Olfactory Neuroblastoma: Clinical Features and Treatment Outcome

OBJECTIVE: The authors analyzed clinical features, long-term treatment outcome, and prognostic factors of the olfactory neuroblastoma. METHODS: Twenty-one cases of olfactory neuroblastomas, treated from 1979 to 2000, were retrospectively reviewed with medical records and radiological findings. Mean follow-up periods are 28.7 months(range 4-178). Extent of tumor was classified by UCLA staging system. Statistical analysis for survival was done using Kaplan Meier method and log-lank test. RESULTS: Mean age was 27 years(13-62), and most common group are second decades(8/21, 38%). Male to female ratio was 13: 8. Common symptoms are nasal obstruction, epistaxis, exopthalmos and headache. There were three cases of T1, five T2, six T3, and seven T4 according to UCLA staging system. The 5-year survival rate was 21.3% and average time was 28.9 months in surgical resection group(n=14) as primary modality have higher survival rate than radiation and chemotherapy group(n=7)[2-year survival rate: 39.2% vs 14.3%, 5-year survival rate: 19.6% vs 14.3%(p=0.0274)]. Early stage(T1, T2) groups showed better survival rate than advanced(T3, T4) groups(38.1% vs 9.1% p=0.0336). The local and regional recurrences were observed in 6(27%) and 2(9%) cases. Mean recurrence free time was 7.8 months(range 1-25). CONCLUSION: Early detection and extent of resection are the important prognostic factors. Regular follow up is mandatary for the detection of recurrence or metastasis.

Sclerotherapy for Craniofacial Venous Malformation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Venous malformations are one of the most common vascular anomalies, and are more frequently found in head and neck region. Various treatment options are available, and intralesional injection of sclerosant is the commonest primary treatment modality. We reviewed 20 cases of venous malformation treated with sclerotherapy at Seoul National University Hospital. MATERIALS AND METHODS: Twenty cases of venous malformation in head and neck were reviewed retrospectively, which had been managed with sclerotherapy from January 1991 to July 2001. The patients were treated at the department of otolaryngology-Head and Neck Surgery or plastic surgery of Seoul National University Hospital. Emulsion of Ethamolin and Lipiodol was used as a sclerosing agent. Some patients received surgical treatment after sclerotherapy. All of the patients received direct-puncture venography(Digital subtraction angiography) before sclerotherapy. Treatment results were evaluated by using MRI, angiography, or CT. If the reduction of volume of mass was more than 50 percent after sclerotherapy, we regarded the result as effective, if less than 50 percents, non-effective. Statistical analysis was done using SPSS10.0 for windows. RESULTS: Among twenty patients, there were eight males(40%), and twelve females(60%). Ages at the beginning of treatment ranged from six to thirty-eight years(mean age:20.6 years). The most common site of lesions was cheek(in 12 cases). Mass sizes(largest diameter) ranged from 2 cm to 20 cm. Nine cases were managed with both sclerotherapy and surgical excision, and eleven cases, only with sclerotherapy. Thirteen cases(65%) responded well to sclerotherapy(volume reduction>or=50%). There was no major complication. Tenderness, induration, swelling, and pain were reported as post-sclerotherapy complaints. Mild dyspnea occurred in one case, and the patient was managed at ICU shortly without fatal event. CONCLUSION: Sclerotherapy with or without surgical excision was an effective treatment modality for venous malformation, with minimal risk of major complications. There were no significant differences in the treatment results according to the initial size of the lesions.

Anti-Allergic Effects of Aloe Glycoprotein (NY945) on Ovalbumin-Induced Airway Allergy in the Guinea Pig

BACKGROUND AND OBJECTIVES: Aloe is one of the well known substances to decrease inflammation and promote wound healing. Although little is known about its mechanism, recent studies suggest that aloe vera extracts may have the anti-allergic effect by inhibiting the mediator release evoked by mast cell activation. Therefore, we were to investigate the effect of NY945, a glycoprotein fraction of Aloe vera, on nasal mucosa of the ovalbumin (OVA) sensitized guinea pigs. Materials and Methods: Female Dunkin-Hartley guinea pigs were sensitized with intraperitoneal injection and subsequent inhalation of OVA. NY945 was injected intraperitonealy before intranasal challenge of OVA with an ultrasonic nebulizer. Airway resistance, mucosal permeability, histamine concentration in the nasal lavage fluid, the number of mast cells and eosinophils in nasal mucosa and serum level of OVA -specific IgE were evaluated. RESULTS: NY945 effectively inhibited respiratory airway resistance in the sensitized guinea pigs. The concentration of dye into nasal lavage fluid was rapidly increased after OVA instillation and NY945 inhibited the OVA -induced microvascular dye leakage. OVA inhalation to sensitized guinea pig resulted in prominent increase of histamine concentration in the nasal lavage fluid. This response was inhibited by intraperitoneal NY945 injection. It also inhibited accumulation of eosinophils in the nasal mucosa in sensitized guinea pigs. However, there was no change in the serum OVA -specific IgE level between the NY945 treated and control group. CONCLUSION: The data suggest that NY945 inhibits early allergic reaction via inhibition of histamine release and eosinophil infiltration.

