2003

bony cartilage junction annulus .

tympanic bone ? (Rivini's notch )

1

Proctor figue

2
1
2
3
4
5
1
1

EAC tympanic bone squama horizontal portion

?
- betadine cream dressing .
-
(frostbite) .
steroid injection
keloid mefenide acetate
2
549
1 (stab wound), (laceration), (contusion)
2 (Hematoma)

, , , ,

: , dental roll apply

3 (Frostbite)

, , ,

, , (Gangrene) .

: 38-42 20 .
4 (Burn)
1

1 (erythema) 2 (blistering) 3 (full-thickness destruction)

: 3-5 , Pseudomonas, Staphylococcus aureus

: ,

malenide acetate sulfadiazine

2

cold compress Steroid 5-10

3

- sodium carbonate / - 3% acetic acid

1
2
3
4
5

6 , ?

.
.
3 .

1
1

3
572

: observation

: 4-5

4
45
.

1
2
3
4
5

1
1

3 556
exostosis

5
3 , .
.
?
1
Antibiotics and observation
2
Antibiotics and electromyography
3
Antibiotics and myringotomy
4
Mastoidectomy and proper drainage
5
Transmastoid decompression
1
1
6

3
965
Stapedectomy safety zone ?

. stapedial foot plate 1mm .

. utricle, saccule 1mm .

A. upper 1/2
B. lower 1/2
C. posterior 1/2
1
1
C
2
B
3
A
4
B
5
A

1
4
1
2001 p.77, Otologic surgery Brackmann 286-9, Tympanoplasty Ugo fish 221
posterior central posteriorinferior location .

7
10 .
?
1
.
2
.
3
.
4
.
5
.
1
1

1
550

1
2
3
4
5

Retraction pocket cholesteatoma ?

Retraction pocket chole .

retraction pocket

1
1

4
???

2
3
4
5
6

?
.
.
.
.
.

1
1
7
8

4
584
1) >
2) >

9
10

3) ~
5) , > >

10
34 72 .
hemotympanum 25/7 . ENoG 0.8, 2.0
. ?
2

3
steroid 10 observation
4
transmastoid facial n. decompression
5
middle cranial fossa app. facial n. decompression
6
translabyrinthectomy
1
1

2
841, 845

11
12 1 100 . PTA tympanometry
type A . ?
1
palate contraction
2
palate relaxation
3
tensor tympani m.
4
TM joint
1
1

12

1
2
3
4
5

2
816, C 3701, ,

palatal myoclonus - synchronous when relaxation of m.

anastomosis ?
facial sensation
facial muscle tone
facial muscle voluntary movement
possible eye closure
sphincter function of mouth

1
2
a
974

13

. petrous bone squamous bone ?

1
1

. B. D ???
Korner's septum, Cog ???

14
PORP
. 6
? ( 2kHz 30dB, A-B gap 30dB)

1
2
3
4
5

1
6

PORP
PORP

5 4
: Hearing loss
1. incus (mc) - CHL
2. drilling , - - high frequency HL
3. stapes , SCC, cochlea drilling injury -
560

15
9 1
?
1

2

3

4

5

1
1

1
652,670

(16-17) .
.
1 Weber test .
16

2
3
4
5
6

?
Acute serous labyrinthitis
acute suppurative labyrinthitis
Viral labyrinthitis
subacute labyrinthitis
labyrinthine sclerosis

1
1
11
12

2
791, 888
serous:
suppurative :

17
2 90 dB HL, 10%
?
2
radical mastoidectomy
3
transmastoid labyrinthectomy
4
chemical labyrinthectomy

5
6

transcanal singular neurectomy

vestibular neurectomy

1
1

2
791,

18

Labyrinthectomy Indication
suppurative labyrinthitis c meningeal irritation sign
in tympanogenic labyrinthitis (if not meningogenic labyrinthitis)
suppurative labyrinthitis c total deaf

1
2
3
4
5

?
low frequency enhancement
enhancement of acoustic feedback
narrow frequency response
tight-fitting external ear canal mold
improved perception of auditory signal

1
1

5
98 , Paparella 1743

transducer : ossicular chain TM direct vibration . (speaker )

1 cosmetic
2 broader frequency response, low distortion , esp in noisy circumferences
3 adequate acoustic gain
4 elimination of ringing feedback
5 improvement of speech discrimination
6 efficient sound transmission mechanism
7 SDS, Gain, wide frequency, in noise
8 distortion, feedback

, battery

FB reaction

infection

damage of normal structure

expensive

much more electrical power

19

Middle ear implantable coupled to ossicular chain

TB stimulator ( BAHA : bone-anchored HA)
Otic capsule stimulator

?
6
2
3
4
5

1) .
2)
3) .
4) .
5) .

