PURPOSE: Cancer arising from the external auditory canal is a rare disease. A lesion that seems harmless in someway, can be lethal when inadequately excised, the tumor may infiltrate nerves, the parotid and auditory tissues before re-invading the skin. Wide resection of the lesion surrounding the structure and reconstruction with an adequate plan is crucial for the treatment of this disease. METHODS: Two patients with external auditory canal cancer were treated with muscle flaps and skin grafts. Lateral temporal bone resection (LTBR) was performed for complete resection of the cancer. The defect cavity was obliterated with highly vascularized tissue using pedicled sternocleidomastoid muscle, and temporalis muscle individually, combined with full thickness skin graft for covering the skin defect of the ear. RESULTS: Clear resection margin was obtained, and both patients showed disease free survival during the follow up. There was no complications of hematoma, infection, flap loss, or wound problem in both patients. Both patient received radiation therapy, there was no osteoradionecrosis or any other complication related to radiation therapy. CONCLUSION: Utilizing pedicled muscle flaps for managing defects after wide resection of the external auditory canal cancer is an effective method for managing this difficult disease.
Disease-Free Survival ; Ear Canal ; Follow-Up Studies ; Hematoma ; Humans ; Muscles ; Osteoradionecrosis ; Rare Diseases ; Skin ; Temporal Bone ; Transplants

OBJECTIVE: Impairment of spermatogenesis has been identified as an inevitable side effect of cancer treatment. Although estrogen treatment stimulates spermatogenic recovery from the impaired spermatogenesis by suppressing the intra-testicular testosterone (ITT) level, side effects of estrogen are still major impediments to its clinical application in humans. Soybeans are rich in genistein, which is a phytoestrogen that binds to estrogen receptors and has an estrogenic effect. We investigated the effects of genistein administration on ITT levels, testis weight, and recovery of spermatogenesis in rats treated with a chemotherapeutic agent, busulfan. METHODS: Busulfan was administered intraperitoneally to rats, and then a GnRH agonist was injected subcutaneously into the back, or genistein was administered orally. RESULTS: The weight of the testes was significantly reduced by the treatment with busulfan. The testis weight was partially restored after busulfan treatment by additional treatment with either the GnRH agonist or genistein. Busulfan also induced atrophy of a high percentage of the seminiferous tubules, but this percentage was decreased by additional treatment with either the GnRH agonist or genistein. Treatment with genistein was effective at suppressing and maintaining ITT levels comparable to that in the GnRH agonist group. CONCLUSION: Genistein effectively suppressed ITT levels and stimulated the recovery of spermatogenesis in rats treated with a chemotherapeutic drug. This suggests that genistein may be a substitute for estrogens, for helping humans to recover fertility after cancer therapy without the risk of side effects.
Animals ; Atrophy ; Busulfan ; Estrogens ; Fertility ; Genistein ; Gonadotropin-Releasing Hormone ; Humans ; Phytoestrogens ; Rats ; Receptors, Estrogen ; Seminiferous Tubules ; Soybeans ; Spermatogenesis ; Testis ; Testosterone

Background: This study evaluated the use of brainstem score (BSS) on pre-procedural diffusion-weighted imaging (DWI) to predict outcomes after mechanical thrombectomy (MT) in acute basilar artery occlusion (ABAO) patients and compared its predictive effectiveness to the critical area perfusion score (CAPS) on perfusion magnetic resonance imaging (MRI) using RAPID. Methods: This study focused on ABAO patients who underwent MT after MRI at Dong-A University Hospital from 2013 to 2023. Ischemic lesion volume and DWI BSS were measured for all. For the group that underwent perfusion MRI using RAPID, CAPS were measured. The primary end point was a poor outcome at 90 days (modified Rankin scale [mRS], >2). Results: 71 patients had ABAO and underwent MT after MRI. The poor outcome group (66.2%) had significantly larger ischemic lesion volume and higher DWI BSS compared with the good outcome group. In the multiple logistic regression analysis, DWI BSS (odds ratio, 8.27; 95% confidence interval, 1.93-35.50; p<0.01) was an independent predictor of poor outcomes. In 26 patients, CAPS was measured on perfusion MRI. In this subgroup, poor outcome group (50.0%) had higher DWI BSS and CAPS than the good outcome group. In the multiple logistic regression analysis, DWI BSS remained a valid independent predictor for predicting outcomes, but CAPS did not function as an independent predictor. Conclusion In this study, the DWI BSS before MT in ABAO patients emerged as a useful imaging marker for predicting post-procedural outcomes. Its predictive ability is not only comparable to but even superior to CAPS on perfusion MRI.

