A Case of Extranasopharyngeal Angiofibroma Originating from Superior Turbinate

Angiofibromas originate predominantly from the posterolateral wall of the nasopharynx and are typically seen in adolescent males, but they may also exist outside of the nasopharynx. Nine patients with extranasopharyngeal angiofibromas have been reported in Korea. The inferior turbinate was the most commonly affected site, and patients reported experiencing various nasal symptoms, such as epistaxis and nasal obstruction. Extranasopharyngeal angiofibroma arising from the superior turbinate is extremely rare and has not been reported to date. Recently we experienced a case of angiofibroma of the left superior turbinate in a 68-year-old male that was successfully treated with endoscopic surgery.

A Case of Nasal Schwannoma Coexisting with Epidermal Cyst / 대한이비인후과학회지

Schwannomas of the sinonasal tract are very rare benign neoplasm, which can arise from nerve sheath containing Schwann cells. Epidermal cysts are also rarely present in nasal cavity. They are thought to be congenital lesion associated with various craniofacial disorders or arise as a result of implantation of epidermal cells into the deeper dermal element. Several cases of the nasal schwannoma or epidermal cyst have been reported repectively, however nasal schwannoma with epidermal cyst never has been reported yet. We report the first case of nasal schwannoma which is coexists with epidermal cyst at the superior turbinate of the nasal cavity.

The Prevalence and Clinical Significance of Superior Turbinate Pneumatization on Computed Tomography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Middle turbinate pneumatization (MTP; concha bullosa) is a common anatomic variation, and superior turbinate pneumatization (STP) was also described. However, there has been little study of the STP and its clinical significance. In this study, we tried to determine the prevalence of STP. We also evaluated whether STP correlates with MTP, inflammation of posterior ethmoid or sphenoid sinus. SUBJECTS AND METHOD: Patients with sinonasal symptoms and for whom paranasal sinus computed tomography (PNS CT) scans was performed between August 2008 and January 2009 were evaluated. A retrospective review of CT scans of 112 patients (224 sides) was done for STP, MTP and paranasal sinus haziness. RESULTS: We found STP in 37 patients (33%)-bilaterally in 14 and unilaterally in 23 patients, and in 51 out of the 224 sides (22.8%). The prevalence of STP in CT without mucosal hazziness is higher (29%) than that in CT with mucosal hazziness (15%). MTP was found in 70 sides (31.2%). There was no association between the presence of STP and MTP. No correlation was found between STP and posterior ethmoid or sphenoid sinus inflammation. CONCLUSION: STP is a not infrequently found anatomic variation and may not be related with MTP and adjacent sinus inflammation

The Clinical Application of Endoscopic Sphenoidotomy and Anatomical Role of the Superior Turbinate

BACKGROUND AND OBJECTIVES: Recently, endoscopic sinus surgery (ESS) is commonly performed to treat the sphenoid sinus disease. Identification of the natural ostium of sphenoid sinus (SS) according to surgeon's operating view play an important role in endoscopic sphenoid approach. This study is undertaken to investigate the role of superior turbinate (ST) as an anatomic landmark of natural ostium of SS in endoscopic sphenoidotomy. MATERIALS AND METHODS: Medical records and computed tomography (CT) images of 77 patients from March 2006 to December 2007 who underwent ESS were analyzed. We tried to investigate the location and distance of the natural ostium on the superior turbinate, skull base and nasal septum. We also measured the anterior wall thickness of the SS by using CT images. RESULTS: The natural ostium of the SS was located on the medial side of the ST in all patients who underwent endoscopic sphenoidotomy (45 cases). The level of posteroinferior end of the ST corresponded to the inferior portion of anterior wall of the SS. The lateral portion thickness of the anterior wall of the SS was thinner than the medial portion (77 cases). CONCLUSION: During an endoscopic sphenoidotomy, the superior turbinate is an important anatomic landmark for identifying the natural ostium of the SS. When widening the anterior wall of SS is performed, we sug-gest that the procedure should be directed to the lateral 1/3 portion, considering the thickness of anterior wall of SS.

Surgical anatomy of natural ostium of the sphenoid sinus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is important for surgeons to identify the location of natural ostium of the sphenoid sinus during sphenoidotomy for sphenoiditis and transsphenoidal approach (TSA). But, it is not easy for a beginner to find it. This study aimed to investigate from a clinical aspect the location of natural ostium of the sphenoid sinus using korean adult cadaveric heads. Material and methods : One hundred sagittally-divided adult cadaveric heads were used. After removing the mucosa of anterior wall meticulously, they were carefully examined and documented serially by photography. The items analyzed were the distance from and the degree of nasal sill and limen nasi to the natural ostium of sphenoid sinus, and the distance from the posteroinferior end of the superior turbinate and the skull base to the natural ostium of the sphenoid sinus. In addition, we tried to investigate whether the natural ostium opens into the medial or lateral to the posterior end of the superior turbinate. RESULT: The natural ostium of the sphenoid sinus was located at 34.3 3.8o and 62.7 9.0 mm away from the nasal sill, and at 35.9 3.8o and 56.5 3.2 mm away from the limen nasi. It was located approximately in the middle of the anterior wall of the sphenoid sinus and medially to the posterior end of the superior turbinate in about 83%. CONCLUSION: By identifying the posteroinferior end of the superior turbinate, the location of natural ostium of the sphenoid sinus can be identified. We recommend that surgeons should look for the natural ostium in the middle of the anterior wall of the sphenoid sinus and medial to the posterior end of the superior turbinate.

Intranasal Transethmoid Approach to the Sphenoid Sinus Ostium in Endoscopic Sinus Surgery: A Safe Technique Using the Superior Turbinate As a Key Landmark / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Identification of the natural ostium verifies the safest entry to the sphenoid sinus (SS) in endoscopic sinus surgery (ESS). In order not to destabilize the middle turbinate (MT), new techniques have recently been introduced on transethmoid approaches to the SS ostium after ethmoidectomy. The aims of this study are to introduce an intranasal transethmoid approach to the SS ostium for sphenoidotomy using the superior turbinate (ST) as a key landmark without destabilization of the MT in ESS for chronic sinusitis with concurrent sphenoiditis and to determine its efficacy by evaluating the outcome of the patients. MATERIALS AND METHODS: Fifty-three chronic sinusitis patients (37 males and 16 females, aged 14 to 63 years) with concurrent sphenoiditis in one or both SSs and their 75 SSs were included in this study. Sphenoidotomy was performed in all patients. The SS ostium was identified just medial to the ST remnant. Number of SSs where the ostium was identified was determined, and surgical complications were evaluated. To assess olfactory changes, a butanol threshold test was performed before and after the surgery. RESULTS: The SS ostium was identified in 73 (97.3%) of the 75 SSs. The preoperative threshold (3.9+/-3.0) in the butanol test significantly improved to 5.1+/-2.5 after the operation in the 75 nasal sides. Olfactory function of only 3 (4.0%) sides worsened after surgery. There were no major complications in all patients. Conclusion: This technique may be an effective and safe approach to the SS ostium in ESS for chronic sinusitis with concurrent sphenoiditis without destabilization of the MT.