1
1

4 ???
297, 306, 2001 71

, 30


20

21

6
7
8
9
10

(traveling wave) sharp tuning ?

1)Hensen's cell
2)Deiter's cell
3)Inner hair cell
4)Outer hair cell
5)Claudius' cell

1
1
1

4
2002
IHC--> thresholdOHC--> sharp tuning

Passive process -

BM (stiffness effect)

(mass effect)

traveling wave

Active process : OHC

1
2
3
4
5

auditory brainstem implant ?

bilateral profound hearing loss due to ototoxicity
bilateral Mondini deformity
bilateral ossified cochlea
deafed by bilateral vestibular schwannomas
postmeningogenic deafness

4 3 ?

NF-2 vestibular schwannoma removal

ABI Ix

1) : bilat. AN, , ,
auditory neuropathy

2) : , ,
22

23

1
2
3
4
5

?
Michel's deformity
Mondini's deformity
Scheibe's deformity
Enlarged vestibular aqueduct syndrome
high jugular bulb

1
1

4
648, C ped. 419 2002

1
2
3
4
5

?
.
.
.
.

1
1

3
773~5

OHC supporting cell IHC cochlear nerve nucleus

.
.

TTS : temporary threshold shift - reversible

PTS : permanent threshold shift - irreversible

24
. ?
( P676 15-3 )
1

2

3

4

5

1
1
1

25

2
676

(neural)

phonemic regression -

SD Good, stria vascularis , best candidate

longitudinal flow theory ?

1
stria vascularis-ductus reuniens-saccular duct-endolymphatic sac
2
stria vascularis-saccular duct-saccule-endolymphatic sac
3
stria vascularis-ductus reuniens-cochlear duct-endolymphactic duct
4
stria vascularis-saccular duct-cochlear duct-endolymphatic duct
5
stria vascularis-cochlear duct-ductus reuniens-endolymphatic sac
5 378 1, 5

13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

1) longitudinal flow theory - slow process
1. stria vascularis ductus reuniens
saccule saccular duct
2. dark cell utricular duct

endolymphatic duct

endolymphatic sac perivascular space

2) radial flow theory - fast process
plasma source Reissner's membrane
3) dynamic flow theory
local radial flow :
+ longitudinal flow : ,
26

? (Bailey 1625 Fig.129.8)

 Tunnel of Corti OHC - Hensen's - inner

pillar cell - Deiter's

27 1300gm
audiology screening TEOAE
normal ?
(TEOAE: 15.6dB, reproducibility:
98%)
1 CT
2
3explo-tympano
4CI
5
1
1

28
1
2
3
4
5
1
1

5
diagram

SRT ?
PTA 12% malingering


roll-over phenomenon

3
493
( ; SRT)
( ; S test)

 ( cochlesr or retrocochlear)

(HA dynamic range
)

SRT; SRT PTA 10dB , 15dB PTA

5 SD test ; SRT 35-40dBshv SD score
SDT < SRT < MCL < UCL < pain
8-10 30-40
75-90
29

1
1

1
2
3
4
5

posturography ?



,

4
553

falling risk
30 . (tympanometry , X
Y ) 1) compliance .
2) mmHg
3) intensity
4) pressure
5) intensity .
(4)

461

31

1
1

32

1
2
3
4
5

X : mmH2O(-400 ~ 200mmH2O)
Y : compliance() :

?
.
.
.

1 : --> ,
808~809, Cummings 2752

2,3,5 809page
. 1 4 , Cummings

Cummings
1 .

11

? (P455 1-2 )

33
?

34

: 3 454

10-15dB .


.
10-15dB .

