The Clinical Efficacy of Silicone Stents for Endoscopic Dacryocystorhinostomy: A Meta-Analysis

We evaluated the effect of silicone stent use during endoscopic dacryocystorhinostomy on postoperative morbidities in comparison with versus without a silicone stent. Two authors independently searched six databases (PubMed, Embase, Scopus, the Web of Science, the Cochrane library, and Google Scholar) from inception of article collection to July 2017. The analysis included prospective randomized studies that compared intraoperative silicone stent insertion (silicone group) with no application of a silicone stent (control group), in which the outcomes of interest were success rate (lacrimal passage patent check with syringing, symptom relief, or endoscopic confirmation of fluorescein dye from the opening of Hasner's valve) and morbidities (e.g., postoperative bleeding, rhinostomy closure, granulation tissue, synechia, and eyelid problems) after certain follow-up periods (over 10 weeks). Nine studies involving a total of 587 participants were included. Functional success rates tended to be higher in the silicone group than in the control, but there was no statistically significant difference in success rates (odds ratio, 1.45; 95% confidence interval, 0.77 to 2.73). According to the surgical type such as mucosal removal and mucosal flap surgery, the results from types didn't demonstrate any significant effect, but the mucosal flap technique seemed to be more beneficial. Regarding postoperative morbidities, although the outcomes of the groups did not present any statistically significant difference, eyelid problems and postoperative bleeding tended to occur more frequently in the silicone group, but rhinostomy closure tended to occur more frequently in the control group. Success and morbidity rates showed no difference between the silicone stent group and control group in the meta-analysis. However, additional analyses revealed that the success rate of endonasal dacryocystorhinostomy using silicone intubation with mucosal flap has shown an improving trend, and morbidities such as granulation and synechia showed decreasing trends compared with the group without silicone intubation.

Association of the Prognosis and the Facial Nerve Enhancement in Gadolinium Enhanced MRI in Patients with Bell's Palsy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aimed to investigate the association of prognosis and facial nerve signal intensity in enhanced magnetic resonance imaging (MRI) in patients with Bell's palsy. SUBJECTS AND METHOD: Patients who visited hospital for Bell's palsy from January of 2015 to June of 2016 were included in this study. A total of 30 patients were gathered and their facial palsy grades were evaluated with the House-Brackmann grade system on the initial visit and at six months after the first visit. In T1-weighted MRI, we measured the signal intensity of the region of interest (ROI), or the most-highly-enhanced portion of the affected facial nerve and the corresponding portion of the contralateral side. We calculated the ratio of ROI of the affected side to the contralateral side, and investigated the correlation between the ratio and the degree of improvement in facial palsy. RESULTS: The most frequent ROI of the affected facial nerve was labyrinthine segment. There was no significant correlation between the ROI ratio and initial H-B grade, or the degree of improvement in facial palsy. CONCLUSION: This study corresponds with the previous studies that indicated that the degree of the gadolinium enhancement of facial nerve in T1-weighted MRI is not related to the prognosis or the severity of the Bell's palsy.