A Case of Glomangiopericytoma of the Ethmoid Sinus / 대한이비인후과학회지

Glomangiopericytoma, a new term referring to the sinonasal type hemangiopericytoma, is a rare sinonasal tumor arising from modified perivascular glomus-like myoid cells. It is a borderline, low grade malignancy tumor, which has good prognosis following a complete surgical resection. Recently, we experienced a case of a glomangiopericytoma in a 68-year-old woman who presented with epistaxis and unilateral nasal obstruction. Endoscopic examinations revealed polypoid mass with bleeding tendency in the left middle meatus. The tumor was located mainly in the left ethmoid sinus and we removed it successfully by endoscopic approach. Histological examination and immunohistochemistry confirmed the diagnosis of glomangiopericytoma. We present the clinical and histological characteristics, therapeutic principles, and prognosis of this rare disease entity with a literature review.

Menopause and Sleep Related Breathing Disorders / 대한폐경학회지

Women after the menopause appear to be more susceptible to sleep related breathing disorders (SBDs). The increased prevalence of SBDs in postmenopausal women may be related to weight gain and the decline in female sex hormones levels. These conditions may cause upper airway obstruction, which can result in sleep disruption. Other sleep disorders, such as insomnia, depression, and fibromyalgia must be ruled out with SBDs in postmenopausal women with sleep difficulties. Once SBD is strongly suspected through medical history and precise physical examinations, polysomnogram is required for confirmatory diagnosis. In addition, other examinations besides polysomnogram should be performed to detect obstructed regions. Treatment of SBD can be classified into surgical method and non-surgical method. Treatment options must be carefully selected by considering the patient's clinical examinations, patient's preference, age and life style.

Frequency of Nasal Septal Perforation at the Suture Fixation Site of a Silastic Sheet Inserted during Nasal Surgery

OBJECTIVE: This study was performed to evaluate the frequency of nasal septal perforation at the suture fixation site of a silastic sheet inserted during nasal surgery. METHODS: Seven hundred and twenty-one patients with silastic sheet insertion during common nasal surgeries were examined. The frequency of perforations and subjective symptoms of the patients were evaluated. RESULTS: Nasal septal perforation at the suture fixation site occurred in seven patients (0.97%). In three patients, perforations occurred immediately after removal of the sheet, while four patients developed perforations 2 to 4 weeks later. In most cases, perforations were small and did not exceed 2 to 3 mm in diameter. No patient complained of nasal symptoms related to the septal perforation postoperatively. CONCLUSION: The frequency of the septal perforation at the suture fixation site of a silastic sheet was very low and subjective symptoms were absent.

A Case of Subcutaneous Cavernous Hemangioma Presenting as a Nasolabial Fold Mass / 대한이비인후과학회지

Hemangiomas are the most common vascular tumor of the head and neck region, but rarely involve the sinonasal cavity. The majority of these lesions present as a benign tumor of the skin and mucosa. Moreover, most nasal hemangiomas occur in the nasal septum or vestibule. The authors experienced a case of subcutaneous cavernous hemangioma that occurred from right nasolabial fold in a 40-year-old man, which was successfully treated by sublabial approach. We expected the tumor as a radicular or nasolabial cyst because of its location, clinical feature, and radiologic findings. However, the final pathologic diagnosis was cavernous hemangioma. We present the clinical characteristics, radiologic findings, and treatment of a subcutaneous hemangioma with a review of the literature.

A Case of Endoscopic Treatment of a Huge Chondrosarcoma Originating from the Ethmoid Sinus / 대한이비인후과학회지

Chondrosarcoma of the ethmoid sinus is a rare malignant tumor and has a poor prognosis due to the frequent local recurrence and distant metastasis. It has unique and distinctive histologic characteristics, being composed of chondroid tumor cells with spindled cytoplasmic extensions. Wide surgical resection is the treatment of choice and radiation or chemotherapy can be combined with the surgery. The prognosis of chondrosarcoma depends on the anatomical location, resectability, and cytologic differentiation of the tumor. The authors experienced a case of huge chondrosarcoma of the left nasal cavity in a 47-year-old woman, which was resected successfully via endoscopic approach. We present the clinical characteristics, pathology, treatment, and prognosis of the tumor with a review of the literature.

