Endoscopic Endonasal Marsupialization of Extensive Nasopalatine Duct Cysts Protruding into the Nasal Cavity

홍상덕,김준호,최지은,정승규 대한비과학회 2014 Journal of rhinology Vol.21 No.1

Nasopalatine duct cysts (NPDCs) are considered the most common non odontogenic cysts of the maxilla. Although the recommended treatment is complete removal of the lesion, complications, such as hematomaor fistula, can occur, especially in extensive cases. The aim of the present paper was to introduce transnasal endoscopic marsupialization as an efficient and useful treatment for NPDC. Materials and Methods : A retrospectivereview of 5 patients with extensive NPDCs (>2 cm) protruding into their nasal cavities was performed. All patients underwent endoscopic endonasal marsupialization. In order to survey the long-term, subjective outcomes,telephone interviews were conducted. Results : The mean age of the included patients with NPDC was 32 years and all were male. Most of the patients had facial pain (100%) and nasal obstruction (80%), and somepatientscomplained of palate swelling (60%). There were no perioperative complications. The mean OPD follow-up duration was 3.7 months and a telephone survey was conducted with 4 patients at a mean of 27.5 postoperative months. Patients complained of some crust formation in the nasal cavity, but no cyst relapse or other significant complications were reported. Conclusions : A large NPDC protruding into the nasal cavity can be easily and efficientlymanaged with endoscopic endonasal marsupialization as a substitute for complete enucleation.

중이염의 재수술:특징 및 결과의 분석

홍상덕,조양선,이현석,홍성화,정원호,복권효,박신홍 대한이비인후과학회 2007 대한이비인후과학회지 두경부외과학 Vol.50 No.7

Background and Objectives:The aim of our study is to analyze the characteristics and outcomes of revision surgery for chronic otitis media. Subjects and Method:December 31, 2004 (N= 208) were performed. The control group who underwent primary canal wal down mastoidectomy (CWDM, N= 51) was compared with the case group who underwent revision CWDM. Results:As a cause of revision ear sur-gery, recurent cholesteatoma comprised 38% of the cases, and granulation tisue in the unexenterated air cels were found to be 62%. Mastoid tip and perisinal air cels were most frequent sites of unexenterated air cells. CWDM was performed in 96.6% of a residual air-bone gap (ABG) of ≤30 dB. Complications after revision surgery were wound infection (3.8%) and temporary facial nerve palsy (1.9%). In the control group, disease control rate, postoperative ABG ≤30 dB, wound infection and facial nerve palsy were 90.2%, 90.5%, 5.9% and 0% of patients, respectively. Conclusion:Disease control rates and complications primary ones. Significance:This is a first report on revision ear surgery in Korean literature and a first report of revision surgery comparing with primary cases. (Korean J Otorhinolaryngol-Head Neck Surg 2007 ;50 :584-9)

Hematoxylin and Eosin Staining for Detecting Biofilms: Practical and Cost-Effective Methods for Predicting Worse Outcomes After Endoscopic Sinus Surgery

홍상덕,동헌종,정승규,김효열,박준오,하상윤 대한이비인후과학회 2014 Clinical and Experimental Otorhinolaryngology Vol.7 No.3

Objectives. Although biofilms have been implicated in poor prognosis after endoscopic sinus surgery (ESS), traditional methods detecting biofilm such as scanning electron microscope and confocal scanning laser microscope were rarely used in the practice. The aims of this study was to determine whether the presence or absence of a biofilm detected by hematoxylin and eosin (H&E) staining followed by light microscopy (LM) that is widely used in daily practice, predicts surgical outcomes after ESS. Methods. Retrospective analysis of prospectively collected data. Fifty-five consecutive adult patients (>18 years) who un- derwent ESS for chronic rhinosinusitis with a minimum of 12-months of follow-up were enrolled in this study. Ran- dom sinonasal mucosal samples were assessed for biofilm presence using H&E staining with LM. Three independent observers scored whether a biofilm was present or absent based on H&E staining/LM, and the interrater variability was calculated. Pre- and postoperative sinus symptoms and sinonasal mucosal grading were assessed. Results. Biofilms were present in 28 patients (51%), and the intraclass correlation coefficient according to H&E staining/ LM was 0.731. The presence of a biofilm was associated with a higher preoperative Lund-MacKay computed tomog- raphy score (22.3 for biofilm-positive patients vs. 18.6 for biofilm-negative patients; P=0.021) and persistent inflam- mation (mucosal edema and discharge) after ESS (P<0.05). Conclusions . The presence or absence of a biofilm based on H&E staining/LM is correlated with disease severity and surgi- cal outcomes after ESS. H&E staining/LM for detecting biofilm could be practical and cost-effective methods for pre- dicting prognosis of ESS.

