Frequency and Patterns of nodal metastasis in supraglottic squamous cell carcinoma

Background and Objectives: Supraglottic larynx is a well-known primary site of the head and neck cancer with frequent nodal metastasis, but pathologically confirmed data is lacking in our country. Patients and Methods: Pathologic reports of supraglottic squamous cell carcinoma were reviewed using the records of 73 patients who underwent surgery as an initial treatment at Severance Hospital between April 1992 and December 1999. Fifty-three patients had simultaneous bilateral neck dissection, while 13 had unilateral neck dissection. The average number of nodes investigated was 46.5 14.0 for the comprehensive neck dissection specimen and 29.4 10.9 for the lateral neck dissection. Results: Seventy-one percent of the patients had patholigically proven nodal metastasis at the time of diagnosis. Ninty-percent(47/52) of patients with pathologically proven metastasis had multiple lymph node metastasis. Nodal metastasis rate according to T stages was as follows ; T1 57.1%(4/7), T2 72.0%(18/25), T3 76.0%(19/25), T4 68.8%(11/16) respectively. Metastasis rate according to subsite was as follows ; 79.3% for epiglottis, 56.5% for false cord, 76.2% for aryepiglottic fold respectively. Ipsilateral and contralateral occult metastasis rate were 28.6%(8/28) and 14.3%(4/28), respectively. The percentage of contralateral occult metastasis for clinically ipsilateral node positive patient was 27.8%(10/36). 40.4%(19/47) of the patients with tumor which involved the midline had contralateral metastasis while 11.5%(3/26) for the patients with tumor were confined to one side. Conclusion: Patients with supraglottic squamous cell carcinoma need aggressive treatment of neck, because nodal metastasis is very frequent at the time of diagnosis. Elective treatment of contralateral neck may be needed for ipsilateral node positive patients. Patients who were clinically proven NO also need to take elective treatments at least for the ipsilateral side.ope

Clinical Characteristics and Voice Analysis of Mutational Dysphonia：Diplophonia and Clinical Use of Electroglottographic Measures

Background and Objectives：Mutational dysphonia, also referred to as mutational falsetto, is defined as the dysphonia that continuously have high pitch after adolescence. The aims of this study were to investigate the acoustic and electroglottographic characteristics of mutational dysphonia before and after voice therapy and to identify the factors that may be of help in its treatment. Subjects and Method：The clinical records of 15 patients with mutational dysphonia were reviewed, and analyses of their voice records were carried out with the help of Lx Speech Studio studio (Laryngograph Ltd, London, UK) program. Results：After voice therapy was combined with manual compression method, the voices of the subjects were lowered in pitch and also improved in voice quality. Furthermore, we were able to classify the mutational dysphonia into 4 categories according to diplophonia and closed quotients. The most common type among the categories was bimodal distribution of fundamental frequency, or so-called diplophonic, accompanied with low closed quotient - falsetto voice - at high frequency area. However, the results also showed that all cases of mutational dysphonia can not be generalized simply as falsetto voice. The effect of the therapy for each type was different, and we could assume that in the cases with diplophonia accompanied with non-trained falsetto voice, it is expected that it can be treated readily. Conclusion：The diplophonia and closed quotient, which were easily analyzed by using Lx Speech Studio program, are important factors which help to classify the mutational dysphonia, choose the treatment options, monitor the efficacy of therapy, and estimate the prognosis of diseases.ope

