Clinical Outcome of Conjunctivodacryocystorhinostomy / 대한이비인후과학회지

Background and Objectives@#The conjunctivodacryocystorhinostomy (CDCR) is rarely performed in epiphora, which is caused by complete proximal bicanalicular obstruction. The purpose of this study is to analyze the characteristics, clinical results and complications of patients who underwent CDCR.Subjects and Method We enrolled 12 patients who underwent CDCR due to proximal canalicular obstruction from 2006 to 2019. We retrospectively analyzed the causes of epiphora, trauma history, the cause of revision operation and the clinical outcome. @*Results@#A total of 12 patients (7 males and 5 females) underwent CDCR (mean age 46 years). The causes of trauma were such as laceration (n=7, 58%) and iatrogenic (n=1, 8%), idiopathic obstruction (n=4, 33%). After the initial surgery, 5 patients (41%) were categorized in good outcome and the Jones tube was located well in 6 (50%) patients. Revision surgery was performed in 6 (50%) cases, with 4 cases having good outcome. The success rate of CDCR, including revision surgery, was increased to 83%. Most common cause of revision surgery was tube migration. In addition, the subjective outcome in patients with traumatic causes were worse but it had no statistical significance compared to that of patients with idiopathic and iatrogenic causes (p=0.07). @*Conclusion@#About a half of the patients had good recovery rate after the initial operation. The outcome increased to 83% after revision operation. The success rate of CDCR for traumatic patients was worse than for those with idiopathic and iatrogenic causes. It seems that accompanied eyelid damage in traumatic patients may have affected the result of success rate.

A Case of a 50-Year Old Women with Cerebrospinal Fluid Rhinorrhea and Right Nasal Cavity Mass / 대한이비인후과학회지

A 50-year-old woman visited the hospital with persistent watery rhinorrhea which she had for 2 months. Endoscopic examination revealed a mass in the right nasal cavity and rdiological findings revealed a bony defect on the lateral wall of the sphenoid sinus associated with the protrusion of the mass lesion. Endoscopic skull base reconstruction was performed via transpterygoid approach, including a watertight closure of the dural defect with both underlay and overlay repairs. Cerebrospinal fluid (CSF) leakage persisted after reconstruction. The right lateral lamella was identified as a secondary CSF leakage site. CSF leakage is common among patients with meningoencephalocele. However, a secondary CSF leakage accompanied with meningoencephalocele in other areas is uncommon. The present patient experienced CSF leakage from multiple sites—one associated with the original meningoencephalocele and another from a secondary defect at the skull base. This complication is rare in clinical practice. Here, we describe this rare case with a brief literature review.

Comparison of Postoperative Results According to Fungus Ball Extension in Maxillary Sinus / 대한이비인후과학회지

Background and Objectives@#Fungus ball is the most common type of fungal sinusitis commonly associated with good prognosis. However, postoperative results depending on the extent of the lesion has not been investigated. This study aimed to identify differences in postoperative results depending on the location and extent of the fungus ball.Subjects and Method Medical records of 165 patients who underwent endoscopic sinus surgery and who were diagnosed with fungus balls by biopsy from 2010 to 2019 were retrospectively reviewed. Patients were classified into four grades according to the location and extent of the fungus ball based on their endoscopic and CT findings. Poor outcome is defined as any pathologic signs such as nasal secretion, granulation, and polyps or narrowing of the natural ostium observed postoperatively according to Kennedy’s criteria, whereas good outcome is defined as absence of pathologic signs. @*Results@#A total of 23 patients were Grade 1, 38 Grade 2, 67 Grade 3, and 37 Grade 4. Grades 1 and 2 were mostly asymptomatic. However, as the location of the fungus ball became closer to the natural ostium, patients complained postnasal drip and purulent discharge. Grades 3 and 4, who have much severe and more extensive lesions than those of Grades 1 and 2, had poor outcome (p=0.007) and took longer time to completely recover (p<0.001). @*Conclusion@#Wound healing was delayed and poor when the fungus ball was located closer to the natural ostium of the maxillary sinus. Therefore, preoperative consultation using endoscopic and CT findings could be useful for predicting their postoperative results.