노령초산부에 관한 임상통계학적 고찰

고상덕(ST Ko),문화숙(HS Moon),홍영재(YJ Hong),유병일(BI Yoo),박영동(YD Park) 대한산부인과학회 1976 Obstetrics & Gynecology Science Vol.19 No.3

1959년 2월부터 1974년 12월말까지 만 15년 10개월간에 연세대학교 의과대학 부속세브란스 병원 산부인과에 입원 분만한 노령초산부 149례와 1964년 1월부터 1967년 8월말까지 만 3년 8개월간에 제일 병원산부인과에 입원분만한 29례, 총 178례의 노령초산부를 조사대상으로 다음과 같은 결론을 얻었다. 1. 노령초산부는 총 분만수 23095례중 178예로서 그 빈도는 0.8%였다. 2. 노령초산부의 연령별 분포는 35세부터 46세까지 였으며 과반수 (51.7%) 가 35-36세 연령 에 속하였다. 3. 산전합병증은 고혈압성 병변이 23.0% 자연조기파수는 21.9%였다. 4. 태위는 두위가 163예(91.6%) 둔위가 15례(8.4%)로서 둔위 빈도가 높았다. 5. 분만방식은 질식분만이 112례(62.9%)이고 복식분만은 66례(37.1%)로서 제왕절개술의 빈도 가 현저히 높았다. 6. 제왕절개술의 적응증은 아두골반 불균형이 48.5%로 수위였고, 노령초산부, 태아절박증, 자궁근종, 둔위 및 shirodkar씨 수술후 상태의 순위였다. 7. 조산아는 14례로서 그 빈도가 7.9%였고 신생아 사망 2례, 사산 1예로서 주산기 사망률 은 16.9이었다. 8. 선천성 기형아는 단 1례도 없었다. 9. 과거력에 있어 자연유산의 빈도는 16.9%였다. 1. There were 178 cases among a total of 23095 deliveries, incidence of 0.8%. 2. Maternal age was distributed from 35 to 49 year. the majority (51.7%) were in age group of 35 and 36 year 3. Concerning the antepartal complications the incidence hypertensive disorder was 23.0% that is higher comparing with 9.7% in the youngest primiparas. the spontaneouse premature of membrane was seen in 21.9% of the case ; higher than 12.2% in the control group. 4. 16 cases (91.6%) were of vertex presentation and breech presentation was higher than that of total deliveries from severance Hospital (4.3%) 5. 112 cases (62.9%) deliveried vaginally and 66 cases (37.1%) abdominally. 6. Among the indication of cesarean section highest was CPD (48.5%) other indication were elderly primipara, fetal distress, myoma, breech presentation and post-Shirodkar operation status in order of frequency. 7. The perinatal mortality rate was 6.9. 8. No congenital malformation of infants was noted. 9. The incidence of spontaneous abortion was 16.9%.

두개저에 발생한 연골점액유사섬유종 1예

이창희,홍상덕 대한두개저학회 2022 대한두개저학회지 Vol.17 No.1

Chondromyxoid fibroma (CMF) is a rare benign cartilaginous tumor that usually arises from metaphysis of the long bone of the lower extremities. Only 1%-5% of CMF occurs in the head and neck and few cases of sinonasal CMF have been reported. Because sinonasal CMF and chondrosarcoma have common radiologic and pathologic feature, it is difficult to distinguish from chondrosarcoma. However fast and accurate diagnosis is important because mortality of chondrosarcoma is nearly 50%. This report describes one case of skullbase CMF attached to posterior septum and rostrum of sphenoid bone, mimicking chondrosarcoma in radiologic findings. We tried to share diagnostic and therapeutic process of skullbase CMF which occurred in unusual location, and elaborate differentiating points of cartilage neoplasms in the nasal cavity which have completely different prognosis.

Extrusion of Gutta-Percha into the Nasal Cavity Causing Maxillary Fungal Sinusitis: A Case Report

남명은,홍상덕,박준오,정승규 대한비과학회 2013 Journal of rhinology Vol.20 No.2

There have been few reports about extrusion of endodontic obturation materials into the maxillary sinus and inducing fungal sinusitis. Endodontic materials and fungus balls both are seen as high attenuation in a CT scan so may be overlooked. We report such a case in which the surgeon and radiologist had missed the foreign materials on preoperative CT scans, and recognized the filling defect on the alveolar bone and a foreign body in the nasal cavity postoperatively.