The Clinical Characteristics and Voice Analysis of Reinke’s Edema

Background and Objectives：Reinke's edema is characterized by the swelling of the vocal folds, which is bilateral, and is found superficial to the vocal ligament, Reinke's space. However, the etiology of Reinke's edema is not well understood, and voice characteristics are still controvertial. The aim of this study was to evaluate the clinical characteristics of Reinke's edema, and to assess the voice qualities in patients with Reinke's edema before and after a laryngomicrosurgery. Furthermore, this study also determined which parameters were most associated with the improvement of postoperative voice quality in Reinke's edema. Subjects and Method：The clinical records from 61 patients with Reinke's edema were reviewed and telephone questionnaires were carried out about smoking, laryngopharyngeal reflux, voice abuse, and allergy. All the patients were classified according to the stroboscopic findings (Yonekawa's classification). The voice analysis of 61 patients with Reinke's edema were performed and compared with 30 normal controls. Also, the voice analysis of 23 patients, who underwent laryngomicrosurgery, was carried out 2 months after surgery. Results：Smoking, voice abuse and laryngopharyngeal reflux may play important roles in developing Reinke's edema. There were 26, 22, and 13 patients identified as Yonekawa types I, II, and III, respectively. The preoperative voice analysis of 61 patients showed decreased FxM (mean fundamental frequency), and increased subglottic pressure. Furthermore, FxSD (fundamental frequency standard deviation), QxM (mean closed quotient), and QxSD (closed quotient standard deviation) were all higher for the patients than the normal group. The postoperative results showed an increase in the FxM and an improvement in the MFR (mean flow rate), Psub (subglottic pressure), shimmer, and HNR (harmonics to noise ratio). The correlation analysis showed that jitter, HNR, QxM, and CFx (% irregularity of frequency) were the parameters, showing the best correlation with improvement in the postoperative voice quality. Conclusion：The fundamental frequency was approximated to normal ranges, and stabilizing of vocal fold vibration, and the improvement of vocal efficiency was also found 2 months after layngomicrosurgery. The parameters which represented voice quality by correlation analysis after surgery were jitter, HNR, QxM, and CFx.ope

Choice of surgical approaches and method of reconstruction for base of tongue cancer

Background and Objectives: There are various surgical approaches for resection of base of tongue cancer, but reports on indications of each approach are lacking. Patients and Methods: From 1993 to 1999, surgically treated patients with base of tongue cancer were reviewed retrospectively. Fourteen patients were included in this study. All but one were previously untreated. Approaches used to remove the tongue base lesions were as follows: lateral pharyngotomy, transhyoid pharyngotomy, mandibular swing approach with or without supraglottic partial laryngectomy(SPL), extended supraglottic partial laryngectomy(ESPL), lingual release or lingual-mandibular release technique, and pull through approach. Free flap or myocutaneous flap were used for the reconstruction of surgical defect in five patients. Results: Surgical resection margin was positive in five patients. In these, the lateral wall of oropharynx was the most frequent site of positive margin. All patients, except one total laryngectomee, could do well without tracheostoma and oral feeding was possible in all cases. Conclusions: In small lateral tumor, transpharyngeal resection was a good alternative for vigorous transmandibular resection. In case of tumor with vallecular or supraglottic involvement, supraglottic partial laryngectomy with or without mandibular swing was needed. For total glossectomy, lip and mandible could be spared with pull through or lingual release approach. Even though we could choose any surgical approach with very wide surgical field, we needed more generous safety margin for this notorious tongue base cancer.ope

Therapeutic Effect of Oncolytic Herpes Simplex Virus on Induced Radioresistant Head and Neck Squamous Cell Carcinoma

Introduction : The sensitivity of tumor cells to radiotherapy is a critical determinant of local control and potential cure in advanced head and neck squamous cell carcinoma(HNSCC). The emergence of radioresistant tumor cells is an obstacle to cancer therapy. Most radioresistant cells have a higher proportion of cells in the Sphase of the cell cycle and a lower apoptotic fraction than radiosensitive cells. HSV replication is increased in cells that have higher S-phase fractions. NV1066 is an oncolytic herpes simplex virus type-1 mutant. We hypothesized that NV1066 replication and cytotoxicity are increased in radioresistant cells. The purpose of this study is to evaluate the antitumor efficacy of NV1066 to treat radioresistant HNSCC. Methods : Radioresistant cells were selected by treating five HNSCC cell lines with repeated conventional fractionated doses of radiation(2Gy/day), using a Cs-137 irradiator, up to a cumulative dose of 70Gy. Clonogenic cell survival and S-phase fractions were compared between radioresistant and parental radiosensitive cells. The two cell populations were then treated with NV1066 to examine viral replication, by the viral plaque assay and viral cytotoxicity. Results : Fractionated irradiation resulted in the selection of radioresistant cells. Radioresistant cells had a higher S-phase fraction(42.9%) compared to parental cells(26.2%). NV1066 replication in radioresistant cells was 7.4 times higher than in parental cells(p<0.01). Treatment with NV1066 resulted in increased cytotoxicity of 24.5% in radioresistant cells compared to parental cells(p<0.05). Conclusion : NV1066 showed increased viral replication and cytotoxicity in radioresistant HNSCC cell lines. These findings suggest a potential clinical application for this oncolytic viral therapy as treatment for radioresistant head and neck cancers.ope