The impact of air pollution on allergic rhinitis

Recently, air pollution has become more and more severe globally and has decreased the quality of life significantly in subjects with or without allergic diseases. Air pollution more severely affects patients with allergic diseases, including allergic rhinitis (AR); therefore, it could devastate quality of life. Many epidemiological studies have shown that air pollutants increased outpatient clinic visits as well as the prevalence/severity of AR and decreased quality of life in patients with AR. Traffic-related air pollution also increases the severity and occurrence rate of AR, and heavy traffic is also associated with an increased prevalence of AR. Immunologically, air pollutants increase airway inflammation and mucin production by triggering the generation of reactive oxygen species and inducing the nucleotide-binding domain, leucine-rich repeat protein 3 inflammasome and apoptosis. Since air pollution affects both the upper and lower airways and is known to be a risk factor for AR, proper diagnosis and treatment should be applied. In this review article, we will address several epidemiological and clinical studies about the effects of air pollution on AR, mechanisms by which air pollutants aggravate AR, and treatment of AR triggered by air pollutant.

Strain-Specific Differences in House Dust Mite (Dermatophagoides farinae)-Induced Mouse Models of Allergic Rhinitis

Objectives@#. Limited information is available regarding strain-related differences in mouse models of allergic rhinitis induced by Dermatophagoides farinae (Der f1). In this study, we compared differences between two mouse strains and determined the optimal dose of Der f1 for allergic rhinitis mouse models. @*Methods@#. Forty-eight mice were assigned to the following six groups (n=8 per group): group A (control, BALB/c), group B (Der f1-sensitized BALB/c, 25 µg), group C (Der f1-sensitized BALB/c, 100 µg), group D (control, C57BL/6), group E (Der f1-sensitized C57BL/6, 25 µg), and group F (Der f1-sensitized C57BL/6, 100 µg). Allergic inflammation was induced with Der f1 and alum sensitization, followed by an intranasal challenge with Der f1. Rubbing and sneezing scores, eosinophil and neutrophil infiltration, and immunoglobulin, cytokine, and chemokine levels in the nasal mucosa and from splenocyte cultures were assessed. @*Results@#. Rubbing and sneezing scores were higher in groups B, C, E, and F than in groups A and D, with a similar pattern in both strains (i.e., group B vs. E and group C vs. F). Serum immunoglobulin levels were significantly elevated compared to the control in groups B and C, but not in groups E and F. Eosinophil and neutrophil infiltration increased (all P0.05). BALB/c mice (group B) showed a greater elevation of splenic interleukin (IL)-4 (P<0.01), IL-5 (P<0.01), and IL-6 levels (P<0.05) and nasal IL-4 mRNA levels (P<0.001) than the C57BL/6 mice (group E). Interestingly, mice treated with 100 µg Der f1 showed a weaker allergic response than those treated with 25 µg. @*Conclusion@#. We found 25 µg to be a more appropriate dose for Der f1 sensitization. BALB/c mice are more biased toward a Th2 response and are a more suitable model for allergic rhinitis than C57BL/6 mice. This study provides information on the appropriate choice of a mouse model for allergic rhinitis.

Role of IL-17A in Chronic Rhinosinusitis With Nasal Polyp

PURPOSE: Th17-associated inflammation is increased in chronic rhinosinusitis with nasal polyp (CRSwNP), and is associated with disease severity and steroid resistance. Overexpressed interleukin (IL)-17A affects CRSwNP by tissue remodeling, eosinophilic accumulation, and neutrophilic infiltration. We aimed to identify the role of IL-17A in CRSwNP and to evaluate the effects of anti-IL-17A blocking antibody on nasal polyp (NP) formation using a murine NP model. Moreover, we sought to investigate whether the inhibition of mechanistic target of the rapamycin (mTOR) signal pathway could suppress IL-17A expression and NP formation.METHODS: Human sinonasal tissues from control subjects and patients with chronic rhinosinusitis (CRS) were analyzed using immunohistochemistry (IHC) and immunofluorescence staining. The effects of IL-17A neutralizing antibody and rapamycin were evaluated in a murine NP model. Mouse samples were analyzed using IHC, quantitative real-time polymerase chain reaction, and enzyme-linked immunosorbent assay.RESULTS: IL-17A+ inflammatory cells were significantly increased in number in NP from patients with CRSwNP compared to that in uncinate process tissues from control subjects and patients with CRS without NP or CRSwNP. CD68+ M1 macrophages dominantly expressed IL-17A, followed by neutrophils and T helper cells, in NP tissues. Neutralization of IL-17A effectively reduced the number of NPs, inflammatory cytokines, and IL-17A-producing cells, including M1 macrophages. Inhibition of IL-17A via the mTOR pathway using rapamycin also attenuated NP formation and inflammation in the murine NP model.CONCLUSIONS: IL-17A possibly plays a role in the pathogenesis of CRSwNP, the major cellular source being M1 macrophage in NP tissues. Targeting IL-17A directly or indirectly may be an effective therapeutic strategy for CRSwNP.

