Anti-Adhesive Effect of GUARDIX-SL(R) after Intact Canal Wall Mastoidectomy: Preliminary Study

BACKGROUND AND OBJECTIVES: Adhesion of middle ear and mastoid cavity after mastoidectomy represents a potential source of surgical failure. GUARDIX-SL(R), absorbable anti-adhesive material, which is composed of sodium hyaluronate and sodium carboxymethyl cellulose, is an effective agent that widely used as a surgical adjuvant to decrease adhesion in the surgery. Therefore, we evaluated the clinical efficacy of the GUARDIX-SL(R) for the prevention of adhesion after mastoidectomy. SUBJECTS AND METHODS: This study was randomized and double-blinded. Conventional intact canal wall mastoidectomy was conducted in both control (n=14) and study group (n=10). To avoid bias because of different surgeons, we only included patients who were operated on by one surgeon. In the study group, 1.5 g GUARDIX-SL(R) was applied in the mastoid cavity at the end of mastoidectomy. To evaluate anti-adhesive effect of GUARDIX-SL(R), the volume of aerated area in the mastoid cavity was calculated and compared with temporal bone computed tomography performed at preoperatively and postoperatively. Besides, to assess the success of operation, pure tone audiometry was also performed at preoperatively and postoperatively. RESULTS: The volume of aerated area of mastoid cavity after mastoidectomy was more increased in GUARDIX-SL(R) group, but was not statistically significant in the GUARDIX-SL(R) group than the control. And all results of pure tone audiometry satisfied the criteria of successful operation which has been suggested by Otological Society of Korea. CONCLUSION: The results suggest that GUARDIX-SL(R) may be an efficacious and safe material in decreasing the incidence of adhesion after mastoidectomy.

A Case of Endoscopic Marsupialization of a Nasopalatine Duct Cyst

Nasopalatine duct cysts (NPDC) are common cystic lesions of non- odontogenic origin of the maxilla. Patients with NPDC generally undergo surgical enucleation via transoral approach. However, with the recent introduction of sinonasal endoscopy and subsequent advances in surgical techniques, endoscopic management has become possible. This study reviews a case of a 40- year-old man had a one-month history of nasal obstruction and swelling of the hard palate. Nasal endoscopy revealed a cyst in the nasal floor and hard palate. He underwent successful endoscopic marsupialization of NPDC. This simple and less invasive surgical procedure should be considered in the future treatment of NPDC.

A Case of Sebaceous Hyperplasia of the Nasal Vestibule

Sebaceous hyperplasia is a cutaneous lesion consisting of soft, yellow, papular lesions usually occurring on the face of elderly patients. The occurrence of the lesion on the nasal vestibule is exceptionally rare. Except for cosmesis, the condition has no clinical significance. However, the lesion is sometimes confused with early basal cell carcinomas. It should be considered as a differential diagnosis in the neoplasm of the nasal vestibule. Biopsy may be necessary if there is any concern about a malignancy. Treatment options include electrodesiccation, laser therapy, and topical bichloracetic acid. In this study, we report a case of sebaceous hyperplasia of the nasal vestibule with an unusual presentation.

Isolated Inverted Papilloma of the Sphenoid Sinus Presenting as Ptosis

Inverted papilloma is a rare form of a benign sinonasal tumor characterized by a potentially invasive nature. The lateral nasal wall represents the most common site of origin. In contrast, involvement of sphenoid sinus is exceedingly rare. The present study describes a case of a 52-years-old patient with an inverted papilloma which originated from the sphenoid sinus. The patient complained mainly of headache, ptosis and diplopia. Radiologic study revealed that the sphenoid sinus was completely occupied by the tumor. Additionally, the ethmoid sinus, cavernous sinus and intracranial fossa have been invaded by the tumor. Endoscopic sinus surgery and postoperative radiotherapy were performed. Two months after the operation, the patient has not revealed any new symptom. However, a remnant of the inverted papilloma still remains. The clinical presentation of the inverting papillomas confined to the sphenoid sinus is often non-specific and insidious, with ptosis and diplopia being predominant. The rhinologic surgeon has to rule out this condition.