The use of a myomucosal flap from the buccinator muscle is a valuable reconstruction method for intraoral defects. In this paper, we report the clinical advantages of using a buccinator myomucosal flap for the treatment of partial mandibular defects caused by osteoradionecrosis. We implemented a buccinator myomucosal flap for the reconstruction of a partial mandibular defect in a 55-year-old man with tonsil cancer and partial mandibular defects caused by osteoradionecrosis. The total operating time was 90 minutes. Twelve months after the reconstruction, the patient remains free of disease. A buccinator myomucosal flap can be used for the reconstruction of partial mandibular defects caused by osteoradionecrosis. It is a reliable method for reconstructing small mandibular defects.
Humans ; Mandible* ; Mandibular Reconstruction ; Middle Aged ; Myocutaneous Flap ; Osteoradionecrosis* ; Reconstructive Surgical Procedures ; Tonsillar Neoplasms

OBJECTIVES: The objective of this study was to compare the long-term auditory performance and language skill depending on the age of cochlear implantation in the Korean population. We especially tried to separate the effect of maturation/development from that of the age at implantation. METHODS: Eighty-six pre-lingual children with profound hearing loss who underwent a cochlear implantation before the age of six and had been followed for more than 3 yr were included in this study prospectively. Categories of Auditory Performance (CAP) and Korean Picture Vocabulary Test (K-PVT) were serially followed up. In order to separate the age at implantation effect, K-PVT results were readjusted to the child's chronological age in the normal hearing population. RESULTS: When the CAP and K-PVT scores were directly compared without chronological readjustment, we failed to show a significant difference for improvements according to the age at implantation. Early cochlear implantation was associated with better language development, only when the K-PVT scores were readjusted to percentile scores of their chronological age. CONCLUSION: Early cochlear implantation was associated with better language development even within the critical period. This advantage may be recognized only when the effect of the age at implantation is separated from the effect of maturation/development.
Child ; Cochlear Implantation ; Cochlear Implants ; Critical Period (Psychology) ; Hearing ; Hearing Loss ; Humans ; Imidazoles ; Korea ; Language Development ; Language Tests ; Nitro Compounds ; Prospective Studies

OBJECTIVES: Chondroradionecrosis (CRN) of the larynx is a rare but fatal complication of radiotherapy. We determined the optimal diagnostic methodology and management of laryngeal CRN in six patients. METHODS: We retrospectively reviewed the records of six patients with Chandler grade IV laryngeal CRN who had received prior radiotherapy (mean total radiation dose, 66.7+/-4.5 Gy) at a tertiary care hospital. Two patients underwent transoral laser microresection of their laryngeal carcinoma plus postoperative radiotherapy. All patients underwent endoscopy, computed tomography (CT), positron emission tomography (PET), removal of necrotic tissue, biopsy under suspension laryngoscopy, administration of antibiotics, and hyperbaric oxygen therapy (HBO). Their diagnostic and therapeutic results were assessed. RESULTS: CT showed CRN of the anterior larynx in three patients and CRN of the posterior larynx in three patients, with one patient having a false-positive result on PET. HBO consisted of a mean of 36+/-6 dives. After early debridement and HBO, five patients showed CRN improvement, but one had aggravation and subsequently underwent total laryngectomy. None of these patients showed local tumor recurrence on pathologic examination or during a mean follow-up of 24 months. CONCLUSION: Although CRN of the larynx may be detected by endoscopic and imaging work-ups, detection may require pathologic examination. Early debridement and HBO may effectively treat CRN, saving the functional larynx.
Anti-Bacterial Agents ; Biopsy ; Debridement ; Endoscopy ; Follow-Up Studies ; Humans ; Hyperbaric Oxygenation ; Laryngectomy ; Laryngoscopy ; Larynx ; Positron-Emission Tomography ; Recurrence ; Retrospective Studies ; Tertiary Healthcare

