A retrospective review was performed for any patient who sustained a unilateral blowout fracture between January 2010 to December 2014. The collected data included information such as age, gender, etiology, and clinical ocular symptoms as examined by an ophthalmologist. This data was analyzed between patients who were injured through physical altercation and patients who were injured through other means. Results The review identified a total of 182 patients. Out of these, 74 patients (40.7%) have been struck by a fist, whereas 108 patients (59.3%) have sustained non-assault related injuries. The average age was 36.1 years, and there was a male predominance in both groups (70 patients [94.6%] in the assaulted group and 87 patients [80.6%] in the non-assault group). Diplopia and enophthalmos were more frequent in patients with assault history than in non-assaulted patients (p<0.05). Preoperatively, 25 patients (33.8%) with assault history showed diplopia, whereas 20 patients (18.5%) showed diplopia in the non-assaulted group (p<0.05). Preoperative enophthalmos was present in 34 patients (45.9%) with assault history, whereas 31 patients (28.7%) showed enophthalmos in the non-assaulted group (p<0.05). Conclusion Patients with an assault history due to a fist blow experienced preoperative symptoms more frequently than did patients with non-assault-related trauma history. Preoperative diplopia and enophthalmos occurred at a higher rate for patients who were assaulted. Surgeons should take into account such characteristics in the management of assaulted patients.

A rare case of transitional meningioma.

Meningiomas are a diverse set of tumors arising from the meninges, which are the membranous layers surrounding the central nervous system. Most meningiomas grow inward toward the brain as discrete, well-defined, dural-based masses and are spherical or lobulated. The borders between the tumor and the brain are usually smooth and clear because they preserve the histologic structures, such as the tumor capsule, cerebrospinal fluid, arachnoid mater, and pia mater [1]. Considering such a growth pattern, we report a rare case of transitional meningioma misdiagnosed as a soft tissue tumor. A 60-year-old female patient presented with a hard and fixed mass that grew spontaneously on her forehead within one year (Fig. 1). There was no history of trauma or exposure to carcinogens, and she was otherwise fit and well. Computed tomography (CT) showed frontal cortical thickening and swelling suggestive of a type of soft tissue tumor. To determine the character of the tumor-like mass, excision was performed (Fig. 2). The pathologist confirmed the mass as a transitional meningioma. Magnetic resonance imaging (MRI) which was taken after primary excision revealed an intracranial mass that was 3.0 cm in size, ovoid and well enhanced (Fig. 3). Wide-excision osteoplastic craniotomy via a bicoronal approach was performed under navigation guidance by neurosurgeon. Fig. 1 Preoperative photograph showing a lesion on the right forehead. Fig. 2 Gross appearance of the specimen. Fig. 3 Brain magnetic resonance imaging (T1) showing a soft tissue mass 3.0 cm in size, ovoid and well enhanced under the skull. The mass shows a dural tail sign. Transitional meningiomas are also called as mixed meningiomas, and these tumors have transitional between those of meningothelial and fibrous meningioma and they are common tumors with meningothelial, fibrous, psammomatous, and angioblastic meningiomas. 90% of meningiomas are consisting of those five types of meningiomas. The brain mass was also established as a meningothelial-type meningioma, 2.5×2.3 cm in size. Histologically, the tumor was lobulated by intersecting collagenous fibers. Immunohistochemical staining was positive for vimentin and epithelial membrane antigen and negative for pancytokeratin. There was no recurrence of meningioma during the 6-year follow-up period. Meningiomas are estimated to constitute between 13% and 26% of primary intracranial tumors, with an annual incidence rate of approximately 6 per 100,000 population. They are the most frequently diagnosed primary brain tumor, accounting for 33.8% of all primary brain and central nervous system tumors reported in the United States between 2002 and 2006 [2]. The exact causes of most of these tumors are not known. They result from abnormal patterns of growth that are most likely due to defects in the genetic material. The exact type of genetic defect or mutation has not been conclusively identified in meningiomas. Despite the lack of definitive evidence that clearly isolates possible causes, it has been suggested that meningiomas are associated with traumatic head injury, prolonged inflammation of the meninges following injury, viral infections, radiation, certain genes, Neurofibromatosis type 2, and hormones, particularly sex hormones, including estrogen, progesterone and androgens. Excessive use of cellular phones has also been implicated as a possible cause, but the evidence to conclusively link cell phone use to meningioma development is lacking [2]. The majority of meningiomas are benign, and they are seldom invasive. Wang et al. [1] studied 7,084 cases of meningiomas and examined the female: male ratio, patient age, subtypes, and locations. The female: male ratio of all types of meningioma is 2.34, while that of transitional meningioma is 2.11. The mean age of among all cases of meningioma is 51.45 years, and that of transitional meningioma is 50.54 years; the age of the patient in this case was 60 years. In their study, there were 323 cases of transitional meningioma among 7,084 cases, accounting for 4.56% of all meningiomas. There were 3 cases of extracranial meningioma among 7,084 cases, accounting for 0.04% of the total. Extracranial extension of meningiomas is very rare, and only a few cases have been reported [1]. Panchmatia et al. [3] reported an asymptomatic forehead lump that was initially diagnosed as an osteoid osteoma. CT was suggestive of an exostosis and an enostosis associated with frontal skull thickening. The mass was excised, and its histological features were consistent with intraosseous meningioma [4]. Nadarajan et al. [4] reported a similar case of unusual meningioma. An 82-year-old man was had a large deformity over the frontal area of his scalp. CT and MRI revealed an intracranial mass that extended across the frontal lobes. The mass permeated the skull and extended through the scalp. The histologic finding of the mass suggested a benign meningioma with low mitotic activity [3]. In cases of a protruding mass on the head, clinicians tend to diagnose the tumor as osteoma or lipoma because of their high prevalence. In this case, the manifestation of the mass was more similar to another soft tissue tumor rather than extracranial meningioma. Following excision, pathology and other radiologic studies such as MRI and ultrasonography indicated that the tumor was a meningioma instead of a soft tissue tumor. The high-power view reveals many whorling epithelioid cells and admixed spindle cells (Fig. 4A). Immunohistochemical staining for epithelial membrane antigen (EMA) disclosed diffuse positivity, which was strongly supportive of meningothelial differentiation. The tumor cells were composed of oval cells with occasional intranuclear inclusion bodies (Fig. 4B). To diagnose meningioma, initial investigations should include contrast-enhanced CT and MRI. In addition, angiography is a valuable tool that allows the surgeon to elucidate the relationship of the tumor with nearby vascular structures and to determine the vascularity of the tumor [3]. Fig. 4 (A) The high-power view reveals many whorling epithelioid cells (red arrow) and admixed spindle cells. The tumor cells are composed of oval cells with occasional intranuclear inclusion bodies (blue arrow) (H&E, ×400). (B) Immunohistochemical ... The meningioma in the present case was misdiagnosed as a soft tissue tumor because of its gross manifestation, and MRI study and punch biopsy were excluded. Unfortunately, nonenhanced brain CT cannot present characteristic feature of meningioma and gives little information to diagnose. The mechanism of extracranial extension was not yet established, but there are two possible theories. One is the proliferation of perineural cells or ectopic arachnoid tissue along the cranial nerve, and the other is misplaced embryonic rests of arachnoid cells and multipotent mesenchymal cells [5]. In conclusion, even if a mass on the forehead has an obvious clinical manifestation, thorough imaging studies are required and suspicions about rare tumors should be addressed before surgery.