A Clinical Review on 197 Cases of Phonosurgery

Background and Objectives：The objectives were to analyze the results of the laryngeal framework surgery (LFS) in one institute during 12 years. We reviewed the present position of LFS in the phonosurgery field and discussed the prospects for this type of surgery in the future. Subjects and Method：One hundred seventy nine charts of patients who underwent LFS in Yongdong Severance hospital from 1992 to 2003 were reviewed. Types of procedures were made according to the classification/ nomenclature of European Laryngological Society. Results：One hundred ninty seven operations had been performed during 12 years in 179 patients. Type I thyroplasty was the most common procedure (28.9%). Type I thyroplasty+Arytenoid adduction (26.4%), Type III thyroplasty (16.8%), Arytenoid adduction (15.2%), Injection medialization (11.2%), Type IV thryroplasty (1.5%) followed in the order of most commonly operated choices. Of 197 cases, 18 cases were revision. There was only one major complication (dyspnea). A variety of dysphonias, which include vocal fold paralysis (71.5%), various pitch problems (mutational dysphonia (14%), androphonia (1.1%)), glottal insufficiency (12.8%), and some cases of spasmodic dysphonia (0.6%), had been treated with LFS. Conclusion：Laryngeal framework surgery is a new type of surgery that aims to improve the voice by restructuring the laryngeal framework. This type of surgery has become increasingly popular, because it has been found to be safe and effective.ope

Retrograde Analysis of Complications of Jejunal Free Flap after Total Pharyngo-Laryngo-Cervical Esophagectomy in Advanced Hypopharyngeal Cancer Treatment

Hypophayngeal cancers are usually diagnosed in advanced stages and in many cases, they need total pharyngocervical esophagectomy and surgical reconstruction. Among many surgical reconstructive methods, jejunal free flap has anatomical and functional advantages such as tubed nature, peristaltic activity, excellent blood supply. In this study we analysed the surgical procedure and complications of jejunal free flap after total pharyngo-cervical esophagectomy. 20 cases performed jejunal free flap from 1995 to 2007 at Severance Hospital were reviewed. According to time of onset, early and late complications were reviewed. Surgical procedure was reviewed with operation record. Oral diet tolerance was reviewed on the basis of pharyngogram and subjective symptoms. The most common complication was stricture, and it occurred in 40% of cases and 63% of them were managed with conservative care. As early complication, fistula formation was all managed with conservative care. Oral feeding tolerance after jejunal free flap was 65% and 7 patients were tolerable to general diet. In our study, stricture was the most common complication and its management is important in post op oral diet tolerance.ope

