A Case of Congenital Nasal Pyriform Aperture Stenosis

The cause of congenital nasal pyriform aperture stenosis is unclear. The development of the facial skeleton occurs between the fifth and the eighth week of gestation. It is at this stage that the stenosis occurs due to overgrowth of the ossification of the maxilla. Infants are obligate nasal breathers. Incomplete and milder forms of nasal airway obstruction may be present with mild respiratory distress, cyanosis, respiratory failure, asphyxia and eventual death. The diagnosis is done by CT, which demonstrates marked narrowing of the nasal inlet. Mild stenosis can be managed conservatively with humidification and topical decongestants but if conservative treatment fails, surgical intervention is candidate. We report a case of congenital nasal pyriform aperture stenosis. The patient, a 2-day old male neonate, had cyanosis during feeding and noisy breathing relieved by crying. His symptoms and signs were improved with surgical intervention without development disturbances.

Expression of NF-K B and I-K B in Allergic Rhinitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: K B is a transcription factor in immune and inflammatory reactions, and exerts its effect by expressing cytokines and chemokines, enzymes, receptors and adhesion molecules. Many of the inflammatory proteins that are expressed in respiratory airways are also regulated, at least in part, by NF-K B. The purpose of this study is to investigate the NF-K B and its inhibitory protein, I-K B expression in normal nasal mucosa and allergic rhinitis. MATERIALS AND METHODS: We have evaluated 20 allergic rhinitis mucosa and 7 normal inferior turbinate. Immunohistochemical study and RT-PCR were done for NF-K B and I-K B expression. RESULTS: NF-K B and I-K B were localized at the epithelium, and in the subepithelial inflammatory cells, vascular endothelial cells, and glandular endothelial cells in both normal nasal mucosa and allergic rhinitis. Compared to normal nasal mucosa, both activated and inactivated forms of NF-K B were significantly increased in the epithelial cell layer of allergic rhinitis. However, for the I-K R expression, no difference could be observed. RT-PCR revealed a significant difference in the expression level of NF-K B mRNA between nasal mucosa and allergic rhinitis, but I- K B expression showed no difference. CONCLUSIONS: This results show that NF-K B is usually activated in the nasal epithelial cell layer and NF-K B may play a role in the inflammatory reaction of allergic rhinitis. But further study is required for the role of I-K B.

The Clinical Usefulness of Axial OMU CT in ESS for Chronic Sinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: OMU CT scans are taken on a direct coronal plane for chronic sinusitis and thus allows evaluation only from the coronal plane. However, axial OMU CT provides view of the surrounding vital structures, variation of air cells, and the anterior to posterior relations of structures associated with chronic sinusitis. We investigated the clinical usefulness of axial OMU CT in chronic sinusitis. MATERIALS AND METHODS: A prospective study was performed in 100 sinuses of 50 patients with chronic sinusitis who underwent endoscopic sinus surgery from May through July of 1998. RESULTS: We observed that axial OMU CT has the advantage of evaluating the outline of the lateral lamella of lamina cribrosa, anterior and posterior ethmoid canal, optic nerve in sphenoid sinus, internal carotid artery in sphenoid sinus, Onodi cell, and anterior to posterior relations of these structures. CONCLUSION: We found that, in chronic sinusitis, axial OMU CT is effective in evaluating the important vital structures, normal variation, and the relations between the structures and that it can help prevent complication during ESS. We therefore recommend axial OMU CT to be included in the routine radiological evaluation for ESS in chronic sinusitis.

