Two Cases of Bilateral Paranasal Sinus Fungus Balls with Sphenoid Sinus Involvement / 대한이비인후과학회지

A fungus ball is the most common manifestation of fungal sinusitis. Bilateral involvement of fungus balls is rare, and bilateral sphenoid involvement is even more uncommon. The authors report two cases of bilateral fungus balls with sphenoid sinus involvement successfully treated with endoscopic sinus surgery. Both patients complained of nonspecific headache; diagnoses were made with CT and histopathological examinations, and surgical removal was achieved via transostial approach. Bilateral fungus balls involving the sphenoid sinus are rare but do occur; their removal is possible through endoscopic sinus surgery with a high cure rate. We thus recommend using CT scanning to identify typical findings of a sphenoid fungus ball even in bilateral paranasal sinusitis and perform aggressive surgical treatment.

Two Cases of Bilateral Paranasal Sinus Fungus Balls with Sphenoid Sinus Involvement / 대한이비인후과학회지

A fungus ball is the most common manifestation of fungal sinusitis. Bilateral involvement of fungus balls is rare, and bilateral sphenoid involvement is even more uncommon. The authors report two cases of bilateral fungus balls with sphenoid sinus involvement successfully treated with endoscopic sinus surgery. Both patients complained of nonspecific headache; diagnoses were made with CT and histopathological examinations, and surgical removal was achieved via transostial approach. Bilateral fungus balls involving the sphenoid sinus are rare but do occur; their removal is possible through endoscopic sinus surgery with a high cure rate. We thus recommend using CT scanning to identify typical findings of a sphenoid fungus ball even in bilateral paranasal sinusitis and perform aggressive surgical treatment.

Pathophysiology and Management of the Ranula / 대한이비인후과학회지

Ranulas are pseudocysts on the floor of the mouth resulting from the retention or extravasation of saliva from the sublingual gland (SLG). The etiology of ranulas is unknown, but they have been associated with local trauma or previous surgery. The anatomic variation of the ductal system of the SLG such as Bartholin's duct might be a possible cause of ranulas. Treatment modalities range from conservative to various surgical techniques, including sclerotherapy, marsupialization, excision of the ranulas with or without excision of the SLG and botox injection. Recently, less invasive treatment modality such as micro-marsupialization has been introduced. It was able to easily and safely treat the ranulas. But it also has the possibility of recurrence, especially in cases having anatomic variation of the ductal system of the SLG. A definitive and reliable treatment choice is surgical resection of the SLG with or without marsupialization than other, more conservative treatments.

Clinical Implications of Septal Deviation in Lateralized Olfaction

OBJECTIVES: Results of butanol threshold tests (BTTs) have shown that birhinal olfaction tends to converge toward monorhinal olfaction of the dominant nostril. However, birhinal olfaction may also be worse than dominant-side monorhinal olfaction. The goal of our study was to investigate the effect of deviated nasal septum on birhinal olfaction in patients with lateralized olfaction and to examine the effect of septoplasty in these patients. METHODS: A retrospective study with planned data collection was conducted in 518 patients who underwent BTTs. Lateralized olfaction was defined as monorhinal BTT scores that differed by >2 between sides. Underestimated birhinal olfaction was defined as a birhinal BTT score >2 lower than the dominant nostril monorhinal BTT score. Patients with lateralized olfaction were divided into 2 groups: group 1, underestimated birhinal olfaction; and group 2, without underestimated birhinal olfaction. RESULTS: Among 518 patients, 112 with lateralized olfaction were enrolled in this study. Group 1 included 23 patients (20.5%) and group 2 included 89 patients (79.5%). The severity of septal deviation (ratio of the distance of narrower side to wider side) did not differ between the 2 groups. Septal deviation to the dominant nostril was more common in group 1 than group 2 (73.9% vs. 37.6%; P=0.002). Five patients with septal deviation to the dominant nostril with underestimated birhinal olfaction underwent septoplasty. Improved lateralized olfaction occurred in all 5 patients postoperatively (P=0.041). CONCLUSION: Septal deviation of the dominant nostril in patients with lateralized olfaction is associated with underestimated birhinal olfaction. Septoplasty may improve olfaction by increasing airflow in the dominant olfactory side.

Combined Endoscopic Sinus Surgery and Rhinoplasty: Efficacy and Limitation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Combined endoscopic sinus surgery (ESS) and rhinoplasty may benefit patients but can pose a considerable task to the surgeon at the same time. The aim of this study is to analyze the surgical outcomes of the concurrent ESS and rhinoplasty with emphasis on the efficacy and limitation. SUBJECTS AND METHOD: Consecutive 21 patients who underwent concurrent ESS and rhinoplasty (combined group) were identified. For comparison, rhinoplasty group who had only rhinoplasty and ESS group who had only ESS over the same period were selected. Medical records, endoscopic findings, and CT scans were reviewed. A telephone survey was done to evaluate subjective outcomes of the surgery. Objective aesthetic outcomes of rhinoplasty were evaluated by comparing the preoperative and postoperative photos by two rhinoplasty surgeons. RESULTS: In the combined group, ten patients (24%) had ESS-related complications and one patient (5%) had rhinoplasty-associated complications. On the other hand, only one patient (5%) had recurred rhinosinusitis in the ESS group but three patients (14%) had complications including revision surgery in rhinoplasty group. Subjective functional satisfaction score after ESS and subjective aesthetic satisfaction score after rhinoplasty did not show any significant difference between the combined group and each matching group. Objective aesthetic evaluation did not show any difference either. CONCLUSION: Concurrent ESS and rhinoplasty have similar subjective functional improvement and objective surgical outcome compared with ESS alone or rhinoplasty alone. However, concurrent surgery had a tendency to show poorer surgical outcome in ESS than in rhinoplasty warranting a cautious approach with patient selection.

A Case of Tracheal Foreign Body Removed by Endoscopic Approach with Tracheotomy / 대한이비인후과학회지

Foreign body (FB) airway obstruction is a life-threatening clinical situation. The FB's are removed by bronchoscopy in the majority of patients, but in highly-selected cases, tracheotomy is occasionally indicated in foreign body extraction, when they are subglottic in location and impacted, or large enough to get obstructed at the glottic chink during endoscopic removal. Authors report one case of tracheal FB which required tracheotomy for the FB removal after the failure of FB removal with rigid bronchoscopy.