Nasal Carriage of 200 Patients with Nasal Bone Fracture in Korea

Background Pathogens in the nasal cavity during nasal surgery could lead to a systemic infectious condition, such as bacteremia, nosocomial infection, or toxic shock syndrome. However, there is no research about the prevalence of nasal carriage in patients with nasal bone fracture. Methods This was a prospective, double-blind, randomized study about the rate of nasal carriage in 200 patients with nasal bone fracture in Korea. Nasal secretions were taken from both the middle nasal meatus and colonized. All analyses were carried out using SPSS software. Results Pathogens were identified in 178 of the 200 cases. Coagulase-negative staphylococci (CNS) were the most cultured bacteria in 127 (66.84%) of the 190 total patients after excluding 10 cases of contaminated samples, and methicillin-resistant coagulase-negative staphylococci (MRCNS) were found in 48 (25.26%). Staphylococcus aureus was the second most identified pathogen, found in 36 (18.95%), followed by 7 cases (3.68%) of methicillin-resistant Staphylococcus aureus (MRSA). The prevalence rate of MRSA in the females was higher than that in the males (RR=4.70; 95% CI, 1.09-20.18), but other demographic factors had no effect on the prevalence rate of MRSA and MRCNS. Conclusions The prevalence rate of these pathogens in patients with nasal bone fracture in Korea was similar to other reports. However, few studies have addressed the prevalence rate of CNS and MRCNS in accordance with risk factors or the change in prevalence according to specific prophylaxis against infectious complications. Additional research is needed on the potential connections between clinical factors and microbiological data.

Atypical traumatic subperiosteal orbital hematoma treated by surgical evacuation.

Abstract Subperiosteal orbital hematoma occurs rarely after blunt trauma. However, this is of importance, as this condition may cause ocular symptoms. The major characteristics of subperiosteal orbital hematomas are painful proptosis, downward displacement of the globe, absence of lid ecchymosis, chemosis without subconjunctival hemorrhage, and motility impairment. Visual impairment is known as a rarely presenting symptom. A 22-year-old male patient presented with right periorbital ecchymosis, swelling, and diplopia with upper lateral gaze limitation. Besides, the patient complained of lower visual field disturbance. Radiologic evaluation revealed traumatic subperiosteal orbital hematoma. The hematoma was evacuated through a lacerated wound on the right lateral eyebrow with additional incision. After the hematoma evacuation, the orbital symptoms are restored. Postoperative computed tomographic scans showed normally restored orbital space without any evidence of remnant hematoma or rebleeding. In case of subperiosteal hematoma, early detection and complete surgical evacuation is crucial for preventing possible complications and sequelae.