BACKGROUND AND OBJECTIVES: Submandibular space might be estimated as the most common space of deep neck infection. It may, in certain cases, be treated conservatively with no need for early open surgical drainage. The purpose of this study is to review the clinical course and outcome in treatment of submandibular abscess. SUBJECTS AND METHOD: A retrospective study was peformed for 9 years on 49 cases admitted from June 1994 to January 2003 for deep neck infection limited to the submandibular space. All patients were treated with intravenous antibiotics. The conservative group was treated with antibiotics only or combination therapy with needle aspiration. The surgical group was treated with intraoral or external drainage. Contrast enhanced computed tomography (CT) imaging was conducted for all cases and had confirmed that they all had an abscess in the submandibular space. RESULTS: The mean period of hospitalization was 7.6 days, with 35 patients treated with IV antibiotics only and 3 patients with aspiration in the conservative group. On the other hand, 3 patients were treated with intraoral drainage and 8 patients with external drainage in the surgical group. One patient required tracheotomy because of severe dyspnea. There was no complication observed in any cases. CONCLUSION: SSubmandibular abscess is an infection of deep neck space and is considered as the most common infection. Conservative treatment is a good therapeutic choice in cases with localized submandibular absess.
Abscess* ; Anti-Bacterial Agents ; Drainage ; Dyspnea ; Hand ; Hospitalization ; Humans ; Neck ; Needles ; Retrospective Studies ; Tracheotomy

PURPOSE: Laparoscopic surgery on the adrenal gland is a highly specific procedure that requires mastery of laparoscopic surgery. From January 2000 to October 2008, 66 laparoscopic adrenalectomies on 65 patients were performed by a single surgeon. This study was done to summarize our experience and to evaluate the safety and effectiveness of laparoscopic adrenalectomy. METHODS: A retrospective review of the patient records was carried out. The patients' demographics, the tumor characteristics, the open conversion rate, the operating time, the length of the hospital stay and other clinical outcomes were studied. RESULTS: There were 8 conversions out of 65 patients. The indications for surgery included functional tumors in 42 patients (19 pheochromocytomas in 18 patients, 14 patients of primary aldosteronism and 10 patients of Cushing syndrome), and 23 nonfunctional tumors. The average tumor size was 3.5 cm. The mean operating time was 163 min. The average length of the hospital stay was 4.1 days. Postoperative complications occurred in 8 patients with no perioperative mortality, and most of the complications could be considered as minor. During follow-up, two patients had adrenal insufficiency and port site hernia, and none had recurrence of hormonal excess. CONCLUSION: Laparoscopic adrenalectomy has several advantages such as minimal postoperative pain, few surgical complications, a short hospital stay and an early return to work. The results confirm that laparoscopic adrenalectomy is the procedure of choice for resection of various benign adrenal neoplasms.
Adrenal Gland Neoplasms ; Adrenal Glands ; Adrenal Insufficiency ; Adrenalectomy ; Demography ; Follow-Up Studies ; Hernia ; Humans ; Hyperaldosteronism ; Laparoscopy ; Length of Stay ; Pain, Postoperative ; Pheochromocytoma ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Return to Work

