Young-Seok Choi

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.

Progenitor cell cycling during hair cell regeneration in the vestibular and auditory epithelia of the chick.

We investigated nucleotide-labeling patterns during ongoing hair cell regeneration in the avian vestibular epithelium and during drug-induced regeneration in the avian auditory epithelium. For utricle experiments, post-hatch chicks received an injection of bromodeoxyuridine (BrdU) and were allowed to survive from 2 hours to 110 days after the injection. Utricles were fixed and immunoreacted to detect BrdU. The number of BrdU-labeled nuclei in the hair cell and support cell layers of the utricular sensory epithelium changes significantly between 2 hours and 110 days post-BrdU. At 2 hours, most labeled cells are isolated, while by 5–10 days, the majority of labeled cells are organized in pairs that are most frequently composed of a hair cell and a support cell. Pairs of labeled cells are seen as late as 110 days. Clusters of more than 3 labeled cells are uncommon at all time-points. The total number of labeled cells increases approximately 1.5-fold between 5 and 60 days post-BrdU. This increase is due primarily to a rise in the number of labeled support cells, and it is likely that it represents additional rounds of division by a subset of cells that were labeled at the time of the BrdU injection. There is a significant decrease in labeled nuclei in the hair cell layer between 60 and 110 days post-BrdU, suggesting that hair cells die during this period. To investigate support cell recycling in the drug-damaged auditory epithelium, we examined nucleotide double labeling after separate injections of BrdU and tritiated thymidine. A small number of support cells that incorporate BrdU administered at 3 days post-gentamicin treatment also label with tritiated thymidine administered between 17 and 38 hours later. We conclude that a small population of support cells recycles during regeneration in both the normal utricle and the drug-damaged basilar papilla.

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.

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.

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.

Results of Hearing Gain according to Ossicular Prosthesis Materials

Objectives: Compare the functional results and extrusion rates according to the type of ossciular prosthesis materials in POR and TOR cases. Methods: A retrospective analysis was performed. Sixty-two patients were involved in POR cases and 70 patients were involved in TOR cases. In POR cases, Plastipore was used in 21 cases, hydroxy-apatite in 20 cases, and titanium in 20 cases. In TOR cases, Plastipore was used in 20 cases, hydroxy-apatite in 25 cases and titanium in 25 cases. We reviewed postoperative air-bone gap (ABG; less than 20dB and more than 20dB) and extrusion rate for more than 1 year follow-up period. Results: In POR cases, extrusion rates (ER) were 14.3%, 15.0%, 5.0% in plastipore, HA, and titanium prothesis, respectively. ABG less than 20dB were 71.4%, 80.0%, 85% in platipore, HA, and titanium, respectively. In TOR cases, ER were 30.0%, 20.0%, 8.0% in plastipore, HA, and titanium prothesis. ABG less than 20dB were 25.0%, 28.0%, 32.0% in plastipore, HA, and titanium prothesis, respectively. Conclusions: There were no differences in hearing gain results and extrusion rates between Plastipore, HA, and titanium prosthesis in POR and TOR cases statistically. But clinically, better hearing gain and low-rate of extrusion were found in titanium prosthesis and this material is recommended in cases of ossicular surgery.

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.