Endoscopic Debridement of Post-radiation Nasopharyngeal Necrosis: The Effects of Resurfacing With a Vascularized Flap

송복현,홍상덕,김효열,정용기,백정환,정만기 대한이비인후과학회 2022 Clinical and Experimental Otorhinolaryngology Vol.15 No.4

Objectives. Post-radiation nasopharyngeal necrosis (PRNN) is a serious complication that severely impacts the quality of life and survival of nasopharyngeal carcinoma patients. Endoscopic debridement is considered the first-line treatment for PRNN. This study aimed to analyze clinical outcomes, focusing on the mucosal resurfacing status and the effectiveness of salvage operations. Methods. Twenty-seven patients who underwent endoscopic debridement were retrospectively analyzed. The patients were divided into two groups according to the initial surgical modality: debridement with a nasoseptal flap (NSF; n=21) and debridement only (no NSF; n=6). Clinical features, postoperative mucosal status, internal carotid artery (ICA) rupture, survival, and final mucosal status were evaluated. The NSF group was categorized according to flap viability to analyze risk factors for flap failure. Results. Regardless of the initial modality, most patients experienced symptom improvement (96.0% for headache and 100% for foul odor); however, complete cranial nerve palsy did not improve in any patients. In the NSF group, complete healing was observed in 66.7%, while all patients in the no-NSF group underwent salvage surgery because none maintained complete healing. In the NSF group, 19.0% of patients required salvage surgery. After the last operation, favorable symptom improvement was noted (100% for headache and 90.0% for foul odor), and 77.8% had completely healed mucosa, whereas only 14.8% and 7.4% had partial healing and persistent necrotic mucosal status. The necrotic or uncovered NSF subgroup showed statistically non-significant tendencies for old age, advanced necrosis stage, advanced T stage, ICA involvement, high frequency and dose of radiation therapy, diabetes mellitus, and underlying comorbidities. Two ICA ruptures and three deaths occurred. Conclusion. Resurfacing the nasopharynx with NSF after endoscopic debridement showed better outcomes than debridement only for PRNN treatment. Despite initial NSF failure, additional resurfacing reconstructive surgery offers advantages in symptom mitigation, quality of life, and survival.

A Case of Isolated Complete Oculomotor Nerve Palsy Following Endoscopic Sinus Surgery

최나연,홍상덕,조현진,박경아 대한비과학회 2014 Journal of rhinology Vol.21 No.2

Orbital complications after endoscopic sinus surgery (ESS), such as optic nerve or medial rectus injuries, arewell known, but isolated complete oculomotor nerve palsy has never been reported. In this case, a 31-year-oldmale was transferred to our hospital after ESS. Physical examination showed complete left oculomotor nervepalsy, with a bony defect on the sellar floor, which had not fully recovered after more than 1 year. We hypoth-esized that blunt trauma could be the main cause of the oculomotor palsy. Surgeons performing ESS must keepin mind the possibility of oculomotor palsy due to blunt trauma, especially when operating around the sphenoidand posterior ethmoid sinus

이비인후과에서 내시경 수술의 적용

정종인,홍상덕 대한의사협회 2015 대한의사협회지 Vol.58 No.6

Endoscopic surgery has developed dramatically in the last few decades in otorhinolaryngology - head and neck surgery. Conventional sinus surgery with an external approach has been replaced by endoscopic sinus surgery, with endoscopic surgical techniques applied on structures of the sinus, including the nasal septum, orbit, and skull base. Endoscopic ear surgery was introduced with diagnostic methods initially, and has transformed surgical concepts in recent years. Endoscopic upper airway surgery was popularized in the 1970s, and its applications have been extended while minimizing morbidity. Endoscopic thyroidectomy is currently performed in some patients with large benign thyroid tumors or micropapillary carcinomas. The applications of endoscopic surgery will be extended to other parts of otorhinolaryngology - head and neck surgery in the near future.

재발성 비인두 방사선 괴사의 내시경 제거술 이후 안면부 절개 없이 시행한 유리 피판술 1례

강영지,홍상덕,정만기 대한비과학회 2021 Journal of rhinology Vol.28 No.2

High-dose radiation therapy is the treatment of choice for nasopharyngeal cancer, and clinical outcomes have improved in recent decades. A certain proportion of patients, however, suffer from post-radiation nasopharyngeal necrosis (PRNN). Patients with PRNN complain of headache, foul odor, or symptoms of cranial nerve palsies. Clinically, intracranial infection or bleeding from carotid artery damage may lead to sudden death or severe deterioration in quality of life. Although the prognosis of PRNN was poor, endoscopic debridement with local vascularized flap recently showed favorable outcomes, and many centers are using this technique with a nasoseptal flap. However, if the flap fails or does not fully cover necrotized tissues, necrosis inevitably reoccurs. In this situation, free flap transfer with a facial incision using a transmaxillary approach is used, but some drawbacks exist. In this report, we propose a new resurfacing technique for recurrent PRNN using a transoral-cervical free flap tunneling approach into the nasopharynx without a facial incision after endoscopic debridement.