The Current Clinical Propensity of Laryngeal Tuberculosis: Review of 60 Cases

Background and Objectives：Although laryngeal tuberculosis is not common, it still occurs with an increasing incidence of pulmonary tuberculosis. The clinical pattern and spread mechanism of this disease have also changed as well. This study was performed to examine the current propensity seen in laryngeal tuberculosis and the clinical characteristics of this disease in patients showing atypical clinical pattern. Subjects and Method：We retrospectively analyzed 60 cases of laryngeal tuberculosis diagnosed from 1994 to 2004 in the department of otorhinolaryngology at Severance Hospital by evaluating clinical and videostroboscopic records. Results：The age of the patients ranged from 25 to 78 years, with their average age being 49.7 years. The ratio between men and women was 1.9：1. The major symptom encountered was hoarseness (96.6%). Clinically, granulomatous (n=22) and ulcerative types (n=11) of laryngeal tuberculosis were still prevalent, however, the incidence of atypical types such as polypoid (n=16) and nonspecific (n=11) were on the rise. Among 27 cases that showed polypoid or nonspecific types, unilateral lesion was seen in 20 cases (74%). The most frequently affected area by this disease was true vocal cord, followed by false vocal cord, epiglottis, arytenoids and posterior commissure. Active pulmonary tuberculosis was present in 28 (46.7%), inactive pulmonary tuberculosis in 20 (33.3%), normal lung status in 12 cases (20%). Primary laryngeal tuberculosis was present in 9 cases (15%). Single lesion, polypoid and nonspecific type were the prevalent characteristics found in patients with inactive tuberculosis or normal lung status. Conclusion：Physicians should be aware of changes in the clinical pattern of laryngeal tuberculosis, which pose serious complications and risk of spreading.ope

