A Case of Surgical Correction of Nasal Vestibular Stenosis / 대한이비인후과학회지

Nasal vestibular stenosis is an uncommon cause of nasal obstruction. There are various causes of the narrowing of vestibule, including previous trauma, surgery, infection, and iatrogenic injury. The disease is characterized by circumferential scar retraction in inlet of nasal cavities which are caused by secondary proliferation of granulation and fibrous tissue. A number of studies were reported on the surgical correction of vestibular stenosis, but no single technique had been widely accepted due to a wide spectrum treatment methods owing to the various causes of disease and deformities of the related anatomy. Here we suggest a new surgical technique for correcting a case of vestibular stenosis caused by trauma.

A Case of Primary Tuberculosis of the Lacrimal Sac Presenting as Epiphora / 대한이비인후과학회지

Extra-pulmonary tuberculosis usually progresses as a secondary infection from pulmonary tuberculosis, and tuberculosis of the head and neck region. Tuberculosis of ocular and periocular areas, however, is a rare disease. Among ocular tuberculosis involving the adnexal structures, a few lacrimal sac tuberculosis has been reported. We recently experienced a case of lacrimal sac tuberculosis presenting as epiphora. Examination revealed bilateral nasolacrimal duct obstruction and the patient underwent endoscopic endonasal dacryocystorhinostomy. During the operation, a biopsy taken from the unhealthy looking lacrimal sac filled with caseous necrotic tissue was suggestive of tuberculosis. Histopathological features and further systemic evaluation confirmed tuberculosis. She was treated medically with anti-tubercular agents. The new opening of the lacrimal sac was patent and epiphora was resolved successfully at a year follow up. This report highlights the requirement of high suspicion of tuberculosis, even in the nasolacrimal drainage system.

Endoscopic Trans-Turbinal Medial Maxillectomy: A Modified Endoscopic Medial Maxillectomy Technique to Preserve the Inferior Turbinate / 대한이비인후과학회지

Endoscopic medial maxillectomy (EMM) and its modifications are surgical techniques are used to treat recalcitrant maxillary sinusitis as well as maxillary sinus tumors. In this report, we propose a simple and efficient modification of EMM, called endoscopic trans-turbinal medial maxillectomy (ETTMM), by which the inferior turbinate (IT), nasolacrimal duct, and anatomical integrity of the nasal valve area are preserved. A total of 10 patients (five tumorous and five nontumorous maxillary diseases) underwent ETTMM. Briefly, a turbinate mucosal flap on the superior aspect of the IT was elevated after middle meatal antrostomy. Then a trans-turbinal window was developed to expose the inferior meatus, after which an extended maxillary antrostomy was generated. Finally, the turbinate mucosal flap was repositioned after complete removal of the antral lesions. All lesions were successfully treated using ETTMM. Our modification was easy to perform, and we achieved good endoscopic visualization and accessibility throughout the whole antrum by creating a trans-turbinal window and extended maxillary antrostomy. We could perform postoperative surveillance easily through the wide antrostomy using rigid endoscopes of various angles. ETTMM is a simple and useful modification of EMM that provides clear visualization and great accessibility to most aspects of the maxillary antrum while preserving the nasal functional units, including the IT and nasal valve area.

Late Metastatic Renal Cell Carcinoma Recurrence Presenting as a Maxillary Sinus Mass 12 Years after Nephrectomy: Case Report and Literature Review

Metastasis to the sinonasal cavity is rare. Late recurrence, such as metastasis developing 10 years or more after nephrectomy, is even more rare. We present a rare case of late metastatic renal cell carcinoma (RCC) in the maxillary sinus after nephrectomy and discuss reported sinonasal metastatic RCC cases. A 64-year-old man presented with left nasal obstruction for the previous one year. He had undergone right nephrectomy to treat RCC 12 years prior. Paranasal sinus computed tomography and magnetic resolution imaging revealed a 4.6-cm-diameter mass exhibiting delayed contrast enhancement that filled the left maxillary sinus and the nasal cavity. Histologically, clear cell RCC was diagnosed. We resected the maxillary sinus tumor to resolve the nasal obstruction for palliative symptom relief. There has been no evidence of recurrence to date, 3 years postoperatively. When a patient with a history of RCC presents with a hypervascular paranasal sinus mass, metastatic RCC should be considered, despite history of nephrectomy. It is important to make an appropriate treatment plan depending on extent of metastases and location of the metastatic tumor.

Two Cases of Acute Isolated Sphenoid Sinusitis in Children

Acute isolated sphenoid sinusitis is a rare disease, and accounts for less than 3% of all sinusitis, especially in young children. Delayed diagnosis or misdiagnosis can occur frequently due to atypical clinical presentations. This can lead to serious complications because of the involvement of anatomically related intracranial structures. Therefore, nasal endoscopy, computed tomography (CT), and magnetic resonance imaging (MRI) are important diagnostic tools to confirm the diagnosis. We report two cases of a previously healthy 6-year-old girl and a 13-year-old boy, whose chief complaints were uncontrolled headache and high fever over 38°C. Physical examination and initial laboratory test results of blood, urine, and cerebrospinal fluid were normal. The diagnosis was made after a brain MRI revealed isolated sphenoid sinusitis. The girl was treated with third generation cephalosporins intravenously. The boy, however, had to undergo an emergent endoscopic sinus surgery as his headache and eyeball-pain symptoms did not resolve by medical treatment alone. Both cases had good outcomes, without neurological sequelae.

