Staphylococcus aureus increases cytokine and matrix metalloproteinase expression in nasal mucosae of patients with chronic rhinosinusitis and nasal polyps.

BACKGROUND: Staphylococcus aureus is a common bacterial pathogen associated with chronic rhinosinusitis with/without nasal polyps (CRSw/sNP). We investigated the effect of S. aureus on the secretion of eotaxin, interleukin (IL)-5, IL-8, IL-13, matrix metalloproteinase (MMP) 2, MMP-9, and tissue inhibitor of MMP (TIMP) 1 in nasal mucosae from CRSwNP patients to assess the roles of these materials in NP pathogenesis. METHODS: We infected organ cultures of NP and inferior turbinate (IT) mucosae taken from patients with CRSwNP with S. aureus ATCC 25923 for 24 hours and incubated the cultures for an additional 48 hours at 37°C. S. aureus infection and staphylococcal enterotoxins were confirmed by real-time polymerase chain reaction. Eotaxin, IL-5, IL-8, IL-13, MMP-2, MMP-9, and TIMP-1 protein levels were measured by ELISA. RESULTS: S. aureus infection significantly increased the concentrations of eotaxin, IL-5, IL-8, and IL-13 in the IT and NP groups (p < 0.01 for all comparisons). S. aureus infection also significantly increased the concentrations of MMP-2, MMP-9, and TIMP-1 in both groups (p < 0.001 for all comparisons). After S. aureus infection, the relative increases in eotaxin (6.42 versus 3.56), IL-5 (15.29 versus 8.89), MMP-2 (1.95 versus 1.58), MMP-9 (2.34 versus 1.95), and TIMP-1 (1.45 versus 1.31) were greater in the NP group than in the IT group. CONCLUSION: S. aureus infection enhances the secretion of cytokines, MMP-2, MMP-9, and TIMP-1 by both NPs and IT mucosae from patients with CRSwNP. S. aureus may play an important role in the pathogenesis of NP via tissue remodeling as well as eosinophilic inflammation.

Bacterial coinfection and antimicrobial resistance in patients with paranasal sinus fungus balls.

OBJECTIVES: The aim of this study was to investigate the incidence of bacterial coinfection and antimicrobial resistance in cases of fungus balls of the paranasal sinuses. METHODS: Between December 1991 and August 2008, 229 patients underwent endoscopic sinus surgery or the Caldwell-Luc procedure for paranasal sinus fungus ball treatment. From 123 of these patients, a total of 124 specimens were obtained for aerobic and anaerobic culture. Antimicrobial susceptibility tests were performed. RESULTS: Ninety-one cultures (73.4%) were positive for bacteria, and 33 showed no bacterial growth. A total of 134 bacterial organisms were isolated: 65 gram-positive, 55 gram-negative, and 14 anaerobic. The most frequently isolated organisms were coagulase-negative Staphylococcus (14.9%), Staphylococcus aureus (12.7%), Enterobacter aerogenes (12.7%), viridans-group streptococci (8.9%), and Pseudomonas aeruginosa (8.2%). Among the gram-positive cocci, 12.2% were resistant to ciprofloxacin, 27.6% to clindamycin, 30% to oxacillin, 35.8% to erythromycin, 35.9% to trimethoprim-sulfamethoxazole, 56.5% to penicillin, 56.8% to gentamicin, and 0% to teicoplanin and vancomycin. Among the gram-negative rods, fewer than 10% were resistant to imipenem, piperacillin-tazobactam, amikacin, gentamicin, ceftazidime, cefepime, and tobramycin, whereas more than 80% showed resistance to ampicillin and cefazolin. When we compared the data from the periods 1991 to 2000 and 2001 to 2008, there were no significant differences in the isolation rates of particular bacterial species and no significant differences in resistance rates except for clindamycin-resistant gram-positive cocci and cefazolin-resistant gram-negative rods. CONCLUSIONS: Bacterial coinfections were identified in more than two thirds of patients with fungus balls and purulent secretions. This finding suggests that bacterial infection may influence the development and persistence of clinical symptoms in a substantial portion of fungus ball cases.

