BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the impact of open-mouth breathing on the upper airway anatomy of patients with sleep-disordered breathing (SDB) based on polysomnography. MATERIALS AND METHODS: A total of 114 subjects (101 males and 13 females) with a mean age of 42.7 years and a mean body mass index (kg/m2) of 26.2 were enrolled in this study. All subjects were divided into four groups (simple snoring, mild obstructive sleep apnea syndrome[OSAS], moderate OSAS and severeOSAS) according to the apnea-hypopnea index. Lateral cephalometric radiograms (retropalatal, retroglossal, and hypopharyngeal distance, and pharyngeal length) were taken with the mouth closed and open. RESULTS: The lateral cephalometric variables were compared between the mouth closed and open positions, and it was found that the retropalatal and retroglossal distances and pharyngeal length were significantly changed in all groups. However, the hypopharyngeal distance did not change significantly in any of the groups. CONCLUSION: Open-mouth breathing significantly reduces the retropalatal and retroglossal distance and lengthens the pharynx in patients with SDB. Since these anatomical changes may worsen SDB or decrease positive airway pressure treatment compliance, ENT doctors should attempt to convert SDB patients from open-mouth breathing to nasal breathing.
Body Mass Index ; Cephalometry ; Compliance ; Humans ; Male ; Mouth ; Mouth Breathing ; Pharynx ; Respiration ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Snoring

Rhinoplasty is one of the most popular surgical procedures in plastic surgeries. Good results depend not only on the surgical technique but also on individual preference and philosophy of the surgeons. This article reports on the survey of the attitude, preference, and philosophy of surgeons, and finally to elicit the evidence based consensus of current trends mainly dealing with the primary rhinoplasty. The Korean Society of Rhinoplasty Surgeons(KSRS) prepared a questionnaire composed of 20 questions asking about the primary esthetic rhinoplasty. A total of 77 out of 450 plastic surgeons attending the rhinoplasty symposium, 2009, Korea replied and the answerswere assessed. Twenty questions were about operation techniques, preference of alloplastic implant, autologous materials and trivia about the complications rates, etc. Many plastic surgeons preferred silicone to Gore-tex(R). In cases of autologous cartilage grafts, experienced plastic surgeons were more likely to use septal cartilage. But generally, ear cartilages were more frequently used when it is concomitantly used with alloplastic implants. Among silicone implants, boat-shape implant was preferred to L-shape regardless of their surgical experiences. Many Korean plastic surgeons prefer open rhinoplasty to closed rhinoplasty and routinely use boat shape silicone with auricular cartilage when they are doing simple primary rhinoplasty.
Cartilage ; Consensus ; Ear Cartilage ; Korea ; Philosophy ; Rhinoplasty ; Ships ; Silicones ; Transplants ; Surveys and Questionnaires

Intramuscular hemangioma, an infrequent but important cause of musculoskeletal pain, is often difficult to establish the diagnosis clinically. This report describes a case of a 32-yr-old woman who presented with severe left calf pain for 10 yr. Initial conservative treatments consisting of intramuscular electrical stimulation, herb medication, acupuncture, and intramuscular lidocaine injection under the diagnosis of myofascial pain syndrome in other facilities, failed to alleviate the symptoms. On physical examination, there was no motor weakness or sensory change. Conventional radiography of the leg revealed a soft tissue phlebolith. Conventional angiography study showed hemangioma. Intramuscular hemangioma within the soleus muscle was confirmed by magnetic resonance imaging. Following surgical excision of the hemangioma, the patient's symptom resolved completely. Intramuscular hemangioma is a rare cause of calf pain and should be considered in the differential diagnosis if a patient with muscle pain, particularly if associated with a soft tissue mass, fails to respond to conservative treatment.
Adult ; Diagnosis, Differential ; Female ; Hemangioma/*diagnosis ; Humans ; Magnetic Resonance Imaging/methods ; Muscle, Skeletal/anatomy & histology/pathology ; Muscular Diseases/*diagnosis ; Myofascial Pain Syndromes/*diagnosis ; Pain ; Radiography/methods ; Time Factors