50dB~60dB .
Sinusoidal rotational test . ampulla phase

12
: 4 489~489, 1-17

.
MRI ? ( P866 F30-19 )

1
2
3
4
5
1
1

cholesteatoma low, high

cholesterol granuloma high,high
chordoma AN
vestibular schwannoma iso, high
meningioma x

5
999, 269~273

meningioma
. MRI T1

gadilinium .

T2

35
,
?
1
.
2
0.13
3
0.2
4
0.6
5
1
1
1

4
745~6

36
1
2
3
4
5
1
1

? (Nasal cycle graph )

3
119

37

1
1

62%. .

1
2
3
4
5

. .

30 . ?
T&T
electrolfactogram
PNS CT
nasal mucosa Bx.
Brain CT

4 or brain MRI
877, Cummings 787

Congenital anosmia . congenital anosmia

Kallmann syndrome . Cummings (, Post-URI
...)

.
.
biopsy
?

38
. ?
( : , : mean daily score)
- 4

 - 3
- 1,2 4
-
1
Cromolyn sodium eye
2
Antihistamine
3
Anticholinergics
4
Steroid
5
N-O
1
1

4
1003 6-7

systemic steroid
.

Rhinorrhea

symptom

sneezing

39
30 TSA
CONSULT
1. TSA .
2. 2 consult
3. 4 .
4. ESS TSA .
: 1)
40
Jugular
1
2
3
4
5
1
1

1
2
3
4
5
1
1

8 .
vein . ?
Glioma
Encephalocele
dermoid cyst
neurofibromatosis
hemangioma

2
1127

41

Furstenberg sign

?
Substance P .
Histamine .
.
.
.

5
43, C 810

- , , ,

- , , , , ,

Resistance vessel vasodilator- PGE2, Histamin, Bradykinin, Substance P, VIP (

)

Resistance vessel constrictor- Noradrenaline, Epinephrine

Cf) PGE2 Capacitance vessel vasoconstrictor

42
12 , , 6
, , , , .
, . ?
( Soft tissue density , Orbit
Subperiosteal abscess )

1

.
2

.
3
.
4

.
5

.
1
1

2
1050, 345

1
Cellulitis
, , , 2-3

43

?
1
.
2
Concha bullosa , sickle knife scissor concha 1/2
medialization .
3
Floppy turbinate superior remnant .
4
nasal polyposis , Debrider .
5
Isolated sphenoid sinus disease Wigand technique .

1
1

2
1206, C1158, 2003

1,3,5 , 2 . 4 ?

Wigand technique revision ESS sphenoid

. transnasal sphenoid ostium ethmoid
roof .

44
50 , , .
. ? (CT

Soft
tissue density
)
1



,


.
2

T2WI .
3
polyp Caldwell-Luc approach .
4
.
5
/ work-up .
1
1

1
223

45
B helper T cell , Ig
isotype switching IgE . Ig E isotype switching
cytokine ?
1
IL-3, GM-CSF
2
IL-2, IL-5
3
INF-, GM-CSF
4
IL-4, IL-13
5
IL-3, IL-4
1
1
1

4
2003
336, 342

IL-4 isotype switching , IL-13 IL-4

.
by !Th1: IL-2, INF-rTh2: IL4,5 --> allergy : IL-5

1
2
3
4
5

46
30 3
.
, .


.
? (CT unilateral
sinusitis (calcification))
.
lateral rhinotomy .
.
.
. .

1
1

fungal sinusitis ???

1137

Unilaterl lesion Fungal sinusitis .

Fungal aspergilloma , 1.2

, 3 allergic fungal allergic fungal . 5
allergic fungal .

47

1
1

1
2
3
4
5

?
.
.
electrocautery .
caudal 2cm .
anterolateral external rhinoplasty approach .