Excision of a Nasal Dermoid Sinus Cyst via Open Rhinoplasty Approach and Primary Reconstruction Using Tutoplast-Processed Fascia Lata.

Nasal dermoid sinus cysts are the most common congenital midline nasal lesion, accounting for 1% to 3% of all dermoid cysts, and 4% to 12% of all head and neck dermoids. Selection of the appropriate reconstruction technique, after dermoid resection, is important for treatment. Here we describe the successful management of a case with a nasal dermoid sinus cyst using an open rhinoplasty approach, and primary reconstruction using Tutoplast-processed fascia lata and crushed septal cartilage.

Contributing factors to prevent prolonged epiphora after maxillectomy.

OBJECTIVE: To analyze the incidence of prolonged epiphora after maxillectomy according to transected nasolacrimal duct management technique, type of tumor, radiotherapy, and timing of tube removal and performance of dacryocystorhinotomy. DESIGN: Retrospective medical record review. Settings University hospitals. PATIENTS: We studied 89 patients (90 cases) who underwent nasolacrimal duct transection during maxillectomy with preservation of orbital contents for the management of sinonasal tumors between July 1, 1996, and January 31, 2008. MAIN OUTCOME MEASURES: The incidence of prolonged epiphora was analyzed according to 4 different transected nasolacrimal duct management techniques: simple transection without any additional procedure, silicone tube stenting, transcanalicular Silastic stenting, and marsupialization without stenting. We also analyzed the relationship between other factors (type of tumor, radiotherapy, and timing of tube removal) and the incidence of prolonged epiphora. Prolonged epiphora was defined as persistent if it lasted longer than 6 months. RESULTS: The overall incidence of prolonged epiphora was 15.6% (14 of 90 cases). The prolonged epiphora rates differed according to the management technique (no procedure, 27.3% [3 of 11 cases]; silicone tube, 7.0% [4 of 57 cases]; transcanalicular Silastic stenting, 66.7% [4 of 6 cases]; marsupialization, 18.8% [3 of 16 cases]; P = .002). The silicone tube technique showed the lowest rate (odds ratio = 0.20, P = .06). In contrast, the incidence of prolonged epiphora was not affected by the type of tumor, postoperative radiotherapy, or timing of tube removal. CONCLUSION: Silicone tube stenting can be used as the effective and convenient transected nasolacrimal duct reconstructive technique to prevent prolonged epiphora.

Palatine tonsil size in obese, overweight, and normal-weight children with sleep-disordered breathing.

OBJECTIVE: To assess palatine tonsil size relative to degree of obesity in children with sleep-disordered breathing (SDB). STUDY DESIGN: Case-control study. SETTING: Tertiary care rhinology clinic. SUBJECTS AND METHODS: We compared the subjective and objective tonsil size, including tonsil height (TH), tonsil width (TW), tonsil thickness (TT), tonsil weight (TWt), and tonsil volume (TV), in 26 obese children and 26 age- and gender-matched control children with SDB, and in 29 overweight children and 29 matched controls with SDB. RESULTS: Despite similar subjective tonsil size in obese and control children, the objective tonsil size, including TH, TW, TT, and TWt, was larger in obese than in control children, and the mean TV was significantly greater in obese than in control children with SDB (8.53 +/- 3.30 mL vs 6.90 +/- 2.05 mL; 95% confidence interval [CI] of the difference 0.03-3.25; P = 0.019). In contrast, mean TV (7.38 +/- 3.43 mL vs 7.65 +/- 1.97 mL; 95% CI -1.92 to 1.37; P = 0.320) as well as the other parameters of objective palatine tonsil size, including TH, TW, TT, and TWt, did not differ significantly between overweight children and controls. CONCLUSION: Obese children with SDB had larger palatine tonsils than did normal-weight children with SDB. This finding suggests that larger palatine tonsils may have a greater effect on upper airway obstruction in obese than in normal-weight children with SDB.