Histochemical Study of Musculature of the Human Upper Esophageal Sphincter / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pharyngoesophageal musculature plays an important role in swallowing, and prevents aspiration and supraesophageal reflux. These muscles are closed during the resting state and opens with swallowing to allow the passage of food. In this study, the histochemical characteristics of the upper esophageal sphincter muscles in human were investigated. MATERIALS AND METHODS: Muscle samples from the inferior pharyngeal constrictor, cricopharyngeus, upper esophageal muscle and sternocleidomastoid (SCM) muscle were obtained from the healthy portion of nine laryngectomized specimen. We used the H&E staining for identifying the gross anatomy of these muscles, and the myofibrillar ATPase staining and the NADH-TR staining for differentiating the muscle fiber type. RESULTS: Analysis of the muscle fiber types of the upper esophageal sphincter muscle revealed a predominance of type I in the cricopharyngeus (78.9%) and the upper esophageal muscle (85.2%), and type II in the inferior pharyngeal constrictor muscle (80%). In the SCM muscle, the percentage of each fiber type was almost the same. The proportion of oxidative fibers within these muscles correlated well to that of the type I fibers. CONCLUSION: The distribution of the type I fibers tended to be higher in the upper esophageal muscle than in the inferior pharyngeal constrictor. These findings about fiber types represents well the physiological features of each muscle, i.e. the inferior pharyngeal constrictors are capable of short rapid contraction and the upper esophageal muscles are capable of slow rhythmic movement.

Frequency and Distribution of Lymphocytes Related to Innate Immunity in Palatine Tonsils and Adenoids / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Palatine tonsils and adenoids protect the human body from various pathogens entering through the pharyngeal mucosa. Many studies have been performed for the specific immunity, but the innate immunity related to cell-mediated immunity has been rarely studied. Natural killer (NK) cells, CD5+ B lymphocytes, and gamma sigma T lymphocytes are the key mediators of natural immunity. The aim of this study was to investigate the role of lymphocytes related to the innate immunity property in these lymphoid tissues by examinig the frequency and distribution of these cells. MATERIALS AND METHODS: Palatine tonsils and adenoids were obtained from 12 children and 5 adults with idiopathic tonsillar hypertrophy. Immunohistochemisty was performed to examine the distribution of the CD5+ B lymphocytes, gamma sigma T lymphocytes and NK cells, and the flow cytometry was performed for the frequency of these cells compared with that of the patient's blood. RESULTS: On immunohistochemistry, CD5+ B cells were strongly stained mainly on the interfollicular and subepithelial areas of both the palatine tonsil and adenoid. But, gamma sigma T lymphocytes, and CD56+ cells were weakly stained on the interfollicular, epithelial, and subepithelial areas of both lymphoid tissues. Flow cytometry showed no difference in the frequency of CD5+CD19+ B cells and CD3+ gamma sigma T lymphocytes in these tissues compared to that of the blood. The frequency of NK cells of these tissues was much lower than that of the blood. And the frequency of CD3+ gamma sigma T lymphocytes of adults was lower than that of children in both the palatine tonsils and blood. CONCLUSION: In the palatine tonsils and adenoids, there were no active immune cells related to innate immunity, except for the CD5+ B lymphocytes in the non-stimulating state. And the innate immunity of the lymphoid tissues has possibility of association with the changing activity according to age.

Traumatic Hypopharyngeal-Cervical Esophageal Injuries / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Traumatic perforation in hypopharynx and cervical esophagus may be fatal, causing mediastinitis or sepsis. We present six cases of clinical experiences to outline diagnosis and management. MATERIALS AND METHOD: We retrospectively reviewed six patients with hypopharyngeal-cervical esophageal injury, over the period of recent two years. We summarized the method of diagnosis, treatment and clinical course with review of the literature. RESULTS: There were two cases of external blunt trauma, two cases of iatrogenic causes, and two cases of intraluminal injuries. The common clinical signs were painful neck swelling and fever. The five of six in routine X-ray showed air shadow in the neck or chest. The neck CT showed air or abscess in all six cases. The surgical drainage was performed in four cases. CONCLUSION: The diagnostic methods of hypopharyngeal-cervical esophageal injuries include chest X-ray, neck X-ray, Gastrografin(r) esophagography and CT after thorough history-taking and physical examination. CT was highly sensitive and important for decision of surgical management. Surgery is recommended if there is large perforation, abscess, mediastinal contamination or sepsis. In selective cases, non-surgical management is possible.