5
271, 1079
33 1) .
34 2)
35 3) electrocautery .
36 4) 1~1.5 .
37 5) 1079,

.
38 ,

 .
48
20 C-L approach , CT zygoma round expansile mass
. ?
1
revision C-L approach
2
intranasal endoscopic surgery
3
needle aspiration
4
biopsy by C-L approach
5
medial maxillectomy

1
1

1
1183

C-L
( cilliary dyskinesia cystic fibrosis)
antrochoanal polyp
fungal sinusitis
POCC

pterygopalatine fossa

, , ,

, oroantral fistula

49
polysomnogram
? (central type sleep apnea )
2
Acromegaly
3
Bulbar polimyelitis
4
Narcotic overdose
5
Degenerative neuronal disease
6
bilateral cervical cordotomy

1
1

1
1372 230

39
.
40 central : narcotic overdose, bulbar polymyelitis, degenerative neuronal disease, bilateral
cervical cordotomy
41 obstructive : adenotonsillar hypertrophy, hypothyroidism, acromegaly
50

1
1

2
3
4
5
6

4
1188
42 transantral ethmoidectomy
43 : , ,
.

51
2
3
4
5
6
1
1

Allergic fungal sinusitis ?

allergic mucin
incresed IgE
nasal polyp
Charcot-Leyden crystal
vasculitis

5
1140

52
2
3
4
5
6
1

Caldwell-Luc approach cell ?

frontal recess cell
agger nasi cell
Concha bullosa cell
posterior ethmoid cell
ethmoid bulla

Wegener's granulomatosis ?
c-ANCA disease activity .
systemic vasculitis phase c-ANCA 90%.
p-ANCA c-ANCA .
c-ANCA WG .
c-ANCA proteinase 3 .

3 1065c-ANCA=anti-PR3 70%, 90%

90%

53
.
200/150mmHg . ?
1
.
2
epinephrine .
3
(PEEP?) .
4
100% .
5
.
1
1

3 ??? 5 ?
454

54
Corrective rhinoplasty open approach .
? (Rhinoplasty collumella incision collumella artery )

2
facial artery
collumellar artery
3
facial artery
collumellar artery
4
facial artery
collumellar artery
5
facial artery
nasal artery
6
facial artery
lat. nasal artery
1
1

45

55
2
3
4
5
6

dorsal nasal artery

angular artery
sup labial artery
angular artery lat.
sup labial artery

3
963
44

facaial a. angular a. lateral nasal a.

sup.labial a. columella a.

FESS ?
antrostomy recirculation

CT mucocele
polypoid change

1
1

4
2003

Ix.

POCC, mucocele

2 ** 1215
3
, expansile mucocele
.
4 # 19-1
5 -

6 -
7 -
8 -
9 -
10
-
11
-
12
-
13
-recirculation phenomenon
56
graft
? (Spreader graft)
1
dorsal septum .
2

3
bony vault overnarrow .
4
external nasal valve .
5
cartilaginous vault augumentation
.

1
1
1

1
1480
spreader graft ,
, ,

57
50 Stankiewicz sign .
.
?
2

3

4
mannitol
5
dexamethasone
6
lateral canthotomy
1

Stankiewicz sign: .

1. , 2. , , , 3.
,
, .

58

amphotericin B ?
2
liposomal formulation drug level systemic toxicity
.
3
hepatotoxicity .
4
fever, chilling 4-6 .
5
fluid overloading .
6
Rifampin .

1
1

3
1138, 402
1 conventional amphotericin B liposomal amphotericin B
46
amphotericin B colloidal dispersion
1 rifampin 5-flucytosine . (,
)

A" journal
2 liposomal formulation conventional amphotericin B more effective .
1 Saline infusions have been advocated to reduce azotemia.
1 Initial doses of amphotericin B occasionally cause marked febrile reactions.
1 Infusions are generally given in 5% dextrose over 2 to 4h.
1 hepatotoxicity .
1 Kims-online ,
2 <1% . - >10% .
47
(, hepatotoxicity )
59

1
2

2
3
4
5

Allergic skin test ?

.
.
.
.

1
late evenig peaksex, race: no significance >
60

2
3
4
5
6
1

61

1
2
62

1
2

2
3
4
5
6

Boies elevator
Asch forceps
Dingman forceps
Freer elevator
Walsham forceps

1)
48

?
sneezing
sneezing, itching
ithcing, blockage
blokage, running
running

2 ???
??? running: parasympathetic?, blockage: sympathetic?

1
2
3
4
5

panoramic view ?
ramus
body
symphysis
condyle
angle

3?
Som 914

63
10 .
2 . , , ,

 .
?
1
.
2
OMU CT .
3
.
4
.
5
.
1
2
64

1
2

1
adenoid ..

