Repair of Late Post-traumatic Enophthalmos / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Enophthalmos is a common sequelae of orbital fracture. Moreover, it is difficult to treat secondarily. We assessed the effect of filling up the orbital volume defect with implants on the correction of late posttraumatic enophthalmos. SUBJECTS AND METHOD: Based on patients' clinical data, we retrospectively reviewed 11 patients who had an operation because of late posttraumatic enophthalmos from July 2001 to December 2005. To correct late posttraumatic enophthalmos, porous polyethylene (Medpor(R)), Medpor(R) enophthalmos wedge implant, absorbable mesh, bone graft particulate, rib cartilage, auricle cartilage, and maxilla anterior wall were used. RESULTS: Among 11 patients, 6 patients were men and 5 patients were women. The average age was 33.2 years with the follow-up period of 21.8 months. Five patients had orbital floor fracture, 1 patients had medial orbital wall fracture, 4 patients had a combination of orbital floor and medial orbital wall fractures, and 3 patients had zygoma fracture. Excellent results were obtained in all 5 patients with diplopia. The amount of enophthalmos corrected was between 1 and 5 mm (mean 2.5 mm). There was no case of visual loss, infection, migration, or exposure of implant, but we carried out re-operation on 1 case due to over reduction. CONCLUSION: Filling up the volume defect with proper implants is a relatively simple, safe and efficient technique in correcting late posttraumatic enophthalmos.

Results and Complications of the Orbital Blowout Fractures Repair / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There has been a recent surge in the frequency of blowout fracture operations in the Department of Otorhinolaryngology. Clinical symptoms and signs, operative timing and the results from fracture site and size have been researched in this study. We conducted this study to examine the postoperative complications causing re-operation in orbital blowout fracture repair in the last seven years. SUBJECTS AND METHOD: Based on patients' clinical data, we retrospectively reviewed 160 patients who had operation because of blowout fracture from January 1998 to December 2004. Fifty-two patients had orbital floor, 74 patients had medial orbital wall, 34 patients had a combination of orbital floor and medial orbital wall fractures. We investigated diplopia, limitation of eye movements, and enophthalmos after the surgery, and analyzed the frequency and causes of re-operation. The mean postoperative follow-up was 24 months. RESULTS: We classified complications into immediate complications which occurred within 24 hours, late complications which occurred between 24 hours and 2 weeks, and delayed complications which occurred 2 weeks or more after operation. The symptoms of complications included diplopia, EOM limitation, cheek hypoesthesia, loss of vision, oroantral fistula, implant infection, ectropion, and etc. In case of sequelae which lasted more than six months, the combination of orbital floor and medial orbital wall fractures was higher than other fracture types. We carried out re-operation on 14 cases and the main cause was incomplete reduction. CONCLUSION: Surgeons should perform proper operation according to fracture site and type, and insert the implant after making an adequate dissection in order to reduce the frequency of complication and re-operation.

Expression of glucocorticoid receptor mRNAs in glucocorticoid-resistant nasal polyps

Glucocorticoids (GCs) are the most effective group of medications available to treat inflammation. Although most patients with inflammation respond to GC, a small group of patients exhibit persistent GC-resistance with prolonged inflammation. Previously, it was proposed that the GC-resistance is caused by low amount of human GC receptor (hGR alpha) and/or excessive presence of a GC receptor isoform, hGR beta that was generated from alternative splicing of the hGR message. We have tested this hypothesis by investigating correlation between the expression pattern of hGR mRNAs in patients with inflammatory nasal polyps and the effectiveness of GC treatment.? We have performed reverse transcription PCR analysis of mRNAs coding each hGR alpha and hGR beta in nasal tissues.? hGR alpha mRNA was more expressed in patients with nasal polyps than in normal subjects. However, the elevated hGR alpha mRNA expression was decreased after GC treatment. Compared with hGR alpha mRNA expression, level of hGR beta mRNA expression was very low in all groups. In patients, hGR beta mRNA was expressed at a similar level regardless of GC efficacy, indicating that there is no correlation between the GC sensitivity and the expression level of hGR beta mRNA. Thus, persistent GC-resistance is not associated with low expression of hGRa or over- expression of hGR beta.