The Effect of Long-Term Follow up on Outcome of Pediatric Endoscopic Sinus Surgery

BACKGROUND AND OBJECTIVES: Chronic pediatric sinusitis continues to be a challenging problem to otolaryngologists and has been reported to show worse prognosis than that of adults. However, most studies were performed with short-term follow-up. In this study, we aimed to assess the clinical outcome of pediatric endoscopic sinus surgery (ESS) with a longer follow-up and to determine the effect of age on postoperative outcome. SUBJECTS AND METHOD: A retrospective analysis was performed on pediatric patients than 15 years with ESS younger from 2005 to 2014 in a tertiary referral hospital. All patients completed a questionnaire regarding symptoms before to from 1 to 9 years after surgery. Telephone survey was performed to evaluate symptoms including nasal obstruction, nasal discharge, PND, and headache at 1 to 9 years after surgery. RESULTS: Seventy-one pediatric patients with bilateral chronic sinusitis were treated with ESS. They showed gradual symptom improvement from 5 year after surgery for the following: nasal obstruction (p=0.032), PND (p=0.005), and headache (p=0.048). However, there was improvement in rhinorrhea after 9 years (p=0.042). In addition, when analyzed in terms of age, the outcome was poor in children younger than 13 years (p=0.003) compared with the older age group. Multivariate analysis showed that preoperative nasal obstruction was dependent on AR, and postoperative symptoms were dependent on presence of AR and involuntary smoking. Nasal discharge was dependent on presence of AR and involuntary smoking preoperatively and postoperatively. These suggest the importance of AR and involuntary smoking as risk factors for prognosis. CONCLUSION: Chronic pediatric sinusitis showed gradual improvement after ESS and should be more carefully monitored on a long-term basis. We should keep in mind that long-term follow-up is needed for pediatric ESS cases.

The Differences in Paranasal Sinus Pneumatization after Adolescence in Korean / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The embryological development of paranasal sinuses has been revealed by previous articles although few studies have reported on the differences of paranasal sinus pneumatization according to age after adolescence. We evaluated changes in paranasal sinus pneumatization in the ages ranging from 10s to over 60s. SUBJECTS AND METHOD: A retrospective review was carried out for patients who underwent osteomeatal unit three-dimensional computed tomography from January 2008 to March 2017. Two hundred and forty patients were selected and matched for age, sex, and existence of sinusitis. The biggest cross-sectional area (CSA) of each sinus was selected from each patient, which was then corrected to the size of the face. CSA and corrected CSA (cCSA) values were used together for analysis. RESULTS: CSAs of frontal, maxillary, sphenoid sinuses gradually increased in the ages ranging in the 30s, and then significantly decreased from those in the 40s onwards. In particular, these tendencies were statistically significant in all types of sinuses between the 30s and 40s, (p0.05). CSAs in patients with chronic sinusitis were not different from those in patients without chronic sinusitis in every sinus and all age groups (p>0.05). CONCLUSION: This study shows that older people have smaller sinuses, and sex difference and existence of sinusitis have no effect on the pneumatization of the sinuses.