PURPOSE: Complete release of the transverse carpal ligament(TCL) is accepted as the standard treatment for carpal tunnel syndrome(CTS). However, loss of grip and pinch power are reported in some patients after complete release of the TCL. This study was designed to evaluate the effectiveness of complete versus partial carpal tunnel release by using the inching technique. METHODS: Nineteen patients(a total of 27 hands) who each had a confirmed diagnosis of CTS were selected from September 2002 to February 2003. The cases were divided into three groups(mild, moderate and severe) based on preoperative electrodiagnostic studies. The patients with partial carpal tunnel syndrome were classified into the mild or moderate groups, while patients with complete carpal tunnel syndrome were classified into the moderate or severe groups. Patient oriented data (functional and symptomatic) were collected and electrophysiologic studies were undertaken preoperatively and postoperatively(on the 2nd week, 1st month, 3rd month and 6th month after surgery). RESULTS: In this study, the mild and moderate groups showed both good functional and symptomatic results and improvements in electrophysiologic studies. CONCLUSION: Carpal tunnel syndrome patients classified into mild or moderate groups based on nerve conduction studies, and whose precise compression sites were pinpointed using the inching technique, can be treated by partial carpal tunnel release.
Carpal Tunnel Syndrome* ; Diagnosis ; Follow-Up Studies* ; Hand Strength ; Humans ; Ligaments* ; Neural Conduction

BACKGROUND: The surgical repair of an isolated coarctation of the aorta, without complex cardiac anomalies, has improved, with very good results. However, despite the success of surgical repair, many long-term complications, such as hypertension, re-coarctation and an aortic aneurysm, still exist. MATERIAL AND METHOD: Between 1991 and 2006, 50 patients diagnosed with an isolated coarctation of the aorta were reviewed retrospectively. The incidence of re-coarctation and hypertension were compared with respect to age and surgical methods. RESULT: There were no early & late mortality, or post operative aortic aneurysms. Hypertension developed in 11 patients (22%). A greater number of patients in the child/adult group had hypertension (52.4%) than in the neonate/infant group (0%). With respect to the surgical methods, the patients in the graft interposition group suffered more hypertension (88.9%) than those in the EEEA (extended end to end anastomosis) group (5.3%). Post operative re-coarctation developed in 2 out of the 29 patients (6.9%) in the neonate/infant group and 2 out of the 21 patients (9.5%) in the child/adult group, but without any statistical difference. There were no statistical differences between the operative type-related groups. CONCLUSION: Even though the surgical outcomes have greatly improved, an isolated coarctation of the aorta still has many long-term problems, such as hypertension and re-coarctation. An isolated coarctation is accepted as a systemic vascular dysfunction, and often progresses to other cardiovascular diseases. Therefore, patients with a coarctation of the aorta have to be carefully followed-up, and aggressive management must be given when required.
Aortic Aneurysm ; Aortic Coarctation* ; Cardiovascular Diseases ; Humans ; Hypertension ; Incidence ; Mortality ; Retrospective Studies ; Transplants

OBJECTIVE: To evaluate the anatomic course of the lateral antebrachial cutaneous nerve (LABCN) and medial antebrachial cutaneous nerve (MABCN) in the forearm. METHOD: We dissected 29 upper extremities of 16 cadavers for LABCN and 20 upper extremities of 15 cadavers for the MABCN. We measured the distance (BT_L) between the biceps tendon (BT) and LABCN on the intercondylar line. The BT is the point at which biceps tendon crosses intercondylar line. The distance (L12) between LABCN and the point of 12 cm distal to BT on the line between BT and radial artery at wrist was measured. The distance (ME_M) between MABCN and medial epicondyle on the intercondylar line was measured. M8 and M10 are the distances between MABCN and the points 8 cm and 10 cm distal to BT on the line from BT to mid-point of flexor carpi radialis and palmaris longus at the wrist respectively. RESULTS: BT_L and L12 were 1.4+/-3.7 mm and 4.4+/-3.7 mm respectively. ME_M, M8 and M10 were 28.6+/-6.9 mm, 18.9+/-8.9 mm and 18.3+/-8.2 mm respectively. The thickness of LABCN and MABCN was 19.1+/-4.9 mm and 13.2+/-4.2 mm respectively. CONCLUSION: The LABCN was emerge just lateral to biceps tendon at the elbow and ran down to radial artery. The anatomic course of MABCN was variable at the elbow and forearm.
Cadaver ; Elbow ; Forearm ; Radial Artery ; Tendons ; Upper Extremity ; Wrist