Surgical treatment of obstructive sleep apnea syndrome (OSAS) has been available in some form for greater than three decades. Early management for airway obstruction during sleep relied on tracheotomy which although life saving was not well accepted by patients. In the early eighties two new forms of treatment for OSAS were developed. Surgically a technique described as a uvulopalatopharyngoplasty (UPPP) was used to treat the retropalatal region for snoring and sleep apnea. Concurrently sleep medicine developed a nasal continuous positive airway pressure (CPAP) device to manage nocturnal airway obstruction. Both of these measures were used to expand and stabilize the pharyngeal airway space during sleep. The goal for each technique was to limit or alleviate OSAS. Almost 30 yr later these two treatment modalities continue to be the mainstay of contemporary treatment. As expected, CPAP device technology improved over time along with durable goods. Surgery followed suit and additional techniques were developed to treat soft and bony structures of the entire upper airway (nose, palate and tongue base). This review will only focus on the contemporary surgical methods that have demonstrated relatively consistent positive clinical outcomes. Not all surgical and medical treatment modalities are successful or even partially successful for every patient. Advances in the treatment of OSAS are hindered by the fact that the primary etiology is still unknown. However, both medicine and surgery continue to improve diagnostic and treatment methods. Methods of diagnosis as well as treatment regimens should always include both medical and surgical collaborations so the health and quality of life of our patients can best be served.
Airway Obstruction ; Continuous Positive Airway Pressure ; Cooperative Behavior ; Humans ; Palate ; Quality of Life ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Snoring ; Tongue ; Tracheotomy

Arytenoid edema following radiation therapy of laryngeal cancer may persist and make careful inspection and evaluation of the larynx difficult. Moreover, it may have serious impacts on functions such as breathing, swallowing, speech and voice. Conservative management such as antibiotics and steroid may be attempted but may be ineffective in progressive and severe cases of edema. We present four cases of persistent postradiation arytenoid edema successfully treated with partial resection of the arytenoid mucosa using transoral CO2 laser.
Anti-Bacterial Agents ; Arytenoid Cartilage ; Deglutition ; Edema ; Laryngeal Edema ; Laryngeal Neoplasms ; Larynx ; Lasers, Gas ; Mucous Membrane ; Respiration ; Voice

Osteoma is the most common benign tumor of the paranasal sinuses. Turbinate osteomas are very rare and only four middle turbinate, one superior turbinate and one inferior turbinate osteoma cases have been reported. We present a rare case of osteoma of the left middle turbinate in a patient presented with unilateral nasal obstruction and epiphora that was removed endoscopically, and conduct a literature review on turbinate osteomas arising from different turbinates, their symptoms and management.
Humans ; Lacrimal Apparatus Diseases ; Nasal Obstruction ; Osteoma ; Paranasal Sinuses ; Turbinates

OBJECTIVES: To determine whether a novel marine micro-organism with anticancer properties, H31, the metabolic product of Bacillus SW31, has anti-tumor effects on head and neck cancer, and potential for apoptotic-enhancing anti-cancer treatment of affected patients. METHODS: The cell viability and apoptosis assays were performed. Changes in the signal pathway related to apoptosis were investigated. Then, the therapeutic effects of H31 were explored in mouse xenograft model and drug toxicity of H31 was examined in zebrafish model. RESULTS: We identified the anticancer activity of H31, a novel metabolic product of Bacillus SW31. Bacillus SW31, a new marine micro-organism, has 70% homology with Bacillus firmus and contains potent cytotoxic bioactivity in head and neck cancer cells using MTT assay. Combined with c-JUN, p53, cytochrome C, and caspase-3, H31 induced apoptosis of KB cells, a head and neck cancer cell line. In a separate in vivo model, tumor growth in C3H/HeJ syngeneic mice was suppressed by H31. In addition, in a zebrafish model used for toxicity testing, a considerable dose of H31 did not result in embryo or neurotoxicity. CONCLUSION: Growth inhibition and apoptosis were achieved both in vitro and in vivo in head and neck cancer cells after exposure to H31, a metabolite from the marine Bacillus species, without any significant toxicity effects even at considerable H31 dose concentrations.
Animals ; Apoptosis ; Bacillus ; Caspase 3 ; Cell Line ; Cell Survival ; Cytochromes c ; Drug Toxicity ; Embryonic Structures ; Head ; Head and Neck Neoplasms ; Humans ; KB Cells ; Marine Toxins ; Mice ; Signal Transduction ; Toxicity Tests ; Transplantation, Heterologous ; Zebrafish