The Differences in Paranasal Sinus Pneumatization after Adolescence in Korean / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#The embryological development of paranasal sinuses has been revealed by previous articles although few studies have reported on the differences of paranasal sinus pneumatization according to age after adolescence. We evaluated changes in paranasal sinus pneumatization in the ages ranging from 10s to over 60s.SUBJECTS AND METHOD: A retrospective review was carried out for patients who underwent osteomeatal unit three-dimensional computed tomography from January 2008 to March 2017. Two hundred and forty patients were selected and matched for age, sex, and existence of sinusitis. The biggest cross-sectional area (CSA) of each sinus was selected from each patient, which was then corrected to the size of the face. CSA and corrected CSA (cCSA) values were used together for analysis.@*RESULTS@#CSAs of frontal, maxillary, sphenoid sinuses gradually increased in the ages ranging in the 30s, and then significantly decreased from those in the 40s onwards. In particular, these tendencies were statistically significant in all types of sinuses between the 30s and 40s, (p0.05). CSAs in patients with chronic sinusitis were not different from those in patients without chronic sinusitis in every sinus and all age groups (p>0.05).@*CONCLUSION@#This study shows that older people have smaller sinuses, and sex difference and existence of sinusitis have no effect on the pneumatization of the sinuses.

Analysis of Treatment Outcome Associated with Pre-Operative Diagnostic Accuracy Changes and Dental Treatment Timing in Odontogenic Sinusitis Involving Unilateral Maxillary Sinus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Unilateral sinusitis is caused by various factors. Odontogenic sinusitis; especially, is different from non-odontogenic sinusitis in clinical features and prognosis. The purpose of this study is to evaluate the prognosis of odontogenic sinusitis in accordance with the changes in diagnostic accuracy over time and the timing of dental treatment.SUBJECTS AND METHOD: 195 patients who underwent endoscopic sinus surgery for unilateral sinusitis within the interval from 2006 to 2017 were reviewed to analyze the etiologies and clinical characteristics. Preoperative CT was assessed to identify patients who had not been diagnosed with odontogenic sinusitis in the past. In the unilateral bacterial sinusitis, we identified changes in incidence, diagnostic accuracy, and outcome in the odontogenic sinusitis. We divided odontogenic sinusitis patients into three groups: preoperative and intraoperative dental treatment group, postoperative dental treatment group, and untreated group. Then we analyzed the difference in prognosis of these three groups.@*RESULTS@#The total number of patients with odontogenic sinusitis was 86 (44%), which accounted for about 36% until 2011, but increased to about 48% after 2013. From 2006 to 2011, there were 15 cases of missed diagnosis of odontogenic sinusitis, but there was 1 case in 2012 and no cases since 2013. The treatment outcome of unilateral bacterial sinusitis was significantly increased from 84.1% before 2011 to 96% after 2012. The success rate was 97.1% in the case of accurate diagnosis of odontogenic sinusitis, but the success rate was 43.8% in case of missed diagnosis. In odontogenic sinusitis, the success rate was low when dental treatment was not performed. However, there was no difference in success rate among different dental treatment timings.@*CONCLUSION@#The incidence of odontogenic sinusitis has steadily increased over the last decade. The prognosis has been improved by appropriate treatment under accurate diagnosis through preoperative examination and radiological evaluation. There was no difference in the prognosis of odontogenic sinusitis according to the dental treatment time. Therefore, it is a good choice for tooth preservation to have an endoscopic sinus surgery first and then decide the dental treatment timing.

Characteristics and Outcomes of Septoplasty in Patients with Paradoxical Nasal Obstruction / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate clinical characteristics and outcome of septoplasty in patients complaining of paradoxical nasal obstruction. SUBJECTS AND METHOD: Medical records of 637 patients who underwent septoplasty from 2011 to 2016 were reviewed retrospectively. One hundred sixty-nine patients whose follow up periods were longer than 3 months were included. These patients were categorized into two groups, the experimental group (paradoxical nasal obstruction) and the control group. We analyzed the degree of nasal obstruction, the sino-nasal outcome test (SNOT)-22 score, which is the sino-nasal outcome, and the minimal cross-sectional area in acoustic rhinometry. The effect of concurrent turbinoplasty was also evaluated. RESULTS: Paradoxical nasal obstruction was found in 19 patients (11.2%). Compared to the control group, the degree of mucosal change (both concave and convex side) had no statistical significance. Although the degree of nasal obstruction and SNOT-22 scores were significantly improved after surgery in both groups (p<0.05), the values for the experimental group were slightly increased at 3 months of surgery after having been improved at one month of surgery. In contrast, those values improved steadily over time in the control group. The tendency of psychologic domain scores was significantly different between the two groups (p=0.021). The results of volume reductive turbinoplasty showed that it maintained the improved symptoms better when performed along with septoplasty. CONCLUSION: Although septoplasty showed beneficial effects in patients with paradoxical nasal obstruction, the effect of septoplasty decreased over time. Concurrent volume reductive turbinate surgery maintained the effect of septoplasty in paradoxical nasal obstruction.

