Horizontal Dorsal Septal Incision for High Deviation Correction During Septoplasty / 대한이비인후과학회지

When performing septoplasty in patients with a high deviation of the nasal septum, effective correction is difficult and postoperative complications such as a saddle nose may result if the bone or cartilage is removed inordinately. Although several surgical techniques have been introduced, some are difficult to apply easily. Furthermore, the deviation may persist despite the application of surgical techniques due to the rebound memory of the remaining cartilage. This study aimed to describe a simple and safe surgical technique for crooked nasal septa with a high deviation. This method using horizontal dorsal septal incision allows easy separation of the highly deviated portion from the upper lateral cartilage. Furthermore, it is less traumatic than other methods, and predictably preserves the keystone area.

Sphenoid Sinus Fat Packing in Transsphenoidal Surgery: Long-Term Fate Assessment Using Magnetic Resonance Imaging

Background and Objectives@#Following the transsphenoidal approach (TSA), appropriate sphenoid sinus fat packing has been preferred to prevent postoperative cerebrospinal fluid leakage; however, studies on the behavior of fat tissue transplanted in the sphenoid sinus are lacking. This study aimed to determine the long-term fate of these fat grafts using magnetic resonance imaging (MRI).Subjects and Method: A total of 139 postoperative MRI scans of 41 patients who underwent sphenoid sinus fat packing using the standard TSA were evaluated. Additionally, MRI time series indicating the vital fat volumes were assessed postoperatively. @*Results@#In 82.9% of cases, the fat volumes measured in the final MRI scans declined to 60% of the initial volume. The fat tissue volume decreased significantly with time, with a median half-life of 18 months. Typically, the sphenoid sinus was eventually almost filled with air rather than transplanted fat. In the subgroup analysis, the fat clearance rate was significantly lower in patients with residual tumors than in those without such remnants (p=0.013). @*Conclusion@#Long-term MRI surveillance of fat grafts in the sphenoid sinus revealed that the transplanted fat graft had degraded and was gradually eliminated.

The Relationship between the Causative Allergens of Allergic Diseases and Environments in Korea Over a 8-Year-Period: Based on Skin Prick Test from 2006 to 2015

BACKGROUND AND OBJECTIVES: The present study evaluated the results of skin prick test using 55 allergens at 20 centers in the Republic of Korea in 2006, 2010, and 2014–2015. The aim was to assess changes in the positive rate of allergens according to temporal, regional, and environmental factors. MATERIALS AND METHODS: In total, 20 hospitals were selected based on the population distribution in the Republic of Korea. A skin prick test panel comprising 55 aeroallergens was distributed to 18 hospitals for this prospective study. The 2006 and 2010 skin prick test results were collected and analyzed retrospectively from 20 hospitals, while the 2014/2015 skin prick test results (from June 2014 to May 2015) were collected prospectively from 18 hospitals. RESULTS: A total of 14,897 SPT test results were analyzed: 4,319 in 2006, 7,431 in 2010, and 1,852 in 2014/2015. The overall rate of skin prick test positivity to more than two allergens was significantly higher in males than females. The positive rates of alder pollens and birch, oak and ragweed pollen positivity were increased in older patients. Several positive rates were increased according to the temperature in spring. The positive rates for beech pollen, birch pollen, hazel pollen, oak pollen, Tyrophagus putrescentiae, mugwort, cat, Acarus siro, Lepidoglyphus destructor and Tyrophagus putrescentiae were significantly increased, while those of Cult rye pollen and dandelion were significantly decreased over the three test periods. The overall positive rate for allergens in Jeju province varied significantly from Seoul and other cities. CONCLUSION: Change in the positive rate of multiple aeroallergens was evaluated in the Republic of Korea over time. Our findings can be used to recommend aeroallergens suitable for inclusion in skin prick test panels in the Republic of Korea and will facilitate further investigation of changes in the patterns of allergic diseases.

