A Case of Lingual Thyroid Treated by Surgical Excision through Transcervical Approach / 대한이비인후과학회지

Lingual thyroid is the most common benign ectopic thyroid tissue but is a rare clinical entity. This developmental anomaly is due to the failure of descent of the gland anlage early in the course of embryogenesis. Patients may have symptoms of dysphagia due to obstruction or even hemorrhage. These symptoms can occur at any time from infancy through adulthood. The clinical findings, laboratory tests, and radiographic imaging studies employed in confirming the diagnosis and in planning appropriate treatment have been evaluated. The primary therapeutic goal is to restore thyroid function but surgical excision of the gland is reserved for more advanced cases of gland enlargement resulting in airway compromise, severe dysphagia that limits oral intake, or hemorrhage. We experienced a case of lingual thyroid that was successfully treated by transcervical approach and summarized the principles of current management for this condition.

Clinical Analysis of Basal Skull Fracture / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Basal skull fractures are different from cranial vault fractures in several aspects. These fractures are difficult to diagnose by ordinary X-ray, routine head CT and are frequently inferred from clinical signs. It involves more commonly the cranial nerves, makes fistulae of cerebrospinal fluid (CSF) and lead to central nervous system infections. Despite the clinical significance of basal skull fracture in otorhinolaryngology, there have been only a few clinical studies. So we began this research for better treatment of basal skull fracture (BSF). MATERIALS AND METHOD: The authors analyzed 100 cases of basal skull fracture treated in the department of neurosurgery, from January 1998 to December 2000. We reviewed the clinical features, radiologic findings, and rate of delayed diagnosis. RESULTS: The basal skull fractures were more common in men than women. In the decreasing order of cause in basal skull fractures were traffic accidents (64%), fall down and assault. Clinical features were nasal bleeding (42%), ear bleeding (41%) and hearing loss (36%). Most of CSF leakages were noted within 24 hours after injury and had ceased by conservative management. The degree of facial palsy had an influence on the recovery of facial nerve function. The types of hearing loss had a role in the recovery of hearing. Six cases (6%) were delayed in the diagnosis of BSF. CONCLUSION: In the BSF patient's treatment, many parts needed otorhinolaryngological treatment. But in the patient's treatment, otorhinolaryngological problems had been ignored by the neurosurgical concerns. From the otorhinolaryngoloical aspect, BSF patients should be given an active treatment.

A Comparative Study between K-Wire and Intranasal Packing in Nasal Bone Fracture / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The majority of nasal bone fractures have been managed by using closed reduction and intranasal packing, leaving rooms for many complaints from patients. But the intranasal Kirschner wire (K-wire) splinting described by Chang in 1994 provided rigid intranasal support and increased less complaints from patients. Although the Kirschner wire splinting can be an alternative method for nasal bone packing that accompanies little complaints from patients, literature regarding the efficiency of Kirshcner wire splinting is rare. We studied the efficiency and clinical outcomes between the K-wire splinting and intranasal packing. MATERIALS AND METHOD: Prospectively, we studied 51 patients with nasal bone fracture who have undergone closed reduction. Of these, 30 patients were immobilized with the Kirschner wire splinting and 21 patients were immobilized with intranasal vaseline packing. On the first prospective day, patients were routinely examined by a visual analogue scale. The degree of satisfaction by both doctors and patients was investigated after a minimum 6 months. Complications were studied. All results were statistically confirmed. RESULTS: Complaints from patients were significantly less when the K-wire was used. There was no statistical difference between satisfaction expressed by doctors and patients, and there were no serious complications in using the K-wire. CONCLUSION: The K-wire is a reliable and useful immobilization method for nasal bone fracture.

Saddle Nose & Septal Perforation Associated with Chemotherapy in Patients with Acute Leukemia / 대한이비인후과학회지

To date, no cases of nasal septal perforation during or after chemotherapy in patients with acute leukemia have been reported. In this study, we report three acute leukemia patients that had septal perforation and saddle nose deformity after chemotherapy and the results of our attempts to determine the causes of this phenomenon. We investigated retrospectively the types of chemotherapeutic agents involved and the duration of chemotherapy until the development of the nasal septal perforation. In addition, we also studied whether there were any remaining malignant cells by biopsy from the septal perforation margin. We found that Ara-C was the only drug that was used in all 3 patients. Nasal septal perforation and saddle nose developed approximately 4~7 weeks after the chemotherapy. A biopsy revealed inflammatory cells but no malignant cell infiltration. In cases of saddle nose associated with septal perforation after the chemotherapy for acute leukemia, one may consider the possibility of side effects of Ara-C. Furthermore, more active diagnosis and treatment are required when patients with acute leukemia complain of epistaxis or nasal obstruction during or after chemotherapy.

