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김지룡(Ji Ryong Kim),이예원(Ye Won Lee),김엘(El Kim),남성일(Sung Il Nam) 대한두개저학회 2017 대한두개저학회지 Vol.12 No.2
To completely remove the petrous bone cholesteatoma (PBC) have been a surgical challenge for many years because of tight adhesion or invasion of the matrix into surrounding vital structures such as the labyrinth, middle and posterior cranial fossa dura, internal carotid artery, facial nerve canal or jugular bulb. The main factors influencing the surgical approach to choose are the inaccessible nature of the petrous bone, the extent of disease, the degree of facial nerve function, and the need for the prevention of cerebrospinal fluid leaks and the recurrence of the lesion. We present the case of a 55- year-old male presenting with right-sided facial palsy PBC treated by transotic approach. Facial palsy in the operated ear improved after surgery. We conclude that transotic approach is a safe and effective approach to the supralabyrinthine PBC region.
비중격 피판 거상을 동반한 경접형동 접근법 시행 후 후각 기능의 단기 회복 양상
김지룡(Ji Ryong Kim),김엘(El Kim),정종인(Jong In Jeong) 대한두개저학회 2017 대한두개저학회지 Vol.12 No.2
Background: The cases of endoscopic skull base surgery applied in more aggressive lesions have increased recently, raising interests about nasoseptal flap (NSF) for reconstruction. However, transient or permanent olfactory dysfunction may occur after NSF elevation, it have great influence on the quality of life of the patient. The aim of this study was to identify proper intervention time by comparing the recovery patterns of olfactory function after NSF elevation with conventional trans-septal approach. Methods: All subject were administered self-reporting olfaction score (Visual Analogue Scale [VAS], 0-10) and the threshold, discrimination, and identification (TDI) score of Korean Version of Sniffin Stick Test II (KVSS II) preoperatively. The trans-sphenoidal approach (TSA) was performed with conventional trans-septal approach or NSF elevation. VAS and TDI were followed-up by 12weeks after surgery. Results: Fifteen patients who underwent TSA were enrolled. Baseline VAS and TDI score were 9.2 and 28.3 in TSA group, and 7.7 and 24.6 in NSF elevation group. VAS of trans-septal approach group was recovered to the preoperative level from 8weeks after surgery, whereas NSF elevation group was 12weeks. TDI scores of trans-septal approach group were 12.1, 25.4, and 24.8 at 4, 8, and 12 weeks after surgery, whereas NSF elevation group were 10.6, 19.7, and 22.1. Conclusions: After TSA with NSF elevation, olfactory function is more gradually recovered than conventional trans-septal approach, and the intervention about permanent olfactory dysfunction may need to be considered for the poorly-improved olfactory dysfunction until 8weeks after surgery.