Effect of Topical Propolis on Wound Healing Process After Tonsillectomy: Randomized Controlled Study

OBJECTIVES: The post-tonsillectomy pain and post-tonsillectomy hemorrhage are the two main problems after tonsillectomy. The aim of this study was to investigate the beneficial effects of water soluble ethanol extract propolis on post-tonsillectomy patient. METHODS: One hundred and thirty patients who underwent tonsillectomy or adenotonsillectomy were randomly divided into the control and propolis groups, each including 65 patients. The propolis group was applied with propolis orally immediately after surgery and by gargle. The pain scores were assessed on post-tonsillectomy 0, 1st, 2nd, 3rd, and 7th–10th day using a visual analogue scale score. Postoperative wound healing was evaluated by scoring pinkish membrane of tonsillar fossae on postoperative days 3 and 7–10. The incidence of post-tonsillectomy bleeding was examined in each group. RESULTS: Post-tonsillectomy pain was significantly less in propolis group compared to control group on postoperative days 3 and 7–10. Post-tonsillectomy hemorrhage was significantly less in the propolis group compared to the control group (P < 0.05). The wound healing was significantly better in the propolis group compared to the control group on postoperative day 7–10 (P=0.002). CONCLUSION: Applying the propolis to post-tonsillectomy wound showed beneficial effect of reducing postoperative pain, preventing hemorrhage, and accelerating of wound healing of tonsillar fossae.

Characteristics and Outcomes of Septoplasty in Patients with Paradoxical Nasal Obstruction / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#The aim of this study was to evaluate clinical characteristics and outcome of septoplasty in patients complaining of paradoxical nasal obstruction.SUBJECTS AND METHOD: Medical records of 637 patients who underwent septoplasty from 2011 to 2016 were reviewed retrospectively. One hundred sixty-nine patients whose follow up periods were longer than 3 months were included. These patients were categorized into two groups, the experimental group (paradoxical nasal obstruction) and the control group. We analyzed the degree of nasal obstruction, the sino-nasal outcome test (SNOT)-22 score, which is the sino-nasal outcome, and the minimal cross-sectional area in acoustic rhinometry. The effect of concurrent turbinoplasty was also evaluated.@*RESULTS@#Paradoxical nasal obstruction was found in 19 patients (11.2%). Compared to the control group, the degree of mucosal change (both concave and convex side) had no statistical significance. Although the degree of nasal obstruction and SNOT-22 scores were significantly improved after surgery in both groups (p<0.05), the values for the experimental group were slightly increased at 3 months of surgery after having been improved at one month of surgery. In contrast, those values improved steadily over time in the control group. The tendency of psychologic domain scores was significantly different between the two groups (p=0.021). The results of volume reductive turbinoplasty showed that it maintained the improved symptoms better when performed along with septoplasty.@*CONCLUSION@#Although septoplasty showed beneficial effects in patients with paradoxical nasal obstruction, the effect of septoplasty decreased over time. Concurrent volume reductive turbinate surgery maintained the effect of septoplasty in paradoxical nasal obstruction.