Principal Clinical Factors Predicting Therapeutic Outcomes After Surgical Drainage of Postoperative Cheek Cysts: Experience From a Single Center

OBJECTIVES: Postoperative cheek cyst (POCC) is a late postoperative complication of radical maxillary sinus surgery including the Caldwell-Luc (C-L) operation. The present study aimed to evaluate the therapeutic outcomes of surgical treatment for POCC and to assess the clinical factors correlated to these outcomes. METHODS: This study included 57 patients (67 nostrils) diagnosed with POCC who underwent surgical drainage. The medical records of the patients were retrospectively reviewed for radiological findings, treatment modalities, residual symptoms, and recurrences. RESULTS: In total, 30 patients were male and 27 patients were female with a mean age of 55 years, and the patients were usually diagnosed with POCC 28.2 years after radical surgery. Endonasal endoscopic marsupialization was performed via inferior meatal antrostomy, and if possible, middle meatal antrostomy was performed at the same time. In patients with cysts that were difficult to reach using an endonasal endoscopic approach, additional open C-L approaches were performed. The median follow-up period was 19.4 months. Overall, adequate drainage and symptomatic relief were achieved in 91% (61/67) of the patients. The recurrence rate was significantly higher in patients who had anterolateral POCC. Failure to achieve symptomatic relief was correlated to a smaller cyst and the use of the open C-L approach for drainage. CONCLUSION: The location and size of the cyst as well as the use of the open surgical approach were important factors in predicting the therapeutic outcome of POCC. The time point of treatment and surgical approaches should be based on the above-mentioned findings.

Two Cases of Septal Perforation Repair using Posterior Margin Based Hinge Flap

Nasal septal perforation is a defect of cartilage, bone, or mucosa of the nasal septum. Nasal septal perforation has several potential causes such as previous septal surgeries, trauma, malignancy, inflammation, or drugs. According to previous studies, successful surgical outcome is affected by the size and location of the perforation. Although many surgical techniques have been reported, there is no standardized nor consistent surgical method for repairing nasal septal perforation. This report suggests a new surgical technique of repairing septal perforation using a posterior perforation-margin-based hinge flap.

Endoscopic Endonasal Repair of Congenital Basal Encephalocele: Report of 3 Cases / 대한이비인후과학회지

Encephalocele is a malformation characterized by protrusions of the brain and meninges through openings in the cranial bones. They are managed surgically and approached in various ways, mainly on the basis of its location. Basal encephaloceles have been traditionally approached intracranially via bicoronal approach in the pediatric population. We report three cases of congenital basal encephaloceles treated by endoscopic endonasal approach in our institution. In 2 patients, the skull base defect was successfully corrected whereas in one case, recurrence was observed. No major complications were encountered. Although the endoscopic endonasal repair approach of basal encephaloceles in the pediatric population is associated with potential technical difficulties, it is a viable and minimally invasive alternative to the traditional craniotomy.

Immediate and Sustained Improvement in Behavior and Life Quality by Adenotonsillectomy in Children With Sleep-Disordered Breathing

OBJECTIVES: To investigate longitudinal changes in behavior and quality-of-life (QoL) in children with sleep disordered breathing (SDB) after adenotonsillectomy (AT). METHODS: This study prospectively enrolled 148 children who underwent AT for SDB. Caregivers filled out Korean attention deficit hyperactivity disorder (ADHD) rating scale (K-ARS) and Korean version of the obstructive sleep apnea-18 (KOSA-18) at preoperative 1 day, postoperative 1 month, and postoperative 6 months. Longitudinal changes in K-ARS and KOSA-18 were evaluated and compared among subgroups. RESULTS: Both K-ARS and KOSA-18 scores improved immediately at postoperative 1 month and were maintained at postoperative 6 months. The mean preoperative K-ARS scores of the non-ADHD, ADHD-trait, and overt-ADHD groups showed uniformly immediate and sustained improvements. Also, the mean preoperative KOSA-18 scores of the small, moderate, and large impact groups were significantly improved both at postoperative 1 month and 6 months. The changes in behavior and QoL showed no significant differences with regard to the aforementioned factors. CONCLUSION: After AT, we may expect immediate and sustained improvements in behavior and QoL in children with SDB regardless of preoperative symptom severity. Moreover, by performing AT, improvements in behavior and QoL are expected regardless of sex, age, allergic trait, or concurrent coblation-assisted turbinoplasty. These findings may help our colleague physicians counselling pediatric SDB patients and their caregivers.