A Case of Forehead Flap Nasal Reconstruction for Dog Bite Nasal Injury

A dog bite is the most common trauma among animal bites, and it has varying severity, from simple skin lacerations to defects in whole tissue layers. Considering the aesthetic and functional importance of the nose, an appropriate reconstruction should be conducted for large and full-thickness tissue defects. Although this is quite common, literature detailing surgical reconstruction is lacking, especially in domestic journals. A 45-year-old male patient visited an outpatient clinic due to nasal trauma caused by a dog bite. The patient’s nose showed whole-layer tissue defects, with necrotic tissues at the periphery. Nasal reconstruction surgery was conducted using a forehead flap and ear cartilage composite graft. Pedicle division was conducted three weeks after primary surgery. The functional and aesthetic outcomes of the surgery were satisfactory. Our experience demonstrates that the forehead flap is a useful option for reconstructing a nose badly injured by a dog bite.

Genetic Variants and Clinical Phenotypes in Korean Patients With Hereditary Hemorrhagic Telangiectasia

Objectives@#. Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular disorder characterized by recurrent epistaxis, telangiectasia, and visceral arteriovenous malformations (AVMs). Activin A receptor-like type 1 (ACVRL1/ALK1) and endoglin (ENG) are the principal genes whose mutations cause HHT. No multicenter study has yet investigated correlations between genetic variations and clinical outcomes in Korean HHT patients. @*Methods@#. Seventy-two members from 40 families suspected to have HHT based on symptoms were genetically screened for pathogenic variants of ACVRL1 and ENG. Patients with genetically diagnosed HHT were also evaluated. @*Results@#. In the HHT genetic screening, 42 patients from 24 of the 40 families had genetic variants that met the pathogenic criteria (pathogenic very strong, pathogenic strong, pathogenic moderate, or pathogenic supporting) based on the American College of Medical Genetics and Genomics Standards and Guidelines for either ENG or ACVRL1: 26 from 12 families (50%) for ENG, and 16 from 12 families (50%) for ACVRL1. Diagnostic screening of 42 genetically positive HHT patients based on the Curaçao criteria revealed that 24 patients (57%) were classified as having definite HHT, 17 (41%) as having probable HHT, and 1 (2%) as unlikely to have HHT. Epistaxis was the most common clinical presentation (38/42, 90%), followed by visceral AVMs (24/42, 57%) and telangiectasia (21/42, 50%). Five patients (12%) did not have a family history of HHT clinical symptoms. @*Conclusion@#. Only approximately half of patients with ACVRL1 or ENG genetic variants could be clinically diagnosed as having definite HHT, suggesting that genetic screening is important to confirm the diagnosis.

Radiologic Findings of Complicated Alloplastic Implants in the Nasal Dorsum

Objectives@#. When performing cosmetic rhinoplasty with alloplastic materials, complications such as implant visualization, inflammation, dislocation, and extrusion should be thoroughly evaluated. Although computed tomography (CT) can provide useful information about the implant status and its interaction with the skin soft tissue envelope (SSTE), the radiologic findings of these interactions have rarely been reported. @*Methods@#. We retrospectively reviewed the data of 80 patients who underwent facial bone CT or ostiomeatal unit CT at Asan Medical Center between July 2008 and January 2020 for the evaluation of dorsal implants with complications. We reviewed the implantation period, implant dislocation, implant curling or deformation, radiodensity (in Hounsfield units), and nasal bone changes including bone erosion or hyperostosis. @*Results@#. Of the 80 patients, 67 (83.8%) had silicone implants and 13 (16.2%) had Gore-Tex implants. The radiologic findings of the silicone implants were as follows: maintenance of the implant shape (80.6%), radiolucency (similar density to that of fat tissue) halo (83.6%), and homogeneous attenuation (82.1%). Peri-implant calcification was often found in silicone implants with >20-year implantation periods. The findings of Gore-Tex were as follows: curling or deformation (84.6%), heterogeneous attenuation (84.6%), and consistent peri-implant calcification over time. @*Conclusions@#. Silicone and Gore-Tex implants have distinctive radiologic features. These findings of alloplastic materials help us to understand how implants behave in the nasal dorsum and how they affect the SSTE.