A Case of Reduction of Frontal Sinus Anterior Wall Fracture Using Bioabsorbable Plate / 대한이비인후과학회지

Frontal sinus fractures are relatively uncommon maxillofacial injuries, making up only 5% to 12% of all facial fractures. Management of the fracture depends on the type and severity of the fracture and the presence of associated injuries. The use of a metalic plate as a reduction material for facial bone fracture has vastly grown; however, in infants, metal implants induce growth restriction of facial bone and the plate needs to be removed after approximately 3-6 months. Due to these weakness, the use of it as a bioabsorbable plate has thus taken over the large proportion of all its uses. A 15-year-old man was admitted to our hospital with a depression fracture of the frontal sinus anterior wall after trauma to the frontal area. Seven days after the trauma, the patient got open reduction. After exposing the fracture site with a butterfly incision, and placing the fractured bony fragments back in original place, the bioabsorbable plates were fixed on them. Postoperatively, depressed frontal area was restored normally. There is no evidence of complication after 28 months from the operation. We report a successful reduction of the frontal sinus anterior wall fracture using bioabsorbable plates.

Retrospective Study on 527 Patients with Maxillofacial Trauma: A 5-year Experience / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In modern society, maxillofacial trauma is correlated with an increase in population and traffic accident due to industrialization and urbanization. Many studies have examined maxillofacial trauma, although these studies have shown various results due to investigator's viewpoint and regional and cultural differences. Hence, we conducted this study to examine the current status of patients with maxillofacial trauma. SUBJECTS AND METHOD: Based on patients' clinical data, we retrospectively reviewed clinical characteristics, demographic information and radiographic findings of 527 patients (633 cases based on the fracture sites) with maxillofacial trauma who had visited our hospital between January 1998 and December 2002. We analyzed patients' sex, cause of trauma, and fracture sites. Furthermore, we analyzed the type of treatment for each fracture site. RESULTS: Patients with maxillofacial fracture showed a male predominance of 2.9: 1, and were prevalent in the 20's, 10's and 30's in the order of frequency. These patients showed an increasing tendency in their numbers on a yearly basis, and were the most prevalent in 2002 and on November according to year and month, respectively. The most common etiology was `violence (36.6%)'. Predilection sites were `nasal bone (52.1%)' and `orbit (21.5% [blowout fracture of the orbital wall])'. CONCLUSION: Patients with maxillofacial trauma showed an increasing tendency in their numbers on a yearly basis and frequently exhibited nasal bone fracture and blowout fracture of the medial orbital wall. Accordingly, these patients frequently consult otolaryngologits in comparison with the past. otolaryngologists will pay more attention to these patients.

Reduction of the Blowout Fracture of the Inferior Orbital Wall Using Elasticity of Silicon Tube / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: For the cases of the blowout fracture of the inferior orbital wall, reduction was performed frequently through transantral approach supporting herniated orbital tissue with silastic block, gauze or ureteral ballon catheter. But transantral approach has significant drawbacks such as instability, displacement of materials, and incomplete reduction. To overcome these shortcomings, we used an elastic silicon tube through transantral approach. In this paper, we compare the operative results between the group in which silastic blocks were used and the group in which silicon tubes were used. MATERIALS AND METHOD: We examined 19 patients whose maxillary sinuses were packed with silastic blocks or silicon tubes through only transantral approach. Among them, silastic blocks were used in nine cases ("block group") and silicon tubes in ten ("tube group"). Differences in preoperative and postoperative ocular symptoms, the percentage of revision operation, and occurrence of the infection of maxillary sinuses were compared between the two groups. RESULTS: In the block group, revision operations were carried out in three cases. Among those, one case was due to the undercorrection of fracture and two were due to the displacement of supporting material. In the tube group, one revision operation was necessary due to the overcorrection of fracture. Postoperative diplopia was observed in two cases among the block group and in one case among the tube group. One case with limitation in extraocular muscle movement was postoperatively detected among the block group. One case of infection of maxillary sinus was observed among the tube group. CONCLUSION: Reduction technique using silicone tube was easy and fast to perform by surgeons. We consider this reduction technique is a good surgical procedure instead of using silastic blocks.