2
3
4
5
6

?
frontal lobe
ethmoid roof
facial skin
infratemporal fossa
carvernous sinus

5
1)2)3)4)--> T4a, 5)-->T4b?T4b: Nasophx, clivus, orbital apex, CN involve(V2 ), MCF, dura,
brain

65
2
3
4
5
6

?
,
, CT .
,
1.5mm
CT

1 2) 1407
OP Ix:
1) (forced duction test )
2) 2 ,
3) 2mm
4) (2cm defect, 3mm -> 345)
+ 345p 5) ()
66

1
2
67

1
2
3
4
5

Taste bud ?
fungiform papillae
foliate papillae
filiform papillae
circumvallate papillae
soft palate

3) 133

1
2
3
4
5

sup. pharyngeal based flap elevation ?

submucosal layer ~ lamina propria
Lamina propria ~ sup. pharyngeal constrictor
sup. pharyngeal constrictor ~ prevertebral fascia
prevertebral fascia ~ prevertebral muscle
prevertebral muscle ~ vertebra

3) 1260

sup. based post. pharyngeal flap: VPI , 14Fr , 20mm2

68
10 , .
1~3cm multiple lymph node
. lab EBV IgG(+), EBV IgM(+) .
?
2

3
steroid
4
ampicillin
5
,
6

1

3)

69
30 .
. CT ? (Axial

CT : Lt.
2
3
4
5
6
1

70

submandibular gland calcification )

facial n. buccal br .
.
mylohyoid m retraction .
.
sublingual gland .

5)1) marginal mandibular br.2) Lingual n.3) Hypoglossal, Lingual n.4) 2

3)

71
1
2
3
4
5
1

?
Lymphangioma
Lymphoma
Hemangioma
Monomorphic adenoma
Pleomorphic adenoma

1
2
3
4
5

Frey SD ?
fascial graft interposition
glycopyrolate application
oral pilocarpine administration
tympanic neurectomy
Botox injection

1288

Frey syndrome
Anticholinergic effect : 3% scopolamine , 1% glycopyrrolate, atropine
Botulinum toxin
(tympanic neurectomy)
,
Pilocarpine - Cholinomimetics

72
50 . . CT
FNAC Chest PA coin lesion . ?
2
Pleomorphic adenoma
3
Mucoepidermoid carcinoma
4
Adenoid cystic carcinoma
5
Acinic cell carcinoma
6
Squamous cell carcinoma
1
2

3
1581

perineural invasion
distant metastasis

73
2cm X 3cm FNAC Acinic cell carcinoma .
CT superficial mass . ?
1
+
2
+
3
+
4
+ +
5
+ +
1
2

74

2 1 1584

1285 < 3-11>, < 3-11>

3 Major salivary gland TNM staging
T stage
T1 : tumor 2cm & extraparenchymal extension(-)
T2 : 2cm < tumor 4cm & extraparenchymal extension(-)
T3 : 4cm < tumor and/or extraparenchymal extension(+)
T4a : skin, mandible, ear canal, facial nerve
T4b : skull base pterygoid plate , encasement of carotid a.
N stage - oral cavity ca. oropharynx ca.
N1 : single ipsilateral LN 3cm
N2
N2a: 3cm < single ipsilateral LN 6cm
N2b: multiple ipsilateral LNs 6cm
N2c: bilateral or contralateral LNs 6cm
N3 : 6cm < LN

2
3
4
5
6
3

Vocal intensity ?
airflow
closed phase
vocal fold length
subglottic pressure
laryngeal muscle tension

75

1
2

76

1
2

2002 18

Increased vocal intensity(loudness)

14 greater subglottic pressure
15 greater airflow
16 greater laryngeal muscle tension
17 longer closing phase

Pitch(frequency) control
1 vocal fold length & tension : primary determinant of pitch