Clarithromycin inhibits rhinovirus-induced bacterial adhesions to nasal epithelial cells.

OBJECTIVES/HYPOTHESIS: We investigated the inhibitory effects of clarithromycin (CM) on the rhinovirus (RV)-induced expression of fibronectin (Fn) and carcinoembryonic antigen-related cell adhesion molecules (CEACAMs), which act as major receptors for Staphylococcus aureus and Haemophilus influenzae, respectively. We further investigated the effects of CM on secondary S. aureus and H. influenzae adhesions to RV-infected primary human nasal epithelial cells (HNECs). METHODS: Cells were pretreated with 10 microM CM 24 hours before RV-16 infection and for 48 hours thereafter. The expression levels of Fn and CEACAMs were assayed by reverse transcriptase-polymerase chain reaction and Western blotting. Bacterial adhesion to cells was assessed by confocal microscopy and the fluorescence intensity of adherent bacteria was analyzed using Image-Pro Plus 5.1 (Media Cybernetics, Bethesda, MD). RESULTS: Clarithromycin significantly inhibited the RV-induced gene and protein expression of Fn and CEACAMs in HNECs. Compared with RV-infected cells, CM treatment significantly reduced the adhesion levels of S. aureus and H. influenzae in RV-infected HNECs to the levels seen in noninfected control cells. CONCLUSIONS: These findings indicate that CM has the potential to prevent secondary bacterial infections in RV-infected HNECs by inhibiting the expression of Fn and CEACAM, thereby interfering with bacterial adhesion.

Cutting and suture technique of the caudal septal cartilage for the management of caudal septal deviation.

OBJECTIVES: To introduce the cutting and suture technique of the caudal L-strut for the management of caudal septal deviation and to evaluate its efficacy and surgical outcomes. DESIGN: Retrospective study. SETTING: Tertiary care rhinology clinic. PATIENTS: Forty-five patients who underwent endonasal septoplasty using the cutting and suture technique of the caudal L-strut. INTERVENTIONS: After elevation of the mucoperichondrial flap, deviated portions of cartilage and bone were excised, leaving at least a 1.5-cm strip of L-strut. If caudal septal deviation persisted, the caudal strut was cut at the convex-most part, and the cut ends were slightly overlapped and sutured together. MAIN OUTCOME MEASURES: Improvement in the treatment of nasal obstruction using a visual analog scale and a questionnaire for subjective satisfaction were evaluated 2 to 6 months after septoplasty. To evaluate outcomes objectively, endoscopic photographs of the nasal cavity before and after surgery were evaluated by 2 independent surgeons. RESULTS: Significant improvement in the treatment of nasal obstruction was achieved, with mean visual analog scale scores of 7.93 preoperatively and 3.63 postoperatively (P < .001). Subjective satisfaction was rated as much improved in 68% of patients, improved in 15%, and no change in 17%. Endoscopic examinations showed that 51% of patients had near-complete correction of the septum and that 47% had improved but a little persisting caudal deviation. One patient had no change in caudal septal deviation on endoscopic examination. CONCLUSION: The cutting and suture technique of the caudal L-strut seems to be a useful technique that can be performed with relative ease and simplicity.

Palatine tonsil size and its correlation with subjective tonsil size in patients with sleep-disordered breathing.