한국인 사골동의 형태해부학적 연구

의학과/박사[한글] 사골동의 해부학적 구조는 극히 복잡하고 정상변형이 심하여 사골미로라고 까지 일켤어지고 있으며, 비과학(鼻科學) 임상에서 비·부비동 질환의 수술적 요법에서는 사골동이 반드시 처치되어야 할 중요한 부위임에도 불구하고 사골동의 해부학적 난해성과 인접 주 요기관의 수술적 손상으로 인한 불가역적인 합병증 속발의 우려 때문에 사골동의 처치가 미흡하게 되거나 심지어 회피되는 경향이 있으므로 비·부비동 수술 후의 치유성적이 불량한 경우를 흔히 경험하게 된다. 이러한 사골동의 해부학적 난해성을 극복하고 보다 적극적인 사골동의 처치를 위해서는 우선 자국인 사골동의 형태해부학적 특성과 정상변형을 숙지 파악하여야 한다. 이러한 목적을 위해서 저자는 한국인 성인사체 비강의 사골동을 연구재료로 사용하여 사골동의 해부학적 구조를 관찰 계측하였다. 연세대학교 의과대학 해부학교실에서 약물처리된 한국인 성인사체 50두부에서 얻은 좌우 100측 비강의 사골동을 연구재료로 사용했다. 먼저 두부를 중앙부에서 시상절개하고 비중격 및 비갑개를 절제하여 사골동을 노출시키고 각 봉소의 개구부에 소식자를 삽입하여 봉소의 영역을 확인하는 동시에 각 개구부의 형태, 방향 등을 관찰하였다. 그리고 사골봉소의 내벽에 창을 만들어 각 봉소의 위치와 수, 크기 및 개구 등의 상태를 관찰하고 봉소개구부의 위치에 따라서 각각의 봉소를 분류하였으며 또한 해부학적 특성과 임상적 의의에 따라 특수봉소로 다시 분류했다. 이밖에도 사골봉소가 인접골부나 다른 부비동내로 확대되어지는 양상을 파악했고 특히 사신경관이 후사골동내로 발현하는 상태를 분류했다. 이상의 관찰이 끝난 후에 1/20mm 눈금츠 척도계와 분도기를 사용하여 사골동의 길이, 좌우경 및 높이, 제Ⅲ기판의 길이와 경사각, 제Ⅲ기판 상단에서 전비극까지의 거리와 이것이 비저와 이루는 각, 그리고 후사골동내에 발현된 시신경관과 전비극간의 거리와 이것이 비저와 이루는 각을 계측했다. 끝으로 연구재료 100예중 20예에서 레귤라 러버 베이스(regular rubber base)를 주사기로 각 사골동내에 주입하여 모형(moulding)을 만들어 이를 1/10ml 눈금의 시험관내에 넣 어서, 이때 모형이 배제하는 물의 양을 가지고 간접적으로 전·후사골동의 용적을 구했다. 한국인 성인사체 50두부에서 얻은 100측의 비강을 재료로 사골동의 형태해부학적 관찰을 하여 다음과 같은 성적을 얻었다. 1. 편측 부비동에서 본 사골봉소의 수는 3-14개였으며 이들 주에서 6-9개인 경우가 68예로서 대부분이었고 6개인 경우가 23예로서 가장 많았다. 2. 전사골봉소군의 봉소의 수는 1-9개였으며 이들중에서 3-5개인 경우가 71예로서 대부분이었고 4개인 경우가 30예로서 가장 많았다. 3. 후사골봉소군의 봉소의 수는 봉소발달이 없었던 편측 1예를 제외하고 1-7개였으며 이들중에서 2-4개인 경우가 77예로서 대부분이었고 3개인 경우가 42예로서 가장 많았다. 4. 사골동의 전후경은 3.59cm, 좌우경 1.12cm, 높이는 1.68cm였다. 그리고 전사골동에서 평균치로 본 전후경은 1.50cm, 좌우경은 0.89cm, 높이는 1.70cm였고 후사골도에서의 전후경은 2.09cm, 좌우경은 1.30cm, 높이는 1.81cm였다. 5. 전사골동의 용적 평균치는 2.48cm**3였으며 후사골동의 용적 평균치는 3.05cm**3였고, 전체 사골동의 용적평균치는 5.53cm**3였다. 6. 전사골봉소군을 좀 더 살펴 보건데 가) 전두와 봉소는 45예에서 존재했으며 이들 봉소의 수는 1-3개였고 이들중에서 1개인 경우가 38예(84.4%)로서 가장 많았다. 나) 누두봉소는 98예에서 존재하였으며 봉소의 수는 1-5개였고 이들중에서 1-2개인 경우가 83예(84.7%)로서 가장 많았다. 다) 사골와봉소는 94예에서 존재하였으며 봉소의 수는 1-5개였고 이들중에서 1-2개인 경우가 74예(78.7%)로서 가장 많았다. 7. 후사골봉소군을 좀 더 살펴 보건데 가) 후사골봉소(posterior cell)는 97예에서 존재하였으며 봉소의수는 1-6개였고 특히 2-3개인 경우가 68예(70.1%)로서 가장 많았다. 나) 최후사골봉소 (postreme cell)는 52예에서 존재하였으며 봉소의 수는 1-2개였고 특히 1개인 경우가 41예(78.8%)로서 가장 많았다. 8. 최상비도는 59예에서 존재하였고 이곳으로 개구되고 있는 최후사골봉소는 52예(88.1%)에서 있었다. 9. 앞으로 따로 분류한 특수봉소에 있어서는 가) 중비갑개봉소는 17예에서 존재하였고 이들 주에서 1예(5.9%)만이 2개의 봉소가 있었으며 16예(94.1%)에서는 1개의 봉소가 있었다. 이들의 개구부는 15예(88.2%)에서 상비도로, 2예(11.8%)에서는 사골와로 개구되고 있었다. 나) 비제봉소는 78예에서 존재하였으며 이들 봉소의 수는 모든 예에서 각각 1개씩이었고 모두가 누두내로 개구되고 있었다. 다) 구상돌기봉소는 3예에서 존재하였으며 모두가 1개의 봉소로서 누두내로 개구되고 있었다. 라) 사골포봉소는 95예에서 존재하였으며 봉소의 수는 1-3개였고 이들중에서 1개인 경우가 83예(84.7%)로서 가장 많았다. 이들의 개구부는 대부분인 87예(79.8%)가 사골와에 있었으나 누두 및 상비도로 개구된 예도 많았다(20.2%). 10. 사골영역을 벗어나 영역외로 확대 발달된 사골봉소를 살펴볼 때, 안와상연으로 사골봉소가 확대된 경우가 43예였고 이들 봉소의 수는 1개인 경우가 37예(86.0%), 2개인 경우가 6예(14.0%)였다. 이밖에도 전두동내로 확대된 경우가 22예, 접형골소액으로 확대된 경우가 29예, 접형동내로 확대된 경우가 19예, 상악골의 안와하연으로 확대된 경우가 12예였고 상악동내로 확대된 경우가 1예였다. 11. 사골봉소 개구부의 모양은 거의가 원형 및 타원형이었으며 (80.8%), 반월형과 방추형(14.4%), 그리고 부정형(5.6%)도 있었다. 12. 사골봉소 개구부의 개구방향은 대부분이 하방(25.8%)과 후하방(48.5%)으로 향했고 전하방(7.1%)과 전방, 후방 및 내방(10.8%)도 있었으며, 또한 상향(7.8%)으로 개구된 예도 있었다. 13. 시신경관이 �측이든 양측이든 사골동내로 발현된 경우는 37두부(74.0%)였고 이것을 비강측별로 보면 52비강에서 시신경관이 사골동내로 발현되었다. 이들 시신경관과 전비극간의 평균길이는 6.37cm, 이들이 비저와 이류는 각은 평균 44.16°였다. 14. 제Ⅲ기판 길이의 평균치는 3.88cm, 제Ⅲ기판이 비저와 이루는 각의 평균치는 45.94°, 제Ⅲ기판의 체판 부착부와 전비극간의 평균거리는 4.94cm였고 이들이 비저와 이루는 각의 평균치는 59.09°였다. [영문] The ethmoid sinus, like the other nasal sinuses, is extremely variable in anatomic characteristics. This honcycomb-like appearance of the ethmoid cells gives the impression of an entangle treatment as they are regarded as a labyrinth. A clear understanding of the normal anatomy and various characteristics of the ethmoid sinus of the Korean is reached only by examination of large series of specimens from cadavers. And it maes possible to diagnose and treat the nasal diseases properly. So far, there has been many studies on this aspect in the western countries and Japan, but in Korea we have still remained in unexplorative field. Therefore, the author examined 100 adult nasal cavities of 50 Korean cadavers in Yonsei University College of Medicine. In this investigation, a study was carried to classify the ethmoid cells according to the location of drainage and determine the number of cells, status of shape and direction of osia, dimension and volume, extramural cellular extensions and relationship to the neighboring structures of the cells. And the following results were obtained. 