Surgical Anatomy of the Anterior Ethmoidal Canal in Ethmoid Roof: Anatomical and Computed Tomographic Analysis / 대한이비인후과학회지

BACKGROUNDS AND OBJECTIVES: This study was undertaken to examine three main relationships. First, the distance and angle from the anterior ethmoid canal to the limen nasi and the sill were measured. Second, The location of the anterior ethmoid canal was examined in relation to the lamellas and the skull base. Third, the existence of bony defects in the canal and the course through the anterior cranial fossa were studied. MATERIALS AND METHODS: This study employed both sagittal computed tomography and cadaver dissection. Seventy sagittally divided heads from randomly chosen Korean adult cadavers were used. Sagittal computed tomography was performed on all specimens. Then they were meticulously dissected under a surgical microscope. RESULTS: The mean distance and angle between the limen nasi and the anterior ethmoid canal was 49.0 mm and 54.5, respectively. The anterior ethmoid canal was located between the 2nd and 3rd lamella in 61 of 70 cases. In 60 of 70 cases, it was attached to the base of the skull, and in the remaining 10 cases, it ran 2 to 3 mm below the skull base. When viewed from the superior side, the course of the anterior ethmoid canal formed a diagonal line from the lateral to the medial side. Partial bony defects of the anterior ethmoid canal were observed in eight cases and complete bony defects in none. CONCLUSION: This study provides surgeons with a better understanding of the anatomy of the anterior ethmoid canal.

Expression of MUC5AC and MUC8 mRNA in human nasal mucosa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: MUC5AC is known to be a major secretory mucin in goblet cells of the mucosa of human lower respiratory tract. But in our preliminary study, we found that the levels of MUC8 mRNAs were significantly increased in the biopsy specimens of the nasal polyps whereas other mucin genes were not. This suggests the possibility that MUC8 might be one of the major overexpressed mucins in the nasal polyps. The purpose of this study is to investigate the cellular location of MUC5AC and MUC8 mRNA. Material and methods : Normal posterior ethmoid mucosa and the polyp tissue were fixed in 4% paraformaldehyde and were hybridized with the RNA riboprobe for MUC8 and the oligonucleotide probe for MUC5AC in the presence of digoxigenin (DIG). RESULT: In the normal posterior ethmoid mucosa, MUC 5AC mRNA and MUC8 mRNA were barely expressed in the epithelium and the submucosal glands. In the polyp epithelium, the expression of MUC 5AC mRNA was localized in the cytoplasm of goblet cells and the expression of MUC8 mRNA was strongly localized in the nucelus of the goblet cells, and weakly localized in the cytoplasm of the goblet cells. MUC8 mRNA was also expressed in low levels in the nucleus of the submucosal glands. CONCLUSION: MUC8 mRNA is localized mainly in the nucleus of goblet cells and is one of the major mucin genes overexpressed in goblet cells of thnasal polyp.

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.

Interleukin-13 Suppresses MUC5AC Gene Expression and Mucin Secretion in Cultured Normal Human Nasal Epithelial Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is not clear which mucins are responsible for the mucus hypersecretion in allergic rhinitis and allergic asthma. Recently, it was found that IL-13 is closely related to allergic inflammation and mucus hypersecretion in in vivo animal models. However, the role of IL-13 in in vitro cellular models has yet to be determined. This study aimed to investigate the direct effect of IL-13 on mucin gene expression and mucin secretion in cultured normal human nasal epithelial cells. MATERIALS AND METHOD: Cells were cultured with passage-2 normal human nasal epithelial cells using the air-liquid interface culture method. After treatment with IL-13, the total mucin and MUC5AC mucin levels were measured using the immuno-blotting assay. The MUC2, MUC5AC, and MUC8 mRNA expressions were measured using RT-PCR. Immunostaining was also performed using a MUC5AC antibody on histologic and cytospin slides. RESULTS: After treatment with 5 ng/ml or more of IL-13, the level of total mucin and MUC5AC mucin secretion decreased substantially. The expression of MUC2 and MUC8 mRNA increased with higher concentrations of IL-13, but the expression of MUC5AC mRNA decreased. On the 7th day after IL-13 treatment, a significant decrease in the number of MUC5AC-positive cells was confirmed with immunostaining. CONCLUSION: These findings indicate that IL-13 suppresses MUC5AC mucin gene expression and mucin secretion in cultured normal human nasal epithelial cells in vitro.