OBJECTIVE: To investigate the correlation of subjective tonsil size with real palatine tonsil size and to compare the differences of each parameter according to subjective tonsil size and between children and adults. STUDY DESIGN: Prospective evaluation of subjective tonsil size (0-4+) and real palatine tonsil size, including tonsil height (TH), tonsil width (TW), tonsil thickness (TT), total tonsil volume (TTV), and embedded tonsil volume (ETV) within the tonsillar fossa. SETTING: Tertiary-care rhinologic clinic. SUBJECTS AND METHODS: We measured TH, TW, TT, TTV, and ETV in 277 children and 63 adults with sleep-disordered breathing (SDB). RESULTS: In both children and adults, subjective tonsil size was significantly correlated with TTV, TH, TW, and TT (correlation coefficients 0.199-0.427 for children and 0.462-0.551 for adults). In children, TTV increased in proportion to subjective tonsil size, but about 45 percent and 34 percent of tonsils markedly deviated from the mean value of their TTV in size 2 and 3 groups, respectively. In adults, TTV of subjective tonsil size 3 and 4 groups was significantly larger than that of size 1 and 2 groups. CONCLUSIONS: Real palatine tonsil size correlated with subjective tonsil size in both children and adults with SDB. Although there is a statistical correlation in children between TTV and subjective tonsil size, there is significant discordance in size 2 and 3 groups, thus greatly limiting the value of subjective tonsil size assessment in the majority of children. However, adult subjective tonsil size may reflect real palatine tonsil size and may help predict it preoperatively.

Cigarette smoke extract enhances rhinovirus-induced toll-like receptor 3 expression and interleukin-8 secretion in A549 cells.

BACKGROUND: Using A549 alveolar epithelial type II-like cells, we investigated the effects of cigarette smoke on the expression of rhinovirus (RV)-induced Toll-like receptor (TLR) 3, interleukin (IL)-6, and IL-8 secretion and viral replication. METHODS: Cigarette smoke extract (CSE) was prepared by smoking two commercial cigarettes with filters (0.9-mg of nicotine and 8.5-mg of tar per cigarette). Cells were infected with RV serotype 16 (RV-16) and cultured for 2 days (RV group), pretreated with 1, 2.5, or 5% CSE for 1 day before RV infection, and culture with CSE for 2 days after infection (RV plus CSE group), or were cultured in medium for 3 days (control group), treated with 1, 2.5, or 5% CSE for 3 days (CSE group). Changes in TLR3, IL-6, and IL-8 mRNA expression were assayed by real-time polymerase chain reaction and TLR3 protein expression were assessed by flow cytometry; IL-6 and IL-8 secretions were measured by ELISA; and RV replication was assessed by viral culture. RESULTS: CSE increased RV-induced TLR3 expression and RV-induced IL-8 secretion at lower concentrations in A549 cells. On the contrary, CSE dose dependently inhibited RV-induced IL-6 secretions and had no effect on RV replications. CONCLUSION: Our results suggest that cigarette smoke may potentiate viral common cold symptoms by enhancing IL-8 secretion at lower concentrations, but not by increasing viral replication.

Rhinovirus upregulates matrix metalloproteinase-2, matrix metalloproteinase-9, and vascular endothelial growth factor expression in nasal polyp fibroblasts.

OBJECTIVES/HYPOTHESIS: Upregulation of matrix metalloproteinase (MMP) and vascular endothelial growth factor (VEGF) has been suggested to have an important role in the pathogenesis of nasal polyps (NPs). The aim of this study was to investigate the effect of rhinovirus (RV) infection on the expression of MMPs, tissue inhibitor of metalloproteinase (TIMP)-1, and VEGF in NP fibroblasts. METHODS: NP fibroblasts (5 x 10(5) cells/mL) obtained from patients with chronic rhinosinusitis with nasal polyps (CRSwNP) were infected with RV serotype 16 (RV-16) for 4 hours. The RV-16 infection was confirmed by seminested reverse transcriptase-polymerase chain reaction (RT-PCR) and in situ hybridization. After 48 hours, MMP-2, MMP-9, TIMP-1, and VEGF protein levels were measured from culture supernatants by enzyme-linked immunosorbent assay. The changes in the expression of MMP-2, MMP-9, TIMP-1, and VEGF mRNA were assayed by RT-PCR. RESULTS: RV-16 infection significantly enhanced the gene and protein expressions of MMP-2, MMP-9, and VEGF in NP fibroblasts, whereas TIMP-1 expression was not significantly affected by RV-16. MMP-2, MMP-9, and VEGF protein expression increased by 2.39-, 2.99-, and 3.02-fold, respectively, in RV-infected NP fibroblasts compared to noninfected controls. RV-16 infection also significantly upregulated the expression of MMP-2, MMP-9, and VEGF mRNA by 1.27-, 1.70-, and 1.53-fold, respectively, compared to control levels. CONCLUSIONS: These in vitro findings suggest that RV infection may contribute to the pathogenesis of NP formation in patients with CRSwNP.

