• Journal of Yeungnam Medical Science
• /
• 제24권1호
• /
• pp.79-84
• /
• 2007

Sphenoid sinus aspergillosis is notorious for its serious complications, such as permanent cranial nerve deficits and possible death. The most common associated symptoms are headache, followed by visual changes, and cranial nerve palsies. Because of an insidious onset, frequently resulting in missed and delayed diagnosis, sphenoid sinus aspergillosis is a potentially lethal medical condition. We report a case of visual loss secondary to isolated sphenoid sinus aspergillosis. A 69-year-old man presented to our hospital with the complaint of headache. The headache started one year previously and was described as severe dull pain localized bilaterally to the temporo-orbital region. The patient took daily NSAIDs for the pain. The neurological examination was normal. The MRI of the brain showed a left sphenoid sinusitis. A transnasal endoscopic superior meatal sphenoidotomy was performed. Aspergillosis was confirmed after a surgical biopsy was obtained. The patient was discharged from hospital without antifungal therapy. One month later, the patient complained of headache and loss of vision bilaterally. The orbital MRI showed a left cavernous sinus and bilateral optic nerve invasion. The loss of visions was permanent. In our case, the diagnosis was delayed; antifungal agents were not administered after surgery and the patient lost his vision as a result. Therefore, early diagnosis and proper treatment are important. Although the treatment of an invasive type of aspergillus has not been established, surgical removal of a nidus and aggressive antifungal therapy are recommended.

• 대한두개안면성형외과학회지
• /
• 제10권1호
• /
• pp.7-13
• /
• 2009

Purpose: Endoscopic transnasal correction of the medial orbital fractures cannot be enable to confirm the reduction degree of orbital volume without imaging modalities. We have intended through this study to make a quantative analysis of preoperative orbital volume increment and the reduction degree of that after ethmoidal sinus packing by using CT scan. Methods: In this retrospective study, 22 patients were selected to evaluate the postoperative volume reduction, who took 2 CT scans which are pre- and postoperative under the same protocol. The postoperative CT scan was carried out in about 5 days after the operation with the packing inserted into ethmoidal sinus. The length of bony defect on each section was measured by PACS program and the area of defect was calculated by summing lengths on each section multiplied by the thickness of the section. When the outline of orbit on the slice is drawn manually with a cursor, PACS program measures the area automatically. Orbital volume was calculated from the sum of the area multiplied by the section thickness. Results: The mean dimension of fractured walls was $2.86{\pm}0.99cm^2$. The mean orbital volume of the unaffected orbits was $22.89{\pm}2.15cm^3$ and that of the affected orbits was $25.62{\pm}2.82cm^3$. The mean orbital volume increment of the affected orbits was $2.73{\pm}1.13cm^3$. After surgery, the mean orbital volume of the unaffected orbits was $22.46{\pm}2.73cm^3$ and the mean orbital volume decrease on the surgical side was $2.98{\pm}1.07cm^3$. The estimated correction rate was 118.30%. Conclusion: The orbital volume increment in fractured orbit showed linear correlation with the dimension of fractured area. The orbital volume changes after ethmoidal sinus packing also showed linear correlation with orbital volume increment in fractured orbit. This study showed the regressive linear correlation between the increment of orbital volume and the correction rate. To evaluate the maintenance of reduction state, we think that the further study should be done for comparative analysis of orbital volume change after removal of packing.

