Immunologic Response to Cryoablation of Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cryoablation has been recognized as a potential tool in the treatment of cancer. Beside its ability to cause local destruction of the primary tumor, cryoablation has been claimed to induce a systemic anti-tumor immune response. We compared cryoimmunologic responses between cryoablation and surgical excision in a murine model of squamous cell carcinoma (SCC). MATERIALS AND METHOD: Six-to 8-weeks-old female mice (total n=30) were used for this study. Tumors were established at the flank of C3H mice with the SCCVII cell line, which is an immunogenic murine SCC of spontaneous origin in the C3H/HeJ mice. The mice underwent surgical excision or cryoablation, when the tumors were between 0.3 and 0.6 cm in the largest dimension. Successfully treated mice were re-challenged with the murine bladder cancer cells, namely, SCCVII cell line or MBT-2 cells at the contralateral flank. One week later, secondary tumor growth was estimated. Spleens were harvested from the mice that had no tumor after re-challenge. Effector splenocytes were added to the target SCCVII cells prelabeled with 3H thymidine. Cytotoxicity was investigated by measuring 3H thymidine releases from target cells. RESULTS: After re-challenging the SCCVII cell line, tumors were developed in 33% (1/3) of the mice treated by surgical excision, compared to 0% (0/4) of mice treated by cryoablation. In the cytotoxicity assay, there were no significant differences between the excision and cryoablation group. CONCLUSION: These results suggest that the anti-tumor immunologic effect of cryoablation in the murine SCC model is not better than that of surgical excision.

Factors Affecting the Improvement of Olfactory Disturbance in Patients Undergoing Endoscopic Sinus Surgery for Chronic Sinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The most common cause of olfactory dysfunction is chronic rhinosinusitis, and endoscopic sinus surgery has been reported to yield beneficial outcome for the olfactory function. The purpose of this study was to study the benefits of endoscopic sinus surgery and investigate the influence of prognostic variables on the olfactory function in chronic rhinosinusitis patients. MATERIALS AND METHOD: We enrolled 52 patients who underwent endoscopic sinus surgery for chronic rhinosinusitis with olfactory dysfunction from July 2000 through April 2003 at Bundang CHA General Hospital, College of Medicine, Pochon CHA University. Patients were classified into 3 groups (well-healing, persistent olfactory disturbance and worse groups). We statistically compared various prognostic variables, such as CT scores, age, gender, allergy, duration of disease. and previous nasal surgery history among the 3 groups. KVSS test was used (Korean Version of Sniffin' Sticks test) for the evaluation of olfactory function. RESULTS: Of the prognostic variables examined, CT scores, gender, allergy, and duration of disease had no influence on the prognosis of olfactory improvement. However, old age and previous nasal surgery were found to have statistically significance on the worse prognosis. The olfactory function improved in 88% of the patients following the endoscopic sinus surgery. CONCLUSION: We concluded that olfactory function of many patients with conductive disorder improved after endoscopic sinus surgery. Gender, allergy, duration of disease had no singnificant influence on the prognosis of olfaction. The severity of sinusitis and the extent of polyps were not consistent with the degree of olfactory repairment

GUARDIX-SL(R) in Sinus Surgery: A Preclinical Animal Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The most frequent complication of FESS (functional endoscopic sinus surgery) is stenosis of the operation site. The complication may influence the postoperative wound healing and the outcome of surgery. There are several measures proposed to prevent the complication. We sought to determine the efficacy of GUARDIX-SL which is made from sodium hyaluronate and sodium carboxymethylcellulose in soluble form. MATERIALS AND METHOD: For 7 rabbits, we made a surgical opening anterior to sinus ostium of the maxillary sinuses on both sides. We put the gelfoams soaked with GUARDIX-SL into the left openings and those soaked with normal saline into the right openings as a control group. We measured the size of the openings after two weeks. RESULTS: There was no synechiae in GUARDIX-SL group whereas we found synechiae developed in two openings in the control group. The mean area of the opening was 9.29 mm2 and 1.61 mm2 in GUARDIX-SL group and the control group (p=0.027), respectively. CONCLUSION: GUARDIX-SL was effective in reducing postoperative stenosis in the animal model.