Radiologic Findings of Complicated Alloplastic Implants in the Nasal Dorsum

Objectives@#. When performing cosmetic rhinoplasty with alloplastic materials, complications such as implant visualization, inflammation, dislocation, and extrusion should be thoroughly evaluated. Although computed tomography (CT) can provide useful information about the implant status and its interaction with the skin soft tissue envelope (SSTE), the radiologic findings of these interactions have rarely been reported. @*Methods@#. We retrospectively reviewed the data of 80 patients who underwent facial bone CT or ostiomeatal unit CT at Asan Medical Center between July 2008 and January 2020 for the evaluation of dorsal implants with complications. We reviewed the implantation period, implant dislocation, implant curling or deformation, radiodensity (in Hounsfield units), and nasal bone changes including bone erosion or hyperostosis. @*Results@#. Of the 80 patients, 67 (83.8%) had silicone implants and 13 (16.2%) had Gore-Tex implants. The radiologic findings of the silicone implants were as follows: maintenance of the implant shape (80.6%), radiolucency (similar density to that of fat tissue) halo (83.6%), and homogeneous attenuation (82.1%). Peri-implant calcification was often found in silicone implants with >20-year implantation periods. The findings of Gore-Tex were as follows: curling or deformation (84.6%), heterogeneous attenuation (84.6%), and consistent peri-implant calcification over time. @*Conclusions@#. Silicone and Gore-Tex implants have distinctive radiologic features. These findings of alloplastic materials help us to understand how implants behave in the nasal dorsum and how they affect the SSTE.

Validation of the Korean version of the StandardizedCosmesis and Health Nasal Outcomes Survey / 대한이비인후과학회지

Background and Objectives@#The 10-item Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) is a recently developed questionnaire for assessing both nasal obstruction and nasal cosmetic satisfaction. It is widely used in rhinoplasty clinics based on its high level of reliability and efficacy in Western countries. In this study we evaluated the validity of the Korean version of the SCHNOS (K-SCHNOS).Subjects and Method The SCHNOS was translated into easily-understandable Korean following the guideline of the developers. Twenty-seven patients undergoing rhinoplasty and a control group of 29 non-rhinoplasty patients completed K-SCHNOS twice at intervals of 2 weeks regardless of pre- or postoperative state. The K-SCHNOS was evaluated for internal consistency, test-retest reliability, and validity. @*Results@#Of the 56 study participants, 39 (69.6%) were male and 17 (30.4%) were female, with the mean (standard deviation) age of 33.5 (12.9) years. Both obstructive domain and cosmetic domains showed high internal consistency with their respective Cronbach’α values being 0.92 and 0.91. The correlations in the test-retest analysis for each item were acceptable, ranging from 0.6-0.82. The association between the obstructive domain and cosmetic domain was 0.48 (95% confidence interval, 0.32-0.61), indicating a very weak correlation. @*Conclusion@#The K-SCHNOS has proven to be a reliable and valid questionnaire to be used by Korean-speaking patients undergoing functional or cosmetic rhinoplasty.

Dorsal Augmentation Using Costal Cartilage: What Is the Best Way?

No abstract available.

Radiologic Measurement of the Nasal Length and Keystone Area in Relation to Nasal Bony and Septal Cartilaginous Dimensions in Korean Adults

Three Cases of Nasal Chondromesenchymal Hamartoma Occurred in Sinonasal Tract / 대한이비인후과학회지

Nasal chondromesenchymal hamartoma (NCMH) is a rare benign tumor of the sinonasal tract. Most NCMH has a benign nature and can be cured by complete resection. Only a few NCMH cases have been reported worldwide due to its rarity. Here, we report three cases of successfully treated NCMH, of which one case was diagnosed during preliminary ultrasound. All three cases were consistent with the benign symptoms of NCMH. Tumor in all of the cases were successfully treated through an endoscopic approach surgery and no evidence of aggressive recurrence was reported.

Efficacy and Safety of Autologous Stromal Vascular Fraction in the Treatment of Empty Nose Syndrome

