See-Ok Shin

Relationship between the extent of fracture and the degree of enophthalmos in isolated blowout fractures of the medial orbital wall

PURPOSE This study investigated the relationship between the extent of fracture and enophthalmos in blowout fractures of the medial orbital wall. PATIENTS AND METHODS Nine patients with isolated blowout fractures of the medial orbital wall, confirmed by computed tomography scans, were evaluated. The area of fracture and the volume of herniated orbital tissue were determined from computed tomography scans using simple linear measurements. Each of the calculated values for area and volume were compared with the degree of enophthalmos to determine whether there was any significant relationship between them. RESULTS Enophthalmos increased proportionally as the area of fracture or the volume of herniated orbital tissue increased (P < .05). The area of fracture and the volume of herniated orbital tissue associated with 2 mm of enophthalmos were 1.9 cm2 and 0.9 mL, respectively, as calculated from the regression curve. CONCLUSION Enophthalmos of 2 mm or more, which is a frequent indication for surgery, can be expected when the area of fracture is 1.9 cm2 or more, or the volume of herniated orbital tissue is 0.9 mL or more.

Endoscopic versus external repair of orbital blowout fractures

OBJECTIVES: This study evaluates the usefulness of endoscopic repair compared to external repair in the treatment of blowout fracture (BOF) of the orbit. STUDY DESIGN AND SETTING: This retrospective study comprised 100 patients who had had surgical repair of orbital BOF since 1992. Forty-eight of the 100 had undergone endoscopic repair, 48 patients had had external repair, and four patients underwent surgery that combined the two approaches. The two basic approaches were evaluated and compared with respect to technique, results and complications. RESULTS: Endoscopically, transnasal and transantral approaches had been used for reduction and support of fractured medial and inferior walls, respectively. In the external approach, various transorbital incisions were made and the fractured wall was repaired with alloplastic or autologous materials. Complete or partial resolution of preoperative diplopia was achieved in 94% of the endoscopic group and 83% of the external group (NS). Enophthalmos was improved in 89% of the endoscopic group and 76% of the external group (NS). Though the endoscopic group had no significant complications, the external group had ectropions, significant facial scars, extrusion of inserted Medpor, and intra-orbital hematoma. CONCLUSIONS: Endoscopic repair appears to be a safe and effective technique for the treatment of BOF of the orbit.

Ultrastructural changes in the cochlea of the guinea pig after fast neutron irradiation.

Guinea pigs were irradiated with fast neutrons. After a single dose of 2, 6, 10, or 15 Gy was applied, scanning and transmission electron microscopy of the temporal bone was performed to assess the effect of fast neutron irradiation on the cochlea. Outer hair cell damage appeared with neutron irradiation of more than 10 Gy, and Inner hair cell damage with neutron Irradiation of more than 15 Gy. Outer hair cells were more severely damaged than Inner hair cells. No statistically significant differences were found in damage of basal, middle, and apical turns. The second and third rows of outer hair cells were more severely damaged than the first row of outer hair cells. The most significant findings in transmission electron microscopy were clumping of chromatin and extension of the heterochromatin in the nuclei of hair cells. The cytoplasmic changes were sequestration of cytoplasm, various changes of mitochondria, formation of vacuoles, and irregularly arranged stereocilia. The morphologic change in stria vascularis was intercellular and perivascular fluid accumulation. It appeared to be a reversible process.

Key maneuvers for successful correction of a deviated nose in Asians.

Background The authors present surgical results of 64 Asian patients with deviated nose and introduce important key maneuvers used in the surgery. Methods Sixty-four consecutive patients who underwent corrective rhinoplasty because of a deviated nose were analyzed retrospectively. Approaches and techniques used for the surgery, surgical results, and complications were evaluated. A questionnaire was used to evaluate each patients functional and esthetic satisfaction. Preoperative and postoperative standardized photographs of the face were evaluated to judge objectively the esthetic outcomes of the surgery. Results An endonasal approach was used in 44 patients and an open approach was used in 20 patients. Five important key maneuvers to correct the deviation were noted, in the order of frequency: septoplasty, osteotomy, spreader graft, turbinoplasty, and camouflage graft. Additional procedures included augmentation of the dorsum, tip surgery, and hump removal. On a 5-point box scale of 0–4, the patients scored their satisfaction on functional improvements as 3.2 ± 0.79 and their esthetic satisfaction as 3.0 ± 0.8. The objective evaluation of the appearance showed complete correction in 84.4%, a minimally visible deviation in 10.9%, and a residual deviation but less than before surgery in 4.7%. Aside from residual deviations, complications included a slight depression of the middorsum after spreader graft and a malpositioning of the dorsal cartilage graft. Conclusion Deviated nose in Asians can be managed successfully by combining key maneuvers that correct specific anatomic abnormalities. Many of these key maneuvers require modifications that take into account the race-specific characteristics of the Asian nose.