• 대한두개안면성형외과학회지
• /
• 제9권1호
• /
• pp.1-7
• /
• 2008

Osteomas are most often located in the femur, tibia, humerus, spine, and talus. They are rare in the skull. Osteomas in the head and neck regions are benign bone neoplasms usually found in the frontoethmoid area. The developmental theory postulates that osteomas develop at the sites of fusion of tissues different embryological origin such as occur at the junction of the embryonic cartilaginous frontal and ethmoid bones. Trauma and infection have also been implicated as causative factors, but many patients with osteoma deny any preceding history of these. Osteomas are usually produce symptoms primary to cosmetic problems and secondary to pressure on adjacent structures. The objects of this study are from a 5-year period of April of 2002 to April of 2007, consisting of 48 male patients and 52 female. There were 33 cases of frontal bone osteomas, 5 cases of madibular bone osteomas, 5 cases of occipital bone osteomas, 6 cases of symptomatic paranasal sinus osteomas, 48 cases of asymptomatic paranasal sinus osteomas, and 3 cases of mastoid osteomas. We reviewed medical records of patients to find out their presentations, diagnostic considerations, therapeutic options, and outcomes. Patients were followed up six months postoperatively on the average. The authors experienced 48 cases of osteoma in the head and neck lesion, which were removed via direct approach or endoscopic approach. The 100 cases who came to the hospital with or without symptoms after diagnosis healed completely without sequelae. During the follow-up periods, excellent functional and cosmetic results were observed with an inconspicuous scar. There was no specific complications related to this procedure. Results of surgery in most cases were satisfied. We discussed the surgical procedure and the characteristics of the osteomas, and we report several cases with the review of literatures.

• Imaging Science in Dentistry
• /
• 제52권2호
• /
• pp.225-230
• /
• 2022

Purpose: This report presents the first known use of a rigid endoscope with augmented reality technology for the removal of an odontogenic cyst that penetrated the maxillary sinus and illustrates its practical use in a patient. Materials and Methods: In the preoperative period, cone-beam computed tomography was performed in a specially designed marker holder frame, and the contours of the cyst and the nearest anatomical formations were segmented in the 3D Slicer program. During the operation, a marker was installed on the patient's head, as well as on the tip of the endoscope, which made it possible to visualize the mass and the movement of the endoscope. The surgical intervention was performed with the support of augmented reality in HoloLens glasses (Microsoft Corporation, Redmond, WA, USA). Results: The use of this technology improved the accuracy of surgical manipulations, reduced operational risks, and shortened the time of surgery and the rehabilitation period. Conclusion: With the help of modern technologies, a navigation system was created that helped to track the position of the endoscope in mixed reality in real time, as well as to fully visualize anatomical formations.

• Journal of Korean Neurosurgical Society
• /
• 제65권1호
• /
• pp.114-122
• /
• 2022

Objective : Early descent of the diaphragm sellae (DS) during endoscopic endonasal transsphenoidal surgery (EETS) for pituitary macroadenoma surgery is occasionally a troublesome event by blocking the surgical field. Here we introduce an alternative technique with the new pituitary retractor and present our clinical experiences. Methods : We designed a simple and rigid pituitary retractor with the least space occupation in the nasal cavity to be compatible in EETS. The pituitary retractor was held by external holder system to support the herniated DS stably. We retrospectively reviewed a clinical 22 cases of pituitary macroadenomas underwent EETS using the pituitary retractor. Results : The pituitary retractor stably pushed up the herniated DS in all cases, and the surgeon proceeded the procedure with bimanual maneuver. The pituitary retractor was helpful to remove tumors around the medial cavernous sinus and behind the DS in 16 and seven cases, respectively. In four cases, the meticulous hemostasis was completed with the direct visualization by the DS elevation with this retractor. Gross total tumor resection was performed in 20/22 patients (91%). The impaired visual function and hypopituitarism were improved in 18/20 (90%) and 7/14 (50%) patients after surgery, respectively. There was no complication related with the pituitary retractor. Conclusion : During EETS for pituitary macroadenomas, the novel pituitary retractor reported in this study is a very useful technique when the herniated DS block the surgical field and bimanual maneuver. This pituitary retractor can help to result in the excellent surgical outcomes with minimal morbidity.

