Endonasal Septal Perforation Repair: Free Mucosal Graft With Lyoplant® Bioscaffold

Nasal septal perforation (NSP) is a common complication of nasal surgery and can cause nasal obstruction, crust, and epistaxis. Many surgical methods have been introduced for repair of NSP, among which mucosal flap and artificial dermis have been widely used. However, mucosal graft can shrink and migrate and is difficult to fix at the perforation site. Mucosal advancement flap requires a wide extent of septal mucosa dissection, and artificial dermis can cause nasal obstruction because of its bulkiness and lower biocompatibility than autologous mucosa. To overcome these problems, we reported successful outcomes in 4 cases of small NSP by free mucosal graft with bioscaffold.

Use of Acellular Allogenic Dermal Matrix in Soft Palate Reconstruction after Excision the Pleomorphic Adenoma / 대한두경부종양학회지

Recent studies have reported on the reconstruction of oral mucosal defects using acellular dermal matrix (ADM). This case report describes the reconstruction of a soft-palate mucosal defect using ADM. A 43-year-old man developed a 2.5 cm × 3 cm soft-palate mucosal defect after the removal of a lump on the soft palate andreconstructed the defect using ADM without further complications. Reconstruction of the soft palate with ADM could be more convenient than traditional methods including primary closure, skin graft, and local or free flap without complications.

The Relationship between the Causative Allergens of Allergic Diseases and Environments in Korea Over a 8-Year-Period: Based on Skin Prick Test from 2006 to 2015

BACKGROUND AND OBJECTIVES: The present study evaluated the results of skin prick test using 55 allergens at 20 centers in the Republic of Korea in 2006, 2010, and 2014–2015. The aim was to assess changes in the positive rate of allergens according to temporal, regional, and environmental factors. MATERIALS AND METHODS: In total, 20 hospitals were selected based on the population distribution in the Republic of Korea. A skin prick test panel comprising 55 aeroallergens was distributed to 18 hospitals for this prospective study. The 2006 and 2010 skin prick test results were collected and analyzed retrospectively from 20 hospitals, while the 2014/2015 skin prick test results (from June 2014 to May 2015) were collected prospectively from 18 hospitals. RESULTS: A total of 14,897 SPT test results were analyzed: 4,319 in 2006, 7,431 in 2010, and 1,852 in 2014/2015. The overall rate of skin prick test positivity to more than two allergens was significantly higher in males than females. The positive rates of alder pollens and birch, oak and ragweed pollen positivity were increased in older patients. Several positive rates were increased according to the temperature in spring. The positive rates for beech pollen, birch pollen, hazel pollen, oak pollen, Tyrophagus putrescentiae, mugwort, cat, Acarus siro, Lepidoglyphus destructor and Tyrophagus putrescentiae were significantly increased, while those of Cult rye pollen and dandelion were significantly decreased over the three test periods. The overall positive rate for allergens in Jeju province varied significantly from Seoul and other cities. CONCLUSION: Change in the positive rate of multiple aeroallergens was evaluated in the Republic of Korea over time. Our findings can be used to recommend aeroallergens suitable for inclusion in skin prick test panels in the Republic of Korea and will facilitate further investigation of changes in the patterns of allergic diseases.

The role of adjuvant external beam radiation therapy for papillary thyroid carcinoma invading the trachea

PURPOSE: To evaluate the effect of adjuvant external beam radiation therapy (EBRT) on local failure-free survival rate (LFFS) for papillary thyroid cancer (PTC) invading the trachea. MATERIALS AND METHODS: Fifty-six patients with locally advanced PTC invading the trachea were treated with surgical resection. After surgery, 21 patients received adjuvant EBRT and radioactive iodine therapy (EBRT group) and 35 patients were treated with radioactive iodine therapy (control group). RESULTS: The age range was 26–87 years (median, 56 years). The median follow-up period was 43 months (range, 4 to 145 months). EBRT doses ranged from 50.4 to 66 Gy (median, 60 Gy). Esophagus invasion and gross residual disease was more frequent in the EBRT group. In the control group, local recurrence developed in 9 (9/35, 26%) and new distant metastasis in 2 (2/35, 6%) patients, occurring 4 to 68 months (median, 37 months) and 53 to 68 months (median, 60 months) after surgery, respectively. Two patients had simultaneous local recurrence and new distant metastasis. There was one local failure in the EBRT group at 18 months after surgery (1/21, 5%). The 5-year LFFS was 95% in the EBRT group and 63% in the control group (p = 0.103). In the EBRT group, one late grade 2 xerostomia was developed. CONCLUSION: Although, EBRT group had a higher incidence of esophagus invasion and gross residual disease, EBRT group showed a better 5-year LFFS. Adjuvant EBRT may have contributed to the better LFFS in these patients.

