Sinusitis due to the Huge Natural Dehiscence of Lamina Papyracea: A Case Report

Natural dehiscence of the lamina papyracea is usually found in ostiomeatal unit CT images and during functional endoscopic sinus surgery. The surgery should be performed on the basis of clinical findings and ostiomeatal unit CT scans to determine the extent of disease and the structural anomalies. Preoperative awareness of dehiscence in the lamina papyracea is essential for avoiding orbital complications during surgery. Sinusitis arising from the natural dehiscence of the lamina papyracea is extremely rare. We report, with a review of the literature, a case of sinusitis due to the natural dehiscence of the lamina papyracea in a 46-year-old female, treated by endoscopic sinus surgery. The CT finding presented a huge natural dehiscence of the lamina papyracea and chronic sinusitis of the maxillary ethmoid sinus. Most of the patient's symptoms resolved without recurrence after endoscopic sinus surgery.

Huge Cholesterol Granuloma With Fungal Ball / 대한이비인후과학회지

Cholesterol granuloma is usually found in chronic middle ear disease. However, it rarely occurs in the sinonasal regions and only a few cases have been reported in the literature. The etiology of the sinonasal cholesterol granuloma is not known yet, and the clinical manifestations are variable. The 78-year-old man complained of facial pain and toothache at first visit. The PNS CT had a homogenous isodense mass occupying right spenoid sinus and extending to right pterygopalatine fossa, infratemporal fossa and masticator space. The PNS MRI had characteristically high signal lesion at both T1- and T2-weighted images. The tumor was completely excised via transantral approach. Pathological confirmation was the cholesterol granuloma with fungal infection consistent with Aspergillus species. This patient is followed up without recurrence.

Multiple Traumatic Pyomucocele

The mucocele of paranasal sinuses is a mucus-filled, epithelial-lined cystic structure resulting from the destruction of the sinus ostia secondary by recurrent inflammation, trauma or intrinsic disease. A 42-year-old man was presented with a left periorbital swelling that developed 7 days ago. CT scan revealed mass lesions with soft tissue density in the left anterior ethmoid and frontal sinus. MRI showed a well- demarcated cystic mass in the left anterior ethmoid sinus with a high signal on both the T1-weighted and T2-weighted images as well as in the left frontal sinus with a low signal on the T1-weighted images and a high signal on the T2- weighted images. The patient subsequently underwent the removal of the left anterior ethmoid and frontal mucocele via a Lynch's approach and a left endoscopic anterior ethmoidectomy. He has no recurrence 6 months after surgery.

Allergic Immune Reaction in Recurrent Aphthous Ulceration by Multiple Allergosorbent Test(MAST) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Recurrent aphthous ulceration (RAU) is most common among benign oral mucosal diseases, but its pathogenesis is not clearly defined yet. We aimed to evaluate the allergic reaction and identify the allergen by using the multiple allergosorbent test (MAST). SUBJECTS AND METHOD: We selected a total of 20 patients with RAU. RAU was not diagnosed by biopsy but by clinical findings, and MAST was performed in all patients. Parameters used were total IgE concentration, type of positive allergens, and the specific IgE concentration. RESULTS: The results were as follows: 1) The total IgE concentration was increased more in the RAU group than in the control group (p<0.05). 2) The type of positive allergens was multiple and had more even distribution in the RAU group than in the control group (p<0.05). 3) The specific IgE concentration according to the positive allergen was higher in the RAU group than in the control group (p<0.05). CONCLUSION: Allergic reactions could be invol-ved in the pathogenesis of RAU. The pathomechanism of allergic reaction to the RAU and the feasibility of treatment options such as avoidance therapy, the immune therapy, and the antihistamine usage need further study.

A Case of Scalp Metastasis from Papillary Thyroid Carcinoma / 대한이비인후과학회지

We present a case of scalp metastasis from papillary thyroid carcinoma which developed on the scalp of a 57-year-old man. The lesion was noticed at the scalp of left parietal area and a biopsy from the nodule showed mostly metastatic papillary form structures with colloidal structure. We performed immunohistochemistry stain using antithyroglobulin antibody, which established the diagnosis of a metastatic lesion from thyroid papillary carcinoma. Total thyroidectomy, excision of scalp nodule, and 131I radiotherapy were performed. No further metastasis has been discovered during the last 12 months.