OBJECTIVES: Regenerative treatment using stem cells may serve as treatment option for empty nose syndrome (ENS), which is caused by the lack of turbinate tissue and deranged nervous system in the nasal cavity. We aimed to assess the efficacy and safety of the autologous stromal vascular fraction (SVF) in the treatment of ENS. METHODS: In this prospective observational clinical study, we enrolled 10 ENS patients who volunteered to undergo treatment of ENS through the injection of autologous SVF. Data, including demographic data, pre- and postoperative Sino-Nasal Outcome Test-25 (SNOT-25) scores, overall patient satisfaction, and postoperative complications, were prospectively collected. Nasal secretion was assessed using the polyurethane foam absorption method, and the levels of biological markers were analyzed in both ENS group and control group using enzyme-linked immunosorbent assay. The SVF extracted from abdominal fat was diluted and injected into both inferior turbinates. RESULTS: Among the 10 initial patients, one was excluded from the study. Subjective satisfaction was rated as “much improved” in two and “no change” in seven. Among the improved patients, the mean preinjection SNOT-25 score was 55.0 and the score at 6 months after injection was 19.5. However, the average SNOT-25 score of nine participants at 6 months after injection (mean±standard deviation, 62.4±35.8) did not differ significantly from the baseline SNOT-25 score (70.1±24.7, P>0.05, respectively). Among the various inflammatory markers assessed, the levels of interleukin (IL)-1β, IL-8, and calcitonin gene-related peptide were significantly higher in ENS patients. Compared with preinjection secretion level, the nasal secretions from SVF-treated patients showed decreased expressions of IL-1β and IL-8 after injection. CONCLUSION: Although SVF treatment appears to decrease the inflammatory cytokine levels in the nasal mucosa, a single SVF injection was not effective in terms of symptom improvement and patient satisfaction. Further trials are needed to identify a more practical and useful regenerative treatment modality for patients with ENS.

Role of Natural Killer Cells in Airway Inflammation

Natural killer (NK) cells have an immune regulatory function as well as cytotoxicity against tumor or infected cells. In the airway, although NK cells constitute a small proportion of the resident lymphocytes, they play an important role in the pathogenesis of chronic inflammatory airway diseases by modulating immune responses. NK cells can promote allergic airway inflammation by increasing the production of type 2 cytokines and inducing eosinophil migration. The increased activity of NK cells can develop or aggravate the destruction of lung parenchymal cells. On the other hand, decreased apoptotic activity of NK cells in eosinophils can serve as an aggravating factor for allergic airway inflammation. The increase in interferon-γ-producing NK cells and the inhibition of type 2 immune response by NK cells can alleviate allergic airway inflammation. This review aims to define the roles of NK cells in chronic inflammatory diseases of lower and upper airways.

Selection of Surgical Technique and Treatment Outcome of Revision Septoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was designed to review our experience with patients undergoing revision septoplasty and to evaluate the causes of persistent nasal obstruction and treatment outcomes of revision septoplasty. SUBJECTS AND METHOD: The medical records of 58 patients (53 men) who underwent revision septoplasty by the author of this study between 2006 and 2012 at our institute were retrospectively reviewed. Data on demographics, symptoms, anatomic site of deviation, surgical techniques performed, and postoperative complications were collected. Patient satisfaction scores were graded with a grading scale from 1 (excellent) to 4 (poor). RESULTS: All of the patients visited our hospital for persistent nasal obstruction after prior septoplasty. Forty-seven patients (81%) showed caudal septal deviation and 11 (19%) showed some other forms of septal deviation. Twenty-one cases (36.2%) were treated with the batten graft with cutting and suture technique, 20 (34.5%) with a batten graft alone, 10 (17.3%) with resection of remnant deviated septal bone and cartilage, 4 (6.8%) with the cutting and suture technique, 2 (3.5%) with a relocation suture, and 1 (1.7%) with a spreader graft. The median patient satisfaction score for 31 patients who answered the telephone interview was 2.06±0.93. CONCLUSION: A considerable number of patients who undergo revision septoplasty have remnant or recurrent caudal septal deviation that was not properly corrected in previous surgery. We recommend the batten grafting and the cutting and suture technique for the correction of caudal septal deviation in revision septoplasty.

Usefulness of Septodermoplasty in Hereditary Hemorrhagic Telangiectasia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Epistaxis is the most common symptom in patients with hereditary hemorrhagic telangiectasia (HHT). The aim of this study is to report treatment of severe epistaxis related to HHT with the septodermoplasty and to assess patient outcomes. SUBJECTS AND METHOD: Six patients with HHT who underwent septodermoplasty from 2009 to 2013 were reviewed retrospectively. We analyzed the clinical characteristics, surgical management and treatment outcomes. RESULTS: Three patients had been diagnosed with definite HHT and three patients with possible HHT. Three patients had combined abnormal vascular structures in visceral organs. The mean preoperative and postoperative hemoglobin were 7.2 g/dL and 12.8 g/dL, respectively, and visual analogue scale score for frequency and intensity of nasal bleeding remarkably decreased after septodermoplasty in all patients. CONCLUSION: Septodermoplasty was a safe and efficacious procedure for reducing the frequency and severity of bleeding in most patients with intractable epistaxis and HHT.