A Case of Undifferentiated Carcinoma Originating from the Inferior Turbinate of Nasal Cavity / 대한이비인후과학회지

Sinonasal undifferentiated carcinoma (SNUC) is a rare and highly aggressive malignant tumor arising from the schneiderian epithelium of the nasal cavity or paranasal sinuses. The presenting symptoms are diverse depending on the site involved and extent of tumor spread. The treatment of SNUC has evolved to improve overall survival rate and include disease-free control with complete surgical resection including radiotherapy and chemotherapy, but the prognosis still remains dismal. We present a patient with several months of history of intermittent nasal bleeding and stuffiness, which proved to be a rare malignant tumor of inferior turbinate origin, diagnosed as undifferentiated carcinoma of early stage in the disease process. The mass was excised en bloc with endoscopic surgical treatment from inferior turbinate without any additional combined treatment and there was no recurrence during the two-year follow-up period. We report herein, with a review of the literature, an undifferentiated carcinoma arising from the inferior turbinate, which was successfully treated by surgical resection only.

Japanese Cedar (Cryptomeria japonica) Pollinosis in Jeju, Korea: Is It Increasing?

Jeju is an island in South Korea located in a temperate climate zone. The Japanese cedar tree (JC) has become the dominant tree species while used widely to provide a windbreak for the tangerine orchard industry. An increase in pollen counts precedes atopic sensitization to pollen and pollinosis, but JC pollinosis in Jeju has never been studied. We investigated JC pollen counts, sensitization to JC pollen, and JC pollinosis. Participants were recruited among schoolchildren residing in Jeju City, the northern region (NR) and Seogwipo City, the southern region (SR) of the island. The JC pollen counts were monitored. Sensitization rates to common aeroallergens were evaluated by skin prick tests. Symptoms of pollinosis were surveyed. Among 1,225 schoolchildren (49.6% boys, median age 13 years), 566 (46.2%) were atopic. The rate of sensitization to Dermatophagoides pteronyssinus (35.8%) was highest, followed by D. farinae (26.2%), and JC pollen (17.6%). In the SR, 156 children (23.8%) were sensitized to JC pollen; this rate was significantly higher than that in the NR (59 children, 10.4%, P<0.001). A significant increment in the sensitization rate for JC pollen with increasing school level was observed only in the SR. JC pollen season in the SR started earlier and lasted longer than that in the NR. JC pollen season in Jeju was defined as extending from late January to mid-April. The prevalence of JC pollinosis was estimated to be 8.5%. The prevalence differed significantly between the NR and SR (5.3% vs 11.3%, P<0.001), mainly due to the difference in sensitization rates. JC pollen is the major outdoor allergen for early spring pollinosis in Jeju. JC pollen season is from late January to mid-April. Warmer weather during the flowering season scatters more JC pollen in the atmosphere, resulting in a higher sensitization rate in atopic individuals and, consequently, making JC pollinosis more prevalent.

A Cross-sectional Epidemiological Study on Trends in the Prevalence of Allergic Diseases among Children and Adolescents in the Jeju Area in 2008 and 2013

PURPOSE: This study was to find epidemiological trends in the prevalence of allergic diseases among children and adolescents in Jeju Province, Korea. METHODS: Two questionnaire surveys of the same method were conducted, respectively, in 2008 and in 2013 with five years' interval with 1,296 participants in 2008 and 878 in 2013 who were elementary and secondary students sampled at random from the same five schools. 'International Study of Asthma and Allergies in Childhood (ISAAC)' was applied to the parents with their written consent to the survey. RESULTS: The results of analysis showed an increasing trend in the prevalence of lifetime asthma (8.6% in 2008 and 10.4% in 2013) and in the prevalence of lifetime allergic rhinitis (25.3% in 2008 and 31.1% in 2013) (p=.003), and a decreasing trend in the prevalence of lifetime atopic dermatitis (32.0% in 2008 and 26.8% in 2013) (p=.011). CONCLUSION: This research showed an increasing trend in the prevalence of asthma and allergic rhinitis among children and adolescents in Jeju Province compared to that 5 years ago, but represented a declining trend in the prevalence of atopic dermatitis.