- vocal fold length : maximum at rest breathing & shortened during

phonation

-CT & Cricopharyngeus muscle : lengthening vocal folds pitch

2 Subglottal pressure pitch
3 Larynx size pitch ( higher pitch)

2
3
4
5
6

?
Collagen fiber
Elastic fiber
Fundamental frequency

Vocal ligament

4Collagen
155

1
2
3
4
5
B. 214

2
3
4
5
6

fiber, elastic fiber , F0

(>)
(Epithelial layer) :
(Superficial layer) : , fibroblasts, elastic & collagen fibers
(Intermediate layer) : collagen fiber
(deep layer) : fibrosis & thickening of collagen fiber
(muscle layer) :
Causes of vocal quality deterioration with aging
Laryngeal cartilage ossification
Arytenoid cartilage excursion
Incomplete glottic closure
Collagen & Elastin fibers
Laryngeal muscle atrophy
Fundamental vocal frequency
: ,
vocal folds edema polypoid degeneration (, smoker ) .

Valsava maneuver ?
Vocal nodule
Reinke's edema
Vocalis sulcus
Recurrent laryngeal nerve palsy

4 ???
1593

, .

- (effort closure), (glottal attack)

2
3
4
5
77

1
2

78

2
3
4
5
6

-
1
60% .
2
.

?
Chest PA
Electroglottography
EMG
Neck CT

2
1592

,
, , ,
, ,
2003 54-56, 2001 113

EGG : recording cycle-to-cycle vocal fold function

- , -

EMG

- ,

motor neuron disease

- , ,

- , , .

1
2
3
4
5

. ?
Stroboscopy
Voice analysis
EMG
TFT
PFT

1
2

3
1590

larynx muscle: CT muscle

(contraction of CT muscle vocal fold tension high pitch sound)

CT muscle motor nerve: External branch of SLN

SLN palsy selective EMG

79
?
1
2
3
4
5

Biopsy severe dysplasia with atypia .

VC stripping
laser cordectomy
laryngofissure with cordectomy
RTx

1
2

2
1396, B. 1471

When a diagnosis of severe dysplasia or carcinoma in situ is made and when the
site of the lesion involves the true vocal cord, microscopic suspension laryngoscopy with
stripping of the epithelium and a closely monitored program of follow-up are incicated.

Microinvasive carcinoma can be managed by endoscopic excisional biopsy(vocal

cord stripping), by laser excision endoscopically, or by radiation therapy.

ex) Sequential vocal cord stripping every 3 months until two consecutive
epithelial stripping specimens can be confirmed to be free of malignant cells.

80
2 . stridor 4 ,
. .
?
2
congenital choanal atresia
3
laryngomalacia
4
vocal cord palsy
5
congegnital subglottic stenosis
6
posterior laryngeal cleft
1

81
tracheotomy
?
2
TA
3
LCA
4
PCA
5
IA
6
CT
1

82
1
2
3
4
5
1
2

tracheotomy pneumothorax, pneumomediatinum ?

.
pleural apex .
marginal alveoli rupture .
pneumomediastium obervation .
.

4 1
.

83
emergency tracheotomy .
?
2
tube obstruction
3
intraluminal ???
4
vasovagal reflex
5
vagovagal reflex
6
CO2 retaining
1
2
84

2
3
4

fiberoptic bronchoscope rigid bronchoscope ?

upper respiratory tract .

5
6
1
85

thick secretion

1 ???

2
3
4
5
6

LPRD ?
laryngeal cancer
contact granuloma
larygeal stenosis
pharygeus globus
laryngocele

5 2021, 2025

86
50 primary mass preacuricular lymph node
?
1
Scalp
2
oropharynx
3
paranasal sinus
4
nasopharynx
5
hypopharynx
1
2

1 2082
.
.

87
T1N0M0 SCC Dx , SOND, 1cm, Level II
extracapsular spread 1 X 1 cm LN ?
2
close F/U
3
post op RTx
4
RND
5
RND + Post op RTx
6
Chemotherapy
1

88

1
2
89

1
2

2) 1607 : , ,
T

1
2
3
4
5

mandibulotomy ?
incisior
canine
premolar
1st molar
2nd molar

2
paramedian mandibulotomy: lat. incisor canine .

2
3
4
5
6

2 ?

4
2003 158

larynx ca. synchronous second 1 cancer lung ca m/cmultiprimary cancer: orophxesophagus larynx- lung

90
modified barium swallowing test
swallowing ?
2
supraglottic swallowing
3
supersupraglottic swallowing
4
effortful swallowing
5
Mandelsohn's maneuver
1
2

3 2092
2002 174

effortful swallowing:

tongue hold or Masako maneuver:

,
, .