The Evaluation and Measurement of Anterior Ethmoidal Canal in Axial OMU CT / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The anterior ethmoid canal is the important surgical landmark in endoscopic sinus surgery, intranasal ethmoidectomy, and frontal sinus surgery. However it is not enough to evaluate the anterior ethmoid canal by coronal OMU CT, especially relating anterior to posterior relationship of the anterior ethmoid canal. The pulpose of this study is to evaluate the anterior ethmoid canal in 1 mm axial OMU CT and measure the five parameters relating the anterior ethmoid canal. MATERIALS AND METHODS: A prospective study was performed in 100 sinuses of 50 patients with chronic sinusitis who underwent endoscopic sinus surgery from May through July of 1998. RESULTS: The anterior ethmoid canal is well demonstrated by 1 mm axial OMU CT. The average of five parameters are 6.2+/-1.5 mm, 6.4+/-4.3 mm, 18.5+/-3.9 mm, 26.5+/-5.6 mm, 24.6+/-14.6degrees. However, there is no difference between the right and left side statistically. We observed that the anterior ethmoid canal is located just posterior to the frontal recess without anterior ethmoid air cell in front of the antirior ethmoid canal in 23%. CONCLUSION: The anterior ethmoid canal is well remarked by the 1 mm axial OMU CT. The length and directional angle of the anterior ethmoid canal is individually variable and there is no anterior ethmoid air cell in front of the anterior ethmoid canal in 23%. In these cases, the anterior ethmoid canal is more likely to be injured. So axial OMU CT may be useful in the radiologic evaluation for endoscopic sinus surgery in chronic sinusitis.

Endoscopic Laser Dacryocystorhinostomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Dacryocystorhinostomy is commonly performed through an external incision. Several transnasal approach were described earlier in this century but they failed to gain popularity probably because of difficult exposure. Whether the endoscopic laser dacryocystorhinostomy improved intranasal visualization and decreased intraoperative complications than external incision. MATERIALS AND METHODS: During recent 3 years, we performed endoscopic laser dacryocytorhinostomy about 10 cases at Joong Ang Gil Hospital. RESULTS: Success rate of revision groups (3 cases) was very good. CONCLUSION: Small-diameter endoscope with angled field of view provides excellent intranasal visualization. Endoscopic laser dacryocystorhinostomy avoids the possibility of pathologic scar formation and injury to the medial canthus. Endoscopic laser dacryocystorhinostomy appears to be the safe treatment especially for revision procedure.

A Clinical Study of Deep Neck Infection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Deep neck space infections, which affect soft tissues and fascial components of the head and neck, were frequently encountered in the preantibiotic era, but their frequency has been remarkably reduced after the development of chemotherapeutic agents and antibiotics. However, they may still result in significant morbidity and mortality despite the use of chemotherapeutic agents and antibiotics. The purposes of this study has been to assess clinical findings and the effectiveness of the treatment of deep neck infection through statistical analysis. MATERIALS AND METHODS: A retrospective study was performed on 86 cases of deep neck space infections in patients admitted for diagnosis and treatment during a 9-year period from January 1988 to December 1996. RESULTS: All cases were treated with either conservative treatment only as in 47 cases (55%), or surgical drainage and antibiotics as in 33 cases (33%), or surgical drainage with tracheostomy and antibiotics as in 6 cases (7%). At the end of the treatment, 83 cases were cured of the disease and 3 cases were reported to have complications. CONCLUSION: We concluded that treatment of deep neck infection requires knowledge of the natural history of the disease and a detailed understanding of anatomy. Management guidelines include (1) hospitalization, (2) culture and sensitivity tests, (3) antibiotic therapy, (4) diagnostic radiographic procedures, and (5) surgical intervention.

A Case of Inverted Papilloma without Associated Malignancy Invading the Anterior Skull Base / 대한이비인후과학회지

The inverted papilloma is an uncommon benign tumor constituting 0.5% to 4% of all primary nasal tumors. The tumor is characterized by local aggressiveness, high rate of recurrence and association with malignancy. Intracranial extension or encroachment without associated malignancy is very rare. The treatment should be en bloc resection to prevent the recurrence. Recently, the authors have experienced a case of large inverted papilloma of the nasal cavity invading the anterior cranial base without associated malignancy. The tumor was removed en bloc by craniofacial resection combined with medial maxillectomy through lateral rhinotomy approach. The defect of the skull base was repaired with pericranial flap and temporal muscle flap. The patient has been followed for 2 years and has showed no recurrence.