The Integrated Surgical Strategy for Removal of Inverted Papilloma Involving the Maxillary Sinus According to the Site of Tumor Origin / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The objective of this study is to determine the appropriate surgical approach for the resection of inverted papilloma (IP) involving the maxillary sinus (MS) according to the site of tumor origin in the MS. SUBJECTS AND METHOD: Twenty-six patients who underwent surgery from January 2002 to April 2008 for IP originating from the MS were reviewed retrospectively in regard to the type of integrated surgical approach, site of tumor origin in the MS and the follow-up clinical results. RESULTS: Ten cases (38.4%) originated from medial wall of the MS; of these, four EES (endonasal endoscopic surgery), two EMM (endoscopic medial maxillectomy), two EES+CP (canine puncture), and two EES+CLA (Caldwell-Luc's approach) were performed. EES+CP procedure were performed in all three cases (11.5%) of the anterior wall origin. One case (3.8%) that originated from the posterolateral wall was removed by EES+CLA. Four cases (15.3%) originated from the medial-posterolateral wall. Two EES, and one each of EMM and EES+CLA were performed. Three cases (11.5%) originated from the superior-posterolateral wall, of which two cases were removed by EES and the other by EES+CLO (Caldwell-Luc's operation). Two cases of inferior-anterior wall and inferior-posterolateral wall were removed by EES+CLO and EES+CLA, respectively. EES+CLO were performed for three cases of the whole wall origin (11.5%). Two recurrent cases were found in each of EES and EES+CLO. CONCLUSION: IP originated from the MS were successfully managed by EES alone or EES combined with other approaches such as CP, CLA, CLO and EMM. These integrated approaches need to be applied in a gradual manner from less severe to more aggressive cases.

Pneumatization Pattern of the Frontal Recess: Relationship of the Anterior-to-Posterior Length of Frontal Isthmus and/or Frontal Recess with the Volume of Agger Nasi Cell

OBJECTIVES: We analyzed the pneumatization pattern of the frontal recess (FR) in a Korean population. We also determined the correlation between the volume of the agger nasi cell (ANC) and the anterior-to-posterior (A-P) length of the frontal isthmus (FI) and FR. METHODS: Multiplanar paranasal sinus computed tomography (CT) images from 105 patients who underwent endoscopic sinus surgery were reviewed. The prevalence of frontal recess cells (FRCs), thickness of the frontal beak (FB), volume of the ANC, A-P length of the FI, and FR were evaluated. RESULTS: The ANC was identified in 96% of the patients and frontal cells (FCs) in 32% (FC type 1, 24.2%; type 2, 4.2%; type 3, 3.1%; and type 4, 0%). The prevalences of frontal bullar, suprabullar, supraorbital ethmoidal, and interfrontal sinus septal cells were 10%, 7.8%, 3.6%, and 6.8%, respectively. The A-P lengths of the FR and FI were 10.1+/-3.1 and 8.4+/-2.9 mm, respectively. The thickness of the FB was 7.8+/-1.8 mm and the volume of the ANC averaged 394.1+/-240.5 mm3. The thickness of the FB did not correlate with the volume of the ANC. In contrast, the A-P length of the FI and FR were positively correlated with the volume of the ANC. CONCLUSION: ANCs and FCs were found in 96% and 32% of the cases in this series. FC type 4 was not seen. What appeared to be FC4 on conventional CT was identified as FBC from reconstructed parasagittal images. A large ANC increased the A-P length of the FI and FR, regardless of the thickness of the FB.

The Surgical Approach for Removal of Inverted Papilloma Originating from the Frontal Sinus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The surgical approach for the removal of inverted papilloma (IP) involving the frontal sinus (FS) depends on the site of tumor origin. This study was designed to determine the appropriate surgical approach according to the site of origin in the FS. SUBJECTS AND METHOD: Eleven patients with IPs originating from the FS, who had surgery at the department of ORL-HNS, Pusan National University Hospital from 1998 to 2007, were retrospectively reviewed for the site of tumor origin, surgical approach, recurrence, mode of reoperation, and complications. The mean age was 53.8 years with a male-to-female ratio of 7:4. The average follow-up duration was 35.7 months. RESULTS: The sites of tumor origin were the whole wall (2/11), medial wall (3/11), intersinus septal cell (2/11), lateral wall (1/11), posterior wall (1/11), anterior wall (1/11) and diffuse whole wall with invasion into the opposite sinus (1/11). In the two cases with whole wall involvement, one was treated by an osteoplastic frontal sinus surgery (OPF) and the other by a modified endoscopic Lothrop operation (MEL). The case with diffuse anterior wall origin was treated by OPF. For the two cases with the intersinus septal cell origin, one was reoperated using MEL after recurrence and the other was initially treated with MEL. A recurrent case with the lateral wall origin was reoperated by MEL. IPs originating from the posterior or medial wall were successfully managed by endoscopic surgery /c or /s trephination. CONCLUSION: IPs originating from the FS were successfully managed by the integrated endoscopic-assisted approach to the FS. Especially, MEL was a safe and effective alternative treatment to OPF for IPs originating from the FS.