Long-Term Outcome of Endoscopic Sinus Surgery in Patients with Aspirin-Exacerbated Respiratory Disease / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Patients with aspirin-exacerbated respiratory disease (AERD) tend to have more severe clinical course and also tend to be recalcitrant to conventional medical and surgical treatment. This study aimed to assess the long-term outcome of endoscopic sinus surgery in AERD patients. SUBJECTS AND METHOD: Fifteen patients with AERD (n=15) were identified through a retro-spective chart review, and compared with 74 patients of CRSwNP (with asthma n=23; without asthma n=51) by analyzing preoperative and postoperative symptoms, endoscopic score, Lund-Mackay CT score, number of revision surgery or outpatient procedures, frequency of clinic visits and medications. The CRS control status was evaluated according to the European Position Paper on Rhinosinusitis and Nasal Polyps 2012 criteria and logistic regression analyses were conducted to investigate the determining factors of preoperative and postoperative symptoms. RESULTS: The AERD group showed higher disease severity than other groups preoperatively: endoscopic score (CRSwNP s asthma 6.3±2.6 vs. CRSwNP c asthma 6.5±2.3 vs. AERD 8.8±1.4, p<0.05), CT score (12.2±4.9 vs. 17.0±4.8 vs. 18.0±2.1, p<0.05), and overall symptom score (30.8±0.4 vs. 33.8±1.5 vs. 37.9±0.7, p<0.01). The rate of revision surgery and outpatient procedures, postoperative clinic visit and prescription rate were higher in the AERD group (p<0.05, respectively). However, postoperative symptom scores and CRS control status were not significantly different among three groups (p=0.267 and p=0.996, respectively). CONCLUSION: Although AERD patients showed higher preoperative endoscopic scores and revision surgery rates, postoperative subjective symptoms were comparable to those of other groups with long-term follow up, suggesting the importance of frequent outpatient care after endoscopic sinus surgery.

The Impact of Allergic Rhinitis on Symptom Improvement in Pediatric Patients After Adenotonsillectomy

OBJECTIVES: It is well known that allergic rhinitis (AR) has positive association with adenotonsillectomy. However, the impact of AR on symptom improvement after adenotonsillectomy is not well documented. Hence, we aimed to evaluate the effect of AR on the symptom improvement after adenotonsillectomy between AR and nonallergic patients. METHODS: A retrospective analysis was performed on 250 pediatric patients younger than 10 years old who received adenotonsillectomy from June 2009 to June 2014 in a tertiary referral hospital. All patients underwent skin prick test or multiple allergen simultaneous test (MAST) before surgery and classified into AR group and control group. Obstructive and rhinitis symptoms including snoring, mouth breathing, nasal obstruction, rhinorrhea, itching, and sneezing were evaluated before and 1 year after surgery using questionnaire and telephone survey. RESULTS: AR group was 131 and control group was 119, showing higher prevalence (52.4%) of AR among adenotonsillectomized patients. Both groups showed dramatic improvement of symptoms such as snoring and mouth breathing after surgery (all P < 0.05). However, AR group showed significantly less improvement than control group in snoring, mouth breathing, nasal obstruction, and rhinorrhea (all P < 0.05). Multivariate analysis showed that preoperative mouth breathing and snoring were dependent on tonsil grade and postoperative symptoms were mainly dependent on presence of AR. Nasal obstruction was dependent on tonsil grade and presence of AR preoperatively and presence of AR postoperatively. These suggest the importance of AR as a risk factor for mouth breathing, snoring, and nasal obstruction. CONCLUSION: AR has positive association with adenotonsillectomy and not only allergic symptoms but also obstructive symptoms such as snoring and mouth breathing improved less in AR group than control group. Hence, patients with AR should be monitored for long-term basis and more carefully after adenotonsillectomy.

Recent Trends of Prevalence in Unilateral Sinusitis and Useful Factors in Differential Diagnosis

BACKGROUND AND OBJECTIVES: Unilateral sinus lesions can be caused by many diseases and exact preoperative diagnosis is often difficult to make. The aims of this study were to evaluate the recent trends for prevalence of unilateral sinus lesions and find useful factors in differential diagnosis. MATERIALS AND METHOD: Preoperative clinical diagnosis including computed tomography (CT) images, endoscopic findings and postoperative diagnosis based on pathology were assessed retrospectively in 384 consecutive patients who underwent unilateral sinus surgery from 2004 to 2013. RESULTS: Chronic bacterial rhinosinusitis (40%) was the most common cause of unilateral sinus lesions, followed by fungal sinusitis (21%), benign and malignant tumors (14%), and odontogenic sinusitis (11%). The incidence of odontogenic sinusitis has recently increased and mismatches of pre- and post-operative diagnosis were commonly found among patients with chronic bacterial rhinosinusitis, fungal sinusitis, or odontogenic sinusitis. Microcalcification in fungal sinusitis and dental lesions in odontogenic sinusitis were confirmed as critical factors by logistic regression analysis. CONCLUSION: The incidence of odontogenic sinusitis has been increasing steadily over the last 10 years. The findings of microcalcification and dental lesions on CT could provide crucial information to make a precise preoperative diagnosis among chronic bacterial rhinosinusitis, fungal sinusitis and odontogenic sinusitis.