Human Rhinovirus-induced Proinflammatory Cytokine and Interferon-beta Responses in Nasal Epithelial Cells From Chronic Rhinosinusitis Patients

PURPOSE: Asthma exacerbation from human rhinovirus (HRV) infection is associated with deficient antiviral interferon (IFN) secretion. Although chronic rhinosinusitis (CRS), an inflammatory upper airway disease, is closely linked to asthma, IFN-beta responses to HRV infections in human nasal epithelial cells (HNECs) from CRS patients remain to be studied. We evaluated inflammatory and antiviral responses to HRV infection in HNECs from CRS patients. METHODS: HNECs, isolated from turbinate tissue of 13 patients with CRS and 14 non-CRS controls, were infected with HRV16 for 4 hours. The HRV titer, LDH activity, production of proinflammatory cytokines and IFN-beta proteins, and expression levels of RIG-I and MDA5 mRNA were assessed at 8, 24, and 48 hours after HRV16 infection. RESULTS: The reduction in viral titer was slightly delayed in the CRS group compared to the non-CRS control group. IL-6 and IL-8 were significantly increased to a similar extent in both groups after HRV infection. In the control group, IFN-beta production and MDA5 mRNA expression were significantly increased at 8 and 24 hours after HRV16 infection, respectively. By contrast, in the CRS group, IFN-beta was not induced by HRV infection; however, HRV-induced MDA5 mRNA expression was increased, but the increase was slightly delayed compared to the non-CRS control group. The RIG-I mRNA level was not significantly increased by HRV16 infection in either group. CONCLUSIONS: HRV-induced secretion of proinflammatory cytokines in CRS patients was not different from that in the non-CRS controls. However, reductions in viral titer, IFN-beta secretion, and MDA5 mRNA expression in response to HRV infection in CRS patients were slightly impaired compared to those in the controls, suggesting that HRV clearance in CRS patients might be slightly deficient.

Benzoin Spray: Cause of Allergic Contact Dermatitis due to Its Rosin Content

No abstract available.

A Case of Ameloblastic Carcinoma in the Maxillary Sinus / 대한이비인후과학회지

Ameloblastoma is the most common benign odontogenic tumor of jaw, whereas ameloblastic carcinoma is extremely rare, aggressive odontogenic neoplasm of mandible and maxilla. Ameloblastic carcinoma is odontogenic malignancy that combines the histological features of ameloblastoma with cytological atypia regardless of metastasis. The clinical course is described as typically aggressive, with extensive local destruction and distant metastatic spread. Ameloblastic carcinoma has been found mostly in the mandible; however, its maxilla lesion has been reported less than 40 cases in the literature. We experienced a case of ameloblastic carcinoma in the maxillary sinus in a 43-year-old male presenting with right facial swelling. No evidence of recurrence was noted at a 5-year follow-up.

Cooperative effect of Alternaria and rhinovirus on the activation of nasal polyp epithelial cells

BACKGROUND AND OBJECTIVES: The nasal epithelium is the first barrier encountered by airborne allergens and is an active participant in airway inflammation. The aim of this study was to determine the activation mechanism of nasal epithelial cells with Alternaria and the effect of rhinovirus on the Alternaria induced activation of nasal epithelial cells. MATERIALS AND METHODS: Cultured epithelial cells were stimulated by Alternaria with or without rhinovirus-16 (RV-16) infection. Release of interleukin (IL)-6, IL-8, and granulocyte macrophage colony-stimulating factor (GM-CSF) into culture supernatants were measured to determine the activation of epithelial cells. Nuclear factor-kappaB (NF-kappaB) and activator protein-1 (AP-1) of the epithelial cells were analyzed using western blot analysis. Intracellular NF-kappaB and AP-1 activity were evaluated by enzyme-linked immunosorbent assay. To determine the epithelial cell activation mechanism, cytokine production was inhibited with NF-kB, AP-1, and mitogen activated protein kinase (MAPK) inhibitors. RESULTS: Exposure of epithelial cells to Alternaria enhanced the production of cytokines. Intracellular NF-kB expression and activity were significantly increased by Alternaria, but not by RV-16. AP-1 expression and activity were not influenced by Alternaria. Increased IL-6 production was significantly inhibited by transcription factor inhibitors. However, IL-8 and GM-CSF production were not inhibited by these transcription factor inhibitors. CONCLUSIONS: Our in-vitro results demonstrate that Alternaria activates nasal polyp epithelial cells via NF-kB pathway and that NF-kB, AP-1, and MAPK are involved in the production of IL-6.