Pneumatization of the sphenoid sinus and its surrounding neurovascular structures / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sphenoid sinus faces the cavernous sinuses in which neurovascular structures such as the cavernous segment of the internal carotid arteries (ICA), optic nerve, and trigerminal nerve are located. In addition, it separates the pituitary gland from the nasal cavity. Therefore, surgeons are required to understand its detailed anatomy for transsphenoidal approach (TSA) or optic nerve decompression. This study is aimed to investigate the surgical anatomy of the sphenoid sinus and its clinical application using Korean adult cadaveric heads. MATERIAL AND METHODS: One hundred sagittally-divided adult cadaveric heads were used. After removing the sinus mucosa meticulously, careful examination and photodocumentation were done serially. The analysed items were the pneumatization type of the sphenoid sinus, the relationship between the pneumatization type of the sphenoid sinus and the incidence of bulging of the optic canal, segment 1 and 3 of ICA, maxillary nerve, and pterygoid nerve, and the incidence of bony dehiscence and thickness of bone at the bulging site of various neurovascular structures. RESULT: The sellar type was found in 90% of the subjects. The incidence of bulging of neurovascular structures were from 34% to 65%, and the incidence of bony dehiscence at the bulging site were from 0% to 9.6%. The more pnermatized the sphenoid bone was, the higher the prevalence of bulging became. The average thickness of bone was less than 0.5 mm. In the complete sellar type, the distances from the anterior wall of the sphenoid sinus to the bulging site at the optic canal, and to segment 1 and 3 of ICA were about 1.9 mm, 19.3 mm, and 9.5 mm, respectively. The distances from the superior wall of the sphenoid sinus to the bulging site at the optic canal and to the maxillary nerve were about 3.7 mm and 17.3 mm, respectively. Bulging of the optic canal attached to the anterior and the superior walls of the sphenoid sinus was 45% and 34%, respectively. CONCLUSION: By elucidating the relationship between the sphenoid sinus and surrounding vital neurovascular structures, this study might be able to provide essential anatomical knowledge for surgeons to reduce surgical complication in applying to the sphenoid sinus.

Expression of MUC5AC mRNA in the Goblet Cells of Human Nasal Mucosa / 대한이비인후과학회지

BACKGROUNDS AND OBJECTIVES: Mucus hypersecretion is a common feature in chronic sinusitis with polyps. Since mucus hypersecretion is commonly accompanied by goblet cell hyperplasia, it is important to identify which mucin gene mRNAs are expressed in the goblet cells of the surface epithelium in the human airway. This study aims to investigate the pattern of expression of MUC5AC mRNA in the goblet cells of human nasal mucosa. MATERIALS AND METHODS: Six nasal polyps, five inferior turbinate mucosa specimens, and three normal-appearing mucosa specimens of the posterior ethmoid sinus were obtained. Each of the specimens were cut into 10 micromiter thick serial frozen sections and in situ hybridization of MUC5AC mRNA was performed with an oligonucleotide probe. Alcian blue(pH 2.5)-periodic acid-Schiff staining was performed on the serial sections. RESULTS: In human nasal polyps, MUC5AC mRNA was expressed in the cytoplasm of most of the goblet cells. However, in the inferior turbinate, MUC5AC mRNA was expressed in only some of the goblet cells. On the contrary, in the normal appearing mucosa of the posterior ethmoid sinus, MUC5AC mRNA was barely expressed in the goblet cells. Furthermore, MUC5AC mRNA was mainly expressed in some of the PAS-positive goblet cells. CONCLUSION: Only a portion of the goblet cells in the human nasal mucosa expressed MUC5AC mRNA. This result suggests that surface goblet cells might have other mucin genes in addition to MUC2 and MUC5AC.

The Changes of the Generation of Superoxide Free Radical and the Activity of Antioxidant Enzymes after Streroid Therapy in Nasal Polyps / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: An intranasal topical and a systemic steroid therapy produce clinical improvement in patients with nasal polyps, but the mechanisms of their action are not clear. Recently, reactive oxygen species such as oxygen free radicals were identified as the potent toxic agents in various pathologic conditions including nasal polyps. The purposes of this study were to reveal the steroid effect on the generation of oxygen free radicals and exmaine the activities of various antioxidant enzymes in human nasal polyps. MATERIALS AND METHODS: Forty patients who received endoscopic sinus surgery due to chronic paranasal sinusitis with nasal polyps were classified into four groups; Group I included 10 specimens with no medication, group II included 10 specimens with oral steroid medication, Group III included 10 specimens with intranasal topical steroid therapy, group IV included 10 specimens with both oral and intranasal topical steroid therapy. We measured the generation of oxygen free radicals and activity of antioxidant enzymes, (SOD, GSH-Px, and CAT) and compared each group using electrophotometric analysis. RESULTS: The generation of oxygen free radicals were lowered in group II, III, and IV, compared to group I. Group IV showed the lowest level in the generation of oxygen free radicals. The activities of SOD, GSH-Px, and CAT, which are specific scavengers of oxygen free radicals, increased significantly in groups II, III, and IV (p<0.05). CONCLUSION: These results suggest that oxygen free radicals may play an important roles in the formation of nasal polyps. The mechanism of steroid action in the treatment of polyps may be explained in the decreased generation of oxygen free radicals and the increased activity of antioxidant enzymes in some ways.