Clinical Features and Prognosis of Sudden Sensorineural Hearing Loss Secondary to Intralabyrinthine Hemorrhage

BACKGROUND AND OBJECTIVES: A number of etiologies of idiopathic sudden sensorineural hearing loss (ISSNHL) have been proposed, including viral infection, vascular disturbance, and immune-mediated mechanisms. Intralabyrinthine hemorrhage (ILH) as a cause of SSNHL is extremely rare, and there have been no studies defining the characteristics of hearing impairment and prognosis in patients with ISSNHL due to ILH. This study aimed to investigate the difference in impaired hearing patterns and prognosis for hearing recovery between patients with ISSNHL due to ILH confirmed by magnetic resonance imaging (MRI) and sex- and age-matched patients with ISSNHL due to causes other than ILH. SUBJECTS AND METHODS: We compared the results of audiometry and MRI in 12 patients who had ILH on MRI (hemorrhage group) and in 23 sex- and age-matched controls without abnormal findings related to their hearing loss on MRI (non-hemorrhage group). Initial hearing impairment, progression, and recovery of hearing loss were compared between the two groups. RESULTS: A majority of patients (92%) in the hemorrhage group complained of dizziness. Initial hearing impairment was more frequent in the hemorrhage group than in the non-hemorrhage group (94.09±35.9 vs. 66.66±30.1, p-value=0.036). The final recovery threshold in the hemorrhage group was worse (78.19±46.26 vs. 37.17±31.96, p-value=0.014) than that in the non-hemorrhage group. In the hemorrhage group, hearing recovery seemed to occur less often at high frequencies (2,000, 4,000, and 8,000 Hz) than at low frequencies (250, 500, and 1,000 Hz). CONCLUSIONS: The presence of ILH was associated with poor hearing prognosis and the occurrence of vertigo. The abrupt onset of hearing loss associated with vertigo and the presence of hyperresonance on fat-suppressed T1-weighted MRI images of labyrinthic fluid strongly suggests acute intralabyrinthine hemorrhage, and is predictive of considerable hearing impairment and poor prognosis.

A Case of Maxillary Sinus Spindle Cell Sarcoma: Alert to Polyurethane Associated Malignancy / 대한이비인후과학회지

There has been no literature that reports a case of sino-nasal malignancy associated with polyurethane implants. However, several previous in vitro and animal model studies revealed that polyurethane implants may cause malignancy in body tissue. In this report, we describe a case of maxillary sinus spindle cell sarcoma diagnosed in a 59-year-old man who had undergone polyurethane nasal packing in the nasal cavity following endoscopic sinus surgery two years ago. Complete removal of the packing material was not confirmed as the patient has not returned for postoperative care. Although there are no direct evidence of association between this spindle cell sarcoma case and polyurethane nasal packing, surgeons should be alert to the complete removal of polyurethane nasal packing after sino-nasal surgery.

Endonasal Rhinoplasty / 대한이비인후과학회지

The endonasal approach for rhinoplasty is an important surgical technique to manage the majority of the nasal problem that present to the nasal plastic surgeons. Open rhinoplasty offers an excellent visualization and therefore facility of precise correction, but causes a larger area of wound and scarring. This review was designed to describe the versatility of endonasal techniques for rhinoplasty.

Packing Materials for Nasal and Paranasal Sinus

All sinus surgeons have the common objective of achieving excellent hemostasis and postoperative healing that avoids adhesion formation and lateralization of the middle turbinate ; however, there is little agreement on how this is best achieved. The use of various interventions, from removable nasal packing or absorbable nasal packing to no packing at all, is widely debated. In view of the present lack of standardization and the many different packing materials used, this report will briefly review the current literature in regard to nasal dressings following ESS and outline important developments in this area of active research.

Musculus Uvulae Shortening for the Treatment of Snoring

BACKGROUND AND OBJECTIVES: We investigated the effectiveness of shortening the uvula muscle for the treatment of snoring. This new and simple procedure was developed to promote the elevation of the uvula position using a minimally invasive technique. SUBJECTS AND METHODS: Fifteen habitual snorers were included in this study. In order to find the exact anatomical position of the uvula muscle, we first dissected the soft palate of a cadaver to better understand the exact anatomical location and structure of the uvula muscle. With this result, we developed a new surgical technique for treating snoring. The results of our surgery were evaluated by both the patient and bed partner before surgery, at 30 days, and 90 days after surgery respectively using the visual analogue scale (VAS). RESULTS: Post-operative physical examinations showed superiorly displaced uvula position. The lower half of the soft palate and uvula were also anteriorly flexed. Those findings remained unaltered beyond the 90th post-operative day. The patient and bed partner snoring symptoms assessed by VAS were significantly improved compared to the pre-treatment values (p<0.05). CONCLUSION: The uvula muscle shortening is an effective and simple method for the treatment of snoring.