Rhinovirus enhances various bacterial adhesions to nasal epithelial cells simultaneously.

OBJECTIVES/HYPOTHESIS: Viral upper respiratory tract infections are often followed by secondary bacterial infections in the form of acute rhinosinusitis. We investigate the effect of rhinovirus infection on the expression of cell adhesion molecules and bacterial adherence to primary human nasal epithelial cells. METHODS: Cells were infected with rhinovirus serotype 16 (RV-16), and then Staphylococcus aureus, Streptococcus pneumoniae, or Hemophilus influenzae were added to the culture. Rhinovirus-induced expression of fibronectin, platelet-activating factor receptor, and carcinoembryonic antigen-related cell adhesion molecule, was assayed by confocal microscopy, real-time polymerase chain reaction, and Western blot analysis. Bacterial adhesion to cells was assessed by confocal microscopy and the fluorescence intensity of adherent bacteria was analyzed using Image-Pro Plus 5.1 (Media Cybernetics, Inc., Bethesda, MD). RESULTS: RV-16 infection significantly increased the gene and protein expression of fibronectin, platelet-activating factor receptor, and carcinoembryonic antigen-related cell adhesion molecule in nasal epithelial cells. Compared with rhinovirus-uninfected control cells, the adhesion of S. aureus, S. pneumoniae, and H. influenzae increased significantly to 2.53-fold, 1.51-fold, and 2.74-fold of control levels, respectively, in rhinovirus-infected nasal epithelial cells. CONCLUSIONS: These findings suggest that increased expression of host cell adhesion molecules may be the mechanism accounting for the increase in susceptibility to bacterial rhinosinusitis associated with rhinovirus-induced upper respiratory infections.

Measurement of aesthetic proportions in the profile view of Koreans.

We have evaluated the usefulness of direct soft tissue measurements in profile photographs for determining the nasal proportions and angles of young Korean individuals and those of rhinoplasty patients, and we compared these findings with existing norms of Caucasian populations. We retrospectively compared preoperative profile measurements of nasal length, nasal tip projection, dorsal height, radix height, nasolabial angle, and nasofrontal angle in 123 patients who underwent rhinoplasty, with measurements in 21 young Korean adults. Rhinoplasty patients were grouped by preoperative diagnosis as deviated nose without saddle or hump, saddle nose, hump nose, and low radix. The young Koreans had a nasal length to nasal tip projection to dorsal height to radix height ratio of 2:0.97:0.61:0.28. Dorsal height differed significantly among groups of rhinoplasty patients. Those with low radix had the lowest dorsal and radix height, whereas those with saddle nose had the smallest nasal tip projection. The average nasolabial and nasofrontal angles were 78.5 degrees and 82.7 degrees, respectively, in young male Koreans and 126.0 degrees and 133.6 degrees, respectively, in young female Koreans. In the deviated nose group, all parameters except for nasofrontal angle were significantly changed after rhinoplasty. In the saddle nose group, nasal tip projection and dorsal height were significantly increased, whereas, in the hump nose group, nasal tip projection and nasolabial angle were significantly altered. Direct soft tissue measurement on profile photographs is useful for assessing nasal characteristics and postrhinoplasty outcomes. Compared with Caucasians, young Koreans had relatively lower dorsum and radix and more acute nasolabial angle, but similar nasofrontal angle.

