Excision of a Nasal Dermoid Sinus Cyst via Open Rhinoplasty Approach and Primary Reconstruction Using Tutoplast-Processed Fascia Lata

Nasal dermoid sinus cysts are the most common congenital midline nasal lesion, accounting for 1% to 3% of all dermoid cysts, and 4% to 12% of all head and neck dermoids. Selection of the appropriate reconstruction technique, after dermoid resection, is important for treatment. Here we describe the successful management of a case with a nasal dermoid sinus cyst using an open rhinoplasty approach, and primary reconstruction using Tutoplast-processed fascia lata and crushed septal cartilage.

Treatment Results of 111 Cases of Antrochoanal Polyp

BACKGROUND AND OBJECTIVES: Antrochoanal polyp (ACP) is a benign maxillary sinus polyp that originates from the mucosa of the maxillary sinus, passes through the sinus ostium, and extends into the choana. Surgical methods employed in the treatment of antrochoanal polyp are simple avulsion, Caldwell-Luc operation, osteoplastic maxillary sinus operation, and endonasal endoscopic removal. In this study, we evaluated the clinical presentation of ACP and compared its surgical outcomes. MATERIALS AND METHODS: We retrospectively reviewed 111 patients who were treated for ACP between January 1995 and May 2008, and analyzed clinical features, radiologic findings, and surgical results. RESULTS: The study group consisted of 111 patients (65 males, 46 females) with a mean age of 20.0 years (range, 4 to 70). Sixty-one cases were accompanied by sinusitis (20 with unilateral sinusitis, 41 with bilateral sinusitis). Endoscopic sinus surgery (ESS) was used to treat 95 cases, and the external approaches of Caldwell-Luc operation or osteoplastic maxillary sinus operation were applied in 12 and four cases, respectively. Among those who received ESS, ACP recurred in 16 cases, whereas none of the patients who received the external approach showed recurrence. CONCLUSION: Endoscopic sinus surgery is a good alternative method for the treatment of ACP. If the antral part of ACP cannot be removed completely, an external approach such as Caldwell-Luc operation or osteoplastic maxillary sinus operation for pediatric patients may be considered to prevent recurrence.

Treatment Results of Sinonasal Sarcomas : 20 Cases in Asan Medical Center / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sinonasal sarcomas are relatively rare tumors, accounting for only about 1 percent of all sinonasal malignancies. The purpose of this study is to analyze the clinical features, treatment modalities and outcomes, survival and prognostic factors of sinonasal sarcomas. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of 20 patients who were diagnosed and treated for sinonasal sarcomas between July 1993 and June 2006. Potential prognostic factors including age, tumor size, histology and adjuvant treatment were evaluated. RESULTS: According to histologic subtype, twenty cases consisted of 7 rhabdomyosarcomas, each 2 cases of spindle cell sarcoma, Ewing's sarcoma, angiosarcoma, and each 1 case of fibrosarcoma, leiomyosarcoma, hemangiopericytoma, peripheral neuroectodermal tumor, myxoid sarcoma, osteosarcoma, chondrosarcoma. The mean follow-up period was 61 months. Fourteen patients (65%) had undergone surgical approach with adjuvant chemotherapy or radiotherapy. Four patients (20%) had undergone surgical treatment only. Two patients (15%) had undergone chemotherapy or radiotherapy. At 5 years, the overall survival rates of sinonasal sarcomas were 65%. The survival rates according to the treatment modality were 100% (surgery only), 66% (surgery with adjuvant chemotherapy or radiotherapy), and 33% (chemotherapy or radiotherapy), respectively. The overall recurrence rates of the sinonasal sarcomas were 25%. The univariate analysis showed that the treatment modality and surgical margin are important prognostic factors for survival. CONCLUSION: The 5-year survival rate of sinonasal sarcomas was 65%. Early diagnosis and wide excision with safe resection margin are important for the treatment of sinonasal sarcomas.

