편도아데노이드 절제술 중 전기수술기에 의한 화상

허성재,나경진,김정수 대한이비인후과학회 2016 대한이비인후과학회지 두경부외과학 Vol.59 No.12

Electrosurgical units are frequently employed during adenotonsillectomies to reduce both operation time and the amount of bleeding. Complications related to electrosurgical units have rarely been reported or taken into consideration by the majority of surgeons during operations. We report a case of an electrosurgical unit induced burn injury during an adenotonsillectomy. More specifically, the injury was a second-degree burn that occurred on the right oral commissure and the lip. The exact cause of the burn was not determined despite a close examination of the electrosurgical unit. An ointment was applied frequently to the lesion to prevent the wound from drying; the wound subsequently healed without any permanent scarring. Preventive methods, such as a thorough inspection of devices prior to surgery, the technique of using the third finger, and the use of a cheek retractor, may be necessary to avoid burn injuries caused by electrosurgical units. Korean J Otorhinolaryngol-Head Neck Surg 2016;59(12):873-6

국소마취로 시행된 부비동 내시경 수술과 비중격 교정술: 환자 불편감 비교 분석

허성재,김정수,박지혜,박창묵,조인지 대한비과학회 2013 Journal of rhinology Vol.20 No.1

Objectives : The goal of this study is to compare the degree of patient discomfort between endoscopic sinus surgery (ESS) and septoplasty under local anesthesia. Material and Methods : A total 95 patients that underwent ESS and septoplasty under local anesthesia between July 2009 and January 2010 were enrolled in this study. The patients estimated the parameters of their own discomfort (pain, position, noise, anxiety, and memory). The score of each of the parameters ranged from 0 to 4. We compared the scores of the parameters between the ESS and septoplasty groups. Results : Of the 95 patients, 61 (64%) received ESS, 32 (34%) received septoplasty, and 2 (2%) received both. The scores of all the parameters were not greater than moderate in both groups. There were no significantly statistical differences between the two groups. However, the ESS group had lower scores than the septoplasty group in the parameters of pain, position, noise, and memory. No remarkable complications occurred. Conclusion : The patients in this study had modest discomfort and no noticeable complications during the surgeries under local anesthesia. Although no statistical difference existed between the two groups, the ESS group experienced relatively lower discomfort levels during the surgery under local anesthesia compared to the septoplasty group.

국소마취와 전신마취로 시행된 비성형술의 환자 만족도과 합병증 비교

허성재,차은주,조현수,박지혜,이진걸,김정수 대한이비인후과학회 2018 대한이비인후과학회지 두경부외과학 Vol.61 No.5

Background and Objectives Since rhinoplasty techniques require meticulous and delicatemanipulation, proper anesthesia is essential. The aim of the current study is to comparepatient satisfaction and complication of rhinoplasty performed under local anesthesia againstgeneral anesthesia. Subjects and Method Patients who underwent rhinoplasty by a single surgeon betweenMarch 2014 and January 2017 were enrolled in this study. Midazolam was utilized to sedatethe patient during local anesthesia. Pain and memory of surgery under local anesthesia, satisfactionof anesthesia, and willingness to undergo the surgery with the same anesthesia methodagain were evaluated. Cardiopulmonary events, nausea, and vomiting were assessed as complications. Aesthetic satisfaction of patients and the doctor was evaluated 6 month after thesurgery. The parameters were compared between local and general anesthesia. Results A total 120 patients were included in this study. The degree of pain was low duringsurgery under local anesthesia. Although most of patients remembered the process of surgeryduring local anesthesia, satisfaction of local anesthesia was high. The satisfaction of anesthesiaand willingness to undergo surgery with same anesthesia were not signifcantly different betweenlocal and general anesthesia. No serious complications developed during local anesthesiaand there were no signifcant differences of aesthetic satisfaction between local and generalanesthesia. Conclusion Patient satisfaction and aesthetic results of rhinoplasty performed under localanesthesia were comparable to general anesthesia, indicating that surgeons do not need to beafraid of applying local anesthesia in rhinoplasty.

