두경부 재건에서 내측 비복동맥 유리피판의 유용성

서유주,한선아,강영,정영호,안순현,정우진 대한이비인후과학회 2021 대한이비인후과학회지 두경부외과학 Vol.64 No.3

Background and Objectives The ideal flap for head and neck reconstruction should be pliable,have sufficiently long pedicle and minimize donor defects. Anterolateral thigh free flap(ALTFF) and radial forearm free flap (RFFF) have been the workhorse flaps for head and neckreconstruction. However, ALTFF is too bulky and RFFF leaves a conspicuous scar on the donnersite. Medial sural artery perforator free flap (MSAPFF) is a possible alternative, which hasthe benefit of thin RFFF and low donor site morbidity of ALTFF. Here, we evaluated for thefirst time the usefulness of MSAPF for head and neck reconstruction in Korean patients. Subjects and Method We carried out a retrospective study of patients who underwent MSAPFFfor head and neck reconstruction from October 2018 to July 2019 by retrieving their data fromelectronic medical records. Patient characteristics, flap characteristics, surgical outcomes, andcomplications of donor sites were analyzed. Results Eight patients underwent MSAPFF reconstruction after head and neck surgery. Therecipient sites were the following: the floor of the mouth, palate, tongue, the base of the tongueand nasolabial fold. The average median flap size was 34.1 cm2 (range 17.5-50 cm2), length 7.1cm (5.0-10.0 cm), width 4.7 cm (range 3.5-5.0 cm), and pedicle length 9.2 cm (range 8-10 cm). There was one flap failure because of pedicle arterial insufficiency. All donor sites were closedprimarily without any complication. Conclusion Based on the findings of this study, MSAPFF may be a new workhorse flap becauseit has thin, pliable tissue with low donor-site morbidity for head and neck reconstruction.

40세 남자 환자에서 발생한 오노디세포 점액낭종 1예

조성동,강승헌,서유주,김현직 대한이비인후과학회 2020 대한이비인후과학회지 두경부외과학 Vol.63 No.8

Sphenoethmoidal (Onodi) cells originate from the ethmoid sinus and are located at the posteriorand lateral direction. The obstruction of the sinus ostium leads to the accumulation ofmucous fluid and eventually leads to the formation of a mucocele. Onodi cell mucoceles cancause visual loss or disturbance due to the adjacency to the orbital apex. Here we report a caseof Onodi cell mucocele with a visual field disturbance, where the patient underwent an endoscopicsinus surgery 12 days after the initial symptom. After 21 days of onset, the subjectivesymptom started to subside. For Onodi cell mucocele patients with visual disturbance, we recommendrapid diagnosis with computed tomography and early marsupialization of the mucocele.

Revisiting the Clinical Scoring System for the Prognosis of Chronic Rhinosinusitis with Nasal Polyps

김진엽,한영은,서유주,최고운,김민경,허진,조득태,양승구,강승훈,김대우 연세대학교의과대학 2019 Yonsei medical journal Vol.60 No.6

Purpose: To evaluate the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) classification,a clinical scoring system, for predicting disease control status in chronic rhinosinusitis with nasal polyps (CRSwNP) and toinvestigate prognostic factors. Materials and Methods: In total, 134 CRSwNP patients who underwent functional endoscopic sinus surgery after maximal medicaltreatment were enrolled. These patients were categorized into four groups according to JESREC classification: 1) non-eosinophilicCRSwNP (non-ECRSwNP), 2) mild eosinophilic CRSwNP (ECRSwNP), 3) moderate ECRSwNP, and 4) severe ECRSwNP. Disease control status among the patients was evaluated at 1 year after surgery, and the patients were divided into two groups(disease-controlled and disease-uncontrolled groups) for the investigation of prognostic factors. Results: There was no significant difference in disease control status between non-ECRSwNP and ECRSwNP groups (p=0.970). Age, Lund-Mackay CT scores, global osteitis scores, tissue neutrophil count, and tissue eosinophil count were associated with diseasecontrol status. In subgroup analysis of the non-ECRSwNP group, only high tissue neutrophil count was related with diseasecontrol status, whereas for the ECRSwNP group, young age, high Lund-Mackay CT scores, high global osteitis scores, and high tissueand blood eosinophil counts were associated with disease control status. Conclusion: No difference in disease control status was identified between non-ECRSwNP and ECRSwNP cases. Tissue neutrophilia,however, appeared to be associated with disease control status in non-ECRSwNP cases, whereas tissue and blood eosinophiliawas associated with ECRSwNP cases.