• Archives of Plastic Surgery
• /
• 제37권1호
• /
• pp.99-103
• /
• 2010

Purpose: Blow-out fractures are reduced through transcutaneous or transconjunctival incisions. But the field of orbital surgery is difficult due to lack of visualization of fracture site, blind dissection of orbital floor, susceptibility of injury of orbital structures. In these situations, the former technique of using an antral balloon catheter has advantages over other methods for reconstruction because of its rapidity, simplicity, and inexpensiveness. Furthermore, the antral balloon catheter allows not only elevation of the orbital bone fragment but also expansion of the maxillary sinus in cases where there is a fracture of its walls. But postoperative follow-up method using computed tomography is expensive. Hence, we report a simple and inexpensive follow-up method using radiopaque dye inflation. Methods: We performed endoscopic transantral approach in 5 cases of blow-out fracture under general anesthesia. To accomplish this technique, a rigid 4 mm, 0 or 30 degree angled endoscopy was inserted into the maxillary sinus. Inflation of the catheter started gradually, with 10 to 15 mL of saline mixed radiopaque dye (saline: dye, 5 : 1) by syringe and while observing the elevation of the fracture site with endoscope until a proper contour was reached. For the maintain of the position of fractured site, 12 French urinary balloon foley catheter were used in fracture site for 7 - 10 days. Results: Postoperative assessment was performed by means of clinical and simple radiographic examination to secure the catheter under the inferior orbital wall and in the maxillary sinus. No specific complications occurred related to this procedure. Results of the surgery and follow-up in all cases were satisfactory. Conclusion: It may be a better alternative to the conventional follow-up method, with less cost and effectiveness of the catheter patency. The advantages of using the urinary balloon foley catheter with the radiopaque dye include the following : it is safe, efficacy, simple, and especially low cost. On drawback of this method is the discomfort to the patient caused by the catheter during the treatment.

• Archives of Plastic Surgery
• /
• 제50권1호
• /
• pp.54-58
• /
• 2023

Patients with Crouzon syndrome have increased risks of cerebrospinal fluid rhinorrhea and meningoencephalocele after LeFort III osteotomy. We report a rare case of meningoencephalocele following LeFort III midface advancement in a patient with Crouzon syndrome. Over 10 years since it was incidentally found during transnasal endoscopic orbital decompression, the untreated meningoencephalocele eventually led to intermittent clear nasal discharge, frontal headache, and seizure. Computed tomography and magnetic resonance imaging demonstrated meningoencephalocele in the left frontal-ethmoid-maxillary sinus through a focal defect of the anterior cranial base. Through bifrontal craniotomy, the meningoencephalocele was removed and the anterior cranial base was reconstructed with a pericranial flap and split calvarial bone graft. Secondary frontal advancement was concurrently performed to relieve suspicious increased intracranial pressure, limit visual deterioration, and improve the forehead shape. Surgeons should be aware that patients with Crouzon syndrome have the potential for an unrecognized dural injury during LeFort III osteotomy due to anatomical differences such as inferior displacement and thinning of the anterior cranial base.

• 치과방사선
• /
• 제29권2호
• /
• pp.477-491
• /
• 1999

Objectives : To evaluate the anatomic variations of the paranasal sinuses on computed tomographs. Materials and Methods : The author examined the CT images of the paranasal sinuses retrospectively in 500 patients who visited Chonbuk National University Hospital between January 1996 and December 1997. Results : The highest incidence of anatomic variation of the paranasal sinuses in bilateral structures was agger nasi cel1(73.2％), followed by concha bullosa(31.1％), Onodi cell(24.0％), Haller ce1109.8％), maxillary sinus septum(3.0％), paradoxical middle turbinate(2.5％), pneumatized uncinate process(2.0％), and bent uncinate process. The highest incidence of anatomic variation in midline structures was nasal septum deviation(53.2％), followed by nasal septum aerated(29.4％), bulla galli(24.7％) asymmetric intersphenoid septum(22.3％), and nasal septum spur(13.8％). The correlation between anatomic variation and paranasal sinusitis was not found. Conclusions : The results of this study will aid in the diagnosis and treatment of paranasal sinus diseases, especially in the treatment planning before functional endoscopic surgery.