뇌척수액 비루의 내시경적 치료

허성재,김정수 대한비과학회 2014 Journal of rhinology Vol.21 No.1

Cerebrospinal fluid (CSF) rhinorrhea has become a relatively common disease due to increasingincidents oftrafficaccidents and endoscopic sinus surgeries, including skull base surgery. Improvements in surgical skills and endoscopicequipment have contributed to broadening the indicationsforendoscopic management ofCSF rhinorrhea. Precise identification of the etiology and leakage site is important for the treatment of CSF rhinorrhea. A variety of sealing techniques, such as overlay, underlay, and bath-plug, showed similar surgical outcomes. In addition, the type of graft material did not make a difference inthe surgical results. Therefore, thechoice of techniqueand graft material depends on the judgment of the surgeon. Endoscopic management of CSF rhinorrhea demonstrated anexcellent success rate and low morbidity. There were only few complications duringendoscopic management of CSF rhinorrhea and these were not serious. In conclusion, endoscopic management is effective for CSF rhinorrhea and should be initially considered for the treatment of CSF leakage.

후두 백반증의 임상적 양상 및 장기간 추적관찰 결과

허성재,조인지,안동빈,김재혁,박준식,손진호 대한이비인후과학회 2011 대한이비인후과학회지 두경부외과학 Vol.54 No.8

Background and Objectives Leukoplakia is a clinical term solely designating a white patch or a plaque of the mucosa without considering its histological feature. Leukoplakia ranges microscopically from a hyperplasia to an invasive squamous cell carcinoma. This study attempted to find out the clinical progress and characteristics of leukoplakia in the larynx. Subjects and Method Included in the study were 154 patients clinically diagnosed as leukoplakia from 1997 to 2010. We reviewed their medical records retrospectively for age, sex, smoking and drinking history, medical record, histopathologic finding, treatment method, and the follow-up records. Results Histopathologic findings of leukoplakia in the larynx showed hyperkeratosis (101 patients), invasive carcinoma (19 patients), dysplasia (14 patients), nodule (9 patients), papillomatosis (4 patients), chronic inflammation (4 patients) and tuberculosis (3 patients). Of the 128 patients, 39 patients who were diagnosed as hyperkeratosis, dysplasia, nodule or chronic inflammation in the larynx had recurrence and received re-biopsy over 2 times. Eight patients of these 39 who had recurrence had progression to invasive carcinoma. The mean interval between diagnosis of leukoplakia and invasive carcinoma was 53 months (ranged 7-114 month). Heavy smoking (more than 20 pack year) and drinking were significantly associated with recurrence or progression to invasive carcinoma. Age, gastroesophageal reflux disease and treatment method were not associated with recurrence. Conclusion Leukoplakia in the larynx led to various histopathologic diagnoses, high recurrence rate, and progressed to invasive carcinoma even after 5 years. Smoking and drinking should be managed and longterm follow-up is needed.

혼수 상태의 환자에서 발생한 병원 감염성 비강 구더기증 1예

허성재,이미진,박창묵,김정수 대한이비인후과학회 2013 대한이비인후과학회지 두경부외과학 Vol.56 No.10

A 82-year-old female was injured in a car accident and admitted to the emergency department in a comatose state. The patient was intubated and then transferred to the intensive care unit. After 2 days, live maggots were discovered from both nostrils. The maggots were treated by mechanical removal and irrigation with an antiseptic solution. After treatment of maggots, endoscopic examination revealed no remnant maggot and abnormal lesion in the nasal cavity. On the following day, maggots were retrieved from mouth in spite of a continuous appliance of an antiseptic solution into the nostrils. More careful concerns to nasal and oral hygiene were performed and no other maggots were found. We present the case of myiasis with a literature review of treatment methods of maggot.

골고정법을 이용한 후방 비중격 교정

허성재,차은주,박지혜,김학건,김정수 대한이비인후과학회 2018 대한이비인후과학회지 두경부외과학 Vol.61 No.3

Background and Objectives Various techniques have been reported for the correction ofdeviated nasal septum, most of them for caudal septal cartilage. For deviated posterior septalcartilage, the typical method of the day is the resection of deviated portion. However, we developeda bone anchoring technique that conservatively corrects deviated posterior septal cartilage. The aim of the current study is to determine the efficacy of this bone anchoring technique. Subjects and Method The patients who had undergone septoplasty using bone anchoringtechnique by a single surgeon (J.S.K) between October 2015 and June 2016 were enrolled inthis study. The result of the surgery was evaluated using a visual analogue scale (VAS, ranged0- 10) for nasal obstruction, acoustic rhinometry, and assessment of surgeon. Results A total of 44 patients were included in this study. The VAS of nasal obstruction wassignificantly decreased after surgery from 7.5±1.7 to 2.4±1.4. In acoustic rhinometry, minimalcross-sectional area and volume were increased after surgery from 0.35±0.18 to 0.52±1.40 cm2 and from 3.6±1.1 to 5.8±1.5 cm3, respectively. Most of the deviated septum was wellcorrected, and complication or recurrence did not developed. Conclusion Bone anchoring technique is easy to perform. It enables the preservation ofseptal cartilage, which is useful in revision septoplasty or rhinoplasty. We conclude that thistechnique is a good method for the correction of deviated posterior septal cartilage.