BACKGROUND AND OBJECTIVES: It is not easy to detect the small-sized vestibular schwannomas because they sometimes show atypical clinical presentation such as sudden deafness and detection by chance. However, it is very important to diagnose a vestibular schwannoma in the earlier stage to preserve facial nerve function and hearing. This study aimed to analyze clinical characteristics of small vestibular schwannomas and to make decision analysis of their diagnostic work-up. MATERIALS AND METHOD: we reviewed retrospectively 42 patients who were diagnosed with vestibular schwannoma of size less than 1.5cm at the Departments of Otolaryngology, Ajou University Hospital and Yonsei University Hospital from June, 1994 to May, 2002. This study analyzed chief complaints, size of tumor, audiological studies, caloric test, imaging study, and treatment modality. RESULT: Sixteen of 42 patients (38.1%) were in group IC , 20 patients (47.6%) for group 0 and 6 patients (14.3%) for group 1. One third of cases presented initial symptoms such as sudden hearing loss, the other third presented tinnitus, and 4 cases were detected by chance. Fourteen cases showed near normal hearing and auditory brainstem response (ABR) showed 76.2% sensitivity, which was relatively lower than we expected. CONCLUSION: Because acoustic neuroma was suspected in patients with unilateral hearing loss, tinnitus, and dizziness were very important considerations. We made the decision analysis in the diagnosis of small vestibular schwannoma. It consisted of earlier intervention of fast spin echo magnetic resonance imaging (MRI) based on a cost-effective approach.
Caloric Tests ; Decision Support Techniques ; Diagnosis ; Dizziness ; Evoked Potentials, Auditory, Brain Stem ; Facial Nerve ; Hearing ; Hearing Loss, Sudden ; Hearing Loss, Unilateral ; Humans ; Magnetic Resonance Imaging ; Neuroma, Acoustic* ; Otolaryngology ; Retrospective Studies ; Tinnitus

PURPOSE: Protein C deficiency is an autosomal recessive disorder, which predisposes the patient to potentially blinding and widespread lethal thromboembolic complications, especially in the homozygous type. We here report the first Korean case of ophthalmic involvement and its surgical treatment in homozygous protein C deficiency. METHODS: A 3.4kg, full term girl was born by normal delivery but showed bilateral leukocoria on day 2. Laboratory results disclosed a very low protein C activity level (10%) in the patient and moderately decreased levels in the other family members. Ophthalmic examination showed bilateral corneal opacity and shallow anterior chamber. B-scan ultrasonography which showed intravitreal mass lesions without microphthalmos and a funnel-shaped retinal detachment suggested bilateral retinal dysplasia. RESULTS: As the eyes were under progression of secondary glaucoma, bilateral lensectomies were performed at 2 months old and corneal opacity was regressed to some degree. However, at 14 months old, the left eye showed moderate corneal opacity with a band keratopathy. CONCLUSIONS: Although visual outcome was very poor after surgery, we could impede or slow down the progression of secondary glaucoma and save the eyeballs in the infant with homozygous protein C deficiency.
Anterior Chamber/ultrasonography ; Cataract/etiology ; Female ; Glaucoma/*etiology ; *Homozygote ; Humans ; Infant, Newborn ; Lens, Crystalline/surgery ; Protein C Deficiency/*complications/*genetics ; Retinal Diseases/*etiology

PURPOSE: Lymphomatoid papulosis (LyP) is one of the primary cutaneous CD30-positive lymphoproliferative disorders. LyP of the eyelid has rarely been reported. Herein, a case of typical LyP of the medial canthal area is reported. In addition, a literature review was performed. CASE SUMMARY: A 40-year-old female presented with a skin mass in the medial canthal area of the left eye that developed 2 months earlier. Initially, a focal skin lesion developed, and even with conservative treatment at a local clinic, progressed to a mass lesion having a central ulceration and adjacent edema. After 6 weeks, the adjacent edema had gradually decreased. On ophthalmic examination, the left medial canthal lesion was a 6 x 6 mm sized elevated mass with a central crater covered by crust. The clinical impression was keratoacanthoma. The lesion was widely excised and reconstructed by a full-thickness skin graft after an incisional biopsy. Histopathologic findings showed dermal infiltration of various inflammatory cells with atypical lymphocytes showing positivity to the CD30 antigen, and LyP was diagnosed. Systemic evaluation showed no evidence of systemic lymphoma and the patient has remained free of recurrence or systemic disease after a 1-year follow-up.
Antigens, CD30 ; Biopsy ; Edema ; Eye ; Eyelids ; Female ; Follow-Up Studies ; Humans ; Keratoacanthoma ; Lymphocytes ; Lymphoma ; Lymphomatoid Papulosis ; Lymphoproliferative Disorders ; Recurrence ; Skin ; Transplants ; Ulcer