A Case of Laryngeal Paraganglioma / 대한이비인후과학회지

Laryngeal paragangliomas occur infrequently and are usually benign neoplasms. The overwhelming majority of these tumors are supraglottic, and submucosal lesions arise from the superior laryngeal parasympathetic paraganglia. MRI could find these lesions and evaluate vascularization of the tumor. It is important to distinguish between carcinoid, atypical carcinoid and medullary thyroid cancer. This can be done with histopathologic evaluation and immunohistochemical markers. Complete excision is recommended in the treatment of the tumor. We describe a case of a 32-year-old woman who had an laryngeal paraganglioma.

A Case of Extramedullary Plasmacytoma Originated from the Nasal Septum / 대한이비인후과학회지

The extramedullary plasmacytoma is a neoplastic proliferation of plasmacytes in reticuloendothelial tissues, and it occurs most commonly in the head and neck area, especially in the upper respiratory tract and the oral cavity. The most frequent sites are the paranasal sinuses, nasal cavity and nasopharynx. If histologic diagnosis of plasmacytoma is confirmed, all screening tests are necessary to rule out multiple myeloma. The treatment and prognosis are different according to sites where the extramedullary plasmacytoma is originated. We experienced a case of extramedullary plasmacytoma that originated from the septum in a 60-year-old man. After the embolization, endoscopicgical removal of the mass was carried out. Its histopathologic finging revealed the plasmacytoma of lambda type. Systemic evaluations were done immediately and there was no evidence of systemic involvement. Additional radiotherapy (50 Gy) was performed. After ten months of treatment, there was no evidence of recurrence. So we report this case with a review of the literature.

A Case of Endoscopic Surgical Treatment of the Middle Turbinate Headache Syndrome

Middle turbinate headache syndrome is rare, and the true incidence of headache from this cause is unknown. Pneumatization or hypertrophy of the middle turbinate can result in its contact with the septum or the lateral nasal wall and may give rise to headache in the periorbital region. It may occur in the absence of inflammatory sinus disease. Clinical history, nasal endoscopic examination, and coronal CT -scan should point to the diagnosis. Treatment is achieved by relieving the contact point by medical or surgical means. The authors experienced a case of middle turbinate headache syndrome, therefore we report this case with a review of literature.

The Results of Myringoplasty Using Cartilage Butterfly Technique(Inlay Tympanoplasty) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Popular myringoplasty techniques include either an underlay or an onlay approach using tissues such as temporalis fascia or perichondrium as grafting materials. The "cartilage butterfly technique" using a tragal cartilage graft that resembled butterfly wings without incising canal skin was described by Eavey in 1998. This study describes the results of using this technique and analyzes the postoperative hearings. MATERIALS AND METHODS: Cartilage butterfly inlay tympanoplasty was carried out in 28 patients to close small-to-medium tympanic membrane perforations from October 1998 to December 2000. We excluded one patient due to accidental removal of graft at another clinic. We evaluated the success rate and postoperative hearing results. RESULTS: The graft take rate was 96.3% (26/27) at the end of the follow-up period (mean follow-up was 6.0 months). All of successful cases had cartilage grafts that were intact and dry at the last visit. One patient failed due to otorrhea and extruding graft. Two patients were not evaluated, because one had profound preoperative hearing loss and the other was a cerebral palsy patient. Mean air-bone gap (A-B gap) was improved from 16.3 dB to 9.8 dB. Ten patients had an A-B gap average between 0 and 10 dB, 14 patients between 11 and 20 dB, and no patient greater than 20 dB. CONCLUSION: The cartilage butterfly technique was effective to close tympanic membrane perforations in selected patients. It could provide advantages in high success rate, ease, speed and patient comfort.

A Case of Cerebrospinal Fluid Rhinorrhea Associated with Primary Empty Sella Syndrome / 대한이비인후과학회지

The empty sella syndrome is applied to the abnormal extension into the sella turcica of an arachnoid diverticulum filled with CSF, which displace and compresses the pituitary gland. Such a diverticulum can erode the sellar floor and lead to CSF rhinorrhea through the sphenoid sinus. Recently we experienced a case of the spontaneous CSF rhinorrhea associated with the empty sella syndrome in a 55 year-old woman. The CSF leakage was repaired successfully by sublabial, transseptal, transsph-enoidal approach.