OBJECTIVES: Vidian neurectomy could be considered the treatment of choice for intractable rhinitis, because it is the only method that can permanently block the pathophysiological mechanism of rhinitis. The goal of this study was to evaluate the effect of vidian neurectomy on nasal symptoms and tear production, and to assess for possible complications. METHODS: Six patients with intractable rhinitis who underwent endoscopic transnasal vidian neurectomy were enrolled. The degree of symptom improvement and complications were assessed through retrospective review of medical records prior to, and 1 year following surgery, and telephone survey after 6.9+/-2.1 years. Schirmer's test was performed before surgery, and these values were compared to postoperative results at 1 day, 1 month, and 2 months. RESULTS: Changes in the visual analogue scale were significant in nasal obstruction (8.5+/-2.5 to 3.0+/-2.0, P<0.05) and rhinorrhea (9.0+/-2.2 to 2.0+/-1.6, P<0.05). Improvements persisted for up to 7 years after the primary surgery. Patients complained of mild dry eyes for 1 month after vidian neurectomy. However, five out of six reported marked improvement of xerophthalmia after 2 months. Aside from mild crusting of the nasal cavity and mild postoperative pain, there were no major complications. During the entire follow-up period, no patient needed additional treatment, such as antihistamines or corticosteroids. CONCLUSION: Vidian neurectomy is effective in alleviating nasal symptoms in patients with intractable rhinitis refractory to other treatments. This effect is sustained for at least 7 years with minimal postoperative complications.
Endoscopy ; Eye ; Follow-Up Studies ; Histamine Antagonists ; Humans ; Medical Records ; Nasal Cavity ; Nasal Obstruction ; Pain, Postoperative ; Postoperative Complications ; Retrospective Studies ; Rhinitis ; Rhinitis, Allergic, Perennial ; Tears ; Telephone ; Xerophthalmia

OBJECTIVES: The aim of this study was to investigate optimal continuous positive airway pressure (CPAP) level, to examine the factors affecting optimal CPAP level, and to develop a predictive equation for optimal CPAP level in Korean patients with obstructive sleep apnea syndrome (OSAS). METHODS: A total of 202 patients with OSAS who underwent successful manual titration for CPAP treatment were included in this study. Correlations between the optimal CPAP level and baseline data including anthropometric and polysomnographic variables were analyzed. A predictive equation for optimal CPAP level was developed based on anthropometric and polysomonographic data. RESULTS: The mean optimal CPAP level in 202 patients with OSAS was 7.8+/-2.3 cm H2O. The mean optimal CPAP level in the mild, moderate, and severe OSAS groups was 6.0+/-1.3, 7.4+/-1.9, and 9.1+/-2.1 cm H2O, respectively. The apneahypopnea index (AHI) (r=0.595, P<0.001), arousal index (r=0.542, P<0.001), minimal SaO2 (r=-0.502, P<0.001), body mass index (BMI) (r=0.494, P<0.001), neck circumference (r=0.265, P<0.001), and age (r=-0.164, P=0.019) were significantly correlated with optimal CPAP level. The best predictive equation according to stepwise multiple linear regression analysis was: Optimal CPAP level (cm H2O)=0.681+(0.205xBMI)+(0.040xAHI). Forty-two percent of the variance in the optimal CPAP level was explained by this equation (R2=0.42, P<0.001). CONCLUSION: A predictive equation for optimal CPAP level in Korean patients with OSAS was developed using AHI and BMI, which can be easily measured during the diagnostic process.
Arousal ; Body Mass Index ; Continuous Positive Airway Pressure ; Humans ; Linear Models ; Neck ; Polysomnography ; Sleep Apnea, Obstructive

OBJECTIVES: The aim of this study was to compare the hearing outcomes between canal wall up mastoidectmy (CWUM) and canal wall down mastoidectmy (CWDM). METHODS: One hundred seventy one chronic suppurative otitis media (CSOM) patients were enrolled in this retrospective study. The patients who underwent the second staged ossiculoplasty at least 6 months after mastoidectomy and who had an intact, well aerated tympanic cavity as well as intact mobile stapes at the time of operation were selected from the medical record. Based on the type of mastoid surgery, the patients were categorized into two groups: the CWUM (n=38) and CWDM groups (n=133). The hearing results of the CWUM and CWDM groups were compared using the pre- and post-operative air-bone gap (ABG) at 3 months after ossiculoplasty. RESULTS: The preoperative ABG in both groups (CWUM and CWDM) were 28.4+/-15.6 dB and 31.8+/-14.5 dB, respectively (P=0.18). Both groups didn't show any significant difference (10.9 dB vs. 13.5 dB, respectively) (P=0.21) for the postoperative ABG closure. The proportion of patients with an ABG less than 20 dB was 58.6% of the CWDM patients and 68.4% of the CWUM patients (P=0.25). CONCLUSION: The type of mastoid surgery (CWUM and CWDM) did not affect the hearing results of CSOM patients. When choosing the type of mastoidectomy procedure for CSOM surgery, the hearing outcomes are basically the same for both types of procedure.
Ear, Middle ; Hearing ; Humans ; Mastoid ; Medical Records ; Otitis Media ; Otitis Media, Suppurative ; Retrospective Studies ; Stapes