Primary Facial Skin Cancer: Clinical Characteristics and Surgical Outcome in Chungbuk Province, Korea

Clinical features of facial skin cancer in Asian population including Korean are not readily available. In the present study, we analyzed the clinical characteristics and the surgical results of primary facial skin cancer in Chungbuk Province, Korea. Eighty-six cases of primary facial skin cancer collected during a 10-yr period (1994-2003) were retrospectively reviewed about the clinical characteristics including age, sex, annual diagnostic rate, types of tumor, specific sites of occurrence, and the surgical results. The average age at the diagnosis was 67 and male to female ratio was 1 to 1.05. The average annual diagnostic rate was 0.73% and the rate surged during the period 2001-2003 compared with the period 1994 to 2000. Basal cell carcinoma was the most common tumor and the nose was the most frequent site. Traditional surgical excision with immediate reconstruction was performed in 81 cases. During the 23 months of average follow-up, three patients had recurrences (3.7%) and three patients had secondary skin cancers. Facial skin cancer is increasing in the province and basal cell carcinoma is most frequent. Traditional surgical excision and immediate reconstruction with local flap are a good therapeutic modality with an acceptable recurrence rate.

Clinical Characteristics of Labyrinthine Concussion

Background and Objectives Inner ear symptoms like hearing loss, dizziness or tinnitus are often developed after head trauma, even in cases without inner ear destruction. This is also known as labyrinthine concussion. The purpose of this study is to determine the clinical manifestations, characteristics of audiometry and prognostic factors of these patients. Materials and Methods We reviewed the medical records of the 40 patients that had been diagnosed as labyrinthine concussion from 1996 to 2007. We studied the hearing levels in each frequency and classified them according to type and degree of hearing loss. Rates of hearing improvement were evaluated according to age, sex, hearing loss type, degree and presence of dizziness or tinnitus. To find out any correlation between hearing improvement and these factors, we used χ2 test or Fishers exact test. Results Bilateral hearing loss was observed in 22 patients, and unilateral hearing loss in 18 patients. There were 4 (6.5%) ascending, 34 (54.8%) descending, 24 (38.7%) flat type hearing loss, which indicated hearing loss was greater in high frequencies than low frequencies. Among 62 affected ears, 20 (32.3%) gained improvement, and it was achieved mainly in low frequencies. There were only 2 ears with dizziness in 20 improved ears and among 20 dizziness accompanied ears, also only 2 ears were improved. Conclusions High frequencies are more vulnerable to trauma than low frequencies. The hearing gain is obtained mainly in low frequencies, and association with dizziness serves poor prognosis.

Endoscopic marsupialization of bilateral lacrimal sac mucoceles with nasolacrimal duct cysts

A lacrimal sac mucocele is an uncommon disease usually treated by ophthalmologists. In rare cases, it is sometimes associated with a nasolacrimal duct cyst presenting as an intranasal cystic mass, which needs the involvement of an otolaryngologist in diagnosis and management. Two cases of lacrimal sac mucoceles with nasolacrimal duct cysts are presented with a brief literature review. Both cases presented with intranasal cystic masses that caused nasal obstruction and were cured with endoscopic marsupialization of the cysts.

The efficacy of an additional cycle of oral steroids in partially recovered Sudden Sensorineural Hearing Loss (SSNHL) after initial oral steroid therapy

Conclusion. There was no beneficial effect of an additional cycle of oral steroid therapy in partially recovered patients with sudden sensorineural hearing loss after initial oral steroid therapy. Objectives. Partial recovery of hearing after one cycle of steroids might be the result of a relatively short duration of medication. We evaluated the efficacy of an additional cycle of steroids in those patients. Subjects and methods. With strict inclusion criteria, we selected the patients with hearing gain more than 10 dB, but still worse than 30 dB with hearing level, at the end of one cycle of steroid therapy. They were divided into a control group with no further treatment and a study group treated with an additional cycle of steroids. We compared their hearing outcomes, recovery rates and the mean duration of hearing improvement. Results. We could not find any significant difference in either hearing outcomes, recovery rates or the mean duration of hearing improvement between the one-cycled group and the two-cycled group.

S226 – MRSA and Pseudomonas Infection in Chronic Otitis Media

Objectives 1) Compare postoperative healing process between otorrhea and non-otorrhea group. 2) Evaluate the influence of MRSA and Pseudomonas infection on postoperative healing process. 3) Describe the affecting factors of postoperative reperforation and retroauricular abscess. Methods Retrospective chart review of 392 patients who were operated with canal wall up procedures by one surgeon and followed up at least over 12 months. The patients were divided into control and study groups; 106 non-otorrhea control group; 74 Pseudomonas infected group (P); 145 MRSA infected group (M); 61 other bacteria infected group (0). The following data were collected: 1) postoperative dressing frequency and duration; 2) the duration of oral antibiotics and intravenous antibitics use; 3) the incidence of postoperative otorrhea; 4) the incidence of reperforation and retroauricular abscess. The Mantel-Haenszel test and ANOVA test were used for statistical analysis. Results Statistical analysis indicates a significant difference in frequency and duration of postoperative dressing and oral antibiotics using peroid (p<0.01). Nevertheless, there were no correlations in postoperative otorrhea and reperforation between the infected group and non-otorreha group (p>0.05). The incidence of retroauricular abscess was high in the antibiotic-changed group (p<0.01). Conclusions MRSA and Pseudomonas infection in chronic otitis media indicated a significant difference in the duration of postoperative follow-up and the antibiotic-using period, compared with the control group. The isolated MRSA or Pseudomonas infection after surgery had more incidence of a retroauricular abscess.