1. Among 100 ethmoid sinuses, the cell count ranged from 3 to 14 in each sinus, and in which 68 per cent contained from 6 to 9 cells and 23 per cent which was predominant, contained 6 cells. 2. The anterior group cells varied in number from 1 to 9, and in which 71 per cent contained from 3 to 5 cells and 30 per cent which was predomainat, contained 4 cells. 3. The posterior group cells varied in number from 1 to 7 except only 1 sinus without any posterior group cell, and in which 77 per cent contained 2 to 4 cells, and 42 percent which was predominant, contained 3 cells. 4. The dimensions of the ethmoid sinus were 3.59cm in anteroposterior length, 1.12cm in width and 1.68cm in height. The dimensions of the anterior group were 1.50cm in length. 0.89cm in width and 1.70cm in height, and the posterior group were 2.09cm in length, 1.30cm in width and 1.81cm in height. 5. The volume of the anterior group was 2.48cm**3, and the one of the posterior group was 3.05cm**3. 6. Among the anterior cell group in detail, the frontal recess cell was presented in 45 per cent, and the number of the cells ranged from 1 to 3, and 38 sinuses and 84.4 per cent of these contained single cell. The infundibular cell was presented in 98 per cent, varied in number from none to 5 and the 83 sinuses and 84.7 per cent of these contained 1 or 2 cells. The bullar recess cell was presented in 94 per cent, varied in number from 1 to 5, and 74 sinuses and 78.7per cent of these contained 1 or 2 cells. 7. Among the postrior cell group in detail, the posterior cell draining into the superior meatus, was presented in 97 per cent varied in number from 1 to 6, and 68 sinuses and 70.1 per cent of these contained 2 or 3 cells. The postreme cell draining into the supreme meatus, was presented in 52 per cent varied in number 1 or 2, and 41 sinuses and 78.8 per cent of these contained single cell. 8. Among all of 100 sinuses, 59 percent had a supreme concha, and 52 sinuses of these and 88.1 per cent had a cell which drained into the supreme meatus. 9. Among the special cells, the middle concha cell was presented in 17 per cent, and of these 16per cent was unicellular and 1 per cent was bicellular. Of these, 15per cent drained into the superior meatus and 2 per cent into the bullar recess. The agger cell was presented in 78 per cent, and the uncinate cell in 3 per cent. The bullar cell was presented in 95 per cent, varied in number 1 to 3, and in which the single cell was 83 sinuse and 87.4 per cent. And 79.8 per cent of these cells drained into the bullar recess but remains of 20.2per cent drained into the infunibulum and the superior meatus. 10. The supraorbital cellular extension was presented in 43 per cent of which 86.0 per cent was unicellular origin, and 14.0 per cent was bicellular origin. And the cellular extension to the frontal sinus was in 22 per cent, extension to the minor wing of the spenoid bone was in 29 per cent, the extension to the sphenoid sinus was in 19 per cent, the extension to the infraobital plate was in 12 per cent and the extension to the maxillary sinus was in 1 per cet. 11. The ostia of the cells varied in shpae and size; being commonly round or oval (80.0 per cent), cresentric or spindle (14.4 per cent) and non-specific shape (5.6 per cent) in order. 12. The most ostia was advantageously faced and directed posteroinferiorly (48.5 per cent), inferiorly (25.8pr cent), anteroinferiorly (7.1%) and otherwise (10.8per cent), but rarely faced upward (7.8per cent). However, the openings upward were noticed considerably greater in bullar recess cells than others. 13. The occurance rate of the optic canal in the posterior ethmoid sinus was 52 per cent, and the canals were projected into the sinus in 25 per cent which are vulunerable during intranasal surgery. The length from the canal to the anterior nasal spine was 6.37cm, and the angle from this length line to the nasal floor was 44.16°. 14. The length of the Ⅲ lamella was 3.88cm, the angle to the nasal floor was 45.94°, and the length from the upper attachment of the Ⅲ lamella to the nasal floor was 4.94cm and the angle to the nasal floor was 59.09°.restrictio