Management of Nasolacrimal Duct Obstruction: ENT Surgeon's Perspective / 대한이비인후과학회지

Epiphora is an overflow of tears onto the face and mainly occurs secondary to abnormal excretory system such as nasolacrimal duct obstruction (NLDO), which could be congenital or acquired. In past years, patients with NLDO have been usually managed by ophthalmologists using external dacryocystorhinostomy (EX-DCR) which has been considered the gold standard of treatment. Recently, the advancement of nasal endoscope and endoscopic sinus surgery has contributed to perform endoscopic DCR (EN-DCR), which now offers comparable success rate to EX-DCR with many advantages. ENT surgeons are familiar with intranasal anatomy and nasal endoscope handling rather than ophthalmologists. Therefore, these advantages lead to more ENT surgeons performing endoscopic DCR. However, the learning curves exist to reach a favorable success rate because surgical technique should be delicate in the narrow nasal cavity. This paper attempts to describe management of epiphora from ENT perspective, focus on surgical anatomy, evaluation modalities and update on endoscopic technique and surgical outcome compared with EX-DCR. This present review would serve as a guide for beginners and increase their confidence with endoscopic anatomy and correct management of epiphora including EN-DCR procedures.

Two Cases of Recurrent Nasolacrimal Duct Obstruction by Remaining Silicone Tube

Endoscopic dacryocystorhinostomy (DCR) is a widely used procedure for nasolacrimal duct obstruction. Because endoscopic DCR has shown higher success rate, fewer complications, and better cosmetic outcome compared to the conventional external approach, it has replaced the external approach. However, since the openings of the nasal cavity formed during surgery are small, recurrence often occurs due to stenosis caused by granuloma formation or the silicone tube. Hence, it is important to remove the silicone tube before granuloma formation around the openings of the nasal cavity after surgery. Failure to remove the silicone tube at the appropriate time can cause inflammation, resulting in granuloma formation. We recently experienced two cases of recurrent nasolacrimal duct obstruction caused by a remaining silicone tube. Here, we present these cases with a brief review of the literature.

A Case of Fibromyxoma of the Maxilla

Fibromyxoma is a rare mesenchymal tumor that is benign, but locally invasive. It is a slow-glowing painless tumor with the potential for extensile bony destruction and cortical expansion and shows a relatively high recurrence rate. Fibromyxoma is found predominantly in the jaw, with the mandible more frequently affected than the maxilla. We recently experienced a case of fibromyxoma originating from the maxilla in a 50-year-old woman who complained of swelling on the right side of her cheek. En bloc resection via a sublabial approach and middle meatal antrostomy were performed. A diagnosis of fibromyxoma was based on pathologic findings. No recurrence or locally residual lesion has been found during 2-years follow up. Therefore, we present this rare case with a review of the literature.

Endoscopic Removal of Retained a Wooden Foreign Body Causing Persistent Intraorbital Inflammation

An intraorbital foreign body can cause a variety of signs and symptoms depending on size, location, and composition and can be classified as metal, inorganic, or organic depending on composition. An intraorbital organic foreign body, such as wood, can cause severe inflammation. An intraorbital foreign body is not only difficult to detect, but also can cause severe complications such as orbital cellulitis, orbital abscess, optic nerve injury, and extraocular muscle injury. A wooden foreign body can be very difficult to detect, even if computed tomography (CT) or magnetic resonance imaging (MRI) is used. Therefore, clinical suspicion based on history taking, physical examination, and radiological examination is essential for diagnosis of intraorbital wooden foreign body. We report a case of repeated intraorbital inflammation due to a retained wooden foreign body in a healthy 56-year-old male patient, who was treated with a combination of intravenous antibiotics and transnasal endoscopic foreign body removal.