A Case of Mucosal Contact Point Headache Caused by Septal Spur / 대한이비인후과학회지

Headaches attributed to disorders of the sinonasal region make their diagnosis and treatment sometimes challenging. Contact point between opposing mucosal surfaces in the nasal cavity can cause headache by a mechanism of referred pain in the distribution of trigeminal nerve. The most common anatomic abnormality of intranasal contact point is the diverse pattern of septal deviation in association with turbinate deformity or hypertrophy. In the absence of other pathological findings, the evaluation for intranasal contact points should be considered. We herein report that a patient, suffering from headache and periorbital pain refractory to medical treatment, experienced a complete abolition of pain after surgical correction of mucosal contact point in the nasal cavity.

A Case of Pleomorphic Adenoma of the Nasal Septum Excised by Endoscopic Surgery

Pleomorphic adenoma originates mainly in major salivary glands such as the parotid and submandibular glands, but has rarely been reported to arise in the nasal cavity, especially the nasal septum. Diverse surgical approaches can be selected according to the size and location of the tumor.The treatment of choice for intranasal pleomorphic adenoma is complete surgical excision with histologically clear margin in order to prevent recurrence. However, endoscopic surgical excision has the benefits of superior visualization of the tumor margin, avoidance of external scar, and less blood loss. We report herein a case of a 48-year-old woman who presented with a seven-monthhistory of right-sided nasal obstruction and intermittent nasal bleeding, diagnosed as pleomorphic adenoma of the nasal septum, that was treated with endoscopic surgery without any recurrence.

Usefulness of Sputum Induction with Hypertonic Saline in a Real Clinical Practice for Bacteriological Yields of Active Pulmonary Tuberculosis / 결핵및호흡기질환

BACKGROUND: Mycobacterial identification in active pulmonary tuberculosis (APTB) is confirmative, even though successful rates using self-expectorated sputum are limited. Sputum specimens collected by hypertonic saline nebulization showed higher bacteriologic diagnostic sensitivities over those of self-expectoration, mostly studied in smear-negative or sputum-scarce patients. The efficacy of induced sputum was rarely assessed in real clinical settings. METHODS: A prospective randomized case-control study was performed in one hospital. The subjects highly suspicious of APTB were asked to provide 3 pairs of sputum specimens in 3 consecutive days. The first pairs of the specimens were obtained either by self-expectoration (ES) from the next day of the visit or sputum induction with 7% saline nebulization in clinic (SI), and the other specimens were collected in the same way. The samples were tested in microscopy, culture, and polymerase chain reaction (PCR). The outcomes of the bacteriological diagnosis were compared. RESULTS: Seventy six patients were assigned to either ES (38 subjects, median age of 51, 65.8% male) or SI (38 subjects, median age of 55, 52.6% male). APTB was clinically confirmed in 51 patients (70.8%), 27 in ES and 24 in SI. Among the APTB, more adequate specimens were collected from SI (41/65, 63.1%) than ES (34/80, 42.5%) (p=0.01). Bacteriological confirmation was achieved in 14 (58.3%) patients in SI, and 13 (48.1%) in ES (p=0.46). In the same-day bacteriological diagnosis with microscopy and PCR, there were positive results for 9 patients (37.5%) in SI and 7 patients (25.9%) in ES (p=0.37). CONCLUSION: Sputum induction improves sputum specimen adequacy. It may be useful for the same-day bacteriological diagnosis with microscopic examination and PCR.

A Case of Dental Implant Complication Coexisting with an Inverted Papilloma in the Nasal Cavity / 대한이비인후과학회지

Unexpected displacement of a dental implant into the maxillary sinus is an unusual but potential complication in dental procedure. A dental implant that migrates into the maxillary sinus often develops paranasal sinusitis and cause diverse peri-implant soft tissue complications. A 59-year-old man complaining of nasal obstruction for several months presented with a huge polypoid mass in the nasal cavity. He had undergone a dental implant procedure in the maxilla at a dental clinic seven years ago. The implant fixture was found displaced to the maxillary sinus. The migrated fixture and nasal mass were removed by endonasal endoscopic surgery and mini Caldwell-Luc operation. The pathology was diagnosed as an inverted papilloma. To our knowledge, this is the first case reported in the literature regarding a dental implant complication that developed independently of sinonasal inverted papilloma.

