Su-Bong Nam

Endoscopic transnasal approach for the treatment of isolated medial orbital blow-out fractures: a prospective study of preoperative and postoperative orbital volume change.

Endoscopic transnasal reduction is a safe and effective technique for the treatment of blow-out fractures of the medial orbital wall. However, because this approach does not use rigid permanent material for reconstruction of the fractured medial orbital wall, some degree of herniation of the orbital contents may occur after the intraethmoidal packing material is removed. The purpose of this study was to evaluate the change in orbital volume in patients with medial orbital wall fractures treated through an endoscopic transnasal approach. This study was a prospective analysis that includes 20 patients who underwent endoscopic transnasal reduction of medial orbital wall fractures between April 2007 and December 2008. Computer-assisted orbital volume measurements were made using axial computed tomography. The mean (standard deviation [SD]) volume increase was 2.00 (0.92) cm3 and the mean (SD) dimension of the fractured orbital wall was 2.76 (0.83) cm2. After endoscopic surgery, an average (SD) volume decrease of 2.15 (0.91) cm3 was achieved with ethmoid sinus packing. After removal of the packing materials, 1.14 (0.78) cm3 increase of the orbital volume was observed. The dimension of the orbital wall fracture significantly correlated with the increased preoperative orbital volume (P = 0.002, r = 0.609); the preoperative increase in the orbital volume also significantly correlated with volume relapse after removal of the packing (P = 0.023, r = 0.452). These findings suggest that in broad orbital wall fractures, reconstruction of the orbital wall by rigid materials or prolongation of the packing period should be considered, because orbital volume can increase again after packing removal, and may thus lead to postoperative complications.

Isolated Persistent Fifth Aortic Arch in a Patient with Cornelia de Lange Syndrome

We report the first case of persistent fifth aortic arch without other cardiac anomalies in a 3-year-old boy with Cornelia de Lange syndrome. He was a 1.6-kg product of a 36-week gestation via spontaneous vaginal delivery and diagnosed with Cornelia de Lange syndrome by his typical clinical features in the neonatal period. At age 3, he was evaluated by cardiology in preparation for surgery for accompanying hypospadia and cryptorchidism. On preoperative evaluation, parallel double-lumen aortic arches were noted from the suprasternal notch view on echocardiography (Fig. 1). Cardiac catheterization revealed no pressure difference from the left ventricle to the descending aorta. Angiography in the ascending aorta showed parallel doublelumen arches, suggestive of a persistent fifth aortic arch, separated by 1 or 2 mm (Fig. 2) with a narrowed lumen of the left subclavian artery. Threedimensional magnetic resonance imaging and computerized tomography angiography confirmed parallel double-lumen aortic arches with a small left subclavian artery (Figs. 3 and 4). The vascular structures were not encircling the trachea and esophagus. This is the first report of a patient with Cornelia de Lange syndrome with a double-lumen persistent fifth aortic arch without other cardiac anomalies [1– 5]. In this case, there were no significant clinical manifestations of this association.

Intracordal auricular cartilage injection for unilateral vocal fold paralysis

We evaluated the efficacy and outcome of intracordal auricular cartilage injection in patients with unilateral vocal fold paralysis. Our interest developed from findings of a canine model study that reported that histologic characteristics of cartilage were preserved 2 and 3 years after intracordal autologous cartilage injection. Between May 2002 and July 2010, 29 patients with breathy dysphonia caused by unilateral vocal fold paralysis underwent intracordal auricular cartilage injection. Each subject underwent preoperative and postoperative perceptual assessments, acoustical voice analysis, and videostroboscopy. Fourteen patients were male, and the mean age was 52-years old. Patients were tracked for a mean duration of 257 days. Injections were performed through a transoral approach under general anesthesia. Perceptual assessments by GRBAS scale, acoustic parameters of jitter, shimmer, noise-to-harmonic ratio, and maximum phonation time significantly improved at 3, 6, and 12 months after cartilage injection (p < 0.005). No major complications were observed after injection. Initial clinical results with intracordal auricular cartilage injection are promising for patients with unilateral vocal fold paralysis. Autologous auricular cartilage can be a safe, effective, and alternative material for vocal fold medialization, and can be a long lasting one.

Objective preoperative estimation of the ability of primary closure on anterolateral thigh free flap donor site: circumference and area ratios of deep tissue to thigh.