Clinical Analysis of Delayed Facial Nerve Palsy after Middle Ear Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Delayed facial nerve palsy (DFNP) following a middle ear surgery is an uncommon event, and is defined to develop 48 or 72 hours after surgery. The pathogenesis of DFNP is not known clearly, but it is presumed to inflammation, neuronal edema or reactivation of herpes virus. The purposes of this study were to provide the clinical aspect of DFNP after middle ear surgery and to discuss the prognostic factors and treatment plan. MATERIAL AND METHOD: From January 1985 to August 1999, in the course of over 5,670 middle ear surgeries, we experienced 12 ipsilateral delayed facial nerve palsies. We analyzed the course of DFNP according to several clinical factors retrospectively. Degree of facial palsy was evaluated with the House-Brackmann grade (HBG). RESULTS: DFNP was developed from 3 day to 14 day after middle ear surgery. The initial degree of facial palsy was HouseBrackmann grade (HBG) II in 6, HBG III in 4, and HBG IV in 2 patients. All patients were treated with steroid and volume expander. The final recovery were HBG I in 11 of the twelve patients. Remaining one patient was found to be HBG Il after a 5-year follow up. In the group who recovered within 1 month, the initial HBG were II or III. CONCLUSION: We obtained satisfactory results with steroid therapy in most patients. The courses of DFNP after middle ear surgery are favorable. The better initial HRG and HBG at 2 weeks are, the earlier recovery can be expected.

Transseptal-Transsphenoidal Approach: Objective Assessment of Postoperative Nasal Functions

THE AIM OF STUDY: The transseptal-transsphenoidal approach (TSA) for pituitary tumors may alter nasal functions, including nasal respiration and olfaction. The aim of this study was to investigate the efficacy of TSA in terms of nasal functions. MATERIALS AND METHODS: Twenty two cases of pituitary tumors, managed at Seoul National University Hospital from May 1997 through March 1998, were included in this prospective study. Nasal functions were evaluated preoperatively and 2 months after the operation through symptom questionnaires, rhinomanometry, acoustic rhinometry and the butanol thres-hold test. RESULTS: The subjective nasal symptoms, including nasal obstruction and olfaction, were not changed following the operation in 72% and 86% of the cases, respectively. In the objective findings, total nasal resistance was not grossly changed after the operation, however, cross-sectional areas at C-notch and 3.3 cm from the anterior nasal spine increased significantly after the operation. Mucosal response to a topical vasoconstrictor after the operation was less effective than before the preoperation. CONCLUSION: TSA for pituitary tumors may be a safe and effective technique in preserving nasal functions subjectively and objectively.

Voice Analysis in Reinke's Edema / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Reinke's edema is defined as swelling confined to the space underneath the epithelial layer known as Reinke's space. Patients suffering from Reinke's edema are known to have abnormally low fundamental frequency and high subglottic pressure. We compared the preoperative and postoperative voice results of Reinke's edema to evaluate quantitative changes of vocal function. MATERIALS AND METHODS: The voice analyses of 15 patients, who were diagnosed with Reinke's edema from 1997 January to 1998 September in Seoul National University Hospital, and 15 normal controls were undertaken with Multi-dimensional voice program (MDVP) and Aerophone II of Kay system. Eight preoperative patients, 13 postoperative patients, and 6 preoperative and postoperative patients were analyzed with respect to fundamental frequency (F0), pitch perturbation quotient (PPQ), amplitude perturbation quotient (APQ), noise-to-harmonic ratio (NHR), subglottic pressure (Psg), mean vocal efficiency, mean flow rate (MFR), maximum phonation time (MPT), and contact quotient (CQ). Using videostrobokymography, vibratory patterns of vocal folds were analyzed. RESULTS: The fundamental frequency was lower than the normal preoperative and postoperative values. The PPQ, APQ, and NHR were decreased to the normal value after operation. The subglottic pressure, although elevated preoperatively and decreased postoperatively, remained high. The mean vocal efficiency was increased to average value of normal controls after operation. The MFR, MPT, and CQ were not correlated with the course of Reinke's edema. The vocal folds vibration returned to regular pattern after operation on videostrobokymography. CONCLUSION: The fundamental frequency and subglottic pressure are not normalized after operation, and the PPQ, APQ, and NHR are good parameters of postoperative voice results. The voice therapy might help to correct the vocal habit of voice abuse and prevent recurrence after operation.