91

?
2

3

4

5

6

1
2

4
1502, 99 33

, , ( ), ,
,

extracapsular spread prognostic factor

.

92
T3N1M0
. ?
2
2500cGy
3
3500cGy
4
5000cGy
5
6500cGy
6
8000cGy
1
2

3
366

93

2
3
4
5
6
2

1 45Gy

?
cricoarytenoid joint fixation
thyroarytenoid muscle invasion
subglottic extension
interarytenoid muscle invasion
recurrent laryngeal nerve invasion

236, B1743, P2340

TA m. invasion (m/c)
CA joint invasion
paraglottic space invasion
RLN invasionmuscle > joint > nerve

94
radial forearm .
?
1
velopharyngeal closure
2
pharyngeal peristalsis
3
laryngeal elevation
4
laryngeal closure
5
opening of upper esophageal sphincter
1
2

2
1574, , 99

RFFF postop. swallowing

peristalsis ..

95
Radical neck dissection , .
?
1
jugular foramen
2
submandibular triangle
3
internal jugular vein
4
common carotid artery
5
supraclavicular fossa
1
2

4
1535

Horner's syndrome: ptosis, anhidrosis, miosis

Sympathetic n. injury

96
2
3
4
5
6
1
2

3
1560, Urken51) RFF2) JFF4) FOCF

97
2
3
4
5
6
1
2

? (PMMC flap)

?
DP flap
PMMC flap
Gastric pull up
Colon interposition
Lateral thigh cutaneous flap

5
1557-, Urken183
DP flap: regional flap
PMMC flap: regional flap
gastric pull up


Total esophagectomy

Rt. gastric, Rt. gastroepiploic, splenic a. .

Clon interposition: pedicled transplantation
Lateral thigh flap: perforator of profunda femoris a.
1
(98-99)
. Nasogastic tube .
98

2)
3)
4)
5)

?
2

3

4

5

6
5 1)
uvular deviation to right
normal gag reflex
pyriform sinus saliva pooling
mandibular neuralgia

1
2

: 4
1512, 1534, 257-, B573

CN VII, IX, X, XI, XII, sympathetic nerve injury, V3?

VII: facial paresis

IX: decreased pharyngeal sensation

X : aspiration, hoarseness, soft palate paresis

XI: SCM or trapezius weakness

XII: tongue paresis

sympathetic trunk: Horner syndrome

Jugular foramen syndrome (9,10,11)

Parapharyngeal space tumor extension jugular foramen

cranial nerve palsy

99
2
3
4
5
6
1
2

?
flexible laryngoscopy
direct laryngoscopy
esophagoscopy
videofluoroscopy
EMG

4
1700

100
RLN ?
1 C 2446, 179, 1620 Cummings F 128-2

CCA, ITA, TEG (Simont's triangle)

2003
101

1
2

Round window
F 3.88 Anatomy of the Temporal bone with surgical implications (Schuknecht)

102
(5 )
1) ,
2) ( 65 )
3)
4)
5)
6)
7),
2
8), hypovolemia, bacteremia
3
9)
3 765 16-2
103

Definitive Meniere`s disease criteria

2
2 20
3
1
4

5

914

104

1
2
3
4
8

105

(3 )?
(isthmus) S shape
cerumen: .
cerumen: lysozyme -->
cerumen: acidic pH(6.5~6.8)

3 ?

1
Cleft palate, craniofacial anomaly
2
NPC, RT
3
surgically removed E-tube

106
40dB .
(perioperative complication) 4
. (1 0 , 2 0.5 , 3 0.8 , 4 1 )
2
Facial nerve palsy
3

4

5
Menigitits
6
Perilymph fistula :
7
SNHL
8
Brain hernia
7 589
107

Tympanosclerosis
1
collagen
2

3

4

5

615

108

2 CI 4
1

2
antrum, facial recess
3
Otitis media incidence CI biosafty .
4
postop dressing rehabilitation
5
Skin necrosis .

109

? (Tensor tympani tenton

cutting )

2
3

? Paparella 1429 1424

Tensor tympnai tendon cutting

?