Bone Marrow-Derived Mesenchymal Stem Cells for Regenerative Medicine

Bone marrow-derived mesenchymal stem cells (BMMSCs) can be differentiated into a variety of cell types, offering promising approaches for stem-cell mediated tissue regeneration. The facial region contains many specific tissues including bone, cartilage, muscle and neurons. Defect or dysfunction of the facial tissues after cancer surgery, trauma, congenital malformations has a huge influence on the patient's life. Therefore functional reconstruction of damaged tissue is highly sought after. BMMSCs are one of the better characterized postnatal stem cell population and most considered for utilization during cell based clinical therapies. The current review describes what is known about BMMMSCs and their capacity for use as regenerative medicine in the area of otolaryngology.

Are Cross-hatching Incisions Mandatory for Correction of Cartilaginous Septal Deviation?

OBJECTIVES: Cross-hatching incisions have been considered mandatory for correcting cartilaginous septal deviation. We evaluated the clinical outcome of septoplasty without cross-hatching incisions to determine the necessity for making septal cartilage incisions. METHODS: The reconstructed septal components during septoplasty were categorized into four anatomical areas: vomer, maxillary crest, perpendicular plate of ethmoid (PPE) and septal cartilage (the area for cross-hatching incisions). During septoplasty, we attempted to complete the surgery only by removing or fracturing the bony part of the septum without cross-hatching incisions on the cartilage. Only in the cases that the deviation was not immediately corrected, the cross-hatching incisions were made onto the cartilage at the end of the procedure. We analyzed the frequency of manipulating the septal components. The changes of symptoms were evaluated using a modified nasal obstruction symptom evaluation (NOSE) scale and a visual analog scale (VAS) preoperatively, 1 and 3 months after the surgery. RESULTS: Seventy five percents of the deviated septums were immediately corrected only by removing or fracturing of the bony septal components. In decreasing order of frequency, the sepal components for correcting septal deviation were the vomer (59%), maxillary crest (49%), septal cartilage (cross-hatching only: 25%) and PPE (15%). The modified NOSE scale and the VAS demonstrated significant improvement of the nasal symptoms postoperatively (P<0.05). CONCLUSION: Most of septal deviations could be corrected by manipulating only the bony septum. The results of this procedure were not different from conventional septoplasty with cross-hatching incisions. Our data suggest cross-hatching incisions during septoplasty might have been overemphasized and that the main cause for cartilaginous deviation may be the extrinsic forces that are generated by the neighboring bony structures.

Are Cross-hatching Incisions Mandatory for Correction of Cartilaginous Septal Deviation?

OBJECTIVES: Cross-hatching incisions have been considered mandatory for correcting cartilaginous septal deviation. We evaluated the clinical outcome of septoplasty without cross-hatching incisions to determine the necessity for making septal cartilage incisions. METHODS: The reconstructed septal components during septoplasty were categorized into four anatomical areas: vomer, maxillary crest, perpendicular plate of ethmoid (PPE) and septal cartilage (the area for cross-hatching incisions). During septoplasty, we attempted to complete the surgery only by removing or fracturing the bony part of the septum without cross-hatching incisions on the cartilage. Only in the cases that the deviation was not immediately corrected, the cross-hatching incisions were made onto the cartilage at the end of the procedure. We analyzed the frequency of manipulating the septal components. The changes of symptoms were evaluated using a modified nasal obstruction symptom evaluation (NOSE) scale and a visual analog scale (VAS) preoperatively, 1 and 3 months after the surgery. RESULTS: Seventy five percents of the deviated septums were immediately corrected only by removing or fracturing of the bony septal components. In decreasing order of frequency, the sepal components for correcting septal deviation were the vomer (59%), maxillary crest (49%), septal cartilage (cross-hatching only: 25%) and PPE (15%). The modified NOSE scale and the VAS demonstrated significant improvement of the nasal symptoms postoperatively (P<0.05). CONCLUSION: Most of septal deviations could be corrected by manipulating only the bony septum. The results of this procedure were not different from conventional septoplasty with cross-hatching incisions. Our data suggest cross-hatching incisions during septoplasty might have been overemphasized and that the main cause for cartilaginous deviation may be the extrinsic forces that are generated by the neighboring bony structures.