Regulation of Mucin Exocytosis in Airway Secretory Cells / 대한이비인후과학회지

Mucin secretion in the airway epithelium acts as an essential barrier process that protects the upper respiratory tract from inhaled particles, environmental pathogens and toxicants. However, dysregulated mucin secretion contributes to pathophysiologic conditions such as rhinitis, asthma, and chronic obstructive pulmonary disease etc. The study on mucin hypersecretion has long been worked, but the exact molecular composition and mechanism for exocytic machinery remain mostly to be elucidated. The regulated mucin secretion, highly coordinated process, is mediated by the cooperative interaction of several proteins existing in the secretory granule, cytoplasm, and plasma membrane. This review provides the information on molecular components of the core exocytic machinery and their functional roles for mucin exocytosis in airway secretory cells.

Complete enumeration for the prevalence of allergic disease in Udo Isle's inhabitants

PURPOSE: This study is to estimate the prevalence of allergic disease for the entire inhabitants living in Udo Isle, one of the islands of Jeju. METHODS: The complete enumeration using International Study of Asthma and Allergies in Childhood group was applied to the 1,090 people residing in the Isle. This survey was performed for 2 months from June to July, 2012. For children, their parents' responses were collected, and for adults, their self-reports and interview were performed simultaneously. Of the 1,003 questionnaires (92.0%) were collected, 925 questionnaires were finally analyzed, excluding those of insufficient responses for questionnaires and inhabitants residing in Udo Isle less than one year. RESULTS: For asthma, the prevalence of "wheeze, last 12 months" was 6.6%. The prevalence of "allergic rhinitis, last 12 months" was 17.9%. The prevalence of "itchy eczema, last 12 months" was 8.1%. The prevalence of "allergic conjunctivitis, last 12 months" was 8.1%. The prevalence of "food allergy, last 12 months" was 2.3%. The prevalence of "drug allergy, last 12 months" was 0.8%. CONCLUSION: The inhabitants of Udo Isle had lower prevalence of atopic dermatitis than that of in the entire Jeju Island. However, compared with other regions, it showed higher prevalence, and it tended to be decreased with aging. The prevalence of asthma, allergic rhinitis, allergic conjunctivitis, food allergy and drug allergy, presented no difference by age.

A Case of Sinonasal Adenoid Cystic Carcinoma Presenting as a Huge Nasal Polyp / 대한이비인후과학회지

Adenoid cystic carcinoma (ACC) is the second most common malignancy in sinonasal tract occurring in the minor salivary gland of paranasal sinuses. It is also an aggressive neoplasm that results in a high incidence of both local recurrence and distant metastasis by perineural invasion. A 67-year-old woman had developed progressive nasal obstruction and facial pain for over two years. The imaging study showed a huge polypoid mass in the paranasal sinuses bulging into the nasal cavity without any adjacent bony erosion and orbital extension. The pathology was reported as a cribriform type of ACC. The mass was removed by endonasal endoscopic surgery and "Mini" Caldwell-Luc operation. Considering local recurrence due to perineural lymphatic invasion, postoperative radiation therapy was performed. We discuss here how the combination of endonasal endoscopic surgery and radiotherapy could provide the best chance for disease control in the selected stages of ACC.

The Influence of the Residential Environment on the Sensitization Rates to Aeroallergens and the Prevalence of Allergic Disorders in the School Children in Jeju / 소아알레르기및호흡기학회지