Cervical necrotizing fasciitis (CNF) is a rare but well-known, rapidly fulminant polymicrobial infection of subcutaneous tissues. It is characterized by progressive destruction of fascia and adipose tissue, with sparing of the overlying skin and muscle in the initial stage. CNF may rapidly spread into the thorax along fascial planes, and the associated diagnostic delay makes this descending necrotizing mediastinitis, the most lethal form of mediastinitis, with a mortality of approximately 40 per cent. So aggressive multidisciplinary therapy with surgical drainage is mandatory. We present three cases of descending necrotizing mediastinitis with literature review.
Adipose Tissue ; Coinfection ; Drainage ; Fascia ; Fasciitis, Necrotizing ; Mediastinitis* ; Mortality ; Skin ; Subcutaneous Tissue ; Thorax

BACKGROUND AND OBJECTIVES: Parapharyngeal infections are rare but they cause life-threatening complications such as mediastinitis, rupture or aneurysm of the internal carotid artery, internal jugular vein thrombophlebitis. So, until now, the recommended treatment of parapharyngeal abscess is early open surgical drainage. The purpose of this study is to review the clinical course and outcome of treatment in parapharyngeal abscess according to method of treatment. MATERIALS AND METHOD: A retrospective study was peformed on 34 cases with parapharyngeal abscess in patients admitted for deep neck infection during a 8-year period from June 1994 to January 2003. All had contrast-enhanced computed tomography (CT) imaging and had confirmation of an abscess in parapharyngeal space. RESULTS: All patients were treated with intravenous antibiotics, 19 cases (conservative group) were treated with antibiotics only or needle aspiration, 15 cases (surgical group) were treated with intraoral or external drainage. The mean period of hospitalization was 8.2 days in conservative group and 11.6 days in surgical group. There was no complication except the mediastinitis in one case of conservative group. Five patients required tracheotomy because of severe dyspnea. CONCLUSION: Neck CT scan is useful diagnostic tool to detect and establish treatment plan of parapharyngeal abscess. Parapharyngeal abscess may, in some cases, respond to antibiotics, become localized to parapharyngeal space and treated conservatively with no need for early open surgical drainage.
Abscess* ; Aneurysm ; Anti-Bacterial Agents ; Carotid Artery, Internal ; Drainage ; Dyspnea ; Hospitalization ; Humans ; Jugular Veins ; Mediastinitis ; Neck ; Needles ; Retrospective Studies ; Rupture ; Thrombophlebitis ; Tomography, X-Ray Computed ; Tracheotomy

BACKGROUND AND OBJECTIVES: As indications for tracheotomy have evolved over the decades, the trends in the pediatric tracheotomy also have changed. The purpose of this study is to review the clinical courses and outcomes in the current pediatric tracheotomy. MATERIALS AND METHOD: A retrospective study was performed on 42 pediatric patients who underwent tracheotomies at Ajou University Hospital from June, 1994 to May, 2004. Charts were reviewed with respect to indications for tracheotomy, underlying diseases, success rate in decannulation and length of support time until decannulation, complication and mortality rate. RESULTS: There were 34 (81.0%) male patients and 8 (19.0%) female patients. Ventilatory support for neurological impairment (47.6%) was the leading indication for tracheotomy, followed by upper airway obstruction (19.0%), prolonged intubation due to respiratory failure (16.7%), cervical trauma (7.1%), craniofacial abnormalities (4.8%) and vocal cord palsy (4.8%). Convulsive disorder (19.0%) and congenital neurological malformation (14.3%) were the most common underlying diseases. Decannulation was accomplished in 70.0% of children with an average of 254.5 days with tracheotomy. The length of support time until decannulation was significantly greater in the neurological impairment group than in the other group. Complications occurred in 19.0% without tracheotomy-related death. CONCLUSION: Tracheotomy is relatively safe in the pediatric population as conservative therapy and its outcomes are thought to be usually related to the underlying disease and age.
Airway Obstruction ; Child ; Craniofacial Abnormalities ; Female ; Humans ; Intubation ; Male ; Mortality ; Respiratory Insufficiency ; Retrospective Studies ; Tracheotomy* ; Vocal Cord Paralysis

