Treatment of Facial Neuralgia Developed after Inferior Meatal Antrostomy by Narrowing of the Inlet with Endoscopic Cartilage Graft

Inferior meatal antrostomy (IMA) is a widely performed surgical technique to treat postoperative maxillary mucocele. The method is safe and easy to perform, without major complications compared with other approaches. Facial pain after IMA is a rare clinical entity that can be challenging to diagnose and treat. The authors present an unusual case of acute facial neuralgia triggered by cold air that developed after IMA. The antrostomy was located at the anterior-most part of the inferior meatus, and the inlet size was relatively large compared with the size of the remaining sinus. Surgical narrowing of the antrostomy inlet using endoscopy dramatically reduced the symptoms, and symptom relief was maintained for up to one year after surgery.

Evaluation and Treatment of Nasal Obstruction Developed after Rhinoplasty / 대한이비인후과학회지

Nasal airway obstruction is one of the most frequent causes of revision rhinoplasty despite the golden rule that nasal function should not be sacrificed because of cosmetic reason. Nasal function is jeopardized due to diverse reasons including inaccurate diagnosis or inadequate surgical technique. Detailed and thorough evaluation of the nose with review of previous operative technique is necessary to find out exact causes of obstruction. Septum, middle vault, tip, nostril, and nasal mucosa are common anatomic areas of obstruction after rhinoplasty. They are often weakened, damaged, or even destroyed losing their original shape, strength, or position. Changes in these anatomic structures are strongly related to static and/or dynamic obstruction. In this article, authors reviewed the common locations, anatomic causes, and treatment strategies of nasal obstruction after rhinoplasty.

Histopathological Evaluation of Collagen Sheet (Permacol®) after Augmentation Rhinoplasty / 대한이비인후과학회지

In Asian rhinoplasty, allograft materials are often required due to insufficient amount of autologous sources for dorsal augmentation. Nowadays, Silicon and polytetrafluoroethylene are commonly used allograft materials although these can often lead to postoperative complications such as protrusion, migration or infection of implanted graft. Permacol® is a collagen sheet which is indicated for soft tissue reinforcement or repair of the head and face area in plastic and reconstructive surgery. Its clinical safety and stability is well established with low complication rates. However, its histopathology has rarely investigated, especially in human. Thus, we reviewed histopathology of two graft-removal cases of patients who had undergone rhinoplasty using Permacol®. In conclusion, Permacol® can lead to fibrosis of imbedded tissues with or without absorption in long-term follow-up. Although Permacol® is gradually absorbed as time passes, the implanted graft can maintain its volume by replaced fibrotic connective tissues.

Rhino-Orbito-Cerebral Mucormycosis Complicated as Facial Paralysis and Ophthalmoplegia without Rhinologic Manifestation / 대한이비인후과학회지

Rhinocerebral mucormycosis is a type of opportunistic infections, which can often be lethal in immunocompromised patients. The infection usually occurs in the nose and can spread to adjacent structures. The most typical symptom is facial pain, followed by headache, fever and bloody tinged rhinorrhea. We experienced three cases of rhino-orbito-cerebral mucormycosis, which showed atypical initial presentations. In our cases, patients visited hospital for unilateral ophthlamoplegia and facial palsy without having any nasal symptoms. After evaluating neurologic and ophthalmic problems, they were referred to the Otolaryngology Head and Neck Surgery Department for confirming nasal invasions. Despite using early a parenteral antifungal agent with immediate surgical debridement, patients died due to a residual cerebral lesions and multiple organ failure. In this article, we present the prognosis and management of rhinocerebral mucormycosis patients with atypical symptoms, as well as a review of the published literatures.

Mucosal Melanoma of the Sinonasal Tract: Retrospective Analysis of 38 Patients of a Single Institution / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mucosal melanoma comprises 1.3% of all malignant melanomas and mainly occurs at the oropharynx and the sinonasal cavity in the head and neck area. Five year survival rate is about 10-46%. We aimed to investigate the clinical features and treatment outcomes of 38 patients with sinonasal malignant melanoma (SNMM). SUBJECTS AND METHOD: A retrospective review of medical records was carried out on 38 patients who were diagnosed as SNMM between August 1995 and December 2012. Clinical features were evaluated and tumors were staged according to the TNM staging system. The Kaplan-Meier method was used to assess survival in the cohort. RESULTS: The 38 patients consisted of 18 males and 20 females, ranging in age from 36 to 91 years, with a median age of 59 years at diagnosis. Common symptoms were nasal obstruction and epistaxis, and mean symptom duration to diagnosis was 2.0 months. The main treatment modalities were surgery only (n=18) or surgery plus adjuvant radiotherapy (n=9). Distant metastases were detected in 15 patients (39.5%) at 8 months after initial therapy. Overall 5-year survival rate was 45.6%. There was no significant difference in survival rate between patients who underwent surgery only and those who had surgery with postoperative radiation (p=0.359). CONCLUSION: Sinonasal mucosal melanoma is a highly recurrent tumor (80% recurrence rate) with poor prognosis (5-year survival rate; 46%). As radiation treatment and/or chemotherapy are not so effective for the recurrent tumor, early detection and surgical resection are mandatory at present. New treatment modality should be developed to improve the survival rate.

Clinical Outcome of Fibromatosis of the Head and Neck Region / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Fibromatosis is an uncommon soft tissue mass lesion that can occur in all anatomic sites. Fibromatoses arising in the head and neck region comprises of approximately 5% of all fibromatoses, which is associated with an infiltrative growth pattern and thus results in difficulty in complete excision. The authors investigate the clinical characteristics of head and neck fibromatoses. SUBJECTS AND METHOD: Six cases of head and neck fibromatoses were analyzed from 1989 to 2011. The imaging and pathologicfindings, surgical management, and clinicaloutcomes were evaluated. RESULTS: Painless mass effect was the most common symptom. The accuracy of diagnostic tools including computed tomography, magnetic resonance imaging and fine needle aspiration biopsy were under 50%. Recurrence was observed in two patients who had undergone surgical excision during follow-up. Salvage surgery was performed in these patients. CONCLUSION: The aggressive excision of head and neck fibromatosis cannot be achieved easily. Vigilant follow-up with or without conservative surgical excision results in good disease control. Radiotherapy can be applied for inoperable or margin positive cases considering age or performance of patient.