A Relationship between the Obstructive Sleep Apnea Syndrome and the Erythrocyte Sedimentation Rate

Objectives

The erythrocyte sedimentation rate (ESR) is a marker for inflammation, and it has been identified as a risk factor for atherothrombotic cardiovascular disease. The aim of this study was to determine the relationship between the plasma ESR level and nocturnal oxygen desaturation or other polysomnographic variables and to examine the role of obesity in patients with obstructive sleep apnea syndrome (OSAS).

Methods

This retrospective study included 72 patients with a diagnosis of OSAS who underwent overnight polysomnography and routine blood tests between July and December of 2005. We compared the plasma ESR level with the sum of all the polysomnographic variables and divided the patient group into obese and non-obese patients.

Results

The mean ESR level was 8.45 mm/hr. There was a significant difference in the ESR level between genders (P<0.001). A significant correlation was found between the percentage of time spent at a SpO₂ below 90% and the ESR level in the obese group (BMI ≥25, N=43, P=0.012). In addition, the ESR levels had a positive correlation with age in the obese group (P=0.002). However, there was no significant correlation with the percentage of time spent at a SpO₂ below 90% in the whole group of patients and in the non-obese group (BMI <25, N=29). The ESR level showed no correlation with the other polysomnographic variables.

Conclusion

The duration of deoxygenation in obese patients with OSAS may be associated with the ESR level which is an independent predictor of cardiovascular disease.     

The Effect of Obstructive Sleep Apnea on DNA Damage and Oxidative Stress

Objectives

Obstructive sleep apnea syndrome (OSAS) is associated with repeated hypoxia and re-oxygenation. This characteristic of OSAS may cause oxidative stress and DNA damage. However, the link of OSAS with oxidative stress and DNA damage is still controversial. In the current study, we investigated whether OSAS causes DNA damage using alkaline single-cell gel electrophoresis (comet assay) and measuring oxidative stress by monitoring serum malondialdehyde (MDA) levels.

Methods

From March 2009 to August 2010, 51 patients who underwent polysomnography (PSG) during the night were enrolled in this study. We obtained serum from the patients at 6 AM. DNA damage and oxidative stress were evaluated using a comet assay and measuring serum MDA, respectively. We divided the patients into two groups according to the existence of comets appearing in the comet assay. Group 1 included 44 patients with negative assay results and group 2 consisted of seven patients with positive comet assay findings. We compared the age, gender proportion, PSG data (respiratory disturbance index [RDI], lowest O₂ saturation level, and arousal index [AI]), time of disease onset, smoking habits, and serum MDA levels between the two groups.

Results

The average age and gender proportion of the two groups were not statistically different (P>0.05). The average of RDI for group 1 was 30.4±18.4 and 8.0±7.7 (P<0.01) for group 2. The average of lowest O₂ saturation level for group 1 was 81.2±7.2 and 87.4±6.5 (P<0.05) for group 2. The average AI for group 1 was 32.8±15.1 and 20.8±7.7 (P<0.05) for group 2. Similarly, serum MDA levels of the two groups were not statistically different (P>0.05). No relationship between positive comet assay results and OSAS severity was identified.

Conclusion

Results of the current study showed that OSAS was not associated with DNA damage as measured by comet assays or oxidative stress according to serum MDA levels.     

The effect of uvula-preserving palatopharyngoplasty in obstructive sleep apnea on globus sense and positional dependency

Objectives

This study investigated the outcomes of uvula-preserving palatopharyngoplasty (UPPPP) in patients with obstructive sleep apnea syndrome (OSAS).

Methods

Twenty men with obstructive sleep apnea syndrome received the UPPPP operation at our institution. We measured symptom changes after UPPPP using a visual analog scale (VAS), and all patients were examined with polysomnography pre- and post-operatively. ''Surgical success'' was defined as reduction in apnea-hypopnea index (AHI) to below 20 events per hour and more than 50% post-operative reduction.