Levocetirizine inhibits rhinovirus-induced ICAM-1 and cytokine expression and viral replication in airway epithelial cells.

Levocetirizine inhibits the production of intercellular adhesion molecule (ICAM)-1 and secretion of interleukin (IL)-6 and IL-8, which may have beneficial effects on the pathophysiologic changes related to human rhinovirus (HRV) infection. We investigated the effects of levocetirizine on rhinovirus infection in primary human nasal epithelial cells (HNEC) and A549 cells. Cells were treated with different concentrations of levocetirizine, ranging from 0.5, 5 or 50nM, either starting at the time of infection and continuing thereafter, or beginning 24h before infection and continuing thereafter. Levocetirizine treatment inhibited the HRV-induced increase in ICAM-1 mRNA and protein levels, as well as the HRV-induced expression of IL-6 and IL-8 mRNA and protein levels. Viral titer, as measured by culture in MRC-5 cells, was reduced by levocetirizine. Levocetirizine treatment also reduced the increased nuclear factor-kappa B (NF-kappaB) expression seen with HRV infection. Levocetirizine inhibited the expression of Toll-like receptor (TLR)3 mRNA and protein levels. These findings indicate that, in HNEC and A549 cells, levocetirizine inhibits HRV replication and HRV-induced upregulation of ICAM-1, IL-6, and IL-8, TLR3 expression and NF-kappaB activation. The results of this study suggest that levocetirizine may have a possible clinical application in the treatment of airway inflammation caused by HRV infection.

Development of mucosal thickening after radiotherapy in contralateral sinuses of patients with nasal cavity and/or paranasal sinus carcinoma.

OBJECTIVES: The aim of this study was to investigate the development of radiotherapy (RT)-induced mucosal thickening (MT) of the contralateral sinuses in patients with nasal cavity and/or paranasal sinus carcinoma. METHODS: We retrospectively reviewed the medical records and the initial and follow-up computed tomography (CT) scans of 37 patients with RT and 10 controls without RT. The CT scans were scored on the Lund-Mackay (LM) staging system. RESULTS: Fifteen of the 37 patients had MT before RT, and the mean LM score was 0.68. The MT incidence significantly increased, to 72.9% (p = 0.009), and the LM score significantly increased, to 2.84 (p < 0.001), by 3 months after RT, after which the LM score decreased gradually to 1.73 at 36 months after RT. Four of the 10 controls had MT before treatment, and their mean LM score was 0.7. Their MT incidence and LM score had not changed significantly at 3 months after treatment. The pretreatment LM scores of the patient group and the control group were not significantly different, but their posttreatment LM scores were significantly different at the 3-month follow-up (p = 0.033). CONCLUSIONS: Use of RT in patients with nasal cavity and/or paranasal sinus carcinoma may cause a significant increase in the incidence of MT and in the LM scores in all sites of the paranasal sinuses by 3 months after RT, after which the LM score decreases gradually.

Infection rate and virus-induced cytokine secretion in experimental rhinovirus infection in mucosal organ culture: comparison between specimens from patients with chronic rhinosinusitis with nasal polyps and those from normal subjects.