Effect of seeding using an avidin-biotin binding system on the attachment of periodontal ligament fibroblasts to nanohydroxyapatite scaffolds: three-dimensional culture

PURPOSE: For periodontal tissue engineering, it is a primary requisite and a challenge to select the optimum types of cells, properties of scaffold, and growth factor combination to reconstruct a specific tissue in its natural form and with the appropriate function. Owing to fundamental disadvantages associated with using a two-dimensional substrate, several methods of seeding cells into three-dimensional scaffolds have been reported and the authors have asserted its usefulness and effectiveness. In this study, we explore the cell attachment of periodontal ligament fibroblasts on nanohydroxyapatite (n-HA) scaffold using avidin biotin binding system (ABBS). METHODS: Human periodontal ligament fibroblasts were isolated from the health tooth extracted for the purpose of orthodontic procedure. HA nanoparticles were prepared and Ca(NO3)2-4H2O and (OC2H5)3P were selected as precursors of HA sol. The final scaffold was 8 mm in diameter and 3 mm in height disk with porosity value of 81.55%. 1x10(5) periodontal ligament fibroblasts were applied to each scaffold. The cells were seeded into scaffolds by static, agitating and ABBS seeding method. RESULTS: The number of periodontal ligament fibroblasts attached was greater for ABBS seeding method than for static or agitating method (P<0.05). No meaningful difference has been observed among seeding methods with scanning electron microscopy images. However, increased strength of cell attachment of ABBS could be deduced from the high affinity between avidin and biotin (Kd=10(-15) M). CONCLUSIONS: The high-affinity ABBS enhances the ability of periodontal ligament fibroblasts to attach to three-dimensionally constructed n-HA scaffolds.

Clinical Features and Treatment Results of 64 Cases of Nasolabial Cyst

BACKGROUND AND OBJECTIVES: Nasolabial cysts are relatively rare and are sometimes confused with tumors due to progressive enlargement. Treatment of a nasolabial cyst consists of sublabial excision or endonasal endoscopic marsupialization (EEM). The purpose of this study was to investigate the clinical features of nasolabial cysts in order to provide a basis for correct diagnosis and treatment. MATERIALS AND METHODS: Sixty-four patients with a nasolabial cyst were surgically treated between December, 1989 and January, 2010 at the Department of Otolaryngology, Asan Medical Center. Their clinical features, radiologic and histopathologic findings, and treatment and outcomes were retrospectively analyzed. RESULTS: The patients comprised 51 (80%) women and 13 men (20%), with ages ranging from 16 to 69 years with a mean of 43 years. Swelling of the nasolabial fold was the most frequently experienced symptom. There was no right or left side preponderance. Sublabial excision was applied in 57 cases (89%), while seven cases (11%) were treated via the endonasal approach. There was no case of recurrence. CONCLUSION: Nasolabial cysts should be suspected in patients with swelling of the nasolabial area and nasal obstruction. Enhanced CT may be needed to differentiate from tumors, odontogenic cysts, or other inflammatory lesions. Nasolabial cysts can be successfully treated via sublabial or endonasal approaches. Postoperative complications or recurrence is very rare.

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.

The Effect of Uvula-Preserving Palatopharyngoplasty in Obstructive Sleep Apnea on Globus Sense and Positional Dependency

OBJECTIVES: This study investigated the outcomes of uvula-preserving palatopharyngoplasty (UPPPP) in patients with obstructive sleep apnea syndrome (OSAS). METHODS: Twenty men with obstructive sleep apnea syndrome received the UPPPP operation at our institution. We measured symptom changes after UPPPP using a visual analog scale (VAS), and all patients were examined with polysomnography pre- and post-operatively. 'Surgical success' was defined as reduction in apnea-hypopnea index (AHI) to below 20 events per hour and more than 50% post-operative reduction. RESULTS: Snoring decreased significantly (6.7+/-2.3 to 3.7+/-2.9 on VAS, P=0.002) but the postoperative globus sense did not differ from that preoperatively (2.0+/-2.4 to 2.1+/-2.7 on VAS, P=0.79). Apnea and apnea-hypopnea indices were significantly reduced after UPPPP (34.7+/-20 to 24.2+/-17.2 events/hour, P=0.029). The surgical success rate was 40% regardless of Friedman stage. There was significant reduction in the AHI on supine sleep in both surgically successful and unsuccessful patient groups. CONCLUSION: UPPPP may minimize postoperative globus sense and other complications, with a success rate comparable to that of previously reported surgical methods in OSAS patients. In addition, it may reduce the apnea-hypopnea index in the supine sleep position.