• Radiation Oncology Journal
• /
• 제21권1호
• /
• pp.19-26
• /
• 2003

목적 : 상악동 편평세포암종 환자에서 방사선치료의 성적을 분석하여, 예후인자와 방사선치료의 역할을 알아보고자 하였다. 대상 및 방법 : 본 연구는 1982년 11월부터 1999년 10월까지 상악동암 중 조직학적으로 편평세포암종으로 진단 후 방사선치료를 시행한 55명을 대상으로 하였다. 임상병기별로 보면, III기가 44명, IV기가 11명이었다. 원발종양병기분류를 보면, 72가 1명, 73가 45명, 74가 9명이었으며, 림프절 전이는 13명에서 있었다. 수술은 12명은 조직검사만, 21명에서는 기능적 내시경 부비동수술을, 22명에서는 전상악동 절제술 또는 아상악동 절제술을 시행하였다. 방사선치료 단독으로 시행한 경우가 8명, 기능적 내시경 부비동수술 후 방사선치료를 시행한 군이 17명, 근치적수술 후 방사선치료를 시행한 경우가 22명, 수술 전 방사선치료를 시행한 경우가 4명, 동시항암방사선치료를 시행한 경우가 4명이었다. 전체환자의 평균 추적관찰기간은 25개월(2.8$\~$125개월)이었다. 결과 : 전체환자의 2년과 4년 국소제어율은 각각 49.0$\%$, 45.5$\%$였고, 2년과 4년 생존율은 각각 42.1$\%$, 33.3$\%$였다. 방사선치료 전의 수술적 절제 정도에 따라 보면 조직검사 군은 4년 국소제어율과 생존율이 각각 32.1$\%$, 21.4$\%$였고, 기능적 내시경 부비동 수술을 시행한 군은 각각 41.9$\%$ 31.7$\%$였고, 근치적 절제술을 시행한 환자군은 각각 56.8$\%$ ,38.5$\%$로 차이를 보였다(p<0.05). 전체환자 중 26명의 환자는 추적관찰 기간 중 무병상태를 보였고, 19명은 국소재발만을, 2명은 림프절 전이와 국소재발을 함께 보였고, 1명은 림프절전이를, 2명은 전신전이와 국소재발을 동시에, 5명은 전신전이를 보였다 결론 : 상악동 편평세포암종 환자에서 방사선치료시 국소제어율과 생존율의 향상을 위해서는 수술시 절제정도가 중요한 예후인자임을 확인하였고, 치료 실패의 부위가 국소인 경우가 높아 효과적인 국소치료방법에 대한 연구가 필요할 것을 보인다.

• Journal of Korean Neurosurgical Society
• /
• 제49권3호
• /
• pp.186-189
• /
• 2011

In recent years the immunocompromised population has increased rapidly to include people with acquired immune deficiency syndrome (AIDS), drug abusers, and transplant patients. Accordingly, the incidence of intracranial fungal infection has increased. Our institution experienced 2 cases of internal carotid artery (ICA) occlusion due to invasion of the cavernous sinus by an intracranial fungal infection. The first case was a 60-year-old man who presented with headache, eye pain, conjunctival injection, right-sided diplopia, and blurred vision. Infected tissues within the frontal and ethmoid sinuses were removed via bifrontal craniotomy and endoscopic sinus surgery through the Caldwell Luc approach. The second case was a 63-year-old woman who developed right-sided facial pain after a tooth extraction. The infection was not controlled despite continuous use of antifungal agents, resulting in death from sepsis. We believe that when intracranial fungal infection is suspected in a patient with orbital symptoms and a focal neurologic deficit, immediate angiographic investigation of possible ICA occlusion is warranted. Aggressive treatment with antifungal agents is the only way to improve prognosis.