Purpose: The purpose of this study was to consider the relationship between the ratio of deep tissue including muscle to thigh at donor sites and the possibility of performing primary closure of donor site. Methods: The subjects were 74 patients who had harvesting of anterolateral thigh (ALT) free flap from June 2005 to June 2011. Primary closure was possible for 65 but not possible for 9. All received CT angiography of lower extremity before their operations. We measured circumference and cross‐sectional area of thigh and deep tissue including muscle at the reference point. Using the measured data, we examined the ratio of circumference as well as cross‐sectional area of deep tissue including muscles to thighs. Results: For whom primary closure was possible, the ratio of deep tissue including muscles circumference to thighs at the reference point was 0.83 ± 0.07 on average, and the ratio of cross‐sectional area was 0.68 ± 0.11. For whom primary closure was not possible, the ratio of circumference was 0.89 ± 0.06 on average, and the cross‐section areas was 0.8 ± 0.07. The average width of flap for those with primary closure was 64.9 mm and without primary closure was 84.4 mm. There was statistical significance in ratios of circumference and cross‐sectional area between primary closure and without primary closure. Conclusion: Primary closure of donor site when performing ALT free flap gets increasingly difficult as the ratio of deep tissue including muscle in the thighs increased. Such information prior to the procedure will be helpful in determining flap design and finalizing the operation plan.

Sclerosing sweat duct carcinoma of the nose with multiple cervical lymph node metastasis

Sclerosing sweat duct carcinoma (SSDC) in the nose, a rare occurrence with no specific symptoms, is frequently confused with rhinophyma or other inflammatory disease. In this report, we describe a 64-year-old woman who presented with a mass on her nasal dorsum for 1 year. Initially, the tumor had been misdiagnosed as a rhinophyma and followed-up for 1 year. She was referred due to a persistent nasal and neck mass. Deep incisional biopsy was performed to produce sufficient tissue and the histopathologic results showed SSDC. We performed wide local excision and reconstruction using radial forearm musculocutaneous free flaps with a costal cartilage framework followed by bilateral neck dissection. SSDC is seldom recognized and is frequently clinically confused with benign syringoma prior to pathologic diagnosis. Wide and deep incisional biopsy is necessary for the correct diagnosis and successful treatment of SSDC.

Role of protein kinase Cµ isoform expression in dimethylhydrazine-induced vascular endothelial proliferation

1,2-Dimethylthdrazine (DMH) has been known to induce vascular neoplasms, such as malignant endothelioma, in animal experiments through the induction of abnormal proliferation of human umbilical vein endothelial cells (HUVECs). We studied the effect of protein kinase C (PKC) isoforms on DMH-induced abnormal proliferation of vascular endothelium to identify the isoforms with higher relevance. The study was conducted with pure culture HUVECs in a control group and a 1x10-9 M DMH-treated group. The mRNA and protein expression of PKC isoforms in DMH-treated HUVECs was evaluated by reverse transcription-polymerase chain reaction and western blotting. DMH-induced PKC production was detected by a PKC activity assay. To investigate the role of the PKC isoforms in DMH-induced abnormal HUVEC proliferation, we modulated PKCµ expression in DMH-treated HUVECs using small interfering RNA. We determined the expression of 11 PKC isoforms by PCR analysis in both the control and DMH-treated groups, and the results were statistically analyzed to detect any differences. According to the results, both groups expressed 6 out of 11 isoforms. Expression of PKCµ was significant in the DMH-treated group, and downregulation of PKCµ inhibited DMH-induced abnormal HUVEC proliferation. The PKCµ isoform is believed to be important in the abnormal growth of vascular endothelial cells induced by DMH, and this was confirmed by an objective siRNA experiment, which showed a clear decrease in PKCµ expression. Therefore, it is believed that PKCµ is a key factor in the abnormal proliferation of vascular endothelial cells, and these results can be used as fundamental research data for abnormal vessel development or the embryologic mechanisms of vessel development.

Multidisciplinary approach to lethal bleeding from an arteriovenous malformation in the external auditory canal.

Arteriovenous malformations (AVMs) are composed of abnormally connecting feeding arteries as well as draining veins and lack a regulatory system. Frequent recurrences and unpredictable behavior are their main problems. Potential mortality and morbidity associated with therapeutic procedures must be considered with these patients. Improper treatment often aggravates the condition, potentially rendering therapy more complex. A multidisciplinary approach, including an endovascular approach, surgical excision, and flap reconstruction, is considered to completely eradicate an AVM. This study introduces a complicated case of AVM with massive bleeding through the external auditory canal that was treated with a multidisciplinary approach.