The Application of Fibrin/Hyaluronic Acid–Poly(L-Lactic-co-Glycolic Acid) Construct in Augmentation Rhinoplasty

Althoughmany graftmaterials have been used for augmentation rhinoplasty, an ideal graft has not yet been developed.As the field of tissue engineering has been developing, it has been applied to the reconstruction of many organs, but its application in the rhinoplasty field is still limited. This study evaluated the utility of allogenic chondrocytes with fibrin/hyaluronic acid (HA)–poly(L-lactic-co-glycolic acid) (PLGA) constructs in augmentation rhinoplasty. Chondrocytes from rabbit auricular cartilage were isolated and cultured with fibrin/HA hydrogels and implanted into PLGA scaffolds. After 8 weeks of in vitro culture, the scaffolds were implanted in the nasal dorsum of six rabbits. Eight weeks postoperatively, the implanted siteswere evaluated with gross, radiologic, and histologic analysis. In vitro, more than 90% of the seeded chondrocytes in the PLGA scaffolds survived for 2 weeks, and they produced a large amount of extracellular matrix and were well differentiated. The grafts maintained their initial shape for 8 weeks after implantation. Radiological and histological evaluations showed that the structure was well maintained with minimal inflammatory response and appropriate elevation levels. However, the formation of neo-chondrocytes was not observed. PLGA scaffolds seeded with fibrin/HA and allogenic chondrocytes can be a biocompatible augmentation material in rhinoplasty in the future.

Five-Year Subjective Outcomes of Obstructive Sleep Apnea Surgery: A Multiinstitutional Study

OBJECTIVES: To evaluate the effect of obstructive sleep apnea (OSA) surgery on long-term (5-year) subjective outcomes, including sleep disordered breathing (SDB) symptoms and other complications, in patients with OSA. METHODS: We enrolled patients who underwent diagnostic polysomnography for OSA between January 2006 and December 2006 in ten hospitals. Patients either were treated for OSA or were not treated for OSA. All patients completed a brief telephone survey regarding their SDB signs and symptoms (e.g., snoring, apnea, nocturnal arousals, and daytime sleepiness), positive airway pressure (PAP) compliance, and any adverse effects of either the surgery or PAP. A positive subjective outcome for either surgery or no treatment was taken to be the alleviation of apnea, defined as a > or =50% increase in score. A positive subjective outcome (compliance) for PAP was defined as a PAP usage of > or =4 hours per night and > or =5 days per week. RESULTS: A total of 229 patients were included in this study. Patients were divided into three groups: a surgery group (n=87), a PAP group (n=68), and a control (untreated) group (n=74). The surgery group exhibited significant improvement in all SDB symptoms compared with the control group. The long-term subjective outcomes of the surgery (52.9%) and PAP (54.4%) groups were significantly better than those of the control group (25.0%). The subjective outcome of the surgery group was not significantly different from that of the PAP group. The overall surgical complication rate was 23.0% (20 of 87) in the surgery group, and 55.0% (22 of 40) of all patients with PAP experienced adverse effects. CONCLUSION: The extent of SDB symptoms was consistently improved in patients with OSA at 5 years postsurgery. Information about the potential long-term subjective outcomes should be provided to patients when considering surgery.

A Case of Petrous Apex Mucocele with Unilateral Ear Fullness Treated with Endoscopic Sphenoid Marsupialization / 대한이비인후과학회지

Mucocele is a benign, encapsulated lesion, lined by epithelium and filled with mucus. Found mostly in the frontal and ethmoid sinus, sinonasal mucoceles cause several symptoms depending on the location. We report a case of mucocele found in the petrous apex that caused ear fullness. It was completely treated with endoscopic sphenoid marsupialization.

A Case of Extrahepatic Metastasis of Hepatocellular Carcinoma in the Nasal Septum managed with Endoscopic Resection

Metastasis of hepatocellular carcinoma (HCC) in the nasal septum is an extremely rare condition. The proper management and the role of surgical intervention are still controversial and there is no evidence-based guideline for this specific condition. The authors of the present study report a case of HCC with sinonasal metastasis, managed by surgery to relieve nasal obstruction and frequent epistaxis. Complete removal of the tumor via endoscopic surgery was performed and the pathology was reported to be consistent with metastatic HCC. No additional treatment modality was considered for the septal lesion. During the 8-month postoperative period, the patient remained alive and satisfied with comfortable nasal breathing. The present case report stresses the importance of interdisciplinary collaboration. Proper consultation between surgeon and oncologist may lead to improved quality of life, even when the patient is in the terminal stage of HCC.