Results

Snoring decreased significantly (6.7±2.3 to 3.7±2.9 on VAS, P=0.002) but the postoperative globus sense did not differ from that preoperatively (2.0±2.4 to 2.1±2.7 on VAS, P=0.79). Apnea and apnea-hypopnea indices were significantly reduced after UPPPP (34.7±20 to 24.2±17.2 events/hour, P=0.029). The surgical success rate was 40% regardless of Friedman stage. There was significant reduction in the AHI on supine sleep in both surgically successful and unsuccessful patient groups.

Conclusion

UPPPP may minimize postoperative globus sense and other complications, with a success rate comparable to that of previously reported surgical methods in OSAS patients. In addition, it may reduce the apnea-hypopnea index in the supine sleep position.     

Long-term Subjective and Objective Outcomes of Adenotonsillectomy in Korean Children With Obstructive Sleep Apnea Syndrome

Objectives

Adenotonsillar hypertrophy is the most common etiology in pediatric obstructive sleep apnea syndrome (OSAS), and adenotonsillectomy is the mainstay of treatment modalities. This study evaluates the long-term effectiveness of adenotonsillectomy in children with OSAS.

Methods

Subjective symptoms evaluated with a 7-point Likert scale and objective respiratory disturbances evaluated by polysomnography were compared before and after adenotonsillectomy.

Results

A total of 17 children with OSAS aged 4-15 years (mean age, 6.65±3.02 years; male:female, 13:4) completed the study. The mean follow-up period was 57 months (range, 30 to 98 months). Significant changes were found in apnea-hypopnea index (from 12.49±12.96 to 1.96±2.01, P<0.001), apnea index (from 5.64±7.57 to 0.53±0.78, P=0.006), minimum SaO₂ (from 81.88±14.36 to 92.76±4.31, P=0.003), snoring (from 43.28±70.63 to 10.70±13.72, P=0.042), and arousal index (from 19.58±7.57 to 11.36±3.99, P=0.006) after adenotonsillectomy. Significant changes were also found after surgery in most of symptoms including snoring, witnessed apnea, morning headache, mouth breathing, gasping during sleep, restless sleep, nasal obstruction, and difficulty with morning arousal. Long-term surgical cure rate and response rate were 47.1% (8/17) and 70.6% (12/17), respectively.

Conclusion

Most of subjective OSAS symptoms and objective respiratory disturbances improved continuously about 5 years after adenotonsillectomy in children with OSAS. However, close follow-up and a sufficient observation period are necessary because of the risk for long-term incomplete resolution.     

Preliminary Findings from Our Experience in Anterior Palatoplasty for the Treatment of Obstructive Sleep Apnea

Objectives

Obstructive sleep apnea (OSA) is a common disorder affecting at least 2% to 4% of adult population characterized by the collapse of the pharyngeal airway. It is well established that retropalatal region is the most common site of obstruction. Consequently, many surgical techniques have been introduced. The purpose of this study is to present our preliminary results in the anterior palatoplasty (AP) compared with results of uvulopalatal flap (UPF).

Methods

Thirty-eight consecutive patients with mild-moderate OSA were prospectively enrolled into a randomised surgical protocol. Surgical success was measured primarily by satisfactory reduction in snoring, as reported by snoring assessment questionnaire (SQ) of sleep partners. Secondary outcomes measures included improvement in the Epworth Sleepiness Scale (ESS) scores, changes in the magnitude of pharyngeal collapse, and postoperative pain intensity.

Results

The ESS after AP improved from a preoperative value 8.5±3.7 to a postoperative mean of 4.9±3.2 (P<0.001) after UPF improved from a preoperative value of 8.1±3.5 to 5.2±3.2 postoperatively (P<0.001). The results of satisfactory reduction in the volume of snoring and response at polysomnographic data were also similar in both procedures. We reported a statistically significant difference of the collapse noted at Müller manoeuvre that improved from 2.7±1.0 on average, to 1.1±0.9 (P<0.001) after AP and with a lesser extent, (from 2.8±1.1 on average to 1.8±1.1; P<0.05), after UPF. The mean duration of pain was 10.8 days for UPF patients and 7.1 days for AP patients. The mean pain score in the first 3 days, was 6.8 in UPF patients and 5.1 in AP patients.

