A Case of Reconstruction of Surgical Defect after Removal of Intraosseous Hemangiomas on Nasal Dorsum / 대한이비인후과학회지

Intraosseous hemangioma arising from nasal bone is rare and has not been reported in the Korean literature. Hemangioma of the bone accounts for 0.7% of all bone tumors. The craniofacial region is a rare site of involvement, with mandible, zygoma, and maxilla being the most frequently affected areas. A 63-year-old male patient presented with complaints of a protruding mass on the nasal dorsum that began 10 years ago. Computed tomography demonstrated a round mass with honeycomb appearance involving the nasal bone. An en bloc excision of the mass and nasal reconstruction was performed. Histopathological examination showed increased number of large cystically-dilated vessels with thin wall lying between thin trabeculae of lamellar bone in marrow space. During a one-year follow-up, the patient had no recurrence and cosmetic results were excellent. A case report of an intraosseous hemangioma arising on the nasal bone is described, together with a discussion of the relevant literature.

Synergistic Effect of Dermatophagoides farinae and Lipopolysaccharides in Human Middle ear Epithelial Cells

PURPOSE: Although the concept of "one airway, one disease," which includes the middle ear space as part of the united airway is well recognized, the role of allergens in otitis media with effusion (OME) is not clearly understood. We aimed to investigate the effect of the interaction between Dermatophagoides farinae (Der f) and lipopolysaccharide (LPS) on the induction of epithelial inflammatory response in vitro. METHODS: Primary human middle ear epithelial cells were exposed to Der f, LPS, or both in different sequences, and the magnitude of the immunologic responses was compared. The mRNA expressiona of mucin (MUC) 4, 5AC, 5B, 8, GM-CSF, TNF-α, TLR4, and MD-2 were evaluated using real-time PCR. MUC levels before and after siRNA-mediated knockout of TLR4 and MD-2 were assessed. Lastly, the involved cell signaling pathway was evaluated. RESULTS: The expressiona of cytokines, and the MUC 4, 5AC, 5B, and 8 genes were augmented by pretreatment with Der f followed by LPS; however, reverse treatment or combined treatment did not induce the same magnitude of response. Increased MUC expression was decreased by TLR4 knockdown, but not by MD-2 knockdown. The signal intensity of MUC 8 was higher in MD-2 over-expressed cells than in those exposed to LPS only. The translocation of nuclear factor-κB was observed in cells pretreated with Der f followed by LPS. CONCLUSIONS: When Der f treatment preceded LPS exposure, Der f and LPS acted synergistically in the induction of pro-inflammatory cytokines and the MUC gene, suggesting an important role in the development of OME in patients with concealed allergy airway sensitization.

Skin Flap Necrosis by Bone Marking with Methylene Blue in Cochlear Implantation

One of surgical complications in cochlear implantation is the necrosis of the skin flap above the receiver-stimulator coil. We present a case of 55-year-old woman who underwent cochlear implantation and developed a bluish skin necrosis due to bone marking. The planned position for the receiver-stimulator was marked using methylene blue through skin to bone. She did not undergo skin flap thinning and underwent successful implantation with complete electrode insertion. Few weeks postoperatively, the patient developed bluish discoloration with progressive thick, blue eschar formation and skin flap necrosis. She subsequently underwent wound debridement and skin flap closure. Cochlear explantation was not necessary. Timely diagnosis and management about this complication is necessary to prevent further skin breakdown and subsequent device extrusion. This report identifies the marking using methylene blue as another possible source of skin flap necrosis in cochlear implantation, and surgeons should be aware of this potential complication.