OBJECTIVE: To evaluate the association between neuralgic pain distribution and the severity of carpal tunnel syndrome (CTS). METHOD: Pain drawings using computerized pain chart system were collected from 131 patients (213 hands) with CTS. The presence and severity of CTS were determined by means of median motor and sensory nerve conduction studies. The severity was divided into 3 classes on the basis of electrophysiological findings: mild (93 hands), moderate (70 hands) and severe (50 hands). The similarities between pain drawing patterns and median nerve dermatome in the hands were evaluated. The pain distributions of the palmar and dorsal sides of each five fingers, palm and dorsum of hand were also evaluated. RESULTS: There were no significant differences in similarity values of pain distribution among the groups of CTS hands divided by severity: similarity values were 0.22+/-0.14 in mild CTS patients, 0.24+/-0.16 in moderate CTS patients and 0.27+/-0.14 in severe CTS patients. In the CTS patients, the pain drawings showed relatively frequent distributions in the palmar side of 2nd to 4th fingers. CONCLUSION: There was no significant correlation between pain drawing patterns and severity of CTS. The pain drawings of patients with CTS indicate distribution to be most frequent in the palmar side of 2nd to 4th fingers.
Carpal Tunnel Syndrome* ; Fingers ; Hand ; Humans ; Median Nerve ; Neural Conduction

Recently, heart transplantation has been accepted as a standard treatment for infant and children with end-stage cardiomyopathy or complex congenital heart disease. Due to the shortage of donors, size-mismatched cardiac transplantation is common. After size-mismatched transplantation, there could be side-effects such as hypertension and hypertensive encephalopathy because of the big-heart. Donor heart is also known to do remodel as time goes by. This is a case report of a size-mismatched heart transplantation between 9-year-old boy and a 39-year-old female whose body weight is almost twice of him. In this case, classical postoperative hypertension and hypertensive encephalopathy developed but was successfully managed. The donor heart has remodeled to normal dimension during 3 years follow-up period.
Adult ; Body Weight ; Cardiomyopathies ; Child ; Female ; Follow-Up Studies ; Heart Defects, Congenital ; Heart Transplantation* ; Heart* ; Humans ; Hypertension ; Hypertensive Encephalopathy ; Infant ; Male ; Organ Size ; Tissue Donors ; Ventricular Remodeling*

OBJECTIVE: To identify the effectiveness of a weight loading device as a method for assessment of unilateral knee pain. METHOD: Twenty-five patients with unilateral knee pain and 25 pain-free controls participated in this study. Patients with a score of 2 or more on modified Kellgren-Lawrence scale based on the radiologic findings were diagnosed as degenerative arthritis. We constructed a device of segmental foot plates with strain gauge weight sensors to measure the weight load of each leg during self-selected walking speed. Using this device, we obtained the ratio of symptomatic side to asymptomatic side of weight load (RATIO) for each patient. The degree of pain according to visual analogue scale (VAS), abnormalities in radiologic findings, and weight load ratio were compared with each other. RESULTS: The RATIO was 1.00+/-0.03 in the control group, and 0.92+/-0.08 in the patient group (p<0.05). In the patient group, there was a significant correlation between RATIO and the VAS score (r=-0.44, p=0.03). In the patient group with degenerative arthritis, the RATIO (p=0.75) and VAS (p=0.94) were not different from those in patient group without degenerative arthritis. CONCLUSION: The foot plate weight loading device may be an effective tool for convenient measurements of knee pain.
Foot ; Humans ; Knee* ; Leg ; Osteoarthritis ; Walking

OBJECTIVE: To evaluate the influence of the length of the median nerve in the diagnosis of carpal tunnel syndrome (CTS). METHOD: Inching test of median sensory nerve using Ten Electrodes was performed in 114 hands of 68 CTS patients and 68 hands of 34 controls. The abnormal cut-off values of 1-cm, 2-cm, 3-cm, 4-cm, 5-cm, 6-cm, and 7-cm segment studies were calculated as the maximal conduction delay per centimeter (maximal CD/cm)+SD x 2 for each segment in controls. Based on such values, the sensitivity of each segment study in the CTS group and the specificity in controls were obtained. RESULTS: In controls, mean CD/cm was 0.20+/-0.08 ms, and maximal CD/cm was 0.26+/-0.08 ms in the segment between 2 and 3 cm distal to distal wrist crease. With the abnormal cut-off value set at 0.26 ms, the sensitivity of the 1-cm segment study was 98.5% in CTS. The sensitivities of the 2-cm through 7-cm segment studies were 93.9%, 93.9%, 92.4%, 92.4%, 92.4%, and 90.9%, respectively. CONCLUSION: These suggest that studies of longer nerve segments tend to lower the sensitivity of the test because the inclusion of the unaffected segments in calculation attenuates the effect of conduction delay at the site of the lesion.
Carpal Tunnel Syndrome* ; Diagnosis* ; Electrodes ; Hand ; Humans ; Median Nerve* ; Sensitivity and Specificity ; Wrist