Can Endoscopic Tympanoplasty Be a Good Alternative to Microscopic Tympanoplasty? A Systematic Review and Meta-Analysis

이상연,이도영,서유주,김영호 대한이비인후과학회 2019 Clinical and Experimental Otorhinolaryngology Vol.12 No.2

Although efficacies and proportions of tympanoplasty performed via endoscopic ear surgery (EES) have gradually introduced, it remains unclear whether total EES is a good alternative to microscopic ear surgery (MES). Herein, we aimed to compare therapeutic effects of EES and MES in patients receiving tympanoplasty or myringoplasty. A search of MEDLINE, PubMed, and Embase databases was conducted to compare the efficacies of EES and MES. Two investigators independently reviewed all studies and extracted data with a standardized form. We assessed risk of bias and calculated pooled odds ratio (OR) estimates with a 95% confidence interval (CI). Thirteen studies (607 EES patients and 678 MES patients) met inclusion criteria for quantitative meta-analysis. In pooled analysis, those who undergo EES have 0.99 times the OR of graft success compared to those with MES (95% CI, 0.84 to 1.16; P=0.894). In qualitative analysis, comparable hearing improvement was observed between the two groups, despite inconsistent audiometric evaluation. The air-bone gaps (ABGs) improved 2.02 dB less in EES than in MES (mean difference of improvements of ABGs, 2.02; 95% CI, –3.84 to –0.20; P=0.029); however, substantial heterogeneity and publication bias limited the integrity of this analysis. Further, EES significantly decreased canalplasty rate, wound complications, and operation time, compared to MES. Moreover, patients receiving EES reported higher cosmetic satisfaction than patients receiving MES. EES can be a good alternative to MES in terms of comparable graft success rate and hearing outcomes in patients receiving tympanoplasty or myringoplasty. Moreover, EES was less invasive, resulting in higher cosmetic satisfaction, reduced morbidity, and shorter operation time. Our results may affect decision-making and outcome prediction in cases of EES; however, confirmation is needed to clarify potential bias.

Neurocognition of Aged Patients With Chronic Tinnitus: Focus on Mild Cognitive Impairment

이상연,이준영,한상윤,서유주,심예지,김영호 대한이비인후과학회 2020 Clinical and Experimental Otorhinolaryngology Vol.13 No.1

Objectives. To investigate the neurocognition of aged patients with chronic tinnitus and reveal the possible association between tinnitus severity and cognitive function, with attention to mild cognitive impairment (MCI). Methods. Fifty-eight elderly patients (≥65 years old) with chronic tinnitus (≥6 months) were prospectively enrolled in this study. All patients assessed the neurocognitive batteries including the Korean version of the patient health questionnaire-9 (K-PHQ-9), the Lawton instrumental activities of daily living scale (K-IADL), and the Montreal cognitive assessment (MoCA-K). After initial evaluation to exclude moderate or severe cognitive impairment by a psychiatrist, the patients were classified into two groups: MCI and non-MCI, according to the MoCA-K scores (cutoff value, 22/23). All patients underwent audiological examinations including psychoacoustic tests of tinnitus. Results. Of 58 patients, 10 (17.2%) met the MCI criteria. The tinnitus handicap inventory (THI) score in the MCI group was significantly higher than that in the non-MCI group. Based on multivariate regression analysis, a significant association between tinnitus severity and MoCA-K score was also detected. Specifically, bothersome tinnitus (THI score ≥30) was closely linked to the presence of MCI. Meanwhile, the impact of MCI on both K-PHQ-9 and K-IADL scores was not evident in patients with chronic tinnitus. Conclusion. Tinnitus severity appears to be a potential independent determinant for predicting the MCI, suggesting the underlying mechanism between chronic tinnitus and cognitive deficit. Given that MCI highly links to dementia, the evaluation of cognitive functions in aged patients with chronic tinnitus need to be considered at the initial assessment of tinnitus.