The Effect of Cigarette Smoking on the Expression of MMP-9, TIMP-1 and VEGF in Nasal Polyp Epithelial Cells and Fibroblasts

BACKGROUND AND OBJECTIVES: It has been known that MMP-9, TIMP-1, and VEGF play an important role in the formation of nasal polyps (NPs). The aim of this study is to investigate the effect of smoking on the expression of MMP-9, TIMP-1 and VEGF in the epithelial cells and fibroblasts of NPs. MATERIALS AND METHODS: The epithelial cells and fibroblasts of NPs obtained from 10 patients who underwent endoscopic sinus surgery were cultured and used. The prepared CSE concentrations were 5%, 1%, 0.5% and 0.1%. In the control group, cells were cultured for 9 hours in the media containing 1 ml of AEGM and DMEM/F-12K. In the CSE group, cells were treated with 5%, 1%, 0.5% and 0.1% CSE for 9 hours. After washing with PBS, cells were cultured in medium for 24 hours. ELISA was performed to measure the secretion of MMP-9, TIMP-1 and VEGF proteins and real-time PCR was performed to assay their mRNAs. RESULTS: The production of MMP-9, TIMP-1 and VEGF proteins did not change significantly in comparison with the control group in epithelial cells and fibroblasts after exposure to CSE. CONCLUSION: These results suggest that CSE does not appear to have an effect on the expression of MMP-9, TIMP-1 and VEGF for developing and growth of nasal polyposis.

Compliance of Auto-adjusting Positive Airway Pressure in Korean Obstructive Sleep Apnea Patients

BACKGROUND AND OBJECTIVES: Continuous Positive Airway Pressure (CPAP) is generally effective in correcting sleep-related respiratory disturbance in Obstructive Sleep Apnea Syndrome (OSAS). But the failure to comply with this treatment poses a serious limitation to its use. The aim of this study is to investigate the state of compliance and the cause of noncompliance of auto-adjusting positive airway pressure (autoPAP) treatment in Korean OSAS patients. MATERIALS AND METHODS: This study performed a survey of 45 patients who had selected the autoPAP treatment between August 2000 and May 2003. RESULTS: Twelve of the 45 patients (26.7%) refused the autoPAP treatment immediately after the first trial due to claustrophobia. Also, twenty patients (44.4%) stopped using it within 1 month. Only 13 patients (28.9%) continued to use it for more than 1 month. Twenty seven of the 33 patients (81.8%) who had used the autoPAP complained of claustrophobia after the first trial. The major factors of low compliance were claustrophobia, restricted body position while asleep, nasal symptoms, high cost, and inadequate education of patients. CONCLUSION: This study shows that claustrophobia is a major cause for the noncompliance of autoPAP. It also shows that the patients are encouraged by the effectiveness of the autoPAP to use it for a longer period. Therefore, we should focus on explaining the effects and drawbacks of autoPAP, desensitization and behavioral modification.

Comparison of Rhinovirus Infection Rate and Virus-induced Cytokine Secretion between Nasal Polyp Mucosae and Normal Sphenoid Sinus Mucosae Organ Culture Model

BACKGROUND AND OBJECTIVES: Human rhinovirus (HRV) infection is the primary cause of the common cold. It was often reported that the frequency of viral rhinitis is higher among patients with chronic rhinosinusitis with nasal polyposis (CRS/ NP) than normal subjects. And, patients with nasal polyps often complain that they suffer from a relatively severe degree of URI. The purpose of this article was to evaluate whether the HRV infection rate and virus-induced cytokine secretion is different between the organ culture model of the nasal polyp mucosae and the sinus mcuosae. MATERIALS AND METHODS: Organ cultures of nasal polyps from sixteen CRS/NP patients and normal sphenoid sinus mucosae from nineteen patients who underwent the trans-sphenoidal pituitary surgery were tested. The successful viral infection by HRV-16 was determined by seminested reverse transcription-PCR. Immunoreactive IL-6 and IL-8 were quantitated using the ELISA. RESULTS: A PCR product indicating the successful RV infection was detected in nine of sixteen (56.3%) polyp samples and eleven of nineteen (57.9%) normal sphenoid sinus samples were tested positive for HRV-16. Rhinovirus infection increased the IL-6 and IL-8 secretion to 236% and 173% in polyp samples and to 231% and 145% in sphenoid mucosa samples respectively. However, there was no significant difference in rhinovirus infection rate and in the rhinovirus-induced IL-6 and IL-8 secretion between the groups. CONCLUSION: The results of this study may suggest that the nasal polyp mucosae, when compared with normal sinus mucosae, did not show more vulnerability to HRV infection nor more intense cytokine response by HRV infection.