PURPOSE: This study is to investigate the influence of the residential environment on the sensitization rates to aeroallergens and the prevalences of atopic disorders in the school children. METHODS: Two elementary schools in Jeju, Korea were selected according to their distinctive residential environment, one located in the area surrounded by the tangerine farms and Japanese cedar forests (tangerine farming community) and the other rarely with them (non-tangerine farming community). All the school children (1,550 students) from the two school were enrolled in this study. Under their parents' informed consent, surveys based on International Study of Asthma and Allergies in Childhood questionnaire were answered by the parents and skin prick tests with 16 common aeroallergens were performed. RESULTS: The questionnaire is responded from 1,290 parents (83.2%) and the skin test was done in 1,284 students (82.8%). The sensitization rates to more than one aeroallergen was 41.9%, increasing by age. The children residing in the tangerine farming community showed significantly higher sensitization rates than those from non-farming one (47.5% vs. 38.4%, P=0.004). The former were sensitized more frequently to house dust mite, citrus red mite and Japanese cedar pollen, while the others to outdoor moulds. However, the prevalence of atopic disorders had no difference between the two groups. CONCLUSION: The residential environment might influence the sensitization rates to prevalent aeroallergens in the environment among school children, but there is no difference in the prevalence of the atopic disorders.

Peripheral Arterial Bypass Using Interpositional Vein Graft in the Hypothenar Hammer Syndrome

PURPOSE: The clinical syndrome of unilateral finger ischemia, caused by digital artery occlusions from embolization from the palmar ulnar artery associated with repetitive striking of the palm, has been called the hypothenar hammer syndrome(HHS). We report the case of a man with this unique disease probably caused by manual work. METHODS: A 52-year-old male left-hand dominant manual worker complained of pain and coldness in the left 4,5th finger. On physical examination, there was a tip necrosis and the result of Allen's test was mildly positive(sluggish filling of hand from the ulnar artery). Arteriograms confirmed occlusion of the distal ulnar artery without direct perfusion of the superficial palmar arch and distal digital artery. Surgical bypass with reverse autologous vein grafting was performed between ulnar artery and superficial palmar arch, common digital artery. RESULTS: He had an uneventful postoperative course and has remained asymptomatic for 18 months since discharge. Patency has been confirmed by color doppler with resolution of cold intolerance and successful digital preservation. CONCLUSION: We introduce a very unique pattern of vascular ischemic disease and recommend the arterial bypass with vein interpositional grafting.

The Etiologic Agents and Clinical Outcomes of Adult Community-acquired Pneumonia in Jeju / 결핵및호흡기질환

BACKGROUND: The appropriate empirical antimicrobial choice in the treatment of community-acquired pneumonia (CAP) should be advocated by community-based information on the etiologic pathogens, their susceptibility to antimicrobials, clinical characteristics and outcomes. Jeju is a geographically isolated and identical region in Korea. However, there is no regional reference on adult CAP available. This study investigated the etiologic agents and clinical outcomes of adult patients diagnosed with CAP in Jeju, Korea, to help guide the empirical antimicrobial choice. METHODS: A prospective observational study for one year in a referral hospital in Jeju, Korea. Patients diagnosed with CAP were enrolled with their clinical characteristics. Microbiological evaluations to identify the etiologic agents in the adult patients with CAP were performed with blood culture, expectorated sputum smear and culture, antibody tests for mycoplasma, chlamydophila, and antigen tests for legionella and pneumococcus. The clinical outcomes of the initial empirical treatment were analyzed. RESULTS: Two hundred and three patients with mean age of 64 and 79 females were enrolled. Ten microbials from 90 cases (44.3%) were isolated and multiple isolates were confirmed in 30. Among the microbial isolates, S. pneumoniae (36.3%) was the most common, followed by M. pneumoniae (23.0%), C. pneumoniae (17.0%), S. aureus (9.6%) and P. aeruginosa (5.9%). The initial treatment failure (23.8%) was related to the isolation of polymicrobial pathogens, elevated inflammatory markers, and the presence of pleural effusion. Among the 30 isolates of S. pneumoniae, 16 (53.3%) were not susceptible to penicillin, and 19 isolates (63.3%) to erythromycin and clarithromycin. However, 29 isolates (96.7%) were susceptible to levofloxacin and ceftriaxone. CONCLUSION:S. pneumoniae, M. pneumoniae, S. aureus, and P. aeruginosa are frequent etiologic agents of adult CAP in Jeju, Korea. The clinical characteristics and antibiotic resistance should be considered when determining the initial empirical antimicrobial choice. Respiratory quinolone or ceftriaxone is recommended as an empirical antimicrobiotic in the treatment of adult CAP in Jeju, Korea.