Vitamin D Levels and Their Relationship with Cardiac Biomarkers in Chronic Hemodialysis Patients

허성재,이종수,박종하,김동민,임경훈,윤선화,정현철 대한의학회 2009 Journal of Korean medical science Vol.24 No.-

Vitamin D insufficiency may be associated with cardiovascular (CV) mortality in HD patients. To test this hypothesis, we cross-sectionally measured 25-hydroxyvitamin D (25D), 1,25-dihydroxyvitamin D (1,25D), cardiac troponin T (cTnT), and N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) in chronic HD patients. Sixty-five patients (M:F=31:34, age 52.2±13.2 yr, DM 41.5%) were selected. Along with the expected low levels of 1,25D, 59 (90.8%) patients had 25D insufficiency (<30 ng/mL) among whom 15 (23.1%) were 25D deficient (<10 ng/mL). The 25D levels showed a negative correlation with cTnT levels (Spearman’s ρ=-0.44, p<0.01) but not with NT-pro-BNP levels (Spearman’s ρ=-0.17, p=0.17). The 1,25D levels, however, did not show any relationship with either cTnT or NT-pro-BNP. In multivariate analysis, being male and having low levels of 25D were independent risk factors associated with cTnT elevation (β=0.44, p<0.01 and β=-0.48, p<0.01, respectively). In conclusion, not only 1,25D but also 25D are commonly decreased in HD patients. Lower 25D levels appear to be associated with cTnT elevation, predicting worse CV outcome, and are possible to involve cardiac hypertrophy or coronary artery disease.

18년 뒤 재발한 비인두의 점액표피양암종 1예

허성재,차은주,김남균,정지윤 대한이비인후과학회 부산,울산,경남 지부회 2022 임상이비인후과 Vol.33 No.3

Mucoepidermoid carcinoma is a common cancer in the salivary glands, but very rarely in the nasopharynx. Since nasopharyngeal tumors often complain of only non-specific symptoms such as nasal obstruction or epistaxis, they are often discovered at an advanced stage, so proper diagnosis and treatment are important. We experienced a 68-year-old women who complained of nasal obstruction. She had a history of surgical removal of a low-grade mucoepidermoid carcinoma in the nasopharynx 18 years ago. On endoscopic examination, a mass was found in the same location of nasopharynx. It was confirmed that it had recurred as a high grade mucoepidermoid carcinoma, and was completely removed by an endoscopic approach. We report a case of recurred mucoepidermoid carcinoma of nasopharynx 18 years after surgery with a literature review.

구강 상악동 누공의 임상양상과 치료 분석

허성재,나경진,조현수,류진현,조현호,최진혁,강동훈,김정수 대한이비인후과학회 2016 대한이비인후과학회지 두경부외과학 Vol.59 No.8

Background and Objectives Oroantral fistula is an epithelialized communication between the oral cavity and the maxillary sinus. The aim of this study is to investigate the clinical characteristics and treatment of oroantral fistula. Subjects and Method Patients who have undergone treatment for oroantral fistula between May 1995 and December 2015 were enrolled in this study. The demographic data of these patients and characteristics of oroantral fistula were analyzed. Patients with oroantral fistula were initially administered oral antibiotics for 3 weeks. If fistula persists in spite of the medication, surgery (soft tissue flap with or without bone graft) was performed. The surgical results according to the presence of bone graft were compared. Results Twenty-two patients were in accordance with the inclusion criteria. The male to female ratio of patients was 12:10, with the mean age of 47.9±13.4 years. The main complaint of patients was pus discharge from the fistula. Two patients were successfully treated with antibiotics whereas 20 patients underwent surgery. Recurrence occurred in 3 patients, who were treated with soft tissue flap, but no recurrence developed in the patients treated with soft tissue flap and bone graft. Although dehiscence of soft tissue flap occurred in one patient treated with bone graft, it was successfully treated by secondary intention without an additional surgery. Conclusion Bone graft bears the negative pressure of the oral cavity and the weight of secretions including the blood. In addition, it induces secondary intention for the dehiscence of the flap. In this regard, bone graft seems to contribute to the surgical success of oroantral fistula. Korean J Otorhinolaryngol-Head Neck Surg 2016;59(8):593-8