Conclusion

The subjective and objective improvements evidenced may suggest how AP is far superior to other techniques aimed at creating a palatal fibrotic scar. In the light of these results we can suggest AP procedure as more practical and comfortable when compared to UPF.     

Association between Positional Dependency and Obstruction Site in Obstructive Sleep Apnea Syndrome

Objectives

The purpose of this study is to find out associations between positional dependency and obstructive levels based on sleep videofluoroscopy (SVF) in patients with obstructive sleep apnea syndrome (OSAS).

Methods

Retrospective review was made of 91 OSAS patients who underwent polysomnography and SVF from August 2009 through June 2010. Polysomnography variables including apnea-hypopnea index (AHI), supine AHI, non-supine AHI, time spent in supine sleep position of the total sleep time and positional dependency (PD) were analyzed. Obstruction sites were evaluated as SVF variables.

Results

Of 91 patients, 65 (71.4%) were positional patients (PP) and 26 (28.6%) were non-positional patients (NPP). An analysis of polysomnography variables according to PD revealed that overall AHI, non-supine AHI and supine AHI in PP was significantly lower than that in NPP. The patients with soft palate obstruction (SP type) were more likely to have PD than the patients with tongue base obstruction (TB type; P=0.046). PD was inversely related to OSAS severity significantly (P=0.001).

Conclusion

These results provide evidence that positional dependent patients may have higher success rate of soft palate OSA surgery alone than non-positional dependent patients. Although PD may be associated with obstruction site, PD only itself may not be useful in planning surgical treatment for OSAS.     

Relationship Between Snoring Intensity and Severity of Obstructive Sleep Apnea

Objectives

The aim of this study was to determine the relationship between the intensity of snoring and severity of sleep apnea using Watch-PAT (peripheral arterial tone) 100.

Methods

A total of 404 patients (338 males and 66 females) who underwent home-based portable sleep study using Watch-PAT 100 for obstructive sleep apnea (OSA) from January 2009 through December 2011 were included in this study. Subjects were divided into 4 groups; no OSA (PAT apnea hypopnea index [pAHI]<5/hour), mild OSA (5≤pAHI<15/hour), moderate OSA (15≤pAHI<30/hour), or severe OSA groups (pAHI≥30/hour). Mean snoring intensity and percent sleep time with snoring intensity greater than 40, 50, and 60 dB were measured by Watch-PAT 100. Correlations of these parameters with apnea hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index were assessed.

Results

The mean age and body mass index were 46.5±14.8 years and 24.7±3.4 kg/m², respectively. Mean AHI and RDI were 16.5±15.3/hour and 20.8±14.3/hour, respectively. The mean snoring intensity in the no, mild, moderate, and severe OSA groups was 44.0±2.7, 45.4±6.0, 47.7±5.0, and 50.5±5.6 dB, respectively (P<0.001). There was a positive correlation between snoring intensity and pAHI or PAT RDI (pRDI) (r=0.391 and r=0.385, respectively, both P<0.001). There was also a positive correlation between percent sleep time with the snoring intensity greater than 50 dB and pAHI or pRDI (r=0.423 and r=0.411, respectively, both P<0.001).

Conclusion

This study revealed that the intensity of snoring increased with the severity of sleep apnea, which suggests that the loudness of snoring might be an indicator of the severity of OSA.     

Functional Benefit after Modification of Radial Forearm Free Flap for Soft Palate Reconstruction

Objectives

To compare the velopharyngeal function, swallowing and speech of the conventional and modified radial forearm free flap (RFFF) for soft palate reconstruction.

Methods

Retrospective clinical study. Twenty-eight patients who underwent oropharyngeal reconstruction with RFFF were divided into two groups: 10 patients had conventional folded RFFF and 18 patients underwent modified method.

