A Case of Inverted Papilloma without Associated Malignancy Invading the Anterior Skull Base / 대한이비인후과학회지

The inverted papilloma is an uncommon benign tumor constituting 0.5% to 4% of all primary nasal tumors. The tumor is characterized by local aggressiveness, high rate of recurrence and association with malignancy. Intracranial extension or encroachment without associated malignancy is very rare. The treatment should be en bloc resection to prevent the recurrence. Recently, the authors have experienced a case of large inverted papilloma of the nasal cavity invading the anterior cranial base without associated malignancy. The tumor was removed en bloc by craniofacial resection combined with medial maxillectomy through lateral rhinotomy approach. The defect of the skull base was repaired with pericranial flap and temporal muscle flap. The patient has been followed for 2 years and has showed no recurrence.

Type IV Collagen and Fibronectin Deposition of Basement Membrane and Lamina Propria in Benign Laryngeal Lesion / 대한이비인후과학회지

Benign laryngeal injuries have been usually differentiated by the clinical finding. Traditionally the pathologic findings between the polyps and nodules by hematoxylin and eosin(H and E) staining looks alike. So we have used immunohistochemical technique to differentiate the laryngeal response to injury. We have studied 25 paraffin embedded tissues(20 cases: vocal polyps, 5 cases: vocal nodules) to compare their distribution of fibronectin and type IV collagen in vocal fold lamina propria by using their monoclonal antibodies. We have chosen fibronectin, a critical structural glycoprotein in the lamina propria, because of its deposition as a result of tissue injury and type IV collagen because of its location only in the basement membrane zone. The results were as follows: 1) In vocal polyps there were sparse fibronectin(less than normal) staining in superficial layer of lamina propria and the type IV collagen staining in basement membrane zone shows thin, normal thickness band form. These suggests that the injury often seems to be confined to the lamina propria only without basement membrane zone disruption. 2) In voal nodules there were intense fibronectin staining(more than normal) in the superficial layer of the lamina propria and the type IV collagen band in basement membrane shows thick and often coupled with disruption injury. The above results represent only two structural proteins, but it may be possible to suggest that the pathogenesis and the development origin of these laryngeal injuries are different. The deposition of fibronectin may explain why some nodules do not respond to voice therapy and suggest the following better treatment.

Endoscopic Intranasal Reduction of Medial Blowout Fracture / 대한이비인후과학회지

Medial blowout fracture with persistent diplopia and enophthalmos was required surgical treatment. Conventionally, surgery of blowout fracture of the medial wall has been performed by the transorbital approach with external incision. The conventional method had some disadvantages of external scar, increased morbidity, and general anesthesia. We performed endoscopic endonasal surgery without external incision in 2 cases of medial blowout fracture under local anesthesia. The bony fragments were removed after the intranasal ethmoidectomy. And the entrapped medial rectus muscle was released from the bony fragments. Merocel(R) was placed in the ethmoid sinus for the support of the orbital defect for 48 hours. Results of the surgery in all 2 cases were satisfactory and there were no evidences of diplopia and enophthalmos so far.