Frontal Sinus Reconstruction with Medpore(R) in Oncocytic Schneiderian Papilloma with Bone Destruction / 대한이비인후과학회지

The cylindrical cell papilloma, also known as oncocytic Schneiderian papilloma, is a rare benign sinonasal neoplasm. It accounts for 2-6% of the total sinonasal papillomas. Due to its rare incidence, this disease is not well-understood by clinicians. Recently, we experienced a case of cylindrical cell papilloma which was originated from the frontal sinus with bony destruction and had extended into the anterior ethmoid sinus in a 69-year old female patient. We adopted the frontal sinus approach via eye glass incision and removed the tumor thoroughly. The anterior wall of the frontal sinus was reconstructed with Medpore(R), and we thus report on the treatment of this case, along with a review of literature.

An Implant for Bone Formation using Autologous Mesenchymal Stem Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of the current study was to examine ectopic bone formation with autologous mesenchymal stem cells (MSC) on a porous 3-D Poly (DL-lactic-co-glycolic acid, PLGA) in canine model. MATERIALS AND METHOD: Bone marrow derived autologous mesenchymal stem cells (MSCs) were isolated and purified from dogs. The porous PLGA scaffold loaded MSCs was treated with osteo-inductive medium containing dexamethasone, beta glycerophosphate and ascorbic acid. Osteogenic differentiation and mineralization were examined with RT-PCR for osteocalcin mRNA and Von Kossa staining of the cell-polymer complex. For in vivo bone formation, polymers containing osteogenic differentiated cells were implanted into the subperiosteal space of the canine maxillary sinus and evaluated at 1st and 2nd month RESULTS: In vitro osteogenic differentiation was evident from 2 weeks after osteogenic induction. The mineralization was increased in a time dependent manner. Ectopic bone was generated in the subperiosteal space of canine maxillary sinus at 1 month and matured at 2 months. CONCLUSION: From these results, we conclude that ectopic tissue engineered bone formation in the facial area is possible and that it may be useful for facial reconstruction or regeneration of bone defect.

Rapid, Non-genomic Reduction of IntracelluarCa2+ and Mucin Secretion by Steroid Hormones in Human Nasal Epithelial Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Airway mucus hypersecretion is one of the major clinical manifestation of patients suffering from various upper or lower respiratory tract diseases. But unfortunately, no drugs are yet available for controlling the airway mucus hypersecretion. Although pharmacological approaches for controlling airway mucus production is currently limited, among the few useful drugs, steroid hormones seem to be the most effective. The effect of steroid hormones is classically described as that of a genomic mechanism involving nucleus transcription. but there is a growing evidence for rapid, non-genomic effect of steroid hormones working through various second messenger systems and ion transporters. MATERIALS AND METHOD: In order to investigate a possible rapid, non-genomic effect of dexamethasone and aldosterone in cultured normal human nasal epithelial (NHNE) cell, the effect of dexamethasone and aldosterone was tested for intracellular calcium response (delta[Ca2+]i) and mucin secretion to external ATP, a known secretagogue in airway epithelial cells, with fluorescence imaging system and ELISA, respectively. Also, we demonstrated the effect of dexamethasone on the mRNA expression of MUC5AC mucin gene for evidence of the existence of non-genomic mechanism of steroid hormones in NHNE cells. RESULTS: Pretreatment with dexamethasone or aldosterone with various concentrations and duration caused a reduction in the delta[Ca2+]i and mucin secretion to ATP. In RT-PCR, Ten minutes dexamethasone pretreatment did not attenuate the mRNA expression of MUC5AC mucin gene, but 24 hours of dexamethasone pretreatment did so. These data indicate that a few minutes of steroid hormone pretreatment can decrease the delta[Ca2+]i and mucin secretion via a non-genomic mechanism. CONCLUSION: In this study, we confirmed the rapid, non-genomic effect of steroid hormones in NHNE cells and suggest this study as a research model for developing antisecretory drugs that have rapid effect.

Correlation between Radiologically Identified Osteitis and Prognosis in Chronic Rhinosinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We studied the correlation between radiologically identified bony osteitis and prognosis of the functional endoscopic sinus surgery in chronic rhinosinusitis patients. SUBJECTS AND METHOD: A retrospective review of medical records were carried out on 77 patients who had been diagnosed as chronic paranasal sinusitis and undergone endoscopic sinus surgery from 2002 through 2003 at our institution. Computed tomography scans were used for grading according to the Lund-Mackay radiologic grading system and diagnosis the pansinusitis coexistence. Medical records were used for grading according to the Lund-Mackay surgical grading system and for follow-up observation and age. Statistical analysis was done for correlation between radiologically identified indices and post-operative prognosis. RESULTS: The study revealed that radiologically identified bony osteitis need a longer post-operative medical management period and also found that if pansinusitis coexist with osteitis, poorer outcome would be accompanied. CONCLUSION: This study provides further evidence that radiologically identified bony osteitis and pansinusitis may act as poor prognostic factors.