Increase of Rhinovirus Replication in Airway Epithelial Cells by Staphylococcal Enterotoxin A and B / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES : The toxins generated from Staphylococcus aureus, Staphylococcal enterotoxin A (SEA) and B (SEB), are reported to have an important role in the pathogenesis of chronic rhinosinusitis. As a basic step for elucidating the pathophysiologic responses of the nasal mucosa of chronic rhinosinusitis associated with rhinovirus infection, this study investigated the effect of SEA and SEB on rhinovirus infection in A549 cells. MATERIALS AND METHOD : The effect of SEA and SEB on the rhinovirus-induced changes in intercellular adhesion molecule-1 (ICAM-1) expression was assessed by flow cytometry. The effect of staphylococcal toxins on the rhinovirus-induced cytokine secretion was measured by ELISA. The effect of the replication of rhinovirus in the cells was examined by viral culture with subsequent determination of viral titer. RESULTS : ICAM-1 expression was increased in the rhinovirus infection group. Cytokine secretion was also increased in the rhinovirus infection group. But there was no additional increase due to staphylococcal toxins regarding the ICAM-1 expression and cytokine secretions. Staphylococcal toxins increased viral titer in proportion to toxin concentrations. CONCLUSION : SEA and SEB increased rhinoviral replication in airway epithelial cells. This result shows that airway epithelial cells with chronic rhinosinusitis are more favorable environments for rhinovirus infection.

Comparison of the Results of Voice Handicap Index and Computer-Assisted Voice Analysis in Patients with Benign Vocal Cord Lesions before and after Microlaryngeal Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Voice Handicap Index (VHI) subjectively evaluates the severity of voice disorders. On the other hand, computer-assisted voice analysis objectively evaluates the severity of voice disorders. The purpose of this study was to compare the results of these two different tests in patients with benign vocal cord lesions and to measure the correlation between parameters of these two tests. MATERIALS AND METHODS: From January 2002 to December 2003, 76 patients who underwent microlaryngeal surgery for benign vocal cord lesions in the Asan Medical Center were included in this study. They all filled out the VHI questionnaires, which were composed of 30 questions about before and after surgery. For 32 out of 76 patients, we also performed preoperative and postoperative acoustic analysis (jitter, shimmer, noise to harmonic ratio) and aerodynamic analysis (maximum phonation time, mean flow rate, mean subglottic pressure). All VHI and voice analysis parameters were entered into a statistical program and analyzed using a Pearson correlation. RESULTS: All the parameters of VHI showed significant improvement after surgery. The values of jitter, shimmer, noise to harmonic ratio, and maximal phonation time showed a significant change after surgery, but the mean flow rate and the mean subglottic pressure didn't. Each VHI parameter provided a significant level of reliability (p0.05) after surgery. CONCLUSION: The VHI provides a measure of self-perception on the severity of the voice disorders that cannot be assessed through objective acoustic and aerodynamic measures. No objective parameters show strong correlation with VHI parameters when compared across other testing methods after surgery. This discrepancy indicates that no objective parameters can yet be regarded as a prognostic factor to evaluate subjective perception.

A Case of Leiomyosarcoma of the Gingiva / 대한이비인후과학회지

Leiomyosarcoma is a malignant mesenchymal tumor that is relatively common in the uterus, the gastrointestinal tract, and the retroperitoneum. Only 3 to 10% of leiomyosarcomas arise in the head and neck. A review of the English-language literature since 1908 revealed 11 cases of primary and one case of metastatic leiomyosarcoma of the gingiva. We report on a case of leiomyosarcoma that arose in a 34-year old male, affecting the mandibular gingiva.

The Long Term Follow-up of Maxillary Sinus Retention Cyst / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Retention cyst of the maxillary sinus is a common incidental finding on Waters' view. The purpose of this study is to evaluate the fate of maxillary sinus retention cyst after at least 3-year follow-up. MATERIALS AND METHOD: Twenty-five patients diagnosed to have maxillary sinus retention cyst on Waters' view between 1997 to 1999 were asked to revisit for the follow-up Waters' view at least 3 years later. Nine patients complied with the request. Medical records, endoscopic nasal findings, and radiological data of nine patients were reviewed. Cyst size was measured by the 2-dimensional milimeter scale and the relative percentage of the total antral area. RESULTS: The cyst was located in the right maxillary sinus in 4 patients, left in 4, and bilateral in 1. Nine out of ten cysts appeared to arise from the floor of the sinus. The area of the cysts ranged in size from 232 mm2 (ratio 36.4%) to 370 mm2 (55.3%), as measured on Waters' view. Six of the cysts resolved spontaneously, three showed no change in size and only one has enlarged twice the size of initial cyst. The patient with enlarged cyst didn't complain of any specific symptoms. CONCLUSION: The majority of cysts (90%) decreased in size or spontaneously resolved after 3 years. Thus, `wait and see' policy may be appropriate unless associated with specific symptoms.