BACKGROUND AND OBJECTIVES: Burning mouth syndrome (BMS) is characterized by a burning sensation in the tongue or other oral sites, usually in the absence of clinical and laboratory abnormal findings. BMS is not an uncommon disease that ENT doctors can encounter in the OPD clinics. However, the causes, pathophysiology, and treatment of BMS are not known yet, and there are just a few reported articles. The aim of this study was to analyze the characteristics of BMS and to evaluate the effects of steroid gargle treatments. SUBJECTS AND METHOD: We reviewed 18 patients with BMS who visited the Department of Otolaryngology, Ajou University Hospital. The patients were analyzed according to the sites, duration of their burning sensations and associated symptoms. Furthermore, the interview included inquiries regarding current diseases, on-going medications, smoking history and psychological factors. The change of symptoms after steroid gargle treatment with/without other drugs was carefully analyzed. RESULTS: The average age of patients with BMS was 56.4 years old, and the male to female ratio was 8:10. The most frequently involved site was tongue (94.4%), followed by lower lip, gingiva, palate, and floor of mouth. We found that the causes of BMS were psychogenic factors for 4 patients, and diabetes mellitus and hypertension for 2 patients each. Approximately 80.0% (8/10 patients) of the women was menopausal. Six (50.0%) of 12 patients treated only with steroid gargle and 3 (75.5%) of 4 patients treated with steroid gargle and other medications showed relieved symptoms. CONCLUSION: Burning mouth syndrome is not an uncommon disease in the ENT field, and has complex etiology. Although the definitive treatment for BMS is not known yet, we think that steroid gargle may be helpful in the treatment of BMS.
Burning Mouth Syndrome* ; Burns* ; Diabetes Mellitus ; Female ; Gingiva ; Humans ; Hypertension ; Lip ; Male ; Mouth Floor ; Otolaryngology ; Palate ; Psychology ; Sensation ; Smoke ; Smoking ; Steroids ; Tongue

BACKGROUND AND OBJECTIVES: Cervical necrotizing fasciitis (CNF) is a rare but potentially life-threatening soft tissue infection primarily affecting the superficial fascial planes. The purpose of this study was to report various causes, courses of the disease, and outcomes of treatment. SUBJECTS AND METHOD: A retrospective chart review of 12 cases treated between January 2000 and January 2004 was done. All of them were studied with CT scan and treated with intravenous antibiotics. We discussed histories, diagnostic points and treatment of each cases, and analyzed them. RESULTS: There were 9 male and 3 female patients. The age distribution was from 17 to 81 years. Three patients had diabetes mellitus, one patient was a heavy alcoholics, and one patient had Buerger's disease. Two patients were expired due to lung abscess and sepsis, but others were discharged with no complication. Wide debridement was performed in all cases. Wound reconstruction was done in two patients. CONCLUSION: Treatment consists of early diagnosis, aggressive surgical debridement and drainage of the involved necrotic fascia and tissue along with broadspectrum intravenous antibiotics coverage.
Age Distribution ; Alcoholics ; Anti-Bacterial Agents ; Debridement ; Diabetes Mellitus ; Drainage ; Early Diagnosis ; Fascia ; Fasciitis, Necrotizing* ; Female ; Humans ; Lung Abscess ; Male ; Retrospective Studies ; Sepsis ; Soft Tissue Infections ; Thromboangiitis Obliterans ; Tomography, X-Ray Computed ; Wounds and Injuries