Comparison of Conventional Excision via a Sublabial Approach and Transnasal Marsupialization for the Treatment of Nasolabial Cysts: A Prospective Randomized Study

OBJECTIVES: Surgical excision via a sublabial approach is considered the standard treatment for nasolabial cysts. Although transnasal marsupialization has been proposed as an alternative method, no prospective study has compared the effectiveness of these techniques. We thus compared the surgical procedure, operating time, postoperative pain, complications, and recurrence rate between the two surgical methods. METHODS: Twenty patients diagnosed with nasolabial cysts were allocated randomly into two groups according to the surgical technique. In the sublabial approach group, the cysts were excised completely using a sublabial approach, while in the transnasal marsupialization group, the cysts were marsupialized transnasally under the guidance of nasal endoscopes. The pure operating time was measured and postoperative pain was evaluated using a visual analog scale. Complications after the procedure were assessed and recurrence was determined according to the clinical symptoms and postoperative radiologic findings. RESULTS: The transnasal marsupialization group had significantly shorter operating times, less postoperative pain, lower complication rates, and shorter duration of side effects than the sublabial approach group. No recurrence occurred in either group after a 1-yr follow-up period. CONCLUSION: Although both methods are effective for treating nasolabial cysts, the transnasal marsupialization of nasolabial cysts has many benefits over the conventional sublabial approach. Therefore, we propose that transnasal marsupialization be the treatment of choice for nasolabial cysts.

A Case of Sinonasal Undifferentiated Carcinoma Originating from the Ethmoid Sinus / 대한이비인후과학회지

Sinonasal undifferentiated carcinoma (SNUC) is a rare, aggressive malignancy and commonly asymptomatic until the tumor has extensively progressed. Patients with SNUC usually show the involvement of multiple sinuses and the nasal cavity. In addition, the invasion of the orbit or cranial vault is a frequent finding. Most case series of SNUC report very poor prognosis despite aggressive multimodality therapy. We present a case of SNUC in a 19-year old female occurred from the right ethmoid sinus with invasion to the orbital content.

A Case of Dermoid Cyst of the Nasal Septum / 대한이비인후과학회지

Nasal dermoid cysts are rare neoplasms, which are diagnosed frequently in childhood. These lesions are derived from both ectoderm and mesoderm, and have keratinizing epithelium with skin appendages. A fistula, pit, or mass is the common clinical presentation. The diagnosis is primarily based on the medical history, physical examination, clinical symptoms, and radiologic findings. Complete surgical excision is the treatment of choice. A 15-year-old boy presented with a fistula on the nasal vestibule, which existed from birth. Fistulography revealed a contrast-filling fistulous tract and cyst in the caudal portion of the nasal septum. The lesion was removed surgically and pathology confirmed the diagnosis of dermoid cyst. We report, with a review of the literature, a rare case of dermoid cyst that occurred from the nasal septum.

Olfactory Neuroblastoma Arising from the Inferior Meatus of Nasal Cavity: A Case Report and Review of the Literature / 대한이비인후과학회지

Olfactory neuroblastoma is a rare tumor of nasal cavity arising from the olfactory neuroepithelium. It is usually presented as a polypoid mass high in the nasal vault including cribriform plate, superior turbinate, and superior portion of nasal septum. Recently, we experienced a case of olfactory neuroblastoma occurred from very atypical location. An 89-year-old man visited our department with symptoms of occasional left nasal bleeding and obstruction. On the endoscopic examination, a polypoid mass with bleeding tendency was observed in the left inferior meatus, but other portions of nasal cavity showed normal appearance. Biopsy was performed and the final pathologic report turned out as olfactory neuroblastoma. We report this unusually presenting case of olfactory neuroblastoma with a review of the literature.