Rosai-Dorfman Disease of the Nasal Cavity and Nasopharynx / 대한이비인후과학회지

Rosai-Dorfman disease is a rare disorder of unknown etiology and is usually associated with benign proliferation of hematopoietic and fibrous tissue that often manifests in the head and neck region. The most common clinical presentation of this entity is bilateral, nontender cervical lymphadenopathy, but an extranodal form of the disease may develop in up to 43% of patients. We report a case of extranodal Rosai-Dorfman disease occurring in the nasal cavity and the nasopharynx. A 25-year-old male visited the clinic with a complaint of nasal obstruction for several months. Mass originating from anterior portion of septum and nasopharyngeal cavity was observed by endoscopy. Endoscopic guided incisional biopsy of the lesion was performed. The histopathologic findings revealed clusters of large, foamy histiocytes with abundant clear cytoplasm, lymphophagocytosis, and heavy infiltration of lymphocytes and plasma cells, which are the key features of Rosai-Dorfman disease.

IL-1beta Induces Lysozyme Overexpression through a Mechanism Involving ERK/p38 Mitogen Activated Protein Kinase Activation in Human Airway Epithelial Cells

BACKGROUND AND OBJECTIVES: Lysozyme, a major serous component of airway epithelial secretions, plays an important role in airway defense. However, little is understood about the regulation of its expression and the associated signaling pathway. The object of this study is to investigate the regulation of lysozyme expression, the downstream signaling pathway of lysozyme expression, and the related protein kinases under inflammatory conditions using the IL-1beta, which acts as a significant cytokine in many airway inflammations. MATERIALS AND METHODS: After the IL-1beta treatment of normal human nasal epithelial cells (NHNE), lysozyme mRNA expression was determined by RT-PCR. Expressed levels of ERK/p38 kinase were determined by Western blot analysis. RESULTS: IL-1beta treated NHNEcells had over-expressed lysozyme compared to the control group. Activated ERK/p38 kinase level showed marked increment by treating NHNE with IL-1beta. Lysozyme expression and ERK/p38 kinase levels decreased when inhibitors of ERK/p38 MAP kinases were added to the IL-1beta treated cells. Finally, expression of lysozyme and activated level of ERK/p38 MAP kinases decreased in a dominant-negative cell line even when treated with IL-1beta. CONCLUSION: From these results, we concluded that IL-1beta induces over-expression of lysozyme via ERK/p38 MAP kinase signaling pathways in airway epithelial cells.

Occult Lymph Node Metastasis in Early Oral Tongue Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The most significant prognosticator of survival for patients with squamous cell carcinoma of the oral tongue has been the association of neck nodal metastasis. However, no consensus exists as to whether an elective neck dissection should be performed in patients with early oral tongue squmous cell carcinoma with a clinically negative neck. SUBJECTS AND METHOD: A retrospective analysis was performed on 54 early oral tongue squamous cell carcinoma patients (T1=26 and T2=28) with clinically negative necks who were treated between 1992 to 2003. All patients had an ipsilateral neck dissection and 29 patients had a contralateral neck dissection. Surgical treatment was followed by postoperative radiotherapy in 20 patients. The follow-up period ranged from 3 to 110 months (mean, 56 months). Data were analyzed using the Kaplan-Meier method, log-rank test, and the chi-square test. RESULTS: Clinically occult, but pathologically positive ipsilateral lymph nodes were found in 26% (14/54) and contralateral lymph nodes in 3% (1/29). Based on the clinical staging of the tumor, 19% (5 of 26) of the cases showed lymph node metastases in T1 tumors, and 36% (10 of 28) in T2. All regional recurrences developed in the ipsilateral necks, there was no cases of contralateral neck recurrence. Patients with no evidence of occult nodal cancer have significantly improved disease-specific free survival rates over patients with any pathologically positive nodes (5 year disease specific survival rate, 90% vs 38%, p< or = 0.05). CONCLUSION: This study showed that ipsilateral elective neck dissection should be performed for early oral tongue cancers. On the other hand, our series suggests that it may not be harmful to observe the contralateral N0 neck in the treatment of early oral tongue cancer.