OBJECTIVE: To investigate the difference in susceptibility to rhinovirus (RV) infection and RV-induced inflammatory response between the nasal mucosae from patients with chronic rhinosinusitis with nasal polyps (CRS/NP) and subjects without CRS/NP (hereinafter, normal subjects). DESIGN: In vitro study. SETTING: Tertiary care rhinology clinic. PATIENTS: We conducted RV infection experiments on the organ cultures of NPs and inferior turbinate mucosae from 16 patients with CRS/NP and sphenoid sinus and inferior turbinate mucosae from 19 patients who underwent transsphenoidal pituitary surgery. MAIN OUTCOME MEASURES: Successful RV-16 infection was determined by positive identification of RV on the surface fluid of organ culture using seminested reverse transcriptase-polymerase chain reaction. Effects of RV on interleukin 6 (IL-6) and IL-8 secretion were measured by enzyme-linked immunosorbent assay. RESULTS: The successful RV infection was achievable in 9 of 16 NP samples (56.3%) and 9 of 16 turbinate samples (56.3%) from patients with CRS/NP compared with 11 of 19 sphenoid sinus samples (57.9%) and 15 of 19 turbinate samples (78.9%) from normal subjects. The RV infection increased IL-6 and IL-8 secretion 236% and 173%, respectively, in NP samples, and 218% and 178%, respectively, in turbinate samples from patients with CRS/NP; compared with 231% and 145%, respectively, in sphenoid mucosa samples, and 181% and 148%, respectively, in turbinate samples from normal subjects. However, there were no statistical differences among the 4 groups. CONCLUSION: These in vitro findings suggest that subjects with CRS/NP mucosa might not be more susceptible to RV infection, and did not secrete more cytokines in response to rhinovirus infection, than those with normal mucosa.

Classification of the deviated nose and its treatment.

OBJECTIVE: To present a simplified classification of the deviated nose and the associated treatment outcome. DESIGN: Retrospective analysis. SETTING: Tertiary care rhinology clinic. PATIENTS: Seventy-five individuals (49 males and 26 females) who underwent rhinoplasty for a deviated nose with minimum follow-up of 36 months. MAIN OUTCOME MEASURES: Depending on the orientation of 2 horizontal subunits (the bony pyramid and the cartilaginous vault) with respect to the facial midline, the nasal deviations are classified into 5 types: I, a straight tilted bony pyramid with a straight tilted cartilaginous vault in the opposite direction; II, a straight tilted bony pyramid with a concavely or convexly bent cartilaginous vault; III, a straight bony pyramid with a tilted cartilaginous vault; IV, a straight bony pyramid with a bent cartilaginous vault, and V, a straight tilted bony pyramid and a tilted cartilaginous dorsum in the same direction. RESULTS: Deformities of types I through V occurred in 24 (32%), 19 (25%), 19 (25%), 7 (9%), and 6 (8%) patients, respectively, in whom 1, 3, 2, 1, and 1 unsuccessful outcomes were found. Four of the 8 failed cases had been approached endonasally. CONCLUSION: The proposed classification for the deviated nose could serve as a valuable adjunct in the treatment of these patients.

Contralateral maxillary sinus lesions in patients with nasal cavity and/or paranasal sinus carcinoma: analysis of computed tomography findings.

OBJECTIVES: The incidence of bilateral maxillary sinus carcinoma is very low in patients with primary maxillary sinus carcinoma. However, surgeons should perform careful diagnosis of any contralateral maxillary sinus lesions to avoid missing a second primary maxillary sinus carcinoma. We therefore investigated the computed tomography (CT) findings of the contralateral maxillary sinus in patients with nasal cavity and/or paranasal sinus carcinoma. METHODS: Between August 1994 and September 2006, 66 patients (41 male, 25 female; age range, 22 to 85 years; mean age, 56.9 years) with nasal and/or paranasal sinus carcinoma were treated. Preoperative and follow-up CT scans of their contralateral maxillary sinuses were retrospectively reviewed. RESULTS: Of the 66 patients, 26 (39.4%) had rhinosinusitis, 6 (9.1%) had retention cysts, and 33 (50.0%) showed normal findings on CT. One patient (1.5%) had bilateral enhanced mass-like lesions. Both masses were diagnosed histologically as poorly differentiated squamous cell carcinoma. The rhinosinusitis findings included mucoperiosteal thickening, sclerotic bone thickening, hyperdense secretion, and an air-fluid level, in order of decreasing frequency. Twenty-three of the 32 patients with benign lesions were included in the follow-up CT analysis, ranging from 24 to 108 months (mean, 45 months). On the final CT scan, rhinosinusitis was aggravated in 5 of 19 cases and improved in 14 cases, and the size of the retention cyst decreased in 4 cases. During the follow-up period, no definite abnormality suggesting tumor development in the contralateral maxillary sinus was detected. CONCLUSIONS: Even though most contralateral maxillary sinus lesions are benign and the incidence of bilateral maxillary sinus carcinoma is very low, second primary maxillary sinus carcinoma should be kept in mind in the differential diagnosis of contralateral maxillary sinus lesions in patients with nasal cavity and/or paranasal sinus carcinoma.