Comparative Study on the Long-Term Effectiveness between Coblator- and Microdebrider-Assisted Partial Turbinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various surgical methods have been tried to relieve the symptoms of nasal obstruction in patients with inferior turbinate hypertrophy. Recently, coblators that use radiofrequency and microdebriders are increasingly used in turbinate surgery. The aim of this study was to compare the long-term postoperative outcome between the coblator-assisted and microdebrider-assisted partial turbinoplasty. SUBJECTS AND METHOD: We selected 60 patients who had nasal obstruction and hypertrophied turbinate mucosa that was refractory to medical treatment. Thirty patients were treated with coblator (group 1) and 30 patients were treated with microdebrider (group 2). Postoperative changes in degree of nasal obstruction were evaluated prospectively at 3, 6 and 12 months after the procedure. Cross-sectional area of second notch and volume of nasal cavity were compared at 12 months after operation. Operation time, duration of crust formation, postnasal drip and postoperative bleeding were also compared. RESULTS: Nasal obstruction was improved significantly in both groups. However, statistical significance of improvement and rate of patient's satisfaction at 12 months after surgery was higher in group 2. There were no significant differences in the degree of postnasal drip, operation time and duration of crust formation between two groups. CONCLUSION: This study suggests that microdebrider-assisted partial turbinoplasty is more effective and satisfactory in long-term relief of nasal obstruction and reduction of mucosal volume in the anterior head of inferior turbinate.

Analysis of Complications after Endoscopic Maxillary Sinus Surgery with Canine Fossa Puncture and Microdebrider / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In patients with extensive polyposis of maxillary sinus or antrochoanal polyp, it is very difficult to remove entire diseased mucosa through middle meateal antrostomy and often require the procedure of canine fossa puncture. The aim of this study was to analyze the complications associated with this procedure. MATERIALS AND METHOD: We performed a prospective study and questionnaire about complications on 56 patients who had undergone a canine fossa puncture and removal of diseased mucosa with microdebrider. RESULTS: A total of 91 canine fossa punctures were performed in 56 patients. Twenty five patients (44.6%) experienced more than one adverse effect. The most common complaint was facial or cheek swelling (29.7%) followed by facial or cheek pain (24.8%), facial bruise (17.9%), facial numbness (11.9%), dental numbness (7.9%), tingling sensation (5.9%) and infection of puncture site (1.9%). Most complications (94.1%) resolved within 4 weeks after surgery. Only one patient (0.9%) had persistent facial numbness even at 14 months after the procedure. CONCLUSION: Removal of extensive polyposis and diseased mucosa of the maxillary sinus with microdebrider through canine fossa puncture is a very useful technique. However, a significant number of patients experience temporary or permanent complications after surgery. Surgeons should be aware of these side effects and inform the patients before performing the surgical procedure.

A Case of Surgical Treatment of Atrophic Rhinitis: Silastic Implant

The literature does not report a cure for atrophic rhinitis, but considerable relief of symptoms such as foul odor, crust formation and nasal stuffiness could be given to the patient by surgical treatment, which always involves a method of narrowing the nasal airway. In this report, a review of the surgical technique of silastic implantation, clinical results and follow up is presented. Forty three years old female patient who was diagnosed as primary atrophic rhinitis was treated surgically with silastic implantation. The result was excellent with complete resolution of the major symptoms. There was no complication such as extrusion of implant. We found that the silastic is a readily available and inexpensive material and the surgical procedureis relatively simple to perform and easily revised. We propose silastic implant as a treatment modality of atrophic rhinitis with a review of literatures.

Two Cases of Ectopic Cervical Thymic Tumors Mimicking as Thyroid Tumors / 대한이비인후과학회지

The thymus arises from the ventral wings of the third and fourth branchial pouches in the embryo. Subsequently, the thymus passes down to the mediastinum by the sixth week of gestation. Several unusual conditions such as remnants of the thymus and incomplete descent may occur along the path of descent. Therefore, thymic diseases such as thymoma, thymic hyperplasia, and thymic cyst can be found in the neck. Thymoma is the most common anterior mediastinal mass in adult. Rarely, it is presented as an anterior neck mass, commonly located in the anterolateral aspect of the neck or adjacent to the thyroid. Cervical thymic cyst is uncommon and usually occurs in the first and second decades. Cervical thymic cyst after the third decade is so rare that it is very difficult to diagnose preoperatively. We experienced two cases of cervical thymic neoplasm in the lower anterior neck in an adult. Here, we present the cases with a review of the related literatures.