Local Gene Delivery for Wound Healing and Tissue Engineering / 대한이비인후과학회지

No abstract available.

Multicenter Evaluation on the Safety of Gore-Tex as an Implant in Rhinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was done to evaluate the safety of Gore-Tex as a nasal implant. Materials and METHOD: A retrospective multicenter study was carried out on 15 surgeons from 11 general hospitals and 4 private practice clinics regarding the safety of the Gore-Tex as a nasal implant. The study involved 853 patients, of whom 656 received primary surgery and 197 revision surgery. Gore-Tex was mainly used as a dorsal implant in a form of sheet or as a reinforced nasal implant. RESULTS: The overall complication rate associated with Gore-Tex was 2.5% (21 cases). Infection was the most common complication (18 cases ; 2.1%) followed by 2 cases of seroma and 1 case of persistent nasal swelling. In 19 out of 21 complication cases, the graft needed removal to control the infection or seroma (91% removal rate). Nine cases of infection developed in both primary cases (1.37%) and in revision cases (4.57%), which suggests a higher association rate between infection and revision cases (p=0.0062). Infection developed within 1 month in 5 cases while 9 cases developed infection after 6 months of operation. Other complications such as aesthetic problems (malpositioning of the implant or dorsal irregularities) were found in 15 cases (1.8%) and hematoma in 1 case. CONCLUSION: The infection rate of Gore-Tex used in rhinoplasty was about 2% and it rose significantly in the revision cases. If infected, almost all of the implanted Gore-Tex needs removal; therefore, we suggest judicious use of Gore-Tex in rhinoplasty.

Treatment of Frontal Sinus-Supraorbital Cell Mucocele: Endoscopic Surgery with Trephination & Transillumination Technique: Case Report / 대한이비인후과학회지

Mucoceles of the paranasal sinuses are chronic expanding lesions containing inspissated mucus, which occurs when sinus ostium is obstructed. A variety of conservative and radical surgical procedures have been introduced, with each approach having advantages as well as disadvantages. Diseased frontal sinus mucosa and bone were commonly ablated by radical frontal sinus surgery such as osteoplastic flap surgery in the past. During the last decade, endoscopic sinus surgery has become the major choice for the treatment of paranasal sinus mucoceles, and the technique of endoscopic sinus marsupialization has been considered non-invasive and successful. But the technique has limitation in cases with small frontal recess or mucocele in the lateral portion of the frontal sinus which is not accessible via the nose, and hypertrophic mucosa obstructing the entire sinus. A 52-year-old man was presented with a supraorbital cell mucocele located in the lateral side of frontal sinus mucocele, which could not be treated by endoscopic surgery alone. Endoscopic surgery with sinus marsupialization, trephination and transillumination technique was introduced. We report this case with a review of related literatures.

Differentiation of adult canine bone marrow stem cells into neurons

In this study, we showed that neurons could be generated from adult canine bone marrow stem cells by culturing with DMSO/BHA/FeCl2. These neurons differentiated from the bone marrow stem cells formed neurites, expressed neuron-specific markers. This differentiation was enhanced by FeCl2. These results suggest that iron can effectively initiate differentiation of adult bone marrow stem cells into neurons.

Bone formation using injectable tissue-engineering materials

AIM: Several injectable materials have been used in the application of osteogenic bone substitute; however, nothing has won universal acceptance. This study was performed to investigate whether chitosan-alginate gel/MSCs/BMP-2 composites are potentially injectable materials for new bone formation. MATERIAL AND METHODS: The composites were injected into the subcutaneous space on the dorsum of the nude mouse to investigate whether new bone would be tissue engineered in the mouse. The composites were examined histologically over a 12-week period. RESULTS: The composites implanted in the mouse were able to tissue engineer new bone, and the newly formed bone consisted of trabecular bone and calcified bone matrix. CONCLUSIONS: The present study shows that chitosan-alginate gel/MSCs/BMP-2 composites have the potential to become real injectable materials for new bone formation.