Results

The average speech intelligibility score in modified RFFF group was 8.0±2.4, and 6.2±2.2 in conventional RFFF group (P<0.05). The nasalance was 27.4±7.8% in modified group and 38.6±2.7% in conventional group during no nasal passage reading and 43.6±7.3% in modified group, 55.2±7.6% in conventional group during high nasal passage reading (P<0.05). The subjective swallowing functional score was 2.8 in modified group and 2.1 in conventional group.

Conclusion

The speech assessment and nasalance demonstrate a more favorable outcome in modified group than conventional group.     

Clinical Characteristics of Allergic Rhinitis According to Allergic Rhinitis and Its Impact on Asthma Guidelines

Objectives

The Allergic rhinitis and its impact on asthma (ARIA) guidelines were suggested for use to classify allergic rhinitis (AR). However, few studies have been performed in Asians. The objective of this study is to identify the clinical characteristics of AR in Korean patients according to the ARIA guidelines.

Methods

For the study, 610 patients who had been diagnosed with allergic rhinitis at Seoul National University Bundang Hospital and 545 patients who had been diagnosed with allergic rhinitis at 3 local clinics were included. All the patients were categorized into 4 groups, such as the mild intermittent, mild persistent, moderate-severe intermittent and moderate-severe persistent groups. The patients were given a questionnaire on allergic rhinitis-related symptoms and they underwent blood tests, including the blood eosinophil count and the serum total IgE level.

Results

The most prevalent type was the moderate-severe persistent group (34.7%), and the moderate-severe intermittent group (17.1%) was the rarest. There were significant differences among the 4 groups for olfaction (P<0.001), self-awareness of rhinitis (P=0.013), a previous history of AR (P<0.001), self-awareness of asthma (P=0.001) and allergic conjunctivitis (P<0.001). On the allergy laboratory tests, there was a significant difference between the groups for the eosinophi count (P=0.004). The number of blood eosinophil was more in the persistent groups than in the intermittent groups.

Conclusion

According to the ARIA guidelines, the moderate-severe persistent group was the most prevalent for Korean patients. Blood eosinophilia and olfactory dysfunction were the most severe in the moderate-severe persistent group.     

Initial Adherence to Autotitrating Positive Airway Pressure Therapy: Influence of Upper Airway Narrowing

Objectives

There is still debate concerning the reason for the high initial failure rate of positive airway pressure (PAP) treatment. The objective of this study is to investigate the factors of the initial adherence to PAP, with an emphasis on the role of upper airway narrowing.

Methods

The patients were divided into two groups according to the continuation of therapy within the first three months of treatment. The demographic and polysomnographic findings, the minimal nasal cross sectional area (MCA), the degree of palatine tonsilar hypertrophy (PTH) and the modified Mallampati grade of the oropharynx inlet (Orophx) were compared between the study groups.

Results

Among 36 patients, 23 continued the auto-adjusting positive airway pressure (APAP) therapy (the adherent group) and 13 discontinued APAP within three months (the non-adherent group). The apnea-hypopnea index (AHI) was significantly higher in the adherent group than in the non-adherent group (P<0.001). The AHI distributions of the two groups are extremely different. Thirteen of the 23 patients in the adherent group had an AHI of more than 60/hr, while none of the patients in the non-adherent group had an AHI of more than 60/hr. In the patients with an AHI from 15 to 60/hr, the MCA at the wide side of the nasal cavity and the sum of the MCAs of both sides were significantly larger in the adherent group than those values in the non-adherent group (P=0.004). The PTH and the Orophx were not significantly different between the two groups.

Conclusion

AHI is a definite significant factor of adherence to APAP therapy. The dimension of the nasal cavity has an influence on initial APAP adherence in the patients who have a not too high level of AHI.     

Long-term effectiveness and safety of endoscopic vidian neurectomy for the treatment of intractable rhinitis

Objectives

Vidian neurectomy could be considered the treatment of choice for intractable rhinitis, because it is the only method that can permanently block the pathophysiological mechanism of rhinitis. The goal of this study was to evaluate the effect of vidian neurectomy on nasal symptoms and tear production, and to assess for possible complications.