Clinical and statistical study of allergens in the allergic rhinitis

의학과/석사[한글] [영문] Statistically analysed for the 101 cases with allergic rhinitis and 40 college students without any allergic symptoms as contrary group were chosen, and prick test and nasal eosinophile count were performed. And the following results were obtained; 1. Among 101 allergic cases, male and female ratio showed 4:5. 2. The 54.5%(55 cases) of allergic group and 15%(6 cases) of contrary group showed positive reaction in allergic skin test, but no significant sex difference was found. 3. In 55 allergic positive cases, showed the peak incidence in 4th decade's aged group (27.3%), and next in order were 3rd and 5th decade's aged group (21.8%). 4. Twenty six causative allergens by skin test was verified, and the most frequent allergens were the animal hairs (43.4%) which were dominantly of cat, dog and horse, and next in frequency were the pollens (34.7%) and house dust (14.0%). 5. The most sensitive allergic reaction to house dust showed in before 5 years, animal hairs in 6-9 years, and pollens in 2nd-3rd decades aged groups. 6. Among 150 positives reaction in 55 patients, ++(60) was most frequent, and next in order were +(58), +++(26) and ++++(6). 7. The allergic rhinitis due to foods only 2% which included two cases of mussel and a case of mushroom. 8. Only 27% of the cases with positive skin test showed single allergen, and 73% was multiple allergens. 9. The most common combination of multiple allergens was between animal hairs each, animal hairs and horse dust, pollens each, and pollens and house dust in order. 10. Among 101 cases of allergic rhinitis, 56.4% (57 cases) showed the nasal eosinophilia and 64.9% (30 cases) of these revealed positive allergic skin test.restrictio