Background: This study evaluated the use of brainstem score (BSS) on pre-procedural diffusion-weighted imaging (DWI) to predict outcomes after mechanical thrombectomy (MT) in acute basilar artery occlusion (ABAO) patients and compared its predictive effectiveness to the critical area perfusion score (CAPS) on perfusion magnetic resonance imaging (MRI) using RAPID. Methods: This study focused on ABAO patients who underwent MT after MRI at Dong-A University Hospital from 2013 to 2023. Ischemic lesion volume and DWI BSS were measured for all. For the group that underwent perfusion MRI using RAPID, CAPS were measured. The primary end point was a poor outcome at 90 days (modified Rankin scale [mRS], >2). Results: 71 patients had ABAO and underwent MT after MRI. The poor outcome group (66.2%) had significantly larger ischemic lesion volume and higher DWI BSS compared with the good outcome group. In the multiple logistic regression analysis, DWI BSS (odds ratio, 8.27; 95% confidence interval, 1.93-35.50; p<0.01) was an independent predictor of poor outcomes. In 26 patients, CAPS was measured on perfusion MRI. In this subgroup, poor outcome group (50.0%) had higher DWI BSS and CAPS than the good outcome group. In the multiple logistic regression analysis, DWI BSS remained a valid independent predictor for predicting outcomes, but CAPS did not function as an independent predictor. Conclusion In this study, the DWI BSS before MT in ABAO patients emerged as a useful imaging marker for predicting post-procedural outcomes. Its predictive ability is not only comparable to but even superior to CAPS on perfusion MRI.

Background: This study evaluated the use of brainstem score (BSS) on pre-procedural diffusion-weighted imaging (DWI) to predict outcomes after mechanical thrombectomy (MT) in acute basilar artery occlusion (ABAO) patients and compared its predictive effectiveness to the critical area perfusion score (CAPS) on perfusion magnetic resonance imaging (MRI) using RAPID. Methods: This study focused on ABAO patients who underwent MT after MRI at Dong-A University Hospital from 2013 to 2023. Ischemic lesion volume and DWI BSS were measured for all. For the group that underwent perfusion MRI using RAPID, CAPS were measured. The primary end point was a poor outcome at 90 days (modified Rankin scale [mRS], >2). Results: 71 patients had ABAO and underwent MT after MRI. The poor outcome group (66.2%) had significantly larger ischemic lesion volume and higher DWI BSS compared with the good outcome group. In the multiple logistic regression analysis, DWI BSS (odds ratio, 8.27; 95% confidence interval, 1.93-35.50; p<0.01) was an independent predictor of poor outcomes. In 26 patients, CAPS was measured on perfusion MRI. In this subgroup, poor outcome group (50.0%) had higher DWI BSS and CAPS than the good outcome group. In the multiple logistic regression analysis, DWI BSS remained a valid independent predictor for predicting outcomes, but CAPS did not function as an independent predictor. Conclusion In this study, the DWI BSS before MT in ABAO patients emerged as a useful imaging marker for predicting post-procedural outcomes. Its predictive ability is not only comparable to but even superior to CAPS on perfusion MRI.

The depressor anguli oris (DAO) muscle is a thin, superficial muscle located below the corner of the mouth. It is the target for botulinum neurotoxin (BoNT) injection therapy, aimed at treating drooping mouth corners. Hyperactivity of the DAO muscle can lead to a sad, tired, or angry appearance in some patients. However, it is difficult to inject BoNT into the DAO muscle because its medial border overlaps with the depressor labii inferioris and its lateral border is adjacent to the risorius, zygomaticus major, and platysma muscles. Moreover, a lack of knowledge of the anatomy of the DAO muscle and the properties of BoNT can lead to side effects, such as asymmetrical smiles. Anatomical-based injection sites were provided for the DAO muscle, and the proper injection technique was reviewed. We proposed optimal injection sites based on the external anatomical landmarks of the face. The aim of these guidelines is to standardize the procedure and maximize the effects of BoNT injections while minimizing adverse events, all by reducing the dose unit and injection points.

The mentalis muscle is a paired muscle originating from the alveolar bone of the mandible. This muscle is the main target muscle for botulinum neurotoxin (BoNT) injection therapy, which aims to treat cobblestone chin caused by mentalis hyperactivity. However, a lack of knowledge on the anatomy of the mentalis muscle and the properties of BoNT can lead to side effects, such as mouth closure insufficiency and smile asymmetry due to ptosis of the lower lip after BoNT injection procedures. Therefore, we have reviewed the anatomical properties associated with BoNT injection into the mentalis muscle.An up-to-date understanding of the localization of the BoNT injection point according to mandibular anatomy leads to better injection localization into the mentalis muscle. Optimal injection sites have been provided for the mentalis muscle and a proper injection technique has been described. We have suggested optimal injection sites based on the external anatomical landmarks of the mandible. The aim of these guidelines is to maximize the effects of BoNT therapy by minimizing the deleterious effects, which can be very useful in clinical settings.

The aim of this study was to elucidate the intramuscular arborization of the teres minor muslce for effective botulinum neurotoxin injection. Twelve specimens from 6 adult Korean cadavers (3 males and 3 females, age ranging from 66 to 78 years) were used in the study. The reference line between the 2/3 point of the axillary border of the scapula (0/5), where the muscle originates ant the insertion point of the greater tubercle of the humerus (5/5). The most intramuscular neural distribution was located on 1/5–3/5 of the muscle. The tendinous portion was observed in the 3/5–5/5. The result suggests the botulinum neurotoxin should be delivered in the 1/5–3/5 area of the teres minor muscle.