Methods

Six patients with intractable rhinitis who underwent endoscopic transnasal vidian neurectomy were enrolled. The degree of symptom improvement and complications were assessed through retrospective review of medical records prior to, and 1 year following surgery, and telephone survey after 6.9±2.1 years. Schirmer''s test was performed before surgery, and these values were compared to postoperative results at 1 day, 1 month, and 2 months.

Results

Changes in the visual analogue scale were significant in nasal obstruction (8.5±2.5 to 3.0±2.0, P<0.05) and rhinorrhea (9.0±2.2 to 2.0±1.6, P<0.05). Improvements persisted for up to 7 years after the primary surgery. Patients complained of mild dry eyes for 1 month after vidian neurectomy. However, five out of six reported marked improvement of xerophthalmia after 2 months. Aside from mild crusting of the nasal cavity and mild postoperative pain, there were no major complications. During the entire follow-up period, no patient needed additional treatment, such as antihistamines or corticosteroids.

Conclusion

Vidian neurectomy is effective in alleviating nasal symptoms in patients with intractable rhinitis refractory to other treatments. This effect is sustained for at least 7 years with minimal postoperative complications.     

Relationship between the Korean Version of the Sniffin' Stick Test and the T&T Olfactometer in the Korean Population

Objectives

The Korean version of the Sniffin'' stick (KVSS) test is widely used in Korea to evaluate olfactory function. However, its validity and reliability have not been studied well. In this study, the authors administered the KVSS and the T%T olfactometer test to evaluate olfactory function and to establish relationships between these two test measures.

Methods

Two hundred and eleven patients participated in this prospective randomized study. One hundred and nine patients with no olfactory symptoms and 102 patients with decreased olfaction participated. All participants were underwent KVSS II and T&T olfactometer testing.

Results

The mean recognition threshold of the T&T olfactometer was -1.8±0.9 for patients with normal olfaction and 4.0±2.6 for patients with decreased olfaction. The mean Threshold-Discrimination-Identification score of the KVSS II was 30.0±3.8 for patients with normal olfaction and 15.9±7.1 for patients with decreased olfaction. Correlation coefficient between the two tests was significantly high (r_s=-0.725, P<0.01).

Conclusion

The KVSS and T&T olfactometry test are both reliable tests of olfactory function and their results are well correlated with each other.     

A Prospective Population-based Study of Total Nasal Resistance in Korean Subjects

Objectives

Rhinomanometry is a widely accepted method for objective assessment of nasal patency. However, few studies have reported the values of otherwise healthy population for nasal resistance in East Asians. The purpose of this study was to measure normal total nasal resistance (TNR) values in a large sample of Korean adults and to reveal parameters contributing to TNR values.

Methods

Subjects were enrolled from a cohort of the Korean Genome and Epidemiology Study. They were evaluated by anthropometry, questionnaire, and active anterior rhinomanometry at transnasal pressures of 100 and 150 Pascal (Pa).

Results

The study sample consisted of 2,538 healthy subjects (1,298 women and 1,240 men) aged 20 to 80 years. Normal reference TNR values were 0.19±0.08 Pa/cm³/second at 100 Pa and 0.22±0.09 Pa/cm³/second at 150 Pa. The TNR of women was significantly higher than that of men (P<0.0001). TNR decreased with increasing age in both genders (P<0.05). In women, lower body weight was related to increasing TNR. In men, current smokers had higher TNR than ex-smokers and never smokers.

Conclusion

The results of the present study provide information regarding the values of otherwise healthy population of TNR and parameters associated with TNR in Korean adults.     

Is Cognitive Function in Adults with Hearing Impairment Improved by the Use of Hearing Aids?

Objectives

In the present study, we investigated whether speech-related cognitive function and speech recognition ability under background noise in adults with hearing impairment are improved with the use of hearing aids.

Methods

Participants were recruited from the ENT Department of Eulji Hospital from September 2008 to July 2009. The study group comprised 18 participants (mean age, 69.5±8.3 years) with sensorineural hearing loss who were fitted with hearing aids, and the control group comprised 11 participants of equivalent age (mean age, 63.1±11.8 years) who were not fitted with hearing aids. All participants were assessed using the computerized Korean visual verbal learning test (VVLT) and words-in-noise (WIN) test prior to fitting of hearing aids for the study group and initially for the control group. Both groups were reassessed in both tests after 6 months. For each group, differences in the results between the two assessments were compared using the Friedman test.