Suppression of IL-1beta-induced MUC5AC Gene Expression by Ginkgo biloba Extract(EGb 761) in Human Airway Epithelial Cells

BACKGROUND AND OBJECTIVES: The purpose of this study is to investigate whether Ginkgo biloba extract (EGb 761) can suppress IL-1beta-induced MUC5AC gene expression in NCI-H292 human airway epithelial cells and to discover what its possible mechanism is. MATERIALS AND METHODS: NCI-H292 human pulmonary mucoepidermoid carcinoma cell line was used. MUC5AC mRNA and protein were measured using the RT-PCR and Western blot analysis. The activation of mitogen activated protein kinases (MAPKs) were determined by means of the Western blot analysis. RESULTS: MUC5AC was induced by treating the NCI-H292 cells with 10 ng/ml of IL-1beta for 24 hours. A pre-treatment of 200 microgram/ml of EGb 761 significantly suppressed the IL-1beta induced MUC5AC expression. The inhibition of MUC5AC gene expression by EGb 761 was noted to be suppressed via both the extracellular signal-regulated kinase (ERK) and the p38 MAPK pathways in a kinase-specific inhibitor study. CONCLUSION: EGb 761 suppresses IL-1beta-induced MUC5AC gene expression in the human airway epithelial cells. Therefore, it may be considered as a possible anti-hypersecretory agent.

Clinical Characteristics and Voice Analysis of Mutational Dysphonia: Diplophonia and Clinical Use of Electroglottographic Measures / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mutational dysphonia, also referred to as mutational falsetto, is defined as the dysphonia that continuously have high pitch after adolescence. The aims of this study were to investigate the acoustic and electroglottographic characteristics of mutational dysphonia before and after voice therapy and to identify the factors that may be of help in its treatment. SUBJECTS AND METHOD: The clinical records of 15 patients with mutational dysphonia were reviewed, and analyses of their voice records were carried out with the help of Lx Speech Studio studio (Laryngograph Ltd, London, UK) program. RESULTS: After voice therapy was combined with manual compression method, the voices of the subjects were lowered in pitch and also improved in voice quality. Furthermore, we were able to classify the mutational dysphonia into 4 categories according to diplophonia and closed quotients. The most common type among the categories was bimodal distribution of fundamental frequency, or so-called diplophonic, accompanied with low closed quotient-falsetto voice-at high frequency area. However, the results also showed that all cases of mutational dysphonia can not be generalized simply as falsetto voice. The effect of the therapy for each type was different, and we could assume that in the cases with diplophonia accompanied with non-trained falsetto voice, it is expected that it can be treated readily. CONCLUSION: The diplophonia and closed quotient, which were easily analyzed by using Lx Speech Studio program, are important factors which help to classify the mutational dysphonia, choose the treatment options, monitor the efficacy of therapy, and estimate the prognosis of diseases.

Anti-adhesive Effect of GUARDIX-SL(R) after Endoscopic Sinus Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Adhesion after sinus surgery represents a potential source of surgical failure. GUARDIX-SL(R) which is composed of sodium hyaluronate and sodium carboxymethyl cellulose, is an effective agent that can be used as a surgical adjuvant to decrease adhesion in the abdominal surgery. Therefore, we evaluated the clinical efficacy and safety of the GUARDIX-SL(R) for the prevention of adhesion after endoscopic sinus surgery. SUBJECTS AND METHOD: This study was randomized and double-blinded. At the completion of endoscopic sinus surgery, 6 mL GUARDIX-SL(R) was applied on Merocel(R) and repeatedly applied on the middle meatus after removal of Merocel(R) (n=22). As a control group, normal saline was applied instead of GUARDIX-SL(R)(n=22). Endoscopic examination was performed at 3 days, 1 week, 2 weeks, and 4 weeks, postoperatively. Adhesion formation was graded as G0-G4, and CT scoring was also performed. RESULTS: The rate of adhesion formation was the highest at 2 weeks after operation and was significantly lower in the GUARDIX-SL(R) treated group than in the control throughout the period of observation. The cases were divided into 3 groups according to the CT scores at 2 weeks after operation: The groups with the GUARDIX-SL(R) treatment also showed lower adhesion formation than the control. The safety profile of the patients was normal at 4 weeks postoperatively. CONCLUSION: The results suggest that GUARDIX-SL(R) may be an efficacious and safe material in decreasing the incidence of adhesion after sinus surgery.