Use of silicone sheets for dorsal augmentation in rhinoplasty for Asian noses.

CONCLUSION: While the complication rate for silicone sheets was similar to that reported for silicone rubber, there are several advantages to the use of silicone sheets for correcting minor dorsal irregularities. Therefore, silicone sheets can be used as a versatile graft material for dorsal augmentation in rhinoplasty. OBJECTIVES: Silicone implants mostly in the form of prefabricated silicone rubber remain the most commonly used materials for nasal augmentation in Asians. The present study analyzed the use of silicone sheets rather than silicone rubber for nasal dorsal augmentation rhinoplasty. MATERIALS AND METHODS: Data from 27 patients who underwent dorsal augmentation with silicone sheets between April 2003 and July 2005 were retrospectively reviewed. RESULTS: All patients received silicone sheets to augment the nasal dorsum and/or radix. Twenty-four patients had satisfactory outcomes. One patient (3.7%) complained the implant was too visible, one experienced infection, and one experienced endonasal extrusion of the implant. All three cases were readily managed by implant removal and administration of antibiotics.

Percutaneous root osteotomy for correction of the deviated nose.

BACKGROUND: This study describes the use of percutaneous root osteotomy near the intercanthal level for correction of deviated noses. This procedure provides complete mobilization of the midline bony septum. The study analyzed outcomes in patients undergoing this procedure. METHODS: The study retrospectively reviewed 50 patients who underwent corrective rhinoplasty involving a percutaneous root osteotomy. Two independent rhinoplastic surgeons assessed treatment outcomes by comparing pre- and postoperative photographs. Complications associated with the procedure were assessed also. RESULTS: Postoperative photographs showed the outcome was excellent in 42 cases (84%), good in 2 cases (4%), fair in 4 cases (8%), and no change in the "central area" in 2 cases (4%). No cases showed a poor or worsening outcome, and there were no complications such as visible scarring or osteotomy site depressions. CONCLUSIONS: Percutaneous root osteotomy appears to be a valuable adjunct procedure for correction of deviated noses.

Detection of parainfluenza virus 3 in turbinate epithelial cells of postviral olfactory dysfunction patients.

OBJECTIVES/HYPOTHESIS: Postviral olfactory dysfunction (PVOD) develops after a common cold, but little is known about the viral pathogen inducing olfactory dysfunction. We hypothesized that human parainfluenza virus 3 (PIV3) may cause PVOD. We therefore assayed the nasal cavity mucosae of PVOD patients for the presence or persistence of PIV3. METHODS: We assessed 25 patients (5 men, 20 women), ranging in age from 31 to 85 (mean, 51) years, diagnosed with PVOD and 22 controls (18 men, 4 women) diagnosed with nasal septal deviation between July 2005 and August 2006. Inferior turbinate epithelial cells were collected using a Rhino-probe mucosal curette, and PIV3 was assayed by seminested reverse-transcription polymerase chain reaction. RESULTS: PVOD occurred most frequently between May and July. Hyposmia was observed in 60% of patients and anosmia in 40%. The most common clinical symptoms were rhinorrhea, sore throat, nasal obstruction, fever, myalgia, cough, and hoarseness. Patients usually visited the outpatient clinic within 3 months after the onset of olfactory dysfunction. Twenty-two of 25 (88.0%) epithelial samples from PVOD patients were positive for PIV3 compared with 2 of 22 (9.1%) epithelial samples from controls. CONCLUSIONS: The high detection rate of PIV3 in the turbinate epithelial cells of PVOD patients suggests that PIV3 may be the causative virus of PVOD.