Malleus lateralized,
which opens the mesotympanic space

110

5
2
vascular tumor (paraganglioma)
3
temporal bone tumor
4
ateriovenous malformation
5
A-V fistula
6
venous hum (dehiscent jugular bulb, HTN)
7
High jugular bulb
8
arterial bruit (high riding CA, carotid stenosis, persistent stapedial a)
816, 2002 173, 2002 65

111

Tripod fracture , open reduction incision site

1
Lateral eyebrow incision
2
Eyelid incision
3
gingivobuccal incision
1414

112
.
. (CT choanal atresia )(3 )
1

2

3
methylene blue dye
4
PNS view
5

6
CT
1

angiofibroma

endoscopic exam

PNS CT

angiography
18
1246

113

. 1)
2) ,
3) (1 )4)
()5) (, ) , 6) 7)
8) , 1100 8-7

114
CT
?
1
optic nerve
2
foramen rotundum: maxillary
nerve (maxillary branch of
trigerminal nerve)
3
vidian canal: vidian nerve
49
2 Som fig 22-82
115
PNS CT coronal view
lateral lamella
1

?

lateral lamella of
ethmoid bone
2

?

.
2002 , 2003 , 1091

1
116

radiofrequency ablation ?(3)

1
submucosal channeling

soft palate for snoring

turbinate for nasal obstruction

tongue base for sleep apnea

2
surface ablation/excision

tonsillotomy

tonsillectomy

UPPP
3
other possible application

H & N surgery: parotid, ND, lymphangioma

2002 159

117
Frontal recess cell ? 1)agger nasi cell
2)frontal cells
3)suprraorbital ethmoid cells
4)frontal bullae cell
5)suprabullar cell 101
118
1

? ( 1229 bulb press test)

Stankiewicz sign

119

house dust mite allergy (3)

1
20, 45% .
2
, ,
3
60 .
4
.
5
mite-proof cover
6
HEPA filter
1095

120
3

lateral osteotomy (2)

2
nasal dorsum straightening
3
open roof deformity
310

121

.(4/11)
2
histopathology
3
lymph nod metastasis
4
pain
5
facial nerve paralysis
6
skin involvement
7
stage
8
location
9
recurrence
10 distant metastasis
11 radiation sensitivity
12 chemotherapeutic sensitivity
2002 56 1584, 99,100

122
Addutor spasmotic dysphonia TA muscle
2 ?
1
.
2
.
1
2
123

EMG electrode TA ~
1980

3
4

maximal phonation time (3)

1
(recurrent laryngeal nerve paralysis)
2
(Sulcus vocalis)
3
(large vocal polyp)
1975
2001 107 () ,
1
(glottic chink) MPT
, , , .

124
2
3
4
5

recurrent respiratory papillomatosis posterior glottis exposure ?(4)

endotracheal tube larygoscope anterior commissure .
posterior exposure laryngoscope .
jet ventilation .
apneic technique .

5
125
1
2

tracheotomy ?(1)
innominate artery

126

pharyngocutaneous fistula
1
wound: erythema, tenderness, fluctuation
2
(foul odor)
3
(turbid fluid drainage)
4
(saliva leakage)
5

6
Leukocytosis
1916, 2002 210methylene blue

127
Airway compomised transglottic cancer Tracheotomy, Functional neck
dissection, Radical neck dissection, Total laryngectomy .

1
Tracheotomy
2
Functional neck dissection
3
Radical neck dissection
4
Total laryngectomy
128

?
1
RT
2
Perichondritis
3
,
4
Osteoradionecrosis
5

332, 1407

129

?
1
,
2

3
< 5mm
4

5

6

7

1706, C2144 Box112-3

130

2
3
4

?(Cummings F 64-6)
Duct of submandibular gland.
Lingual a.
Hypoglossal n.

C1208

superficial to mylohyoid m.
SMG
associated LNs
facial a.&v.
motor n. to mylohyoid m.&ant. belly of digastric m.
marginal mandibular n.(most superficial)

superficial to hyoglossus m.

deep lobe of SMG

sublingual gland

Wharton's duct

lingual n.

hypoglossal n.(most inferior)

deep to hyoglossus m.
lingual a.
stylohyoid ligament
CN IX