Effect of Hot Steam Inhalation on Microcirculation of Nasal Mucosa

BACKGROUND AND OBJECTIVES: Nasal inhalation of hot humidified air may alleviate nasal symptoms associated with rhinologic disease. Thus, hot steam inhalation is often recommended as a home remedy for various nasal disorders such as the common cold and allergic rhinitis. But the mechanism of its effect is not fully known and correct guidelines for implementing hot steam inhalation have not been settled. We studied microcirculation of nasal mucosa using the nasal Laser Doppler Flowmetry (LDF) in ten healthy subjects in order to evaluate normal physiologic reactions to hot steam. MATERIALS AND METHODS: 10 healthy volunteers inhaled hot steam (about 42degrees C) 10 times, 20 times, 30 times, 50 times and 100 times respectively. Nasal LDF was then performed using a Peiflux 4001 (Perimed, Jartalla, Sweden) and the microcirculatory parameters perfusion, velocity, and concentration were each recorded at base line immediately, 15 minutes, 30 minutes, 60 minutes, 90 minutes and 120 minutes after hot steam inhalation. RESULT: Microcirculatory perfusion was highest at 15 minutes after hot steam inhalation regardless of how many times inhalation occurred. It was found that at 15 minutes, there was a significant increase of microcirculatory perfusion in subjects inhaling 50 times and 100 times (p<0.05). But, at 120 minutes, significant increase of microcirculatory perfusion was only seen in subjects inhaling 100 times (p<0.05). CONCLUSION: After inhalation of hot steam, an increased microcirculatory perfusion of nasal mucosa was registered. Up to inhaling of 100 times, it leads to effective increasement of microcirculation of nasal mucosa.

Anatomical Study of the Artery and the Nerve of the Thyroid Gland / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: An awareness of the surgical anatomy and the possible dispositions of the superior, recurrent laryngeal nerve and the thyroid arteries are very helpful in avoiding injury during thyroidectomy. MATERIALS AND METHODS: The relationship of the superior and recurrent laryngeal nerve to the superior and inferior thyroid artery and the incidence of the thyroid ima artery were studied in 43 adult cadavers. RESULTS: The superior thyroid artery (STA) arose commonly from the external carotid artery (59.3%). And the superior laryngeal nerve (SLN) was closely related to the STA. The inferior thyroid artery (ITA) arose commonly from the thyrocervical artery (81.4%) and eight different types of relationship between the ITA and the recurrent laryngeal nerve (RLN) were found. Among them, the most common type was the RLN which passed in front of the ITA (39.5%). And the incidence of the thyroid ima artery was 9.3%. CONCLUSION: The course and anatomic relationship of laryngeal nerve to the thyroid arteries is not constant, therefore careful identification of these structures should be performed during operation to decrease the surgical complications, such as vocal cord paralysis or hemorrhage.

Expression of Heat Shock Protein 70 in Influenza A Virus Induced Acute Maxillary Sinusitis of Rabbits / 대한이비인후과학회지

BACKGROUND: Heat shock proteins(HSPs) are released from the cells by temperature elevation or other stresses, including cytokines, hypoxia, inflammation or reactive oxygen species. These proteins likely play a role in cellular repair and survival mechanisms. OBJECTIVES: In order to elucidate the relationship between the HSP 70 and viral induced maxillary sinusitis. MATERIALS AND METHODS: The degree of HSP expression was evaluated in New Zealand white rabbits with maxillary sinusitis induced by inoculation of Influenza A virus(KOREA /1/ 80/H3N2) into the mucosa. The animals were serially sacrificed 1, 5, 7, 14, 21, 28th day after inoculation. The localization of the induced form of HSP 70 in the normal & infected maxillary mucosa were studied with immunohistochemical staining. RESULTS: The normal sinus mucosa did not show any staining for the HSP 70. As contrasted with the normal group, the mucosa of the first day after viral inoculation showed very light staining in the epithelial layer. The degree of immunoreactive staining was gradually increased up to the seventh day. Epithelial layer of the mucosa, cilia and submucosa were heavily stained at seventh day after inoculation, and then the degree was reduced at 14th day. The staining of the mucosa was completely disappeared at 28th day after viral inoculation. CONCLUSION: These results suggest that the HSP 70 was produced from acute stage of the infected mucosa by the Influenza A virus. Presumably, it is closely related to the inflammatory reaction in the mucosa of the maxillary sinus.