Microbiologic Study of the Ear Canal in Koreans / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was designed to isolate bacteria and fungi from healthy ear canal in Koreans and compare with known pathogens. SUBJECTS AND METHOD: Specimens were collected from the external ear swab and cerumen of 45 healthy volunteers from February 2003 to May 2003. RESULTS: Forty-five subjects were cultured. In 8 subjects, we failed to obtain enough cerumen. Three canal and 11 cerumen showed no growth. Forty-two canal specimens yielded 72 microorganisms, of which 84.7% were gram positive bacteria. Twenty-six cerumen specimens yielded 43 microorganisms and 76.7% of them were gram positive. Staphylococci was 76.4% of canal bacteria and 74.4% of cerumen bacteria. In both canal and cerumen, the most commonly isolated microorganism was Staphylococcus capitis. Coryneform bacteria were 6.9% of bacteria in canal and were not isolated from cerumen. Two Aspergillus species and one Penicillium species were isolated from canal and cerumen. CONCLUSION: Coagulase-negative staphylococcus (CNS) were found to be the predominant microorganism and, in particular, Staphylococcus capitis was the most commonly isolated microorganism from the normal external auditory canal in Koreans.

The Expression of p53 and PCNA in Patients with Locally Recurrent Laryngeal Cancer after Radiotherapy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The biologic changes in recurrent laryngeal cancer following radiotherapy are not fully understood. The authors investigated the expression of p53 and proliferating cell nuclear antigen (PCNA) in patients with locally recurrent laryngeal cancer after radiotherapy. MATERIALS AND METHODS: The authors investigated the expression of p53 and PCNA by immunohistochemical stain in 15 patients with recurrent laryngeal cancer after radiotherapy. RESULTS: The expression of p53 protein was significantly different between laryngeal cancer before radiotherapy (4/15, 26.7%) and recurrent laryngeal cancer after radiotherapy (8/15, 53.3%) (p<0.05). Also, PCNA index was significantly different between laryngeal cancer before radiotherapy (mean, 11.9%) and recurrent laryngeal cancer after radiotherapy (mean, 18.0%) (p<0.05). CONCLUSION: The expressions of p53 protein and PCNA were increased more in the recurrent laryngeal cancer after radiotherapy than in the laryngeal cancer before radiotherapy. Recurrent laryngeal cancers changed to biologically aggressive cancer after following radiation therapy.

Normative Measurements of the Inner Ear Structures on Temporal Bone CT Images Using PACS / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The reports of normative measurements for inner ear structure using computer-based programs are rare. The purpose of this study was to measure the normative data of the Korean inner ear structures and establish the basic data for diagnosis of congenital inner ear anomaly. SUBJECTS AND METHOD: Temporal bone CT of 38 patients (16 men and 22 women) without apparent disease of middle and inner ear, fractures or major disorder such as seizure or tumor were retrospectively reviewed. Fifteen dimensions on axial views and 9 dimensions on coronal views were measured in PACS using pi-view program. The slice thickness of CT was 0.6 mm. RESULTS: From the axial view, the canal diameter of SSCC was 1.09+/-0.15 mm, the bony island width was 5.70+/-0.50 mm, the bony island width of LSCC was 3.99+/-0.58 mm, the cochlear upper turn width & height were each 5.63+/-1.07 and 3.03+/-0.65 mm. The vestibular aqueduct were observed 95.3%. From the coronal view, the cochlear height was 5.14+/-0.36 mm. The length of IAC was significantly longer in male than female (p10 dB). CONCLUSION: We established the Korean normative measurements of the inner ear structures, which can be used for further diagnosis of the inner ear anomaly.