Results

There was no difference in mean age between the study group and control group. In the study group, total VVLT score (reflecting short-term memory) was significantly improved from before hearing aid use to 6 months after hearing aid use (P<0.05), and VVLT recognition score (reflecting learning ability) was also significantly improved from before hearing aid use to 6 months after hearing aid use (P<0.05), but there was no change in the control group. For VVLT latency score (reflecting efficiency of memory) and speech discrimination score in the WIN test, no statistically significant difference was found between the initial and 6-month assessments in the study group or in the control group (P>0.05).

Conclusion

The speech-related cognitive function of individuals with hearing impairment improved after using hearing aids. This finding indicates that hearing aids may induce acclimatization of the central auditory system.     

Differences of Upper Airway Morphology According to Obesity: Study with Cephalometry and Dynamic MD-CT

Objectives

We investigated difference of parameters of polysomnography, cephalometry and dynamic multi-detector computerized tomography (MD-CT) in wake and sleep states according to obesity.

Methods

We evaluated 93 patients who underwent polysomnography and cephalometry. MD-CT was performed in 68 of these 93 patients. Fifty-nine and 34 patients were classified as obese and non-obese, with obesity defined as BMI ≥25. Cephalometry results were analyzed for 12 variables. Using the MD-CT, we evaluated dynamic upper airway morphology in wake and sleep states and divided the upper airway into four parts named as high retropalatal (HRP), low retropalatal (LRP), high retroglossal (HRG), and low retroglossal (LRG). A minimal cross sectional area (mCSA) and collapsibility index (CI) were calculated for each airway level.

Results

Diastolic blood pressure (P=0.0005), neck circumference (P<0.0001), and apnea-hypopnea index (P<0.0001) were statistically significantly different between the obese and non-obese group. Among 12 cephalometric variables, there was a significant difference in only the distance from mandibular plane to hyoid bone (P=0.003). There was statistical difference in CI of HRG and LRG in sleep state (P=0.0449, 0.0281) but no difference in mCSA in wake and sleep states.

Conclusion

The obese group had more severe sleep apnea than the non-obese group. We believe that the increased severity of apnea in the obese group may be have been due to increased collapsibility of the upper airway rather than decreased size of the upper airway.     

Idiopathic Sudden Sensorineural Hearing Loss With Minimal Hearing Impairment

Objectives

The aim of the study was to determine the characteristics of patients who did not match the audiometric criteria of idiopathic sudden sensorineural hearing loss (SSNHL) but complained of acute hearing loss.

Methods

By thorough medical chart reviews, historical cohort study was performed with consecutive data of 589 patients complaining of acute unilateral sensorineural hearing loss without identifiable causes between 2005 and 2013. Those patients demonstrating a hearing loss of at least 30 dB at three consecutive frequencies based on pure tone audiometry were classified as group I; the others were classified as group II. Patients'' characteristics, final hearing, and hearing improvement rate (HIR) between the two groups were compared.

Results

Group II exhibited distinctive characteristics, including an early age of onset of the hearing loss (P<0.01), an absence of accompanying diabetes (P<0.01) and hypertension (P<0.01), and better unaffected hearing and final hearing compared with group I (P<0.001). However, the HIR of the patients in the two groups was not significantly different (P>0.05).

Conclusion

Patients who did not meet the audiological criteria of SSNHL exhibited distinctive characteristics compared to SSNHL patients.     

Relationships between Lymph Node Metastasis and Expression of CD31, D2-40, and Vascular Endothelial Growth Factors A and C in Papillary Thyroid Cancer

Objectives

To investigate the relationships between lymph node metastasis (LNM) and expression of CD31, D2-40 and vascular endothelial growth factors (VEGF)-A and -C in patients with papillary thyroid cancer (PTC).

Methods

Paraffin-embedded thyroid tissues of 72 patients were evaluated, which included 25 patients with thyroid nodular hyperplasia (TNH), 24 PTC patients without LNM, and 23 PTC patients with LNM. Three pathologists, who were blinded to the patient''s clinical information, assessed the immunohistochemical staining results. The amount of expression was scored as high (>25% of cells stained) or low (0-25%).

Results

A higher level of VEGF-A expression was observed in the PTC groups regardless of LNM when compared to the group with TNH (91.3%, 79.2%, 4.0%, respectively). VEGF-C expression in the PTC with LNM group was significantly higher than the other two groups (P<0.05). No difference in microvessel density (MVD) scores was observed using CD31 among the three groups. The lymphatic vessel density (LVD) score using D2-40 was significantly higher in patients having PTC with LNM than the other groups (P<0.05).

Conclusion

VEGF-C and D2-40 were more highly expressed in patients having PTC with LNM than in patients having PTC without LNM or in those having TNH. Analysis of VEGF-C level and LVD using D2-40 may be helpful in the diagnosis of PTC and the evaluation of LNM potential in patients with PTC.     

Effect of Botulinum Toxin Type A on a Rat Surgical Wound Model

Objectives

The tension on a wound is one of the important factors that determine the degree of fibrosis and scar formation. We hypothesized that local botulinum toxin type A (Botox) induced paralysis of the musculature subjacent to a surgical wound with a skin defect would minimize the repetitive tensile forces on the surgical wound''s edges, and this will result in a decreased fibroplastic response and fibrosis of the wound.

Methods

This is a prospective randomized experimental study. Two distinct surgical wounds were made to the dorsum of 15 adult rats, respectively. One of the 2 wounds was injected with Botox, and the other wound was used as a control, and this was done for all the rats'' wounds. We evaluated the wound size, the degree of fibrosis and inflammation, the blood vessel proliferation, the thickness of the wound and the expression of transforming growth factor (TGF)-β1 in the wounds.

Results

There were significant differences of wound size at the 3rd and 4th week between the Botox and control groups (P<0.05). The Botox group showed less infiltration of inflammatory cells than the control group at the 2nd week (P<0.05). The Botox group showed a smaller number of fibroblasts and less fibrosis than the control group at the 4th week (P<0.05). The Botox group showed much strong collagen density than the control group at the 8th week (P<0.05). For the immunohistochemical staining, there was a lower transforming growth factor (TGF)-β1 expression in the Botox group than that of the control group at the 4th week (P<0.05).

Conclusion

The wounds of the Botox-treated group showed a larger wound size, less infiltration of inflammatory cells and less fibrosis, a much greater amount of collagen and a lower expression of TGF-β1 than did the control group. Botox might be used to decrease the fibrosis of a surgical wound without damaging the epithelial growth in situations for which decreased fibrosis is necessary, such as for treating laryngeal, tracheal and nasal stenosis.     

Partial Superficial Parotidectomy via Retroauricular Hairline Incision

Objectives

The purpose of this study was to evaluate the usefulness of retroauricular hair line incision (RAHI) in partial superficial parotidectomy by comparison with modified Blair incision or facelift incision.

Methods

Medical records of 73 patients with benign parotid tumor who underwent partial superficial parotidectomy were retrospectively reviewed. Size and location of tumors, operative time, occurrence of facial nerve paralysis and Frey''s syndrome, and cosmetic outcomes were compared among RAHI, facelift incision (FLI), modified Blair incision (MBI) groups.

Results

RAHI group showed better cosmetic results than FLI group or MBI group compared with other type of incisions (P<0.001, P<0.001, respectively). Among the 3 groups, there were no significant differences of operative time and location of tumor (P=0.377), size of tumor (P>0.999), occurrence of temporary or permanent facial nerve paralysis (P=0.745) and Frey''s syndrome (P=0.940).

Conclusion

Partial superficial parotidectomy can be done safely by RAHI in most cases of benign parotid tumor. Compared with MBI or FLI, RAHI has better cosmetic outcome with no increase of operative time or postoperative complications.